Take a Walk in the Woods. Doctor’s Orders.
(THE NEW YORK TIMES, July 12, 2018)
“Forest bathing,” or immersing yourself in nature, is being embraced by doctors and others as a way to combat stress and improve health.
By Amitha Kalaichandran, M.D.
First we sat in a circle on the leafy ground, each sharing a moment in nature from our childhood that filled us with joy. Next our guide, Kiki, a newly trained forest therapist who insisted we call her by her first name, led us on a mindful — and very slow — walk through the forest.
“What do you hear, smell, see?” Kiki asked, encouraging us to use all five senses to become deeply “immersed” in the experience.
An older woman in the group told us that she was undergoing a difficult and stressful period in her life, and that being among the trees felt “healing.” Others mentioned that the activity reminded them of walks they took as part of Boy Scouts or commented on the sounds: insects, birds, the rustling of leaves. I noticed the bright green acorns that dotted the forest floor, which reminded me of my childhood collection of acorns and chestnuts. Admittedly, I was also worried that the early morning rain was fertile ground for vicious mosquitoes (West Nile!) and ticks (Lyme!).
We ended the two-hour forest walk with a tea ceremony, sipping a concoction of white pine needles steeped in hot water.I left feeling relaxed and more at peace, though with at least two dozen bites from mosquitoes that seemed immune to DEET.
Kiki had been trained according to standards set by the Association of Nature and Forest Therapy, a professional group that has certified more than 300 people across North America to be forest therapy guides, among them psychotherapists, nurses and six M.D.s. The sessions are modeled after the Japanese tradition of shinrin-yoku, or forest bathing.
Over the years, I’ve had physician mentors recommend Richard Louv’s books, “The Nature Principle” and “Last Child in the Woods,” which describe the benefits of time spent in the wilderness, from stimulating creativity to reducing stress. Florence Williams’s best-selling book, “The Nature Fix,” has a chapter dedicated to the benefits of forest therapy.And now, it appears that more North American doctors are starting to incorporate spending time in forests into their practice.
Some small studies, many conducted in Japan and Korea, suggest that spending time in nature, specifically in lush forests, might decrease stress and blood pressure (especially in middle-aged men), improve heart-rate variability and lower cortisol levels while boosting one’s mood. An analysis of studies from 2010 that focused on exercising in nature found improvements in self-esteem, particularly among younger participants. Overall effects on mood were heightened when there was a stream or other body of water nearby.
But other studies have shown mixed results. A cross-sectional study from Korea found no change in blood pressure with forest bathing, and a systematic review from 2010 found that while time in the forest may boost mood and energy, any effects on attention, blood pressure and cortisol may not be statistically significant. Another recent review from Australia underscored the challenges of drawing causal links to disease prevention, with the authors calling for robust randomized controlled trials.
Several theories have been proposed as to why spending time in forests might provide health benefits.Some have suggested that chemicals emitted from trees, so-called phytoncides, have a physiological effect on our stress levels. Others suggest that forest sounds — birds chirping, rustling leaves — have a physiologically calming effect. Yet evidence to support these theories is limited.
On a recent visit to Japan, I met with Dr. Hiroko Ochiai, a surgeon based at Tokyo Medical Center, and her husband, Toshiya Ochiai, who is currently the chief executive of the International Society of Nature and Forest Medicine. Dr. Ochiai is trained in forest therapy and currently conducts most of her sessions with volunteers within a forest in Nagano, about three hours from Tokyo, with the help of a local guide, and plans to offer forest therapy soon at one of Tokyo’s largest hospitals.
“I usually encourage participants to sit or lie down on the forest ground and listen to the sounds,” she says. “The hypersonic natural world can be soothing, and things are always moving even while we are still. It can be very calming.”
Last June the Northside Hospital Cancer Institute in Atlanta began to formally offer forest therapy as part of a pilot project in collaboration with the Chattahoochee Nature Center. Twelve patients with newly diagnosed cancers recently signed up for a session, according to Christy Andrews, the executive director of Cancer Support Community Atlanta.
“It was a four-hour session that seemed to have an impact on the patients,” she said. “I remember one participant telling me afterward that it was a way to ‘steer away from cancer,’ and the group became very cohesive. I think it helped reduce the isolation in a way that’s different from a regular support group.”
Dr. Suzanne Bartlett Hackenmiller, an obstetrician-gynecologist based in Cedar Falls, Iowa, began guiding patients in her practice through the Prairie Woods in Hiawatha Iowa, though she has also led groups in forests around Des Moines. She became a certified guide through the Association of Nature and Forest Therapy three years ago and tries to tailor her offerings based on the group she is leading.
“I generally get a sense of where people are at. For some, it’s best for me to stick to the science, but others may literally want to hug a tree. The traditional tea ceremony at the end might turn some people off, so I’m conscious of that and adjust accordingly,” she says.
In one exercise, she has participants close their eyes as she guides them through experiencing the different senses, imagining feeling their feet growing into the ground like roots of a tree, for instance, listening to nearby sounds and observing how far they may extend, or smelling the air. It’s similar in many ways to a guided meditation.
“I recently held a session where four out of the 20 participants were in wheelchairs, so I found a local park that had plenty of trees and a paved sidewalk so everyone could enjoy it,” she says.
At the University of California, San Francisco, Benioff Children’s Hospital in Oakland, Dr. Nooshin Razani, a pediatric infectious disease doctor and director of the Center for Nature and Health, has offered a similar program for the past four years. The “Shine” program, linked to the East Bay Regional Parks District, offers “ park prescriptions,” a movement that is growing in popularity, and aims to improve accessibility to nature for low income children.
One Saturday a month, Dr. Razani leads a group of up to 50 people through a lush forest of redwood trees and lakes on the outskirts of Oakland. The groups consist of patients ranging in age from a few months to 18 years, accompanied by at least one adult family member. A few of her medical colleagues — an orthopedic surgeon and primary care doctor — have also attended, and the Oakland-based pediatrics residency program at the medical centers invites doctors in training to join the group. Shine recently celebrated its 60th park outing.
“The accessibility part is huge for me. Many children don’t have access to green spaces in their community,” Dr. Razani says. “We also have evidence that supports the mental health aspects of spending time in forests, and for the resident doctors who participate, it’s a way to show them how children interact with nature based on the developmental stage. Sometimes the doctors’ need is just as much as the patients’.” In February, Dr. Razani published findings of a randomized trial that found that park visits — regardless of whether they were led by a guide or not — were associated with a decrease in stress three months after the visits.
A few hours after my own forest walk, the woman in our group who had mentioned her stress emailed me to say that she had checked her blood pressure afterward and noticed it was lower than usual. “It would be nice to see if there was a meaningful change from before, if they collected that information,” she wrote.
She had hit on one of the biggest issues around guided forest walks and forest therapy. Is it an evidence-based activity with proven clinical benefits?
The science is still lacking to prove it.But there is some evidence — as well as good old common sense — to suggest that spending time in nature is good for both the mind and body, whether done as a group or alone. It may be something we all need more of.
Amitha Kalaichandran, M.H.S., M.D., (@DrAmithaK) is a resident physician in pediatrics based in Ottawa, Canada.
Why living around nature could make you live longer
(The Washington Post, April 19, 2016)
Living closer to nature is better for your health, new research suggests — and may even extend your life.
A study just published in the journal Environmental Health Perspectives found that people who live in “greener” areas, with more vegetation around, have a lower risk of mortality. The health benefits are likely thanks to factors such as improved mental health, social engagement and physical activity that come with living near green spaces.
The research relied on data from a vast long-term Harvard study funded by the National Institutes of Health called the Nurses’ Health Study, which has collected health information biennially on more than 100,000 female registered nurses in the U.S. since 1976. The new paper analyzed participant data from between 2000 and 2008, taking note of any deaths that occurred and their causes. At the same time, the researchers used satellite data to assess the amount of green vegetation surrounding each participant’s home during the study period.
The researchers found that people living in the greenest places — that is, people who had the most vegetation within 800 feet of their homes — had a 12 percent lower rate of mortality from any non-accidental cause than people living in the least green places. Specifically, they found that the relationship was strongest for deaths related to respiratory disease, cancer and kidney disease. These results were the same regardless of the participants’ income, weight or smoking status and also did not significantly change between urban and suburban locations.
In statistical analyses, though, the researchers found that participants’ mental health, social engagement, level of physical activity and exposure to air pollution likely explained how the green spaces were making a difference.
This is all in line with the ways previous research has suggested greenness can affect health. Places with more vegetation are generally thought to be less polluted, and the presence of vegetation, itself, can help keep air cleaner. And green spaces like parks can help encourage people to get outside, exercise and engage with other people — all factors that can improve overall health. The effects on mental health may be somewhat less straightforward, but nonetheless important, as this study suggested.
“We were really surprised to find that the mental health pathway explained about 30 percent of the relationship between greenness and mortality,” said Peter James, the study’s lead author and a research associate at the Harvard T.H. Chan School of Public Health.
There are several theories about how nature affects mental health, said Howard Frumkin, dean of the school of public health at the University of Washington, who was not involved with the new study. One of them is known as the “biophilia” hypothesis, which was proposed by renowned biologist and naturalist E.O. Wilson. This theory embodies the idea “that we evolved as a species embedded in nature over most of our existence as a species, and something about that nature contact still resonates with us,” Frumkin said. “Something about contact with nature is soothing and restorative and thereby good for mental health.”
It may also be that the social engagement that green spaces encourage can improve people’s mindsets as well. “Social connectedness is a predictor of good mental health, which is in turn a predictor of good physical health,” Frumkin said.
Still, much remains uncertain about the exact mechanisms by which exposure to nature can improve health, Frumkin noted. And scientists are still trying to figure out what type of contact with nature works best.
“Is a it a view out the window or do you need to get out and walk among the trees?” Frumkin said. “Does a bush do the trick or do you need a tree? Does it need to be in leaf during the summer, or does it work during the winter when it’s lost its leaves? There are lots of questions about the mechanisms and specifically about what form of nature contact offers benefit.”
James and his team hope to continue exploring the finer details in future research. They’re interested in looking more closely at some of the specific causes of mortality revealed in this study, especially cancer, in order to examine not just how greenness is connected to deaths but to the overall incidence of disease.
“We also do want to explore this with other cohorts,” James added. While he and his team controlled for demographic factors in this study, it’s still worth pointing out that most of the participants were white, and since they were all registered nurses, the socioeconomic range within the group was somewhat narrow.
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James added that, while this study focused on greenness around the participants’ residences, it’s worth noting that most people spend a great deal of their time away from the home. So a good idea for future research would be to focus on a broader set of the spaces people interact with on a daily basis.
The challenge with all these ideas for future studies is that research on the health effects of greenness is difficult to get funded, Frumkin said, pointing out that even this study was “a piggyback onto an existing study that’s being funded for other reasons.” He feels that if more resources were afforded to the understanding of human interactions with nature, the health benefits could be immense.
“If we had a medication that did this — a medication that prolonged life, that addressed very different unconnected causes of disease, that did it at no cost and with no side effects — that would be the best medication of the decade,” Frumkin said. “But we don’t have a medication like that except for this ‘vitamin N’ — nature.”
Kids do not spend nearly enough time outside. Here’s how (and why) to change that.
by Collin O'Mara
On Parenting Perspective
As the weather turns warmer and the days are longer, many parents are looking forward to spending more quality time with the family. A great place to start is by taking your kids outdoors — a lot. As the parent of a 6-year old and a 10-month-old, I think a lot about how our family can provide experiences that help them reach their potential. As the head of the National Wildlife Federation, I am also focused on where children spend their time, and how it impacts their lives.
Here is a sobering statistic: The average American child spends five to eight hours a day in front of a digital screen, often at the expense of unstructured play in nature. The good news is departing from this trend is easier than you think, and quality outside time can fit into even the busiest of schedules. It is worth the effort; the benefits go beyond a little time spent in the fresh air.
Over the past few decades, children’s relationship with the great outdoors and nature has changed dramatically. Since the 1990s researchers have noticed a shift in how children spend their free time. The days of the free-range childhood, where kids spend hours outside playing in local parks, building forts, fording streams and climbing trees, have been mostly replaced by video games, television watching and organized activities such as sports and clubs. We have traded green time for screen time — and it has had an impact on kids’ well-being and development. Our approach to raising children has changed as well, as parents who allowed kids to play largely unsupervised from dawn to the dinner bell have yielded to “helicopter parents” who are afraid to allow their children to roam free, because of perceived safety concerns.
So if childhood has changed, why is it still important for kids to spend time in nature? Here are a few of the benefits:
- Better school performance. Time spent in nature and increased fitness improve cognitive function.
- More creativity. Outdoor play uses and nurtures the imagination.
- Much higher levels of fitness. Kids are more active when they are outdoors.
- More friends. Children who organize their own games and participate in unstructured group activities are less solitary and learn to interact with their peers.
- Less depression and hyperactivity. Time in nature is soothing, improves mood and reduces stress. It can also increase kids’ attention span, because things move at a slower pace than they do on the screen.
- Stronger bones. Exposure to natural light helps prevent vitamin D deficiency, making outdoorsy children less vulnerable to bone problems, cardiovascular disease, diabetes and other health issues.
- Improved eyesight. Time spent outdoors can help combat increasing diagnoses of nearsightedness.
- Better sleep. Exposure to natural light, and lots of physical activity, help reset a child’s natural sleep rhythms.
- A longer life span and healthier adult life. Active kids are more likely to grow into active adults.
And the best part, all of these benefits — especially those related to health and well-being — also apply to the adults spending more time with their children outdoors.
Kids who play more outdoors have fuller and more wholesome lives. Often, when they go outdoors they transform. I love watching my older daughter’s smile grow as her senses awake to the sight of birds and butterflies, the smell of flowers and trees and the sounds of water rushing or leaves rustling. Importantly, she gets a vital break from her intense indoor, too often digitized and highly regimented lifestyle.
Here are the NWF’s top tips for helping children and families reap the benefits of spending time outdoors.
- Explore wildlife with Ranger Rick — From colorful birds to playful squirrels, wildlife holds a special fascination for children of all ages. Taking time to learn about and explore local wildlife with the children in your life is a great way to get kids engaged with the natural world and spending time outside. The National Wildlife Federation’s outdoor ambassador Ranger Rick and his friends provide countless ideas for family outdoor adventures at rangerrick.com.
- Commit to a green hour — Whenever possible, set aside an hour of nature play time for kids each day. The American Academy of Pediatrics and the Centers for Disease Control agree an hour of free play and moderate activity daily is a prescription for lasting health. Increasing a child’s time in nature and the outdoors does not have to be a heavy burden for parents and caregivers; a quick stop at a local park on the way home from school, fishing in a local stream, or an impromptu picnic outside all count. More information is available at: nwf.org/greenhour.
- Garden for wildlife in your backyard — Every family, whether they have a windowsill in an apartment or a yard, can take small actions that make a big impact for children and wildlife. Planting native plants and providing wildlife with food, water, shelter and places to raise their young can transform any space into a bustling wildlife destination and help kids cultivate a love of nature: nwf.org/Garden-for-Wildlife.
At a time when parenting can seem fraught with complexities, one of the best things we can do for ourselves and our children is simply opening the door and stepping outside.
Collin O’Mara is the president and CEO of the National Wildlife Federation and a father of two. Find him on Twitter @Collin_OMara.