Doc to patient: Take a hike and call me in the morning

[Guest guest]

By Daphne

Special to The Washington Post

Tuesday, November 17, 2009

" I have a StairMaster right in my own basement, but honestly it's been there

for years gathering dust and making me feel guilty, " said Miriam, one of my

patients. " It wasn't until I started walking the three-mile trail in the

park near my house that I got serious about exercising. I do it now rain or

shine. I love the fresh air. The best part is that I get a great workout and

don't even mind sweating. "

At this point, I have heard enough variations on Miriam's story that I have

started to make formal " park prescriptions. " The prescribing instructions

are considerably more detailed than ones you might get with a medication;

they include the location of a local green space, the name of a specific

trail and, when possible, exact mileage.

It turns out I am not alone. I've begun hearing about doctors around the

country who are medicating their patients with nature in order to prevent

(or treat) health problems ranging from heart disease to attention deficit

disorder.

Eleanor Kennedy, a cardiologist in Little Rock, helped create a downtown

" Medical Mile " with the support of local funders and the National Park

Service's Rivers, Trails, and Conservation Assistance Program. " If my

patients feel that they can get outdoors, they are more likely to be

consistent about exercise, " she told me. " Whether you are waddling, walking

or running, going out and exercising will help build your confidence,

flexibility and adaptability. " And it will also be good for your heart -- a

particular benefit in Arkansas, where rates of heart disease and stroke, as

well as obesity and diabetes, are among the highest in the country.

Other physicians, from New Hampshire to Texas, are sending their patients

out to wade through streams and walk on beaches and trails. Earlier this

year the city of Santa Fe, N.M., launched a Prescription Trails program to

target the high rates of diabetes in the community. The program, partially

funded by the Centers for Disease Control and Prevention, includes a trail

guide that physicians can hand to their patients.

" Of course, this is not the only answer to the obesity epidemic, " said

Suk, an orthopedic surgeon and former health adviser to the NPS,

" but it sure is a good start. All these insurance companies focus on

prevention, but no one thinks of the free public land resources that we have

at our disposal. "

Louv, author of the best-selling book " The Last Child in the Woods "

and coiner of the term " nature deficit disorder, " is all for these

prescribing patterns. " I think that physicians can do more [to get people

out into nature] than any other professional, " he said. Louv's book and Web

site (http://www.childrenandnature.org) cite dozens of studies documenting

the positive impact that wilderness outings can have on mental and physical

health. The fact that the American Academy of Pediatrics has invited Louv to

deliver the keynote address at its 2010 annual meeting indicates that the

larger medical community is starting to recognize the therapeutic value of

time spent in the woods.

Fortunately, the custodians of nature are also on board. Levitt,

chief of interpretation and education at Golden Gate National Recreation

Area, an NPS site in California, loves the idea of park prescriptions. In

the near future, he and his colleagues hope to create a prescription " tool

kit " for doctors, possibly in partnership with a large health organization

such as Kaiser Permanente. " I see this as a mutually beneficial

arrangement, " Levitt said. " We know what parks exist to do and . . . doctors

want to care for their patients. "

Rick Potts, the Park Service's chief of conservation and outdoor programs,

echoed Levitt's enthusiasm: " Science is validating what moms have known for

generations: Being outside is good for your health.

" I've never known a ranch kid on Ritalin, " added Potts, who comes from rural

Montana.

He expects support from the newly confirmed NPS director, Jarvis.

" We all see that the role of national parks in the 21st century is evolving.

They are becoming more critical to our well-being as a society. " As Potts

continued talking, using such terms as " affordable prevention services " and

" increasing access, " he sounded more like a government official discussing

health reform than one explaining park systems.

In fact, it's not too much of a stretch to think of our national park system

as an integral part of our health care system; the NPS is already offering

wellness services that are free and accessible to all, regardless of

preexisting conditions. And according to Suk, the NPS wants to to expand

that access by supporting public open space developments such as Little

Rock's Medical Mile in communities around the country.

So don't be surprised if, at your next visit to the doctor, you are handed a

trail map and itinerary along with your lab slip. In fact, if you are not

offered one, you should demand it.

And once you set foot on the trail, how hard should you exercise? I like

what Dr. Kennedy tells her patients: " Hard enough that you can still talk in

sentences but not in paragraphs. "

is a family physician and an associate clinical professor at the

University of California at San Francisco.