Natural Medicine: More Doctors Prescribing Time Outdoors
Birdwatch for long-tailed ducks. Search for shells. Sketch some snowdrops.
These are some of the prescriptions you might receive if you go to a doctor in the Shetland Islands of Scotland and say that you are suffering from stress, heart disease, diabetes, mental health problems or other chronic conditions.
Starting Oct. 5, the UK's National Health Service (NHS) in Shetland has authorized doctors there to prescribe time outdoors, The Guardian reported. Doctors will pass out pamphlets written by the Royal Society for the Protection of Birds (RSPB) advising patients on walks to take and wildlife to watch out for.
The Shetland doctors are only the latest in a growing number of healthcare providers incorporating nature into their treatment plans as evidence mounts for the health benefits of time spent in wild spaces. In his 2005 book Last Child in the Woods, Richard Louv cited 60 studies finding that time outside helped mental and physical health, and that too much time spent away from nature caused harm. Now, the website of his Children & Nature Network lists more 700, Louv told The New York Times.
One doctor who was inspired by Louv's book was Dr. Robert Zarr, a Washington, DC pediatrician who started a nonprofit called Parks Rx America to make it easier for doctors to prescribe time in nature. The site has mapped and rated parks in the DC area and allows doctors to find parks near patients' homes.
Dr. Zarr told The New York Times he usually writes one or two park prescriptions per day, usually for children dealing with weight issues or teenagers dealing with mental health problems. Zarr said he lets his patients take the lead in planning activities.
"Is there anything they want to do that's enjoyable outside, that they're willing to commit to?" he said he might ask. "[Y]ou just told me you play soccer. How often do you go? Would you be willing to commit to going once a week or twice a week?"
Drug: Exercise in Glen Canyon Park (See attached Google map.) Dose: 45 minutes of walking or running Directions: Monday, Wednesday, Friday, and Saturday at 7:00 AM Refill: Unlimited
What I've noticed in my practice mirrors what has been observed in the studies: Inactive patients who initiate a new exercise regimen outdoors are more likely to stick with it than those who join a gym or work out in the confines of their basement. It seems that a number of things contribute to this "stickiness": the constantly varying scenery, the camaraderie of the trail, the fact that monthly dues and expensive Spandex outfits aren't required. And consistent with the research findings, my patients report a host of other benefits from their nature routine: less fatigue throughout the day, a sense of calm, better sleep, a drop in weight, and even lower blood pressure. Of course, not every patient takes the nature Rx and "runs" with it. But for many, a physician's advice, backed by a paper document, is just the push needed to venture onto the trails.
The phenomenon is not limited to the U.S. and UK. In fact, the benefits of spending time in forests was extensively researched in Japan in the 1980s, Joanne O'Connor wrote for The Guardian.. The researchers found that just two hours in the woods could reduce blood pressure and stress hormones and boost concentration and memory. Further, chemicals released by trees called phytoncides actually boosted the immune system. The practice of forest bathing, or shinrin-yoku, then grew into a national health program in Japan. It has since spread around the world, with sessions offered in parks from London to New York.
Akasawa forest in Japan was the first designated area for forest bathing.Saigen Jiro
Dr. Qing Li, who wrote Forest Bathing: How Trees Can Help You Find Health and Happiness, gave Time readers a primer in the practice. Try this out next time you find yourself stressed out and near some green space.
First, find a spot. Make sure you have left your phone and camera behind. You are going to be walking aimlessly and slowly. You don't need any devices. Let your body be your guide. Listen to where it wants to take you. Follow your nose. And take your time. It doesn't matter if you don't get anywhere. You are not going anywhere. You are savoring the sounds, smells and sights of nature and letting the forest in.
The key to unlocking the power of the forest is in the five senses. Let nature enter through your ears, eyes, nose, mouth, hands and feet. Listen to the birds singing and the breeze rustling in the leaves of the trees. Look at the different greens of the trees and the sunlight filtering through the branches. Smell the fragrance of the forest and breathe in the natural aromatherapy of phytoncides. Taste the freshness of the air as you take deep breaths. Place your hands on the trunk of a tree. Dip your fingers or toes in a stream. Lie on the ground. Drink in the flavor of the forest and release your sense of joy and calm. This is your sixth sense, a state of mind. Now you have connected with nature. You have crossed the bridge to happiness.
At least 4 new studies suggest that connecting with nature improves our minds and moods. But you already knew that,… https://t.co/9HRxDgeHXy— Greenpeace USA (@Greenpeace USA)1511557202.0
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By Bob Jacobs
Hanako, a female Asian elephant, lived in a tiny concrete enclosure at Japan's Inokashira Park Zoo for more than 60 years, often in chains, with no stimulation. In the wild, elephants live in herds, with close family ties. Hanako was solitary for the last decade of her life.
Hanako, an Asian elephant kept at Japan's Inokashira Park Zoo; and Kiska, an orca that lives at Marineland Canada. One image depicts Kiska's damaged teeth. Elephants in Japan (left image), Ontario Captive Animal Watch (right image), CC BY-ND
Affecting Health and Altering Behavior<p>It is easy to observe the overall health and psychological consequences of life in captivity for these animals. Many captive elephants suffer from arthritis, obesity or skin problems. Both <a href="https://doi.org/10.11609/JoTT.o2620.1826-36" target="_blank">elephants</a> and orcas often have severe dental problems. Captive orcas are plagued by <a href="https://doi.org/10.1016/j.jveb.2019.05.005" target="_blank">pneumonia, kidney disease, gastrointestinal illnesses and infections</a>.</p><p>Many animals <a href="https://doi.org/10.1016/j.neubiorev.2017.09.010" target="_blank">try to cope</a> with captivity by adopting abnormal behaviors. Some develop "<a href="https://doi.org/10.1016/j.applanim.2017.05.003" target="_blank" rel="noopener noreferrer">stereotypies</a>," which are repetitive, purposeless habits such as constantly bobbing their heads, swaying incessantly or chewing on the bars of their cages. Others, especially big cats, pace their enclosures. Elephants rub or break their tusks.</p>
Changing Brain Structure<p>Neuroscientific research indicates that living in an impoverished, stressful captive environment <a href="https://doi.org/10.1016/j.jveb.2019.05.005" target="_blank" rel="noopener noreferrer">physically damages the brain</a>. These changes have been documented in many <a href="https://doi.org/10.1002/cne.903270108" target="_blank" rel="noopener noreferrer">species</a>, including rodents, rabbits, cats and <a href="https://doi.org/10.1006/nimg.2001.0917" target="_blank" rel="noopener noreferrer">humans</a>.</p><p>Although researchers have directly studied some animal brains, most of what we know comes from observing animal behavior, analyzing stress hormone levels in the blood and applying knowledge gained from a half-century of neuroscience research. Laboratory research also suggests that mammals in a zoo or aquarium have compromised brain function.</p>
This illustration shows differences in the brain's cerebral cortex in animals held in impoverished (captive) and enriched (natural) environments. Impoverishment results in thinning of the cortex, a decreased blood supply, less support for neurons and decreased connectivity among neurons. Arnold B. Scheibel, CC BY-ND<p>Subsisting in confined, barren quarters that lack intellectual stimulation or appropriate social contact seems to <a href="https://doi.org/10.1590/S0001-37652001000200006" target="_blank" rel="noopener noreferrer">thin the cerebral cortex</a> – the part of the brain involved in voluntary movement and higher cognitive function, including memory, planning and decision-making.</p><p>There are other consequences. Capillaries shrink, depriving the brain of the oxygen-rich blood it needs to survive. Neurons become smaller, and their dendrites – the branches that form connections with other neurons – become less complex, impairing communication within the brain. As a result, the cortical neurons in captive animals <a href="https://doi.org/10.1002/cne.901230110" target="_blank">process information less efficiently</a> than those living in <a href="https://doi.org/10.1002/dev.420020208" target="_blank">enriched, more natural environments</a>.</p>
An actual cortical neuron in a wild African elephant living in its natural habitat compared with a hypothesized cortical neuron from a captive elephant. Bob Jacobs, CC BY-ND<p>Brain health is also affected by living in small quarters that <a href="https://doi.org/10.3233/BPL-160040" target="_blank">don't allow for needed exercise</a>. Physical activity increases the flow of blood to the brain, which requires large amounts of oxygen. Exercise increases the production of new connections and <a href="http://dx.doi.org/10.1126/science.aaw2622" target="_blank">enhances cognitive abilities</a>.</p><p>In their native habits these animals must move to survive, covering great distances to forage or find a mate. Elephants typically travel anywhere from <a href="https://www.elephantsforafrica.org/elephant-facts/#:%7E:text=How%20far%20do%20elephants%20walk,km%20on%20a%20daily%20basis." target="_blank">15 to 120 miles per day</a>. In a zoo, they average <a href="https://doi.org/10.1371/journal.pone.0150331" target="_blank" rel="noopener noreferrer">three miles daily</a>, often walking back and forth in small enclosures. One free orca studied in Canada swam <a href="https://doi.org/10.1007/s00300-010-0958-x" target="_blank" rel="noopener noreferrer">up to 156 miles a day</a>; meanwhile, an average orca tank is about 10,000 times smaller than its <a href="https://www.cascadiaresearch.org/projects/killer-whales/using-dtags-study-acoustics-and-behavior-southern" target="_blank" rel="noopener noreferrer">natural home range</a>.</p>
Disrupting Brain Chemistry and Killing Cells<p>Living in enclosures that restrict or prevent normal behavior creates chronic frustration and boredom. In the wild, an animal's stress-response system helps it escape from danger. But captivity traps animals with <a href="https://doi.org/10.1073/pnas.1215502109" target="_blank">almost no control</a> over their environment.</p><p>These situations foster <a href="https://doi.org/10.1037/rev0000033" target="_blank">learned helplessness</a>, negatively impacting the <a href="https://doi.org/10.1155/2016/6391686" target="_blank" rel="noopener noreferrer">hippocampus</a>, which handles memory functions, and the <a href="https://doi.org/10.1016/j.neuropharm.2011.02.024" target="_blank" rel="noopener noreferrer">amygdala</a>, which processes emotions. Prolonged stress <a href="https://doi.org/10.3109/10253899609001092" target="_blank" rel="noopener noreferrer">elevates stress hormones</a> and <a href="https://doi.org/10.1523/JNEUROSCI.10-09-02897.1990" target="_blank" rel="noopener noreferrer">damages or even kills neurons</a> in both brain regions. It also disrupts the <a href="https://doi.org/10.1016/j.neubiorev.2005.03.021" target="_blank" rel="noopener noreferrer">delicate balance of serotonin</a>, a neurotransmitter that stabilizes mood, among other functions.</p><p>In humans, <a href="https://doi.org/10.1006/nimg.2001.0917" target="_blank" rel="noopener noreferrer">deprivation</a> can trigger <a href="https://doi.org/10.3389/fnins.2018.00367" target="_blank" rel="noopener noreferrer">psychiatric issues</a>, including depression, anxiety, <a href="https://doi.org/10.3389/fnins.2018.00367" target="_blank" rel="noopener noreferrer">mood disorders</a> or <a href="https://doi.org/10.1177/1073858409333072" target="_blank" rel="noopener noreferrer">post-traumatic stress disorder</a>. <a href="https://doi.org/10.1007/s00429-010-0288-3" target="_blank" rel="noopener noreferrer">Elephants</a>, <a href="https://doi.org/10.1371/journal.pbio.0050139" target="_blank" rel="noopener noreferrer">orcas</a> and other animals with large brains are likely to react in similar ways to life in a severely stressful environment.</p>
Damaged Wiring<p>Captivity can damage the brain's complex circuitry, including the basal ganglia. This group of neurons communicates with the cerebral cortex along two networks: a direct pathway that enhances movement and behavior, and an indirect pathway that inhibits them.</p><p>The repetitive, <a href="http://dx.doi.org/10.1016/j.bbr.2014.05.057" target="_blank">stereotypic behaviors</a> that many animals adopt in captivity are caused by an imbalance of two neurotransmitters, dopamine and <a href="https://doi.org/10.1016/j.neubiorev.2010.02.004" target="_blank" rel="noopener noreferrer">serotonin</a>. This impairs the indirect pathway's ability to modulate movement, a condition documented in species from chickens, cows, sheep and horses to primates and big cats.</p>
The cerebral cortex, hippocampus and amygdala are physically altered by captivity, along with brain circuitry that involves the basal ganglia. Bob Jacobs, CC BY-ND<p>Evolution has constructed animal brains to be exquisitely responsive to their environment. Those reactions can affect neural function by <a href="https://www.penguinrandomhouse.com/books/311787/behave-by-robert-m-sapolsky/" target="_blank">turning different genes on or off</a>. Living in inappropriate or abusive circumstance alters biochemical processes: It disrupts the synthesis of proteins that build connections between brain cells and the neurotransmitters that facilitate communication among them.</p><p>There is strong evidence that <a href="https://doi.org/10.1523/JNEUROSCI.0577-11.2011" target="_blank">enrichment</a>, social contact and appropriate space in more natural habitats are <a href="https://doi.org/10.1111/j.1748-1090.2003.tb02071.x" target="_blank" rel="noopener noreferrer">necessary</a> for long-lived animals with large brains such as <a href="https://doi.org/10.1371/journal.pone.0152490" target="_blank" rel="noopener noreferrer">elephants</a> and <a href="https://doi.org/10.1080/13880292.2017.1309858" target="_blank" rel="noopener noreferrer">cetaceans</a>. Better conditions <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5543669/" target="_blank" rel="noopener noreferrer">reduce disturbing sterotypical behaviors</a>, improve connections in the brain, and <a href="https://doi.org/10.1038/cdd.2009.193" target="_blank" rel="noopener noreferrer">trigger neurochemical changes</a> that enhance learning and memory.</p>