Required Reading: Therapeutic Landscapes: An Evidence Based Approach to Designing Healing Gardens and Restorative Outdoor Spaces

By Mark A. Ellison, Ed.D.

The most impressive book I have read in 2014 on the restorative and therapeutic power of nature is by Naomi Sachs and Clare Cooper Marcus titled: Therapeutic Landscapes: An Evidence Based Approach to Designing Healing Gardens and Restorative Outdoor Spaces. This book is the first on the topic published since 1999, and fills a critical gap, addressing emerging issues such as sustainability; the participatory design process; restorative spaces in public places; and gardens for veterans and active duty military personnel with traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD).????????????????????????

The beauty of this book is that it can benefit those dipping their toes in this subject for the first time, or for more experienced researchers and practitioners looking to advance their knowledge base. This really is a wonderful handbook for healthcare organizations on how to incorporate nature into their patient settings. The demand for this type of expertise will only become more prevalent as additional, more natural and holistic methods for promoting healing are sought, and government demands for efficiency and accountability in the healthcare setting increase.

Marcus and Sachs cite a substantial array of research on the links between nature and health. Chapters focus on designing therapeutic gardens for specific populations such as veterans, mental and behavioral health facilities, the elderly and children. There is also a chapter dedicated to funding the development of gardens and the business case for having them.

This book is very impressive and includes over 300 visual illustrations that make it appealing. I highly recommend this book as an authoritative resource on the therapeutic use of landscapes and nature. It should be required reading at all healthcare facilities as they prioritize how to utilize scarce resources in ways that have the greatest impact on patient health and healing, and for any class delving into the study of how nature can impact human health.

An Interview with Therapeutic Landscapes Expert Naomi Sachs

By Mark Ellison, Ed.D.

I recently had the opportunity to talk with Naomi Sachs, ASLA, EDAC, Founding Director of the Therapeutic Landscapes Network, and co-author of the recently published book Therapeutic Landscapes: An evidenced based approach to designing healing gardens and restorative outdoor spaces. Naomi received her MLA from the University of California at Berkeley and is currently pursuing a Ph.D. in architecture at Texas A&M University focusing on access to nature in healthcare environments through the Center for Health Systems and Design. Naomi is an informative and influential voice on the therapeutic use of gardens and nature for human health. Naomi took time to answer a few questions related to her new book, research interests and how to incorporate nature into the home landscape.

Naomi Sachs

Naomi Sachs

Hiking Research: What inspired you to pursue a nature/landscape focused career?

Naomi Sachs: I grew up in a rural town in northeastern Connecticut, and I think having nature all around me (and not much else!) instilled in me a deep appreciation for trees, plants, wildlife, water, and fresh air. My affinity with nature, combined with a love for art, photography, research, and writing made landscape architecture a good fit. I was thrilled to learn about healing gardens in the mid-nineties when I had started looking into graduate schools. This area of the field seemed like (and is) a way to make a positive difference in people’s lives while doing something creative.

Hiking Research: Talk about your new book Therapeutic Landscapes and why you chose to pursue this.

Naomi Sachs: A book on access to nature in healthcare facilities was long overdue. The last books on the subject were published in 1999 (funnily enough, three books related to the subject were published in the same year: Healing Gardens, edited by Clare Cooper Marcus and Marni Barnes; Restorative Gardens, by Nancy Gerlach Spriggs, Richard Enoch Kaufmann, and Sam Bass Warner; and The Healing Landscape, by Martha Tyson). Since then, much new research, and many new issues, have emerged that needed to be addressed – for example, sustainability; the participatory design process; restorative spaces in public places; and gardens for veterans and active duty military personnel with traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD). The book, with practical design guidelines, case studies, and over 300 color illustrations, is user-friendly and accessible to designers, healthcare providers, students, and lay people.????????????????????????

Hiking Research: What research projects are you currently involved with?

Naomi Sachs: First, I’ll say that as hard as it is, I love being a PhD student. I do enjoy design, and still love being the Director of the Therapeutic Landscapes Network. But exploring new ideas and coming up with original research is extremely satisfying. As a student in architecture at Texas A&M University, I have the pleasure of working with incredibly smart, talented, and experienced faculty and students in the Center for Health Systems and Design  For my dissertation, I’ll be focusing on developing a standardized healthcare garden evaluation “toolkit” – a set of research instruments that will allow designers and clients to assess outdoor spaces in hospitals. Right now, no such thing exists and so designers and researchers end up reinventing the wheel with each new study; this makes it hard to compare findings from one study to another—too often, we are trying to compare apples and oranges—which undermines the credibility of the research and our ability to generalize from one scenario to another. The toolkit will not only enable the evaluation of gardens; it will also be used as a tool for research and evidence-based design. In testing the toolkit, I’ll be looking specifically at what design and programming elements influence garden use, and how that affects patient, visitor, and staff satisfaction.

Hiking Research: Describe the Therapeutic Landscapes Network, its purpose, and importance.TLN_homepage

Naomi Sachs: The Therapeutic Landscapes Network is an international, interdisciplinary knowledge base and gathering space focused on healing gardens, restorative landscapes, and other green spaces that promote health and well-being. The network is made up of designers, health and human service providers, scholars, students, gardeners, and nature enthusiasts. Though our focus is broad, our primary emphasis is on evidence-based design in healthcare settings. I created the TLN’s precursor, the Therapeutic Landscapes Database, in 1999 as a sort of online encyclopedia—a way to provide up-to-date information to people all over the world. With the advent of social media, through sites like Linked In, Facebook, and Twitter, we have become much more interactive, which is wonderful. Our vision, “Connecting people with information…people…nature” has become a reality.

Hiking Research: Are healthcare providers embracing nature as an important element in their facilities for patient and employee health and well-being?

Naomi Sachs: I think healthcare providers are really starting to embrace nature as a critical element in the environment of care. As Clare and I often say, it’s no longer just “the icing on the cake.” This is not just true of access to nature. The concepts of patient- and family-centered care; evidence-based design; and “salutogenic design” – design for wellness rather than illness—are all gaining acceptance by designers and clients. Beyond common sense and intuition, there is solid research to validate the profound health benefits that can be derived from contact with nature. Healthcare settings (and by this I mean not just general acute care hospitals but also hospices, assisted living facilities, mental and behavioral health clinics, and so on) are some of the most difficult places for people to be. The patients, visitors, and even the staff are under an enormous amount of stress. Gardens are an excellent way to reduce that stress and provide a life-affirming experience. People in the industry now see the social as well as economic value of providing gardens and other ways to connect with nature.

Hiking Research: What are five suggestions you have for people who want to incorporate nature into their landscape at home?

Naomi Sachs: Well, it’s very personal, especially when it comes to landscape for the home. As with all landscapes, a big part of the design process entails practical issues, like how much space there is, how much time and money the client wants to put into the garden, etc. So it’s hard to suggest five specific elements. Some critical considerations:

  1. The garden must be safe. I know this isn’t very sexy, but whether it’s at home or in a healthcare facility, safety is paramount – especially if the garden is for small children, people with physical or developmental disabilities, or the frail elderly. So, for example, a garden for young children shouldn’t have poisonous plants. A garden for frail elders should have walking surfaces that are smooth and easy to walk on (or roll on with a wheelchair or walker). The garden should also feel safe, and comfortable.
  2. The garden should be a source of fascination, and inspiration. Back when I was doing more design work, I would ask my clients, “What makes your heart sing? What inspires you? What do you really want to do in this garden?” Some people love to entertain; they should have a big space for that. Some people want space for their kids to play, or to do yoga, or to meditate…some people want it all! Creating a healing garden—rather than just a back yard—at home takes some more reflection, some careful thought about what is going to really touch and nurture that person or that family.
  3. The garden should engage all of the senses. We mostly think about sight, but how can the garden delight our sense of smell, sound, touch, and even taste? In a small space, plants that can do “double duty” by engaging more than one of the senses are best. For example, lambs ears are soft and fuzzy and are also a beautiful silver color. Lavender flowers and foliage look beautiful, feel soft to the touch, and are deliciously fragrant. The flowers can be harvested to used for cooking, baking, drinking, or even for medicinal purposes.
  4. Decide what you can and can’t do (or do and don’t want to do). . If you love to garden—to dig in the dirt, plant seeds, pull weeds, harvest flowers, herbs, or food—then that should be a big part of the garden. If you work 60 hours a week and commute a long way and have kids, maybe you want a garden that needs less maintenance, where you and your family can just be in the free time that you have. It’s rather counter-productive to worry about a garden that you don’t have the time, or the funds, to maintain!
  5. Consider how you can enjoy the garden in all of the seasons. If it gets cold where you live and you can’t use the garden in the winter, what can you plant that gives it interest in the off season? Evergreens; plants with berries, or colorful bark, or interesting form; or even elements like a pair of really colorful chairs that stays outside…these can all brighten up the garden and give us something to look at in those dark days. I love to plant things with berries that attract birds, and I put out birdfeeders and heater bird baths. Well, I used to, before I moved to Texas. For people like me who endure hot summers, and mosquitoes and other insects, it’s important to make the garden usable in those times. A big tree, or a screened-in porch or gazebo with a ceiling fan, allows you be partially outdoors, or to feel outdoors, even on beastly days.
  6. And a bonus idea: A healing garden (or any type of garden, really), should be good for the earth. We get so much—physically, mentally, emotionally—from nature. The least we can do is treat her with love and respect. So, avoid pesticides and herbicides; conserve water; use native plants, and plant the right plant in the right place so it thrives. The wonderful thing about most of these strategies is that they also encourage birds, butterflies, and beneficial insects; these creatures can really bring a sense of magic to the garden.

Hiking Research: How can we promote more interdisciplinary collaboration among researchers and practitioners on the links between nature and health?

Naomi Sachs: Healthcare design cannot happen without multidisciplinary collaboration. It just doesn’t work. Research on healthcare design must also be interdisciplinary. I think that the world, in general, is heading in this direction. It’s more challenging for people to step outside of their own bubble, to try to understand and speak someone else’s language, but it is so much more rewarding for the people involved and for the end users. I chose, at least for now, to focus my attention on access to nature in healthcare. Many talented people are doing other fantastic work—Richard Louv with the Children & Nature Network; Robin Moore and Nilda Cosco with the Natural Learning Initiative; Sharon Danks and the International Green Schoolyards Movement; Richard Jackson and Howard Frumkin with issues of urban planning and public health; your work with the International Society of Nature and Forest Medicine…many organizations working with community gardens, urban farming…the list goes on (check out the TLN’s related organizations page for some of these). Part of what excites me about my work with the TLN and as a PhD student is pulling people, research, and ideas from different disciplines together and seeing what grows from that rich mixture.

A Walk in Nature is Good for Your Health Even if it’s “Brrr” Outside

By Florence Williams, Guest Writer

By all accounts, the weather for most of this winter has been unusually lousy all up and down the East Coast. As the Washington Post’s weather team explains it, an amplified jet stream pattern has created a “sliding board of significant cold air deliveries,” not to mention broken chunks of the polar vortex barreling down from Hudson Bay. Translation: Brrr.

Photo by Mark Ellison

Photo by Mark Ellison

Yesterday morning was cold and gray in D.C., the temperature on my phone reading 28 degrees. On the streets and sidewalks, icy patches remained of the previous day’s sleet.

Still, I knew I should go for my regular walk along the C&O Canal. It’s mostly scenic, although to get there I have to cross a freeway. And in winter, with the leaves gone, that freeway sounds and looks closer to the canal once you’re on it. I knew my feet would be cold and the ground hard, potentially treacherous is spots. No doubt about it; walking in the dead of DC winter is kind of a drag.

I know what you’re expecting me to say, that once I was out there it wasn’t so bad and I had a rewarding experience communing with the ice crystals and the clouds and the bracing breeze. But I’m not going to say that, because the fact is I didn’t enjoy it very much.  On these cold days (and we’ve had a lot of them – January and February so far have been among Washington’s very coldest), it takes me a full 20 minutes of vigorous walking to stop being stiff with shivers. Even after that point, I still grumble. Oh man, it sucks out here. Sometimes the wind bites into my collar and the balls of my feet go numb. I’d rather be holding a hot cup of tea and wearing sheepskin slippers in the breeze of my heat duct.

Cross-country skiing is a great way to enjoy the solitude and beauty of nature in winter.  Photo by Mark Ellison

Cross-country skiing is a great way to enjoy the solitude and beauty of nature in winter.
Photo by Mark Ellison

So why do I go? We all need a little sunshine, but this dark winter I haven’t even had that justification.  I go because of how I feel after. On these days, I like not the walking but the having walked.  I like the satisfaction of conquering my couch potato instincts, but more than that I tend to have a good day.  I can focus at work, my mood is even and I tend to sleep better.

Neuropsych research backs me up.  Marc Berman, now at the University of South Carolina, found that even when his research subjects walked through an arboretum in a Michigan winter, they performed better on cognitive tests than they had before the walk and better than subjects who walked through an urban setting.

We might not always crave spinach either, but that doesn’t mean we should only reach for pie. Regular walks in nature are usually pleasant, but even when they’re not, they’re “good for us.” Of course saying something is good for you is a sure way to make it a chore. How to avoid that? Other experts suggest keeping it fun, maybe by walking with friends or keeping your mind engaged. For me, knowing I’ll  sleep and work well is usually (but not always) motivation enough. For those other days, please pass the tea.

Florence Williams

Florence Williams

Florence Williams
Florence Williams is a contributing editor at Outside Magazine and a freelance writer for New York TimesNew York Times MagazineSlate, Mother JonesHigh Country NewsO-Oprah, W., Bicycling and numerous other publications. Her first book, BREASTS: A Natural and Unnatural History  (W.W. Norton 2012) received the Los Angeles Times Book Prize in science and technology and the 2013 Audie in general nonfiction. It was also named a notable book of 2012 by the New York Times.

Five Ways Nature Can Prepare Your Brain for Success in 2014

Organizations are always looking for ways to improve workplace productivity, develop leaders, and help employees work more efficiently. Spending all day inside, in a cubicle that reverberates with stress drains attention, saps creativity, reduces productivity, and negatively impacts leadership ability. To lead effectively the brain needs to be at optimal functioning capacity.

Cross-country skiing on the Blue Ridge Parkway (North Carolina, USA) Photo by Mark Ellison

Cross-country skiing on the Blue Ridge Parkway (North Carolina, USA)
Photo by Mark Ellison

As we kick off 2014, why not resolve to deal more effectively with your workplace stress in a way that will jump-start your brain for success: spend time in nature. There is a growing body of research that shows time in nature prepares the brain for optimal functioning. Time in nature also helps to tap into the things we are passion about, develop a sense of purpose and increase productivity.

Going into nature provides restoration and the opportunity to disconnect or escape phones, computers, televisions,noise and other stress inducing variables which have a negative impact on physical and mental health. Here are five ways getting away from stress and  spending time in nature can impact your effectiveness at work, and possibly make your boss happier:

1. Improve attention capacity and the ability to focus: Stephen and Rachel Kaplan’s Attention Restoration Theory is based on the concept of soft fascination, or the soothing sights and sounds of nature that are relaxing, allowing attention capacities to rest,  leaving room for reflection. One type of soft fascination is the sound of birds, which a recent study found to be the most preferred form of fascination.

Sunset at Ruby Beach, Olympic National Park Photo by Mark Ellison

Sunset at Ruby Beach, Olympic National Park
Photo by Mark Ellison

2. Enhance creativity: Research by faculty at the University of Utah and University of Kansas found that spending time in nature can improve creativity up to 50%. Being more creative on the job means you can generate better ideas and more innovative solutions to problems.

3. Increase cognitive ability: Spending time in nature increases cognitive abilities. Part of this is clearing the mind of distractions.

4. Improve memory: Heavy multitasking can make it difficult to remember things. Research has found that time in nature positively impacts the ability to remember.

5. Reduce stress and elevate mood: Our brains on stress are a jumbled mess. The stress that builds up in our mind impacts the entire body in a negative way if not properly dealt with. This can have negative consequences on the ability to work with others, and cause issues of workplace incivility. Time in nature reduces stress and elevates our mood, which can impact productivity and the ability to work with others. A recent study conducted by Lisa Nisbet for the David Suzuki Foundation 30X30 Nature Challenge found that spending time in nature increases happiness and self reported levels of productivity!

Here are a few suggestions on how to incorporate nature into your health and personal development plan in 2014:

1. Practice mindfulness/meditation in nature: You have to take time to slow your mind and body down and be in the present moment for your brain to begin to let go of stress and “cognitive leftovers” from the days activities. This is at the heart of mindfulness, which is now being utilized in cutting edge leadership development programs, and identified by the Center for Creative Leadership as “one of the five big leadership ideas.” Nature is the perfect setting to practice mindfulness and meditation. Janice Maturano recently published a book on this topic, Finding the Space to Lead.  Try this as a mindfulness exercise in nature:

Sunlight on a mountain stream (North Carolina) Photo by Mark Ellison

Sunlight on a mountain stream (North Carolina)
Photo by Mark Ellison

Find a quiet place in nature and just be. Close your eyes and for 15 minutes enjoy the sounds of nature. Notice what is happening in the environment and you: sounds, sensations, thoughts and feelings. Then, focus on your breathing. Don’t manipulate it, just breath in and out through your nose. Your mind is going to wonder, each time it does, return your attention to your breath. As thoughts and emotions come and go, don’t linger on them, let them go, they will pass away.

2. Green exercise: Exercising in nature essentially multiplies the benefits of exercise, helping the body and mind. Find a greenway or nature trail where you can go for a walk on your lunch break, or after work. Don’t listen to music, enjoy the sounds of the birds, the wind, and notice the beauty of nature. If you have more time, plan a hike for several hours, or bike on a rail trail.  I incorporate time in nature into my overall tracking of health goals. Just as I track the  minutes of cardio exercise, yoga, and the number of steps taken each day, I also record the time I spend in nature.This is easily done in an Excel spreadsheet where I can analyze trends in my health behavior.

3. Nature journal:  Take 15 minutes a day to start a nature journal. All you need is a notebook, a pencil or pen and a nature spot. Keeping a nature journal can help you clear your mind and focus on nature more directly. When you do a journal entry, record the date and time, weather conditions and your impressions of the setting. Identify something in nature that captivates your attention and draw it to scale. An excellent resource for learning more about nature journaling is a book by Clare Leslie and Charles Roth, “Keeping a Nature Journal: Discover a Whole New Way of Seeing the World Around You.”

4. Practice Shinrin yoku: Shrin yoku is spending time in nature, just enjoying the experience, taking in the beauty and peace it offers. A good resource for this is a book written by wilderness guide Amos Clifford, “A Little Handbook of Shrin yoku.” 

5. Be a Nature Advocate: Advocate for policies that bring nature into your work environment or for access to nature near the workplace. This could be as simple as having plants and pictures of nature in the workplace, and  tables outside for meetings or lunch breaks.

An excellent resource on nature and the brain is Eva Selhub and Alan Logan’s book Your Brain on Nature. It is great read, and references many research studies.

Spending time in nature does not need to be complicated or time consuming and can last as little as fifteen 15 minutes or an entire day. Remember, the amount of time you spend in nature, and the quality of the environment you are in will directly impact how well nature heals your mind and body. Incorporate time in nature into your health routine and  reap the benefits it offers your brain in 2014.

Note: The North American Chapter of the International Society of Nature and Forest Medicine will host a webinar on January 28, 2014 at 7:30 p.m. EST. Dr. Lisa Nisbet, assistant professor of psychology at Trent University in Ontario will discuss her research on nature relatedness and happiness. Register online at http://www.anymeeting.com/PIID=EA52DE87814E3D.

Kalevi Korpela Discusses Finland’s “Power Forests” for Well-being and Emerging Research

I had the opportunity to meet Dr. Kalevi Korpela at the joint conferences of the Society of Outdoor Recreation Professionals and the International Union of Forest Research Organizations in May 2013. It was at this conference that we had the initial meeting of the North American Chapter of the International Society of Nature and Forest Medicine. Dr. Korpela, Professor of Psychology at the University of Tampere in Finland, is on the board of (INFOM) based in Tokyo, Japan. Dr. Korpela’s research has made significant contributions to the understanding of how nature impacts human health and well-being. He took time recently to answer several questions about his research and the “Power Forests” for wellbeing in Finland and other European countries.

Dr. Kalevi Korpela, Professor of Psychology, University of Tampere Photo courtesy University of Tampere, Finland

Dr. Kalevi Korpela, Professor of Psychology, University of Tampere
Photo courtesy University of Tampere, Finland

Hiking Research: What inspired you to pursue psychology as a career and to research how nature impacts well-being?

Kalevi Korpela: I remember being interested in psychology already in high school. After matriculation, I was thinking about architecture or psychology for university studies but only went to psychology exams. I did like and still like this Dostoyevski quote: “A human being is a mystery: if you spend your entire life trying to puzzle it out, then do not say that you have wasted your time.” At our department of psychology in Tampere University we had a tradition of environmental psychological studies dating back to early seventies. In my master’s thesis I found myself being interested in environmental psychology and writing a thesis on cognitive maps of the city.

Hiking Research: What research projects are you currently involved with?

Kalevi Korpela: The project “Urban Diversity” 2010-2013 is ending. We have tried to figure out how to combine building and the possibilities of nature in fruitful ways in process planning. The research consortium includes the Tampere University of Technology (School of Architecture), Departments of Regional Studies and Psychology at the Univ. of Tampere.

The project “Recovery from work stress: integrating perspectives of work and environmental psychology”, 2012-2016, investigates the relationship between “green exercise”, indoor plants, window views and recovery from work stress in a 3-year longitudinal survey. We also carry out interventions during the lunch break (relaxation, park walks) to investigate short-term recovery from stress during the workday.

The project “Outdoor recreation 2009”, 2010- , is a survey study of outdoor recreation and well-being using a representative sample of Finns. A recent paper about this data is Korpela, K., Borodulin, K., Neuvonen, M., Paronen, O., & Tyrväinen, L. (2013). Analyzing the mediators between nature-based outdoor recreation and emotional well-being. Journal of Environmental Psychology. doi: 10.1016/j.jenvp.2013.11.003. (An earlier paper is also available online through the journal Health Promotion International). The research consortium includes the Finnish Forest Research Institute (FFRI/METLA), Statistics Finland, University of Tampere, The National Institute for Health and Welfare, Centre for Health Promotion Research (UKK Institute), and MTT Agrifood Research Finland.

The project “Green infrastructures for health in the future living environments (GreenHealth)”, 2013-2014 has carried out the walking experiments in Helsinki city center, an urban park and urban woodlands. The first results are in press in Journal of Environmental Psychology. The research consortium includes The Finnish Forest Research Institute (FFRI/METLA), The National Institute for Health and Welfare (THL), Dept of Psychology (Univ. of Tampere), and the Japanese team who has carried out tens of walking experiments in Japan: Forestry and Forest Products Research Institute, (Prof., Dr. Takahide Kagawa, Dr. Yuko Tsunetsugu, and Dr. Norimasa Takayama); Nippon Medical School (Dr. MD Qing Li) and Chiba University (Prof., Dr. Yoshifumi Miyazaki)

LEADER- project “Forest Project – Network of densely wooded regions in Europe”, 2012-2013 has created awareness-enhancing / engagement-based forest trails to four countries. Forest trail partners are Finland (Finnish Forest Research Institute and University of Tampere), Sweden, Luxembourg and France. The project partners and funders also include LAG (=Leader action group) Växtlust, Sweden; LAG Müllerthal, Luxembourg; LAG Pays de la Déodatie, France; Aktiivinen Pohjois-Satakunta ry, Finland. Funders include EU, several municipalities, and some private funders.

A view from a trail in the "Power Forest" in Finland.  Photo courtesy Finnish Forest Research Institute

A view from a trail in the “Power Forest” in Finland.
Photo courtesy Finnish Forest Research Institute

The first trail (of this kind, ever; according to our knowledge) was opened on May 20, 2010 near Ikaalinen Spa, Finland (view brochure). We developed the trail in the “Health from the Forest” project 2008-2010 in co-operation with the Finnish Forest Research Institute (Parkano Unit) and Ikaalinen Spa. The project was funded by the European Regional Development Fund (ERDF) and the Council of Tampere Region.

The idea is that the awareness-enhancing psychological tasks along the trail may allow even less ideal environments to be experienced in stress-alleviating ways and help people to be physically active. The tasks were written by K. Korpela and their ideas draw from several lines of research: a) experimental research results on the onset of psychological, physiological and behavioral changes in restorative natural settings, b) studies on people’s everyday favorite places and their restorative qualities, c) studies on the effects of cognitive sets and role-taking on human perception and environmental attitudes d) studies on psychology of suggestive information.

Thus, the tasks aim to i.a. induce relaxation, improve mood, induce cognitive reflection and attentional restoration, and enhance the search for a favorite place which can be socially shared.

In the LEADER-project, identical tasks were used in all four countries and the wordings were translated from the original Finnish trail signposts. User surveys are presently collected from each country to investigate people’s attitudes in these trails and tasks.


Hiking Research: What needs to happen for the use of “forest therapy” to become more accepted by healthcare providers? Is nature often used by psychotherapists in European countries?

Kalevi Korpela: We need more solid and causal evidence of the effects of forest therapy and nature’s restorative effects, in general. For example, the Finnish Current Care Guidelines are very strict and require good scientific evidence for any procedure to be accepted as care. Current Care Guidelines are independent, evidence-based clinical practice guidelines.

The guidelines are intended as a basis for treatment decisions, and can be used by physicians, healthcare professionals and citizens. The guidelines are developed by the Finnish Medical Society Duodecim in association with various medical specialist societies.
We also need more co-operation, and need to provide more informing and PR work for healthcare providers. I do not know the European situation but know that there are perhaps half a dozen psychologists in Finland who use nature in their practice.

Hiking Research: What are your suggestions for using nature to help people cope with work stress? Have you worked with organizations that are utilizing nature to help employees improve health? If so, describe what they are doing?

Kalevi Korpela: I will be wiser on this after our research project (see above). But indoor plants and window views might be important in workplaces as well as possibilities for being in a greenspace during the lunchbreak. Our forest trail project has shown that spas might include these trails in their activities.

Hiking Research: Do you collaborate with forestry researchers? If so, how? How can we promote more interdisciplinary collaboration focused on how nature impacts health?

Kalevi Korpela: Yes, I have co-operated a lot with the Finnish Forest Research Institute In Finland as well as in Europe (the COST system), we have funding systems for collaboration and for creating networks for interdisciplinary collaboration. Societies like the International Society of Nature and Forest Medicine are important.

Prescriptions for Parks Bill Provides Free State Park Access

An obstacle to the use of nature for improved health is often healthcare providers who are unaware of where to send patients who could benefit from time in nature, and who could help the patient once they go to a park or nature area. This  is preventing many people from connecting with the natural environment and experiencing the health benefits it offers. With over 72 million people in the United States considered medically obese and over 40% considered sedentary (Centers for Disease Control and Prevention) it is imperative to find innovative ways to promote health and well-being. A missing link to encourage people to utilize nature for improved health is free access to nature areas, specifically public lands.

Photo by Mark Ellison

Photo by Mark Ellison

New Jersey Assemblywoman BettyLou Decroce (R) is taking one of the first steps in this direction. She introduced a bill that would create “Prescriptions for Parks,” allowing healthcare practitioners to write a prescription for a New Jersey State park pass for individuals diagnosed with obesity-related conditions such as diabetes, asthma, high blood pressure and heart disease, which maybe treated with exercise. New York, Chicago, Indiana, New Mexico and California have implemented similar park prescription programs.

Describing the need for Prescription for Parks program Decroce states, “Healthcare practitioners cannot emphasize enough the importance of exercise as part of a individual’s treatment program especially for those with metabolic, respiratory and cardiac conditions. This measure provides those suffering from these diseases an incentive to not only exercise, but an opportunity to do so outdoors, surrounded by the beauty of our state’s natural resources. Treadmills and exercise bikes are great for physical fitness, but there’s nothing like a hike, a jog or swim in the forests and lakes or rivers found in nature. Our State parks are an underutilized resource, by incentivizing residents to exercise and visit State parks citizens will be healthier, insurance companies will shoulder less of a burden, healthcare tax dollars will be saved and New Jersey’s beautiful parks will be highlighted and enjoyed.”

Photo by Mark Ellison

Photo by Mark Ellison

The Park Prescription pass would be valid for free entrance and parking to all 50 State park facilities for two 12-week sessions, and could be renewed. Also included in the bill is a requirement for the Division of Parks and Forestry to develop a brochure for suggested workouts within park facilities, utilizing already established activity programs and trails.

This is a model that should be considered nationally for all state and national parks where a park prescription would provide free access.  To maximize the potential of this program, classes need to be offered at parks that help people understand how exercising and spending time in nature impacts mental and physical health.Offering educational programs that include ecotherapy professionals such as horticultural therapists or the emerging field of forest therapy would raise the level of health benefits experienced by visitors to parks. Nature provides many health benefits, but utilizing the expertise of these professional therapists trained in how to tap into the restorative power of nature is essential to help participants fully benefit from their time in nature, and to continue to experience the benefits once they return home.

There are a number of programs  that are encouraging exercise and promoting the use of public lands as a health resource.

-Indianapolis based non-profit Exercise in Medicine has developed toolkits to educate healthcare care professional on effective methods for prescribing exercise.

-The Prescription Trails program in New Mexico that developed a trail rating system simplifying the process of identifying and prescribing trails.

-The Children and Nature Initiative in Brooklyn prepares “nature champions” to train other healthcare practitioners to prescribe outdoor activities for children.

-The Kids in Parks Initiative sponsored in part by the Blue Ridge Parkway Foundation is designed to connect and promote child health, park health, and community health. One of the programs is designed to make hiking more attractive and has a website for participants to log miles hiked to receive prizes related to outdoor activity.

-Green Gyms in England  are structured programs to use gardening, trail maintenance, environmental conservation, and other nature-based activities as exercise. They are promoted as a fun and free alternative to gyms.

The Institute at the Golden Gate offers a top-notch resource guide for developing Park Prescription programs.

The National Recreation and Park Association recently published a review of five Park Prescription programs.

We must develop a framework that supports patients so they can seamlessly transition from a healthcare provider to exercising in nature.This will require educating healthcare providers on the health benefits of time in nature; developing resource guides to help providers make recommendations on where patients can go, and to help patients navigate the options; and having educational programs at parks to introduce people to nature and how it positively impacts their health. To support this healthcare flexible spending accounts should cover expenses related to exercising in nature and state parks such as entry fees and program registration costs. Health insurance should cover the cost of ecotherapy preventive care programs.

This type of program requires collaboration and innovative thinking. Grant funding will be required to get it off the ground. Once implemented, this could transform the health of a community.

Warriors Hike the Appalachian Trail as Ecotherapy for PTSD

The Appalachian National Scenic Trail is a 2,180 mile “green tunnel” extending from Georgia to Maine offering access to solitude and the healing power of nature for millions of people. In 2013, 1,130 hardy souls thru hiked the Appalachian Trail (AT) northbound. Some hiked the trail as a personal challenge, others for the thrill of adventure, and many set out on the quest for personal transformation.  We all fight different battles and nature offers a balm that can heal many psychological and spiritual wounds.

2013 Warrior Hikers Photo courtesy of Warrior Hike

2013 Warrior Hikers
Photo courtesy of Warrior Hike

What better setting to walk off the stress of war than the AT? The November/December issue of Journeys Magazine, the official publication of the Appalachian Trail Conservancy (ATC) has an article on the Warrior Hike “Walk off the War” program, designed for combat veterans transitioning from their military service. The program was inspired by Earl Shaffer, the first person to thru hike the AT in 1948, who told a friend he was going to “walk off the war” to work out the sights, sounds, and losses of World War II. Recognizing the physical, mental, and spiritual benefits of long distance hiking, Warrior Hike partnered with the Appalachian Trail Conservancy, the Continental Divide Trail Coalition, and the Pacific Crest Trail Association to offer thru hiking experiences for returning combat veterans.

Viewing the beauty of autumn leaves in a forest can be used as a form of ecotherapy, providing healing to the mind, body, and spirit. Photo by Mark Ellison

Viewing the beauty of autumn leaves in a forest can be used as a form of ecotherapy, providing healing to the mind, body, and spirit.
Photo by Mark Ellison

The Warrior Hike program was spearheaded by Sean Gobin, a USMC Captain who thru hiked the AT in 2012 after returning from active duty in Afghanistan.The 13 participants selected to participate in the Warrior Hike program in 2013 received the equipment and supplies needed to complete a thru hike, support in towns along the AT from veterans and hiking organizations, and job placement assistance once they completed the hike. Veterans must apply to be part of the program, and applications are currently being accepted for 2014.wh

Since 2001 over 2.5 million veterans have returned home from the wars in Iraq and Afghanistan but many of them have never transitioned from their experiences. This is evident by the recent report from the Department of Veteran Affairs which states that over 20% of Iraq and Afghanistan veterans suffer from Post Traumatic Stress Disorder (PTSD). According to the National Institute of Mental Health, PTSD affects over 7 million American adults and  “develops after a terrifying ordeal that involved physical harm or the threat of physical harm. The person who develops PTSD may have been the one who was harmed, the harm may have happened to a loved one, or the person may have witnessed a harmful event that happened to loved ones or strangers. PTSD was first brought to public attention in relation to war veterans, but it can result from a variety of traumatic incidents, such as mugging, rape, torture, being kidnapped or held captive, child abuse, car accidents, train wrecks, plane crashes, bombings, or natural disasters such as floods or earthquakes.” Symptoms of PTSD include having flashbacks, bad dreams, or frightening thoughts; feeling emotionally numb, guilty, depressed or worried; and being easily startled, on edge, or having angry outbursts.

An autumn snow on the Appalachian Trail near Mt. Rogers (Virginia) Photo by Mark Ellison

An autumn snow on the Appalachian Trail near Mt. Rogers (Virginia)
Photo by Mark Ellison

Post Traumatic Stress Disorder affects thousands of veterans returning from combat, but also many others who have experienced trauma in different settings. Lets face it, we live in a violent world. The therapeutic use of time in nature to help heal psychological and spiritual wounds can bring renewed hope to individuals, their families, and society as a whole. Time in nature can be powerfully transforming. Many of us know this intuitively, and research is beginning to substantiate this. Assessing the healing that combat veterans experience on the AT through a research project associated with the Warrior Hike program could help to attract additional funding to support it, and encourage healthcare providers to recommend hiking the Appalachian Trail as a treatment alternative for people who have experienced traumatic events. The Warrior Hike program is a wonderful example of how to use nature for healing (ecotherapy) and should be emulated to help as many as possible experience the restorative power that nature offers.