When most physicians think of the word “prescription,” drugs come to mind. Not all prescriptions, however, require a trip to the pharmacy. Lifestyle interventions can also be prescribed. Take, for instance, the burgeoning interest in nature prescription.

An emerging body of evidence is focusing on nature prescription, providing guidance on how to prescribe this way.

 

What is a ‘nature prescription’?

Nature has been a resource to man from our beginning, and the notion of prescribing nature is old. The 16th-century Swiss physician Paracelsus contended that healing comes from nature—not physicians. In Japan, shinrin-yoku (forest bathing) is promoted as a public-health measure.

Precker M. Your next doctor's prescription might be to spend time in nature. American Heart Association News. October 19, 2021.

 

No standard definition exists for nature prescription, according to the authors of a review published in the International Journal of Environmental Research and Public Health.

Kondo MC, Oyekanmi KO, Gibson A, et al. Nature prescriptions for health: A review of evidence and research opportunities. Int J Environ Res Public Health. 2020;17(12):4213.

Instead, the practice usually involves a physician or other healthcare professional offering the patient a written recommendation to spend time outside.

 

They represent a growing trend. The Association of American Physicians cited connecting children and families with nature as a top priority in 2019.

Furthermore, the US National Physical Activity Plan advised the use of park prescriptions. Such prescriptions are compelling because they use existing resources and draw on recent research.

 

Rooted in medicine

Results from a systematic review and meta-analysis published in Environmental Research demonstrated that greenspace exposure led to numerous health benefits including decreases in hypertension, heart rate, and salivary cortisol levels, as well as in the incidence of diabetes and all-cause and cardiovascular mortality.

Twohig-Bennett C, Jones A. The health benefits of the great outdoors: A systematic review and meta-analysis of greenspace exposure and health outcomes. Environ Res. 2018;166:628–637.

 

There were, however, issues with the study’s quality and design heterogeneity, which could limit its results. Still, its authors recommended nature prescriptions and street greenery to improve health outcomes.

“Our findings should encourage practitioners and policymakers to give due regard to how they can create, maintain, and improve existing accessible greenspaces in deprived areas,” the authors wrote.

Publishing in medRXiv, Australian researchers found that, compared with controls, nature prescriptions yielded numerous health benefits. In their meta-analysis, they found that prescription nature programs decreased systolic blood pressure by an average of 4.9 mmHg and diastolic blood pressure by an average of 3.6 mmHg.

Nguyen P, Rahimi-Ardabili H, Feng X, et al. Nature prescriptions: A scoping review with a nested meta-analysis. medRXiv. March 27, 2022.

They also found that these programs reduced depression and anxiety scores, and increased daily step counts.

 

“Nature prescription programmes may provide cardiometabolic and mental health benefits and increase physical activity,” they wrote. “Effective nature prescription programmes can select from a range of natural settings [and] activities and might be implemented via social and community channels, besides health providers.”

 

How to write a nature prescription

If you’re on board with writing nature prescriptions, a good resource is Park Rx America. This physician-led organization touts the importance of nature-rich areas and the need to incorporate them into daily life. It counts spending time in nature as the most important first step in human and planetary health.

The organization’s website offers guidance on how to go about constructing the nature prescription. The process begins with asking open-ended questions to find out where the patient feels safe and comfortable outside, and what they like to do outside. Identifying the frequency and duration of the planned activity establishes the “contract” with the patient for the  prescription.

How to prescribe nature and send reminders. Park Rx America. 2022.

 

“Be patient with yourself and with your patient,” the site recommends. “This short but intense conversation about what your patient likes to do outside, where, with whom, for how many minutes/hours, and how many times per week, is one that will change at every visit, similar to adjusting medication doses for maximum benefit. It is rare that any two prescriptions are identical. One size does not fit all, and that's true within the same patient experience over multiple visits. Like any new intervention you adopt as a provider, there is a learning curve.”

This 2.5-hour promenade can be done in any natural setting such as a forest, and can involve a guide. The guide invites participants to engage their senses. The participants then form a circle to share their experiences in a non-judgmental manner. Nature serves as the therapist, and the guide provides structure and safety.

Things you can do in nature. Park Rx America. 2022.