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Why Doctors Are Prescribing Nature Walks
Why Doctors Are Prescribing Nature Walks
Why Doctors Are Prescribing Nature Walks
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That’s partly why Razani’s program focuses on children who do not have adequate green space
close to home. Often, these are the populations who need the healing benefits of nature the most.
“The end condition the clinician is seeing may vary, from obesity and anxiety,” she says, but two
important upstream reasons for these conditions are “stress and lack of access to outdoor space.”
When the body is stressed, it undergoes physiological changes, says Mat White, a health and
environmental psychologist at the University of Vienna in Austria. Stress stimulates the release of
the stress hormone cortisol, which in turn raises your blood pressure and heart rate. Chronically
elevated levels of stress are connected to anxiety and depression, he notes. Stress has also been
connected to heart disease, obesity, and other negative health outcomes.
Scientists think that having positive experiences in nature can help alleviate stress and reduce
cognitive fatigue, thereby improving health. “The major theories in the field currently coalesce
around the idea of stress reduction,” White says.
These theories are based on research that started gaining traction around 2010, experts in the field
say. Many studies have found correlations between spending time in nature and improved mental
or physical health. “We know there’s a robust relationship between mental health and nature
exposure,” says Matthew Browning, founding director of the Virtual Reality and Nature Lab at
Clemson University who studies the link between the natural world and human health. There’s
also a relationship between long-term exposure to nature and reduced risk of cardiovascular
disease and death from any cause, he says. One major early study in the field, published in 2008
in the Lancet, found that people in England living in greener areas had lower rates of death from
circulatory diseases and from any cause. “Physical environments which promote good health may
be important in the fight to reduce socioeconomic health inequalities,” the authors wrote in the
study.
People who live in greener areas also tend to have lower health care costs, says Browning. In
a study published in the May 2022 issue of the journal Environment International, Browning and
his colleagues examined the total health-care costs of 5 million people in Northern California
over a decade and compared those costs with the amount of green space or trees around each
person’s home, determined through satellite data. Living closer to green areas was correlated with
lower health care costs, and the link persisted regardless of other factors that can affect health
outcomes, like income, education, occupation, and housing conditions.
When it comes to how nature exposure helps our stressed-out brains, researchers have two main
theories, says Gregory Bratman, director of the environment and well-being lab at the University
of Washington. The first, known in scientific circles as the Stress Reduction Theory, is that
exposure to many forms of nature engages the parasympathetic nervous system, which is
responsible for rest and digestion and encourages stress recovery. (It’s nicknamed the “rest and
digest” system.) The other, the Attention Restoration Theory, suggests that nature engages
people’s “soft fascination,” says Bratman. This gives our directed attention, which we use to
focus, time to replenish, he says.
Much of the research has focused just on the visual aspects of nature—seeing the green of trees
or grass, or the blue of a river or ocean. But “nature experiences are multi-sensory,” notes
Bratman. Practitioners of shinrin-yoku(or “forest bathing”) in Japan theorize that the scent and
experience of breathing in the compounds that trees exude into the air could impact immune
function, says Bratman. Sound is another key sense that may indicate safety or danger, allowing
relaxation or exacerbating stress—and soothing nature sounds fit firmly in the first camp, says
Rachel Buxton, a conservation scientist at Carleton University in Canada, who studies
soundscapes, seabird ecology, and ecological restoration.
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Future research
Scientists still don’t know everything about how nature affects health. Many of the studies that
find a relationship between the two just look at trends in the general population—not within
specific groups, like people with anxiety or depression, says White. Establishing the direct effects
of nature on certain conditions would involve ethically complex experiments on small groups of
patients, he notes. Because of these complications, scientists don’t have much high-quality
evidence as to how nature could affect those people who, theoretically, are in most need of a park
prescription.
It’s also possible that pressuring someone to spend more time in nature might reduce some of the
benefits of the visit, says White. In a study published in 2020, White and his colleagues found
that feeling social pressure to visit nature was associated with a higher likelihood to get outside,
but also with less personal motivation, less happiness during the visit, and higher anxiety. As
soon as you tell someone to do something, “there’s a chance it undermines people’s intrinsic
enjoyment,” says White.
Many important questions about how to maximize a nature prescription remain unanswered. “We
don’t really know how much time people need to spend in nature, [or] what types of nature,” says
Browning. The quality of nature someone is exposed to is also likely important, but researchers
are not quite sure what that means. Is a manicured park with turf grass and a ballfield enough, or
do people benefit more when they go out in the woods—somewhere rich in biodiversity? What’s
more, the type of nature someone finds relaxing could be highly individual, based perhaps on
their familiarity with a particular landscape, says Browning.
Scientists are working to fill in these knowledge gaps. Razani, for example, recently received a
$1.2 million grant to study the effects of her nature intervention on anxiety in children. And the
scientific literature is constantly growing in this area, says Ulrika Stigsdotter, a professor of
landscape architecture and planning at the University of Copenhagen in Denmark, who focuses
on evidence-based health design for outdoor spaces.
Some of that research revolves around how outdoor spaces can be better designed specifically for
nature therapy, Stigsdotter notes. If researchers hope to use nature-based treatments to improve
the health of specific patient groups, like those with anxiety or depression, the setting really
matters. The design of a garden or landscape needs to fit who will be using it, she says: Someone
with cancer may respond to certain garden designs differently than someone struggling with
depression or someone else who recently moved to a retirement facility. “The treatment program
depends on the context,” she says.
In the general population, it’s also important not to overstate the effects of nature, says White.
“These effects of green and blue space are small” for most people, says White, particularly
compared to other factors that affect our health like relationships, job satisfaction, and financial
stability. “They’re marginal effects, but they apply to millions of people. So the overall public
health benefit is huge, but small for any given individual.”
Harnessing these health impacts across entire populations will necessarily mean expanding
access. A prescription to get outside can’t address the issues surrounding access to green space. It
can’t expand green space in neighborhoods that lack them, or guarantee that vulnerable people
feel comfortable going to these green spaces, or combat all the stress and illness people face.
“If we had healthy ecosystems [available to] all income levels, we wouldn’t need to take
excursions into nature,” says Razani.
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Still, Razani has seen the power of her program in action. She’s seen a little boy with
developmental issues come alive learning about trees, impressing the park naturalist with his deep
knowledge. She’s watched another child with autism and anxiety became calm, engaged, and
confident while exploring a regional park. The adults involved in the program transform too, she
says. One mother, a survivor of domestic abuse, brought her daughters and eventually started
leading nature outings herself for other survivors.
The more researchers learn about the stress-reducing powers of nature, “what public health
people have always been saying—that health starts outside the clinic—is just becoming more and
more apparent,” says Razani.
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