Prescription: A Walk in the Park
WebMD

Few of us would argue that a stroll outside on a sunny day is a great pick-me-up. Now it seems that it may be just what the doctor ordered. The benefits of nature for both body and soul are finding their way to the prescription pad as growing numbers of healthcare providers are telling their patients to “take a hike”—literally.

Prescription: A Dose of Nature
Many healthcare researchers and practitioners say that ecotherapy (also known as green, nature, and earth-centered therapy)—a term coined by pastoral counselor Howard Clinebell in his 1996 book of the same name—can have regenerative powers, improving mood and easing anxiety, stress, and depression. But that’s not all. Healthcare providers are also giving their patients “nature prescriptions” to help treat a variety of medical conditions, from post-cancer fatigue to obesity, hypertension, and diabetes.    

Scientists have long known that sunlight can ease depression, especially seasonal affective disorder (SAD). New research is expanding those findings. A 2007 study from the University of Essex in the United Kingdom, for example, found that a walk in the country reduces depression in 71% of participants. The researchers found that as little as five minutes in a natural setting, whether walking in a park or gardening in the backyard, improves mood, self-esteem, and motivation.

The growing interest in ecotherapy has even given rise to academic programs, such as one begun at John F. Kennedy University, for example, which offers a graduate-level certificate in ecotherapy, an umbrella term which includes horticultural therapy, animal-assisted therapy, time stress management, and managing “eco-anxiety.”

JFK ecotherapy professor Craig Chalquist, PhD, co-author of Ecotherapy: Healing with Nature in Mind, has acknowledged that ecotherapeutic methods “do not represent a cure for the woes of industrial civilization, nor can they be judged by expectations more appropriate to a body of knowledge and practice examined by many years of research.” In other words, research thus far has not proven that spending time in nature—while admittedly part of a healthy lifestyle—can prevent, treat, or cure a condition. Still, says Chalquist, initial indications and a growing body of research offer a “hopeful picture” of the efficacy of ecotherapeutic practices.

Back to the Garden for Breast Cancer Survivors
Kathy Helzlsouer, MD, MHS, Director of the Prevention and Research Center at Mercy Medical Center in Baltimore, has long been recommending to breast cancer survivors that they get outdoors more.

For 30 to 40% of breast cancer survivors, persistent fatigue follows their treatment, says Helzlsouer. To help her patients learn how to manage this fatigue, Helzlsouer created “Be Well, Be Healthy,” a holistic program that includes tips not only on managing stress and improving diet and exercise patterns, but also on incorporating nature as part of the healing process.

“Among the frustrations we saw in our patients,” says Helzlsouer, “was that they didn’t have the energy to garden, a favorite activity for many of them.”

For those who enjoy gardening, Helzlsouer prescribes getting back outside, even if it’s starting out with five minutes of weeding. Those who aren’t gardening enthusiasts are advised to find a nearby park where they can take a walk, “commune with nature,” and reap the mind-body results of both a relaxing setting and physical exercise. The Medical Center itself is as convinced as Helzlsouer of the benefits of nature and has incorporated a garden for patients and visitors in its newly renovated urban facility.

Getting Kids on the Path to Health
Other healthcare providers are also finding that being in a natural environment has numerous benefits. School nurse Stacy Bosch, RN, MSN, NCSN, of the Clark County School District in Nevada, sees many students who are overweight and/or have type II diabetes. More often than not, the youngsters’ time spent outdoors is minimal. To get the kids—and their parents—away from the TV and the computer and increase their physical activity in order to help control weight and blood sugar, Bosch writes a prescription for the entire family to go to one of the county’s nature areas and simply take a walk.

So far, Bosch has received positive feedback from the families who have followed her prescription. “They’re excited to be doing something together that will benefit all of them,” she says.

Bosch is one of three dozen healthcare providers who took part in the inaugural Health Care Nature Champions training program, offered through a partnership between the U.S. Fish and Wildlife Service, National Environmental Education Foundation, and a variety of healthcare professionals and organizations. The idea for nature champions resulted from the 2007 Children and Nature Summit, during which U.S. Fish and Wildlife Service staff met with doctors, educators, and outdoors professionals about finding ways to overcome "nature-deficit disorder" in children. The two-year pilot project aims to  improve family health by connecting children and their families with easily accessible nature sites.

Maria Brown, MD, a member of the Johns Hopkins School of Medicine's Department of Pediatrics, who also serves as an instructor at St. Agnes Hospital in Baltimore—where one out of three children is overweight—says that the Nature Champion program is a handy tool for prescribing a more active lifestyle for kids and their families.

“It gives healthcare providers a concrete, positive way to suggest their patients get more physical activity,” she says. “Who’s going to argue with a prescription to get outside more?” The prescriptions come with maps to nearby parks and refuges, many of which offer outdoor experiences led by park rangers and volunteers.

According to Brown, most major medical organizations—including the American Academy of Pediatrics, the American Medical Association, and the American Heart Association—recommend at least 60 minutes of physical activity a day.

“What the ‘Children and Nature Initiative’ is trying to advocate for is that as much of this time as possible be outside,” says Brown, adding that outdoor time is beneficial for children’s physical, cognitive, social, and emotional development.

“And while just being outside in and of itself is relaxing and restorative and plays its role—for both children and adults—it won’t help with our challenging obesity epidemic, which can lead to so many other health problems,” says Brown.

“Most people understand the importance of getting kids moving,” agrees Angelique Marquez, RD, of the Children’s Heart Center in Las Vegas. Even before being trained as a Nature Champion, Marquez prescribed outdoor activity for patients who had heart disease or were at high risk with conditions such as hypertension, high cholesterol, and diabetes.

Adding Nature to Your Day
For families who don’t live near a park, there are other ways to incorporate nature into their daily lifestyle, says Marquez, such as walking to school or to the store or playing on a playground. Kids should always be supervised by a responsible adult, Brown advises, and parents should be familiar with which playgrounds are safe in their neighborhood. (For playground safety tips, check out the National Association for Playground Safety at www.playgroundsafety.org) 

Safety is an important factor for adults as well. Whether you’re taking an urban hike or a walk in the park, the USDA Forest Service recommends that you go with a companion (or at least let someone know where and when you’ll be going); keep your eye on the weather; wear appropriate clothing for the conditions and locale; be aware of your surroundings; and—especially if it’s warm outside—take along a bottle of water so you won’t become dehydrated, and slather on the sunscreen, and if necessary, insect repellant.

Clearing Your Mind
Being outside not only improves physical health but offers mental clarity as well, which is one reason certified sex counselor Eric Marlowe Garrison, MAEd, MSc, suggests that his clients meet him outside.

“People talk more when they’re moving,” says Garrison, who practices in both New York City and Richmond, Virginia. “The act of physical movement triggers the mind. I can accomplish more with my clients during a 45-minute walk in Central Park than in two hours in my office.”

Garrison, a “country boy” at heart, started taking his practice outside about five years ago. At that time, his decision was based on personal preference, but he now finds that research is backing up his instincts. In a 2010 Japanese study of “Shinrin-yoku” (defined as “taking in the forest atmosphere, or forest bathing”), for example, researchers found that elements of the environment, such as the odor of wood, the sound of running stream water, and the scenery of the forest can provide relaxation and reduce stress; those taking part in the study experienced lower levels of cortisol, a lower pulse rate, and lower blood pressure.

For Garrison, however, the studies really don’t matter. They only confirm what he has long believed. “I can’t deny what I’m seeing with my clients,” he says. “There’s a world of benefit to being out in nature.”