NATURE AS PRESCRIPTION

Nature prescriptions (NRx) given by healthcare- and social-service providers have been shown to improve systolic and diastolic blood pressure and scores of depression and anxiety.

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Exposure to the natural world is increasingly recognized as a mechanism for health promotion, disease prevention, and even disease treatment. Contact with nature has been shown to positively affect biomarkers of allostatic load (ie, heart rate, blood pressure, heart rate variability, and salivary cortisol); measures of brain activity (ie, electroencephalogram [EEG], functional magnetic resonance imaging [fMRI]);and mental well-being,vitality,and quality of life. Presence and use of natural “green spaces” is associated with lower rates of mortality, cardiovascular disease,type 2 diabetes, obesity, depression, and anxiety. The health benefits of natural spaces are truly holistic and extend beyond physical and mental/emotional benefits to include enhancement of social, spiritual, and even environmental health.

This is especially pertinent in an era of simultaneous, epidemic levels of chronic disease, increasingly indoor and sedentary lifestyles, growing social isolation, and ecological destruction. Data support the theory of biologist EO Wilson’s “biophilia hypothesis”that human affinity for the natural world is an intrinsic adaptation resulting from millions of years of co-evolutionary exposure with our surrounding environments. The dearth of contact with the natural world in modern society has been suggested to contribute to a variety of chronic physical and mental/emotional conditions known colloquially as “nature deficit disorder.” Recent events like the global Covid-19 pandemic have demonstrated how essential contact with nature is and how opportunities to access local green spaces benefit individuals’ and community’s physical, mental, and social health.

One recent method of promoting more time in nature is the use of formal nature prescriptions by physicians and other healthcare and social service providers. People have shown they are more likely to engage in a lifestyle or health-behavior change when given formal prescriptions. Use of nature Rx is increasingly common as providers understand the scientific validity of empirical studies identifying the health benefits of time in nature and recognize NRx as an accepted and available professional practice.

These methods are being increasingly adopted in countries like the UK, where the National Health Service has begun a £5.77-million ($7.06-million) “green social prescribing” program to improve health outcomes and address health inequalities. In Japan, people commonly visit national “forest bathing centers” to engage in physician-personalized, nature-based mindfulness nature walks known as shinrin-yoku. In the United States, resources like Park Rx America are facilitating the writing and inclusion of NRx in patient EHR (electronic health record) charts.

To increase adherence/compliance and optimize health outcomes of a NRx program, it is best to adopt a patient-centered approach, integrating experience and communication between various partners (ie, healthcare, recreation, social services, transportation, etc). An optimal NRx includes:

  • Patient choice of activity to reflect personal interests and cultivate self-efficacy;
  • Specific “dosage” of NRx, including activity, frequency, and duration;
  • Sharing information about specific health benefits for conditions being addressed;
  • Information about local resources (eg, parks), including location, proximity, amenities, hours, and contact info;
  • Opportunities for individual or group social experience; and
  • Clinical followup and opportunities for patient accountability, input, and feedback.

Incorporation of NRx in the clinical treatment plan can be a simple and effective method of improving multiple aspects of patient health and well-being.

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