Evidence suggests that being outdoors has many physical and mental health benefits.
By David Levine, ContributorJan. 5, 2018, at 12:29 p.m.
The primary benefit of being outdoors is exercise, perhaps the single most important healthful activity anyone can engage in. (Getty Images)
Is Mother Nature medicinal? Can spending time outdoors help those with heart disease better cope with their condition? Could a walk in the woods actually be therapeutic?
The answer is a definitive yes. And for both physical and mental health reasons.
In fact, an emerging area of study known as ecotherapy, sometimes called green therapy or nature therapy, stems from the belief that health is not separated from the environment but part of our natural web. “The trend of nature therapy has been increasing over time,” says clinical psychologist Barry Jacobs, who specializes in helping families cope with serious and chronic medical illnesses as director of behavioral sciences for the Crozer-Keystone Family Medicine Residency Program in Springfield, Pennsylvania. “Over my career I have seen more emphasis on it, especially for people with chronic illnesses like cardiovascular disease.”
The primary benefit of being outdoors is exercise, perhaps the single most important healthful activity anyone can engage in. Most chronic diseases, and certainly heart disease, are directly linked with lack of physical activity. “Of all the countries in world, we still are probably among the top three unhealthiest countries because we are not active and out and about,” says Dr. Gerald Fletcher, a cardiologist in Jacksonville, Florida, who is affiliated with the Mayo Clinic Jacksonville.
Exercise generally doesn’t cost any money, especially if it’s just a walk outdoors, says Fletcher, who is also the recent chair of the American Heart Association’s Council on Clinical Cardiology. And exercise can be as effective as – and in some cases replace – medications for heart disease. Before beginning to exercise regularly, patients should discuss their plans with their doctor.
For those suffering from angina, or chest discomfort related to heart disease, exercise alone can allow some patients to stop taking beta blockers, which have side effects and are expensive, Fletcher says. And even those with more advanced heart disease can benefit. Fletcher says he has patients with ejection fractions – a measurement of the percentage of blood leaving the heart each time it contracts – of just 20 to 30 percent of normal who can exercise if well supervised.
And while any exercise is good, outdoor exercise is best. “It is important to get into the outside environment. It’s more fun, you see others exercising, it’s a social thing,” Fletcher says. “If one can exercise outside, it is more productive and beneficial –more enjoyable. I have knee problems, so I open the windows and exercise, and it is more emotionally rewarding and productive, and I tend to exercise more.”
Being physically active not only strengthens the body, it strengthens the mind as well. That is critically important for patients with heart disease. There are strong links between heart problems and depression, with each contributing to and potentially exacerbating the other.
Exercise is one of the most effective tools in preventing and treating depression. A literature review of more than 26 years of research on physical activity, or PA, published in 2013 in the American Journal of Preventive Medicine, declared that “There is promising evidence that any level of PA, including low levels … can prevent future depression.” The author, George Mammen, concludes by saying, “From a population health perspective, promoting PA may serve as a valuable mental health promotion strategy in reducing the risk of developing depression.”
And structured or intensive exercises like running, biking, swimming or playing basketball aren't required to improve mental outlook. The AJPM study found that it only takes about 20 minutes of walking a day to reap rewards. The Mayo Clinic reports that “exercise includes a wide range of activities that boost your activity level to help you feel better.” This includes walking the dog, talking stairs instead of the elevator and spending time in nature.
Indeed, combining activity with nature may be the best way to improve one’s health. A much-cited 2010 study in Environmental Health and Preventive Medicine found that the Japanese practice of shinrin-yoku, or forest bathing, led to “lower concentrations of the stress hormone cortisol, lower pulse rate, lower blood pressure, greater parasympathetic nerve activity, and lower sympathetic nerve activity than do city environments.”
Another study, in the June 2015 issue of Landscape and Urban Planning, found that participants who took a 50-minute walk in a natural environment in Stanford, California, experienced decreased anxiety, rumination (repetitive, negative thought patterns) and negative affect (feelings or emotions), better preservation of positive affect and other cognitive benefits such as better memory, as compared to those who walked in urban settings.
“You can extrapolate from there and say that reducing stress helps with managing all sorts of conditions,” Jacobs says. “It is a fairly safe assumption and I would certainly recommend it to someone, especially someone with a life threatening event like a heart attack.”
Getting out of the house and into nature, Jacobs says, also helps patients “get the focus off themselves. One of the biggest problems for many patients with heart disease is they are very, very cautious. They are physically limited initially, and tend to become isolated and sedentary. The idea of getting them out in the world, especially in the company of other people, is extremely important for recovery.”
Jacobs recommends that his heart disease patients walk with a spouse, join a hiking club or participate in a community garden. “These are all great activities, and are not so physically rigorous. They begin to enjoy life again. That has tremendous therapeutic effect," he says."It is almost a spiritual feeling of the cycle of life, of being connected to the world. I really believe that is a great benefit.”
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