Have you been outside yet today?

Michelle Seguin MD, IFMCP
Board Certified Family Medicine Physician
Co-Founder Re:Think Health

Have you been outside in nature in the last week to walk, hike, play, walk a dog, listen to birds, garden, or have a picnic?

If you answered NO to each of these questions, chances are you’re “Nature Deficient”. 

That’s right, nature deficient.  The solution: nature therapy! At least that is what Dr. John La Puma is advocating for in his most recent publication, “Nature Therapy: An Essential Prescription for Health.”¹  Dr. La Puma defines nature therapy as “prescriptive, evidence-based use of natural settings and nature-based interventions”. 

Nature contact can be passive or active and occur outdoors or in an indoor space.  One of the most cited examples of the benefits of nature exposure was the 1984 study by RS Ulrich⁵, which examined records on post-cholecystectomy recovery of patients in a suburban hospital.  Patients were assigned to a room with a window view of natural setting or a room with the view of a brick wall.  Those patients with the natural setting view had “shorter postoperative hospital stays and took fewer potent analgesics”.  This study, among others, seems to suggest that one doesn’t need to be IN nature to benefit FROM nature.  

The possible effects of nature contact on human health are broad and documented in the medical literature.  In the review published by Frumkin, H. et al in 2017, a summary of evidence-based health benefits of nature contact range from stress reduction, improved sleep, increased social connectedness, reduced mortality, reduced obesity, and improved pain control³.  Despite its relatively new use in the U.S., forms of nature therapy are well integrated within medical systems across the globe.  

To date, there are at least 11 nature therapy sub-types ranging from therapeutic horticulture to green exercise to nature meditation.  For example, “shinrinyoku” (translation: “forest bathing”), the traditional practice of “immersing oneself in nature by mindfully using all five senses” has played a pivotal role in preventative healthcare in Japan since the 1980s.  In a recent review published by Hansen, M. et al, researchers identified therapeutic effects of shinrinyoku on “immune system function through stimulation of natural killer cells” and “improvements in cardiovascular function through induction of relaxation response” via increased parasympathetic activity².  Despite the growing body of evidence demonstrating the beneficial effects of nature contact on human health, there are still many questions which remain unanswered.

At this point you may be asking yourself, “how much time in nature is enough? What is the dosing necessary to improve health?”  It appears to be 120 minutes per week based on a 2019 study of nearly 20,000 people published in Scientific Reports⁴.  This study found that “people who spent two hours a week in green spaces were substantially more likely to report good health and psychological well-being than those who don’t.”  Additionally, exposure (active or passive) could be all at once or cumulative over the week. Most importantly, these results were robust and significant across different occupations, ethnic groups, socioeconomic status, and individuals with chronic conditions and/or disabilities.  

We know that clinic days are long and time with your patients is limited. Given the potential reach for such a relatively low-risk and highly accessible therapeutic intervention, asking about nature contact may be a question you’ll want to include in your next patient intake.  

Clinical Takeaway:

Nature Experience Rx¹

SPECIFIC: Specific exercise or activity

LOCATION: Specific place/location

DURATION: Specific days of the week and for specific duration

HEALTH GOALS: Include health goals

Example:  Nature Rx: “Walk in Forsyth Park for 20 minutes with your phone off with a walking buddy 3 days a week.  Write down your blood pressure, pulse, mood, and/or stress level 5 minutes before and after the walk.”

Sources:

1. La Puma, J. “Nature Therapy: An Essential Prescription for Health.” Alternative and Complementary Therapies.  Vol. 25, No. 2, April 2019.
2. Frumkin, H., et al.  “Nature Contact and Human Health: A Research Agenda.” Environmental Health Perspectives.  Vol. 125, No. 7. July 2017.
3. Hansen, M. Int. J. Environ. Res. Public Health 2017, 14, 851; doi:10.3390/ijerph14080851
4. White, M. et al.  “Spending at least 120 minutes a week in nature is associated with good health and wellbeing.”  Scientific Reports. Vol. 9, Article No. 7730. June 2019.
5. Ulrich, RS.  “View through a window may influence recovery from surgery.”  Science 1984 April 27; 224: 420-1.