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Headwaters is the new WMS magazine column dedicated to offering journalism on environmental health including climate change. The goal of the column is to put environmental events and science into the context of wilderness medicine, and functions to raise awareness on key issues relating to our health and the environment.

The WMS Board of Directors has recently approved a position statement supporting public lands for the purposes of outdoor recreation. The statement emphasizes encouraging continued research on the clinical uses of outdoor recreation therapy.

The new statement reads: "The Wilderness Medical Society is the main professional organization operating at the interface of healthcare and outdoor activities. There have been many scientific studies documenting the health benefits of being physically active in the natural environment, including a reduction in both mortality and morbidity of chronic diseases such as cardiovascular disease, hypertension, diabetes, depression and anxiety. The WMS supports efforts to increase the opportunities for, and participation in, outdoor physical activities by both governmental and non-governmental agencies. The WMS also supports the advancement of knowledge through research in the health benefits of outdoor recreation.”

The inspiration for the development of the new WMS position statement started with a request from the student section of the American Medical Association (AMA). They contacted the WMS back in September 2019 to sign onto and support a resolution encouraging federal, state, and local governments to create and maintain public lands and outdoor spaces for the purposes of outdoor recreation. Their statement also includes continued research on the uses of outdoor recreation therapy.

Mental illness and chronic disease such as heart disease and diabetes are among the leading cause of death in the United States. Physical activity alone has shown to help control weight, reduce risk of cardiovascular disease, type 2 diabetes, and cancer. Physical activity strengthens bones and muscles, improves mental health, prevents falls in older adults, and increases chances of living longer. The proposed AMA resolution on advancing the role of outdoor recreation in public health defines outdoor recreation as “outdoor leisure time that occurs in urban, human made, and or natural environments involving elements of nature such as terrain, plants, wildlife and water bodies.” Outdoor physical activity specifically has been shown to positively impact physical, mental and social health. An inspiring study titled, “Is Outdoor Recreational Activity an Independent Predictor of Cardiovascular Disease Mortality-NHANES III?” provides evidence that there exists an inverse association between outdoor recreation and cardiovascular mortality.

Recreating outside lowers cortisol levels and systolic blood pressure. Several experiments performed in 24 forests across Japan have been conducted on the effects of Shinrin-yoku or taking in the atmosphere of the forest, or forest bathing. The results show that forest environments promote lower concentrations of cortisol, lower pulse rate, lower blood pressure, greater parasympathetic nerve activity, and lower sympathetic nerve activity than do city environments. Japanese physicians have developed an entire research field dedicated to forest medicine, which is used as a strategy for preventive medicine.

Outdoor recreation is effective preventive medicine. A 2018 Oregon study released last year estimated a financial savings related to chronic disease between $735 million and 1.4 billion per year by patient participation in outdoor recreation. The report calculates how much energy people used when engaging in outdoor recreation in the year 2017. They found the energy equivalent to 144 million pounds of body fat, which would fill nearly 30 Olympic-sized swimming pools. This reduction in body fat corresponds to reductions related to chronic illnesses such as heart disease, stroke, depression, dementia, diabetes and several cancers. The research team developed a tool to quantify the savings when people engage in outdoor activities. The results were consistent across the state, when outdoor recreation was easily accessible, healthcare costs went down.

Multiple studies have found that outdoor recreation can enhance well-being, happiness and quality of life, particularly for veterans. Symptoms of depression, stress and PTSD improve with outdoor therapy programs. Outdoor adventures can have direct positive impacts on psychological resilience. A pilot study published in The Journal of Adolescence presents two different experiments investigating effects of outdoor adventures on young people’s mental health. The first study involved 14-year-olds organizing and mastering the challenge project of crossing the Alps. The participants reported an increase in life satisfaction and mindfulness after a successful nine-day hike through the German, Austrian and Italian Alps. The second study involved undergraduates from a German university who learned to survive in the wilderness of the Norwegian Hardangervidda. Participants scored higher in life satisfaction, happiness, mindfulness, and self-efficacy. The youth had lower perceived stress after having spent eight days in the wilderness. The findings suggest that outdoor education and wilderness programs can foster mental health. As a lack of randomized controlled trials is a major academic void, in the new WMS statement, the area of outdoor recreation and public health is highlighted as an important field of research worth developing and funding.

Through this formal statement, the WMS stands alongside other organizations such as The National Recreation and Park Association and the CDC. WMS recognizes the importance of outdoor recreation to public health and support improving access to recreational opportunities and continuing research efforts., The CDC for example, in conjunction with the National Park Service, built The Healthy Community Design Initiative, also known as the Built Environment and Health Initiative. The current administration has cut funding to the program; however, during the previous administration the program provided tools to help communities include health in their planning and development processes. Much of their focus was on access to outdoor places for physical activity such as parks and trails. Organized recommendations to federal state and local governments and encouragement from networks of organizations will hopefully improve access to recreational opportunities and advance research efforts.

The momentum of value based care and the proven health benefits of outdoor recreation have made possible the conception of clinical tools such as park prescriptions and referrals to outdoor organizations as potential clinical treatments. Park Rx America is one organization that provides clinical tools to providers that desire to prescribe nature and publicly accessible land and water or other protected areas to their patients in the clinical practice setting. However, this may not quite be ready for widespread use in general clinical practice, as there are still insufficient program resources, lack of available recreation spaces, and limited research on the underlying mechanisms and effective dose and duration of outdoor recreation.

The new statement is consistent with the mission of the WMS to encourage activities to improve the scientific knowledge of the membership and general public in human health activities in a wilderness environment. Along with teaching, practicing and investigating wilderness medicine, WMS supports physical activity through adventures and explorations all over the world; it also recognizes the unique exercise- independent benefits and activities attributed to outdoor recreation and pledges to support creation and maintenance of existing public lands and outdoor spaces for the purposes of outdoor recreation. Wilderness is good medicine and the WMS will work with relevant stakeholders to encourage continued research on the clinical uses of outdoor recreation.

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