In today’s busy world, it’s go, go, go from the second you wake up until you manage (hopefully) to fall asleep. No wonder so many of us — patients and clinicians included — are anxious, irritable, and just plain tired. One documented solution: spend some time in nature. While this is something clinicians can do themselves, they can also prescribe nature walks to patients.
We spoke with Qing Li, MD, PhD, professor at Tokyo’s Nippon Medical School in Japan and the founding chairman of the Japanese Society for Forest Medicine. He also authored the book “Forest Bathing,” which has been translated into 26 languages. He told us that while stress can induce negative emotions such as anxiety, depression, anger, fatigue, and confusion, connection with the natural world such as with “shinrin-yoku” (forest bathing) can reduce stress and stress hormones like adrenaline, noradrenaline, and cortisol.
The term “forest bathing” was created in the early 1980s by the Japanese Ministry of Agriculture, Forestry and Fisheries and refers to a healing technique that restores the physical and psychological health of the human body through a “5 senses experience” (vision, smell, hearing, touch, and taste) when the body is exposed to a forest environment.1
“The idea that humans have a biological need to connect with nature is called biophilia, from the Greek, meaning ‘love of life and the living world,’” said Dr Li.
The concept was made popular by the American biologist E.O. Wilson in 1984 who believed that, because we evolved in nature, we have a biological need to connect with nature, he explained.
“We are genetically determined to love the natural world. It is in our DNA, and this affinity for the natural world is fundamental to our health. Contact with nature is as vital to our well-being as regular exercise and a healthy diet. ‘Our existence depends on this propensity, our spirit is woven from it, hope rises on its currents,’” wrote Wilson. “We are ‘hardwired’ to affiliate with the natural world — and just as our health improves when we are in it, so our health suffers when we are divorced from it.”
“People can enjoy forest bathing by utilizing the 5 senses while walking through a park, wooded area, or forest,” said Dr Li. Here are his tips for forest bathing:
1. Turn off all electronic devices.
2. Make a plan based on your physical abilities and avoid tiring yourself out.
3. If you have an entire day, stay outdoors for about 4 hours and walk about 3 miles. If you have just a half-day, stay outdoors for 2 hours and walk about 1.5 miles.
4. Take a rest whenever you are tired.
5. Drink water/tea whenever you feel thirsty.
6. Find a place you like, then sit for a while and read or enjoy the scenery.
According to Dr Li, when we walk slowly through the forest — seeing, listening, smelling, tasting, and touching — we bring our rhythms into step with nature.
“Shinrin-yoku is like a bridge,” he said. “By opening our senses, it bridges the gap between us and the natural world. And when we are in harmony with the natural world we can begin to heal. Our nervous system can reset itself and our bodies and minds can go back to how they ought to be. No longer out of kilter with nature, but once again in tune with it. We are refreshed and restored. We may not travel very far on our forest walk, but in connecting us with nature, shinrin-yoku takes us all the way home to our true selves.”
In 2017, Robert Zarr, MD, MPH founded PRA, a nonprofit organization whose mission is to educate health professionals about the benefits of prescribing nature and to provide an electronic platform for health professionals to locate and prescribe visits to parks. PRA’s park prescription specifies where the patient will go, the activity that will take place, the dose (time spent in a park/wooded area), and frequency. Prescriptions are delivered via text message with a reminder for the patient to fill his or her prescription.
PRA’s park prescribing platform provides a doctor-friendly method to document the park prescription in electronic medical records. The platform also has the clinical value of specificity, electronic reminders, and a patient/client-centered commitment to redirect the trajectory of illness into one of health
“Dr Zarr has some advice for busy clinicians seeking to ‘prescribe parks.’ Rather than thinking about writing a nature prescription as something ‘in addition to,’ think about it as a tweak in the work that clinicians already do in counseling your patients,” he said.
“Many clinicians already take time to counsel their patients regarding lifestyle changes, including diet and exercise, but may not be taking advantage of the tremendous functionality (daily reminders, commitment to place, activity, dose, and frequency, patient response to filling a prescription) of our platform [at PRA]. Like any new change in your practice (use of new medication or diagnostic test) it might take a little time to get used to it. Be patient with yourself,” he encouraged.
Dr Zarr also recommends questions to strike up a conversation with patients about time in nature. “Given that each clinician develops their own style and flow of their practice, there is no right or wrong way to incorporate a brief conversation about spending time in nature with patients,” he said.
According to Dr Zarr, here are some ways that prescribers can incorporate a question about nature into the office visit:
- How much time do you spend outside?
- Where is that place that you like to go where you feel safe and comfortable outside?
- Is there a park or nature setting where you wish you spent more time?
- Where do you go outside to relax and de-stress/unwind?
- Is there a place you go outside where you have a strong connection?
- Did you know that spending time outside can help to improve your… (diabetes, high blood pressure, high cholesterol, chronic stress, memory, cognitive function, ADHD)?
- Have you ever thought about taking a few minutes every day to notice what’s happening around you in the natural world?
On the PRA website there is a quote from a psychiatrist about the benefits one of her patients received after going on walks in nature.
“I remember a patient with an early stage of Alzheimer’s dementia telling me about his experience with nature walks after being prescribed [to go to] a park nearby his house. He said, ‘Being in contact with trees, birds, the sun … turned me back to those happy memories of my childhood when my mind was sharp and bright. After every walk, I feel energized, joyful, and reminded of simple things. Also, I’m sleeping much better at night.’ It is so satisfying to find a tool which facilitates well-being in an accessible way!”
Anissa Hernandez, MD, Psychiatrist3
In the US and Canada, there are a multitude of ways to get your green on. Each website gives information about the benefits of being in nature and lists local organizations whose programs patients (and clinicians) can participate in.
https://parkrxamerica.org/ (Learn how to write a prescription for nature).
https://www.parkrx.org/ (Contains a directory of programs in the US).
https://www.parkprescriptions.ca/ (Contains a directory of programs in Canada).
Forest Bathing by Qing Li, MD, PhD
- Wen Y, Yan Q, Gu X, Liu Y. Medical empirical research on forest bathing (Shinrin-yoku): a systematic review. Environ Health Prev Med. 24, 70 (2019). doi:10.1186/s12199-019-0822-8
- Park Prescription Program Toolkit. Park Rx. Assessed May 9, 2022. https://www.parkrx.org/parkrx-toolkit
- How to Prescribe Nature and Send Reminders. Park Rx America. Assessed May 9, 2022. https://parkrxamerica.org/providers/how-to-prescribe-nature.php