Doctor's orders: Take a hike, you'll feel better

Bukit Jambul, Penang

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 While more doctors are looking at using time outside as a medical strategy, park prescription programmes face issues of access. Photo: Unsplash/Jon Flobrant 

 When Annette Coen went for a health check-up last summer in Washington state, she and her doctor discussed concerns around her weight and asthma. Then her doctor offered a novel prescription: regular hikes in the woods.

He gave Coen a one-year pass to Washington's state park system and told her to "go for walks, go camping, do what you need to do," Coen, now 53, told the Thomson Reuters Foundation.

A year on, she said the park prescription was a "great experience" for her and her whole family. "I have lost 13.6 kg since April this year... just being out and about," she said.

With the Covid-19 pandemic highlighting the health benefits of spending more time outdoors, a growing faction of the US medical community is prescribing time outside the same way they would traditional medication.

The idea of writing out park or nature prescriptions has taken hold particularly among pediatricians.

"It all came together" during the pandemic, said Maya Moody, president-elect of the Missouri chapter of the American Academy of Pediatrics (AAP), pointing to spikes in childhood anxiety and pediatric obesity since the coronavirus outbreak started.

With lockdowns keeping children indoors, "we were seeing 30-, 50-, 60-pound weight gains," said Moody, who attends to around 3,000 low-income children in the St. Louis area.

This April, she became one of about a dozen pediatricians across the state who have started offering nature prescriptions.

"When I give a prescription, it's

specific, just like an antibiotic. They use it for this many days, and I say go to this park," she explained. Buy-in has differed with different age groups, Moody noted, with younger children and their parents being more open to the approach but teenagers expressing skepticism.

"Sixteen- and 17-year-olds look at me and say, 'You want me to get off TikTok and get an actual tick in the woods?'" she said.

But Moody said the fact that doctors and health experts are now seriously looking at how something as simple as a walk in the park can help patients is exciting.

A spokesperson for the AAP said the group is forming a committee on the issue of nature prescriptions but declined to offer additional details.

Take a walk

Nature prescriptions are still new, so there is little data on their effectiveness, but one 2018 analysis by researchers from Britain's University of East Anglia did find they "may have substantial benefits".

There has been much more research done on the general benefits of being outdoors - in one example, starting next month, a study supported by the Welsh government will look at the benefits of treating hospital patients outside.

In more than 500 scientific studies in recent years, researchers have linked time spent in nature with decreased anxiety, reduced risk of obesity and even reduced overall mortality, said Maryland-based pediatrician Stacy Beller Stryer.

Stryer is also associate medical director with Park Rx America, an online platform that helps medical professionals write nature prescriptions.

Using its database of thousands of parks and public lands, prescribers can filter by activity, distance from a patient's home and amenities such as playgrounds.

"Once (the patient) decides on where to go, the prescriber talks about what they should do - maybe walk a dog? And how often - maybe every Monday, Wednesday and Friday for 30 minutes?" she said.

Writing out an actual prescription for time in nature gives patients a useful extra push, said Brent A. Bauer, research director of integrative medicine and health at the Mayo Clinic in Minnesota.

"More than half of my patients who receive a 'prescription' for time in nature go ahead and do so successfully," he said.

A census of park prescription programmes last year estimated that there were more than 100 nationwide.

The Pittsburgh Parks Conservancy began a pilot programme in collaboration with the UPMC Children's Hospital of Pittsburgh in 2016, after a pediatric resident was leading patients in a weight management clinic, said Kathryn Hunninen, a senior manager with the conservancy.

"He wanted to encourage patients to get outside but didn't know where to send them," she said.

"This started with an inquiry from him to the parks system and has blossomed from there."

In a 2018 survey, more than 80% of personnel at participating Pittsburgh clinics said they were frequently recommending that patients visit parks.

Last year, Salt Lake County in Utah offered park prescriptions to its employees "to improve or maintain physical and mental health while building sustainable health behaviors," Sarah Kinnison, who oversaw the programme, said in an email.

That first year, 335 employees participated, and the county is running the program again this fall.

Financial stability

While more doctors are looking at using time outside as a medical strategy, park prescription programmes face issues of access.

In low-income neighborhoods, parks are four times smaller and more crowded on average than parks in high-income areas, said a study released last year by the Trust for Public Land, a nonprofit that analysed government data from 14,000 US towns and cities.

It also remains unclear how to keep the programmes financially sustainable. Currently they have to rely on ad hoc funding, often cobbled together from grants, philanthropy or as publicly funded pilot projects.

The costs involved are not particularly high, but they do exist, said Bradford S. Gentry, co-director of the Center for Business and the Environment at Yale University.

They could include the costs of park passes, the salaries of community health workers and park workers to coordinate and lead programmes, and transportation to and from the green space, he said.

"If there are all of these (health) benefits, how do we move from grant funding or public funding to health systems funding?" asked Gentry, who focuses on the intersection of health and land conservation. "I haven't found an answer yet."

The US Department of Health and Human Services did not respond to a request for comment.

Gentry pointed to Oregon, where work is underway to try to address the funding issue by requesting that certain federal rules be waived involving Medicaid, the US government's health care programme for low-income people.

Every five years states have the opportunity to request such a waiver, if they can show it will result in better care and cost no extra money, said Lori Coyner, who was the state's Medicaid director until July and is now senior Medicaid policy adviser at the Oregon Health Authority.

The state's waiver request is due in December, when it plans to ask for more flexibility in how local organisations address health issues.

"We believe there is real opportunity to use some of these Medicaid dollars... to promote spending more time outdoors," Coyner said. - Thomson Reuters Foundation

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Healing through hiking mountains

The arduous Pacific Crest Trails offered the author of The Girl In The Woods the chance to take back control of her life after being raped.

The first time I heard of the Pacific Crest Trail was at the recent George Town Literary Festival, when a friend expressed interest in hiking it. Stretching across mountains running along the western coast of the United States, it is a challenging trail that should be attempted by only the hardiest of hikers.

My own experience with hiking is limited to beginner trails in national parks and forest reserves. Hiking is fun, but I know well enough of its dangers – years ago, another friend of mine had gone hiking and disappeared. The friend at the festival who wanted to hike the Pacific Crest is a man in his 30s. In Girl In The Woods, the hiker, who goes by the name “Wild Child”, is a young woman of 19 and a survivor of rape.

Wild Child grew up as Deborah “Debby” Parker, a sheltered child who lived under the wing of her protective mother and influential, high-achieving brother. On the second night of her stay at college, she was raped.

The emotional and psychological effects of the rape, compounded with the lack of empathy from her college and her family, became the catalyst for her decision to hike the entire Pacific Crest Trail.

For Wild Child, the hike was both a method of escaping a society that made her feel vulnerable and of confronting danger and, through that, regaining her sense of control and trust.

Author: Aspen Matis Publisher : William Morrow/HarperCollins, non-fictionNature and the wilderness is often portrayed as a place of peace and isolation, but any illusion that the wilderness of the Pacific Crest Trail is isolated and peaceful is proven false in Wild Child’s experiences along the trail. The Pacific Crest Trail hiking line is a male-dominated environment, peopled with strange men and women, and offers very little protection from physical or verbal violence stemming from racism, misogyny, or sheer sadism.

Following Wild Child’s journey along the trail brings us to very close intimacy with her personality, her decisions, and her pain. Although survivor accounts and articles on the way rape affects psychology exist in abundance, Girl In The Woods vividly shows how rape shatters one’s sense of safety, trust, and control over one’s body and environment; more importantly, the book allows readers to witness the challenges of regaining that lost sense of security and control.

As we follow her journey, we are also made to confront rape culture – both when it is perpetrated by the people around Wild Child and when we are tempted to criticise her lack of self-preservation. Wild Child exposes herself (at times literally) to strangers and dangers, and readers may find themselves finding fault and blaming her for “tempting rape”. We are made to confront and encouraged to unshackle from our own preconceived, perhaps subconscious, perpetuation of victim blaming and rape culture.

The topic of rape may frighten some readers away from the book, but the harsh desert beauty of the Pacific Crest Trail and Wild Child’s own personal resilience tames its violence, so the experience of reading the book is not unpleasant.

Girl In The Woods is a powerful testament of nature’s healing qualities and an intimate examination of surviving rape.

It is an elegant narrative of loss of innocence, regaining of strength, and finding love and self-acceptance.

It is not merely an account of a survivor but an adventure book, a record of a coming-of-age, and a story of personal growth as the protagonist transforms from the insecure Debby Parker to Wild Child the hiker, before finally emerging as Aspen Matis (the name that she answers to now, and the pseudonym used to pen the book), a fully fledged survivor.

The only arguable weakness of Girl In The Woods is that the description of the landscape along the Pacific Crest Trail is rather sparse.

Perhaps this was omitted because it was unnecessary to the narrative, but I would have appreciated more details on the desert, mountains and forests that were traversed.

I tend to notice the beauty of natural landscapes when I travel, and keenly felt the omission of detailed descriptions on the beautiful American rural landscape.

But this is a minor complaint in an otherwise outstanding memoir.


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