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Running head: HIKING AND WELLNESS Mitten 1"
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Recommended"APA"citation:"Mitten, D., Overholt, J. R., Haynes, F. I., D’Amore, C.
C., & Ady, J. C. (2016). Hiking A Low-Cost, Accessible Intervention to Promote
Health Benefits. American Journal of Lifestyle Medicine, 1559827616658229.
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Hiking: A Low-Cost, Accessible Intervention to Promote Health Benefits"
Denise Mitten, Ph.D., Prescott College, 220 Grove Ave, Prescott, AZ 86303; e-
mail: dmitten@prescott.edu; phone; 231-598-7477 "
Jillisa R. Overholt, Ph.D., Warren Wilson College, PO Box 9000 CPO 6268,
Asheville, NC 28815; e-mail: joverholt@warren-wilson.edu; phone; 828-771-3820"
Janet C. Ady, Ph.D., Sustainability Education, Prescott College, AZ 86301; e-
mail: jady@prescott.edu Chief, Division of Community Partnerships, National
Conservation Lands System, Bureau of Land Management, 20 M Street SE, Washington
DC, 20003"
Chiara C. D’Amore, Ph.D., Sustainability Education, Prescott College, AZ
86301; e-mail: cdamore@communityecologyinstitute.org ; phone; 410-730-0394 Founder
& President, The Community Ecology Institute, Founder and Director, Columbia
Families in Nature. Columbia, MD, 20144"
Francis I. Haynes, MA, Adventure Education, Prescott College, Prescott, AZ
86301; e-mail: fran.haynes@prescott.edu, phone; 540-798-3933"
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Communication regarding manuscript will go to Denise Mitten: dmitten@prescott.edu"
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" "
HIKING AND WELLNESS Mitten 2"
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Abstract"
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Research has connected sedentary lifestyles with numerous negative health outcomes,
including a significant increased risk for mortality. Many healthcare professionals seek
ways to help clients meet physical activity guidelines recommended by the Office of
Disease Prevention and Health Promotion, the World Health Organization, and the
American College of Sports Medicine in order to promote active lifestyles and improve
overall wellness. Hiking is a cost effective intervention that encourages people to be
physically active while spending time in nature. Time in nature can lead to health benefits
through contact with the natural elements, participation in physical activity, restoration of
mental and emotional health, and time with social contacts. Benefits may be immediate,
such as decreased blood pressure, decreased stress levels, enhanced immune system
functioning, and restored attention, or transpire over time, such as weight loss, decreased
depression, and overall wellness. Health care providers are ideally positioned to
recommend and prescribe hiking to clients. Federal, state, and local natural resource
agencies are beginning to partner with healthcare professionals to promote outdoor
nature-related activities. Examples of successful doctor and other healthcare practitioner
partnership programs are described, along with tips for getting started."
"
Key Words: hiking, nature prescription, health benefits of outdoor activity, sedentary
lifestyle, natural environments, activity guidelines, restoration, physical activity
HIKING AND WELLNESS Mitten 3"
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Hiking: A low-cost, accessible intervention to promote health benefits"
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Hiking is the act of walking for a substantive distance in the outdoors, often over natural
terrain with obstacles such as rocks and tree roots to navigate around.1 In this paper the
authors demonstrate that as an outdoor physical activity, hiking has potent health benefits
and is economical and convenient for most people. The absence of whole-body
movement, primarily through sitting, has led to increasing sedentary lifestyles of much of
the United States (U.S.) population. Encouraging physical activity, such as hiking, is a
way that healthcare professionals can promote patient wellness and health in both a
preventive and curative manner. Hiking is unique in that it can help patients meet
guidelines for regular physical activity and concurrently tap the significant health benefits
that may be attained by spending time in natural settings. Hiking can be considered
accessible in terms of the limited skills and equipment needed, as well as the ability for
individuals to pick the terrain difficulty and the speed at which they walk.
"
In the U.S., 43.3% of the total population qualifies as sedentary, the largest percentage of
any country’s population worldwide.2 Inactive and insufficiently active adults engage in
less than 150 minutes of walking or moderate-intensity physical activity per week,
whereas for children and adolescents this means engaging in less than 60 minutes of
moderate to vigorous physical activity a day.3 Inactivity increases with age, and women
and older adults are more likely to live sedentary lives.2 A lack of physical activity
contributes to numerous health issues that can result in illness and premature death, such
as cardiovascular disease and some cancers. An estimated 5.3 million premature deaths
HIKING AND WELLNESS Mitten 4"
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per year worldwide are attributed to physically inactive lifestyles.2 In addition to the
detrimental health impacts, physical inactivity and sedentary lifestyles increase healthcare
costs for individuals as well as the overall healthcare system.4 Hiking is one way to
address inactivity and resulting illnesses. An Outdoor Participation Report showed hiking
as an increasingly popular form of physical activity in the U.S.5 For select patients who
can access hiking trails may find hiking is an enjoyable way to engage in enough physical
activity to meet and exceed various recommended guidelines.
"
The aim of this article is to provide health care practitioners with the information and
tools they need to feel confident when advising patients to incorporate hiking into their
comprehensive health care strategy. After reviewing the need and recommendations for
physical activity, we briefly present the wide array of important health benefits gained
from being active in natural environments. We then specifically explore how hiking can
promote health and wellness. Suggestions on how to start hiking are provided for
practitioners to use for themselves and share with their patients. A template Prescription
for Outdoor Activity is provided with practitioner instructions. "
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The relationship between inactivity and morbidity and mortality"
Early humans may have walked up to 12 miles a day finding food, exploring, and
securing shelter. This activity provided our muscles and bones with abundant physical
activity and our brains with enough oxygen for continued neuronal
development. Present-day humans, especially in the U.S. and many other developed
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countries, are more sedentary across their lifespan. This lack of activity accounts for an
estimated 6 to 10% of all deaths from major noncommunicable diseases (NCD)6 and 9%
of premature deaths worldwide.7 Irrespective of bodyweight, sedentary behaviors, such
as sitting at a desk and watching television, are adversely associated with health
outcomes such as obesity, cardiovascular disease, hypertension, and type 2 diabetes, as
well as emotional and cognitive problems including anxiety, depression, mental fatigue,
and stress.6,8,9,10 Additionally, poor skeletal health and some cancers, particularly breast
and colon cancer, are linked to sedentary lifestyles.6
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Engaging in moderate intensity physical activity has few negative side effects and is a
low-cost alternative to prescription drugs.11 As an example, regular hiking can lead to
weight loss and Dietz12 reported that even a five percent reduction in weight has
substantial health benefits.
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An early study published in The Lancet by Jerry Morris and colleagues13 confirmed the
relationship between heart disease and level of physical activity at the workplace, and
began the current movement to inform the medical community about the health benefits
of being physically active. Since that time, research has continued to demonstrate that
“being physically active is a major contributor to one’s overall physical and mental
wellbeing”14 and that those who are active in their professional and/or personal lives may
avoid the health risks that come with a sedentary lifestyle.15 For example, a recent study
HIKING AND WELLNESS Mitten 6"
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of 10,043 individuals with dyslipidemia (high cholesterol) showed an inverse association
between fitness and all-cause mortality.16
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A number of systematic reviews by the U.S Centers for Disease Control and Prevention
(CDC), U.S. Department of Health and Human Services “Physical Activity Guidelines
for Americans" project, and others have linked physical activity to health benefits and
concluded that interventions should be developed that aim to both reduce sedentary
behavior and promote physical activity.17-21""
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The studies and reviews informed the following recommendations for physical activity,22
which are supported and promoted by the Office of Disease Prevention and Health
Promotion,23 the WHO’s Physical Activity Guidelines,3 and the American College of
Sports Medicine.24 While each guideline is slightly different, the following captures the
essence of the recommendations"
● Children and adolescents from ages 6 to 17 should engage in 60 minutes or more
of physical activity each day."
● Adults, including healthy older adults aged 65 and older, are encouraged to
engage in 150 minutes or more of moderate-intensity physical activity each week."
The WHO’s Physical Activity Guidelines qualified physical activity as being of
moderate-intensity and added muscle strengthening activities two or more times per week
for all adults.3 The guidelines recommend that people unable to exercise for the proposed
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time frames strive to be as physically active as they can based on their present condition
and abilities. "
Healthcare providers are increasingly recognized as playing a pivotal role in encouraging
people to become more physically active.25,26 When these recommendations come from a
physician it was found that patient compliance was higher. Objective PA-11 of Healthy
People 2020 encourages physicians to include physical activity counseling and education
during office visits.27 Valuing the role of physical activity in a clinical practice helps
improve health indicators and save healthcare costs.28,29 "
Healthcare providers searching for cost-effective interventions should consider hiking.
Hiking helps people meet physical activity guidelines and carries the added benefit of
exposure to the natural environment. Hiking is not an ideal activity for everyone and is
not necessarily accessible for all patients. Because of transportation constraints, some
people may find hiking inaccessible. At the same time, programs like Rails to Trails are
creating a network of flat trails out of former rail lines throughout U.S. neighborhoods
and cities to be accessible for people of all ages and abilities. Rails to Trails also lists
wheelchair friendly trails by state.30 A recent call to action by the Surgeon General
recognizes the health-promoting benefits of walking and the necessity for safe, walkable
spaces as well as a culture that embraces the act of walking for fitness, transportation,
socialization, and more.31 As a form of walking, hiking encompasses the additional health
benefits of time spent in nature."
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The natural environment and health benefits"
Researchers from more than 30 disciplines as varied as public health to outdoor education
have studied the effects of exposure to nature on human well-being.32 This research has
examined multiple populations (e.g., children, adults, patients, inmates, students), types
of exposure to nature (e.g., view of nature, domestic proximity to nature, being passive or
active outdoors), and outcomes (e.g., positive psychological and physiological changes,
decreased morbidity and mortality, and positive subjective measures), and has suggested
that the benefits of exposure to nature are both pervasive and generalizable.33-36 Possible
pathways through which exposure to nature increases human health and well-being
include: contact with natural elements (e.g., daylight, fresh air); participation in physical
activity; restoration of mental and emotional health; and time with social contacts. These
pathways are often intertwined and may work synergistically across the lifespan.
"
While the benefits obtained from time spent in nature are frequently linked with the
increased physical activity associated with time spent outdoors,37-40 the literature
demonstrates that simply being exposed to nature, even in passive ways, has clear
benefits. For example, an early landmark study demonstrated that viewing nature through
a hospital window decreased recovery time and pain medication requests, and increased
general well-being of patients recovering from gallbladder surgery.41 More recently, the
increasingly popular activity in Japan and some other Asian countries of forest bathing or
Shinrin Yoku has been the subject of much study. Researchers have found the benefits of
simply spending time in forests, or forest bathing, to include: 1) decreased systolic blood
HIKING AND WELLNESS Mitten 9"
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pressure42; 2) decreased stress levels (measured through prefontal cortex activity and
salivary cortisol)43; 3) deactivated sympathetic nervous system (measured via urinary
adrenaline and noradrenaline levels)44; 4) strengthened immune system (measured via
enhanced natural killer cell activity and intercellular anticancer proteins).45,46,47 Each of
these studies compared forest and urban environments, finding significant differences in
health-related effects between the two environments throughout the study period. A
theory is that inhaling the volatile antimicrobial organic compounds, or phytoncides,
from particular trees may contribute to the health benefits. The studies indicated that
health benefits begin accruing immediately upon exposure to natural environments, then
increase continually with sustained mild to moderate physical activity in nature. These
effects persisted over time, lasting as long as one week after a forest bathing session. "
Participating in hiking can simultaneously harness the health benefits of simply being in
nature and of partaking in physical activity. Furthermore, unlike other forms of exercise
such as going to the gym, many hikers report that hiking does not feel like exercise or
working out.48 In one study, hikers burned more calories than runners or walkers because
they tended to spend longer periods of time outside enjoying nature than they would have
if exercising in a different environment.49 This is partly because physical exercise is often
incidental to other goals of hiking, which include sightseeing, socializing, or experiencing
nature. This means individuals may be more likely to persist in the activity over time, and
to spend more time in a given session.49 In addition, studies have found that exercise
conducted outdoors has greater health benefits than comparable exercise conducted
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indoors. A study by Jelalian and colleagues50 randomly assigned 76 overweight
adolescents to either a 16-week outdoor wilderness program or an indoor exercise
program having comparable amounts of caloric expenditure and caloric intake. At the end
of treatment, the older adolescents in the outdoor wilderness group lost four times as
much weight as the indoor exercise group. A systematic review of 11 trials by Thompson
Coon and colleagues48 used 13 measures to evaluate the effects of exercise on mental
well-being and found that participant self-reports for outdoor exercises included positive
effects such as greater feelings of revitalization and positive engagement, decreases in
tension, confusion, anger, and depression, and increased energy. The same exercises
conducted indoors did not elicit reports of these positive effects. "
Many researchers have studied restoration of mental and emotional health, including
stress reduction related to time in nature.51,52,53 In the 1980s Rachel and Stephen Kaplan
developed a theory of attention restoration (ART), which strove to explain how exposure
to restorative environments—such as natural environments—can help people improve
focus and mental health by resting directed attention.54,55 Building on this concept,
empirical studies have found that when people are feeling stressed or depressed they tend
to choose outdoor places such as wooded urban parks, places offering scenic views of
natural landscape, and locations at the edge of water such as lakes or the ocean.56 Olds57
concluded that being in places with natural features can heal some cases of emotional
depression. Sturm and colleagues58 confirmed emotional benefits of time in nature,
including reduced hopelessness, depression, and suicide ideation. People with greater
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connectivity to nature have been shown to demonstrate greater trait mindfulness and
overall psychological well-being.59 "
Time with social contacts in nature promotes positive psychosocial outcomes and
research shows that people engage in physical activity more consistently when they do so
with others.60 Hiking is an activity to share in families, friendship groups, and with
pets.61,62 For example, increased family bonding results from social connections created
with others during time in nature. Natural environments stimulate social interaction
between children63 and an evaluation of a program in which students participate in a
range of projects outdoors, such as constructing footpaths, found that children’s
psychosocial health improved significantly as a result of participation.64 Recent research
on family nature clubs, community-based organizations that regularly bring families
together to enjoy the benefits of time spent in nature, found that participation has
significant positive overall effects on parental family life satisfaction, particularly in the
areas of spending time together, sharing positive experiences, and a sense of parental
efficacy; participation was also beneficial to the external relationships of these families,
especially with regards to developing friendships with other families and a sense of
connection with community.62 A participant in this research study stated, “We have hiking
club traditions and the hikes give us the chance to talk about things the kids like. We are
also able to share stories about the things we experience on our hikes together. I think
that all provides another added benefit on a family level.”62 "
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Time spent outdoors engaged in activities such as hiking can help individuals complete
the developmental challenges faced in each life stage. Research provides convincing
evidence that the benefits of time in nature are particularly profound for young children
due to children’s greater levels of plasticity.65 For example, children who regularly play
in natural environments show more advanced motor fitness, including coordination,
balance and agility, and are sick less often.66 According to Ewert and colleagues,33 teens
are concerned with body image, sexuality, identity, and their future and encouraging
participation in hiking provides teens an opportunity to relax, expend energy, and reflect
on their needs and desires.67 Among middle aged women in Iran, a ‘green walking
program’ demonstrated increased personal growth, positive relations with others, self-
acceptance, and sense of purpose in life.68 Similarly, among older adults in Canada,
hiking was linked to active aging in a way that promoted resistance to essentialism
(providing a sense of control over the aging body and lessening dependence on
medication), increased physical activity, and camaraderie.69 Programs that promote
hiking, either through individual education or through the formation of activity groups,
offer alternative or adjunct health care to populations of all ages."
"
Success stories: health care practitioners encouraging patients to hike"
In April 2008, several U.S. federal and nonprofit agencies organized an online meeting
titled “Reconnecting Kids With Nature for Health Benefits.” The meeting was convened
by the Society for Public Health Education for health care professionals, public health
educators, environmental educators, and land conservationists to raise awareness of
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national efforts to promote children’s involvement in outdoor nature-related activities.
Examples included school and youth organization partnerships to provide recreational
activities on public lands for families; cost-share programs for local projects to connect
children to forests; ambassadors on national wildlife refuges and fish hatcheries to
encourage conservation values in children; programs to encourage children and families
to visit national wildlife refuges and national parks; volunteer programs to restore habitat
and build trails; and environmental health tools and resources to integrate into health
education and practice.70 "
"
The following programs, initiatives, and partnership specifically support health care
professionals to help their patients engage in nature-based physical activities such as
hiking and are representative of the many such efforts now occurring in the U. S. at
national, regional, and local levels. Few of the programs have been able to effectively
evaluate"all elements of a program that has medical experts prescribing outdoor activity
for health. Some specific outcomes that have been measured are the number of
prescriptions written, the number of participants in special events, time spent
participating, and participant attitudes toward exercising in nature.
"
Children and Nature Initiative: Rx for Outdoor Activity - The National
Environmental Education Foundation’s (NEEF) ‘Children and Nature Initiative: Rx for
Outdoor Activity’ program educates pediatric healthcare providers to integrate the value
of being active in nature into patient care while promoting good health, enjoyment, and
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environmental stewardship. The program also connects healthcare providers with local
nature sites, so that they can refer families to easily accessible outdoor areas such as
parks and nature preserves. NEEF’s nature site partners include: the U.S. Bureau of Land
Management, the National Park Service, the U.S. Forest Service, the U.S. Fish &
Wildlife Service, the National Audubon Society, and local parks and recreation
agencies.70,71 Tools such as nature prescription pads and a patient brochure give
healthcare providers resources for patient education.72"
Nature Prescription Program - National Trails Day celebrations held in Henderson,
Nevada in 2011 and 2012 helped more than 3,000 participants learn about the Nature
Prescription Program. The Nature Prescription Program (which emerged from the NEEF
Children and Nature Initiative) is administered through a partnership comprised of
professionals from the Bureau of Land Management, National Park Service, U.S. Fish &
Wildlife Service, U.S. Forest Service, and a variety of health care professionals and
organizations.73 Southern Nevada partners include the Children’s Heart Center, the
Outside Las Vegas Foundation, the Clark County School District, and approximately 100
health care providers. Some of the people on the one-mile Let’s Get Healthy! Family Fun
Walk at the National Trail Days celebrations were following doctor’s orders according to
a nature prescription, while others received prescriptions there.74"
Tiger on the Trail - In Harpers Ferry, West Virginia Dr. Mark Cucuzella began Tiger on
the Trail as a voluntary collaborative to promote outdoor physical activity at a local
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middle school (the school's mascot is a tiger). It resulted in a partnership with the
National Park Service, a novel health/physical education program, and a change in school
policy. Tiger on the Trail promotes non-competitive physical activity using nature as the
gym. Students learn about health, fitness, nature, and local history while hiking to and
through local parks during school hours. Two hundred Tiger on the Trail participants
indicated positive attitudes regarding physical activity, their happiness and ability to pay
attention in school, and their intent to engage in outdoor physical activity post-
intervention.75 "
Local Green Space Mapping - In Washington, DC, Unity Health Care pediatrician
Robert Zarr mapped and rated the green spaces in the city for accessibility, cleanliness,
safety, amenities, and services, producing a database that can be linked directly to
patients’ electronic medical records. As of 2015, 180 doctors at 26 Unity Health Care
locations across the city have signed on to the database, representing a potential reach of
more than 100,000 patients. Dr. Zarr recently studied 212 patients, and found a
statistically significant increase in time spent outdoors following a nature prescription.76"
Healthy Parks, Healthy People - The National Park Service’s ‘Healthy Parks, Healthy
People’ program is catalyzing similar efforts nationally. For example, ‘Getting Doctors
Onboard Healthy Parks Healthy People Bay Area’, launched in 2012, involves numerous
partners in all nine counties of the 7.1 million-resident San Francisco metro area. The city
of San Francisco has adopted park prescriptions within its Department of Public Health,
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with weekly health-oriented programs at parks throughout the city. Plans to further the
program include establishing a framework for regional park-health partnerships
nationwide and an April 2016 conference on park prescriptions, designed to provide
practical information for implementing and carrying out local programs.77,78 Health care
providers and nature care providers continue to find mutual benefits in collaborating to
encourage people to get out and hike."
"
Next steps: recommending hiking to your patients
The following are specific suggestions for health care practitioners interested in
encouraging their clients to include hiking as a part of their plan for a healthy lifestyle: "
1. Learn about local nature programs and natural places by searching the internet or
consulting local environmental educators or natural area managers. Likely places and
sources might be city, county, state or federally managed natural areas within a ~10
miles radius; programs such as Rails to Trails, Parks and People, or National Scenic
Trails that may offer trail maps and guided hikes; hiking and outdoor adventure clubs,
which often have announcements on Meetup, Facebook pages, and other social media
sites; family nature clubs such as those listed with the Children & Nature Network;
and webpages with search functions to identify nearby natural areas such as Nature
Rocks, Nature Find, and Find Your Park.
● Visit nearby natural areas to be able to personally recommend specific areas
appropriate for clients. Groups of medical professionals can meet near local trails
and hike together and with patients such as Docs in the Parks programs do. "
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● Promote local areas and events as some doctors’ offices and clinics do by
posting photographs and maps of trails on their office walls. Provide information
about outdoor events, such as National Trails Day, to clients. Every Kid in a Park
is the theme for the National Park Service’s centennial anniversary in 2016 and
the National Park Service is working with many partners to encourage children to
visit parks, especially fourth graders."
2. Familiarize yourself with tips for successful hiking experiences so you can
confidently advise patients that may be new to hiking.
● Hiking Safety – People should choose hiking routes that are appropriate to their
fitness and experience level. Before going to a new location, learn about the
trail’s difficulty, length, location, and type of environment (e.g., open sun, a wet
marsh, rocky). Once a trail has been chosen, it is a good habit to make sure a
close friend or relative knows of your plans, including the trail name, location,
length, the expected hike duration, and the estimated return time. Hike with at
least one companion whenever possible. Local hiking groups are a way to learn
about locations to enjoy and to find hiking companions.!
● Hiking Gear - Hiking requires minimal equipment. A pair of sturdy shoes, a
small daypack, and a water bottle are enough to get started. When hiking on level
terrain, a basic pair of tennis shoes or trail running shoes may suffice. A pair of
hiking boots can be beneficial for hiking on uneven or steep terrain. Trekking
poles reduce strain on joints, improve efficiency, and are useful on uneven and
steep terrain or for clients with balance, hip, knee, or ankle concerns. A daypack
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holds essentials needed during the hike. Depending on the length and type of hike,
consider packing: 1) 3 to 4 liters of water; 2) snacks; 3) a map of the hiking area;
4) sun protection; 5) extra layers such as a rain jacket; 6) a headlamp or flashlight.
Printed hiking guides are excellent supplements to maps, since they often provide
a detailed description of the area or the hiking trail that can aid in planning. !
3. Write prescriptions for outdoor activity for clients that recommend specific
programs and local areas to go hiking. Consider using a nature prescription to indicate
the type and time period of outdoor activity recommended and the health issue the
activity will address. During the next visit, the length of time or distance hiked can be
adjusted and new sites suggested, if appropriate. A sample outdoor activity
prescription form is included below.
● Offer guidance for getting into shape for hiking if needed. When starting any
new form of physical activity, people should start slowly.79,80 For those that are
new to hiking and not currently physically fit, for the first month a sample plan
might include three twenty-five to thirty minute hikes a week on level terrain; the
goal being to achieve a twenty to thirty-minute mile. The second month, fifteen
minutes of hike time on hills can be incorporated into the three weekly hikes,
increasing hiking time to forty to fifty minutes until it is comfortable to hike at
least 150 minutes per week. Mitten80 emphasizes the importance of conducting
both warm up and cool down stretches when hiking. Physical activity apps can be
used to tracks steps, elevation, miles hiked, and calories burned during hiking
excursions.!
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!
Conclusions
In The Lancet Series on Physical Activity, Das and Horton14 challenged healthcare
professionals to be on the forefront of creating a lifestyle inclusive of activity. They
advocated for assembling “the best experts in the field and the best evidence to
understand what we know about the relationship between human health and physical
activity and creating a social revolution towards an active lifestyle and away from a
passive one.”14 Health care practitioners are in a pivotal position where they can serve as
trusted advisors to counsel their clients to pursue new opportunities and to develop a
holistic health care plan inclusive of physical activity in nature, such as hiking. As health
care practitioners enhance their knowledge of the important health benefits of hiking they
can help change client behavior to create a culture of wellness that includes activity in
natural environments. In the U.S., hiking is positioned well to become part of a
comprehensive health care strategy to counter many sedentary lifestyle related health
conditions that currently lead to high morbidity and mortality rates. The synergistic effect
of physical activity and time spent in nature make hiking an ideal activity to increase
overall health and wellness. Multiple benefits for health and general well-being accrue
from a lifestyle enriched by regular time in nature, among them breathing air rich in
beneficial organic compounds, physical activity, restoration, and social bonding.33
Benefits may be immediate, such as restoration, or transpire over time, such as decreased
depression and overall physical health improvement. In short, hiking is a cost effective
HIKING AND WELLNESS Mitten 20"
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intervention that helps people to meet physical activity guidelines, and carries the added
benefit of exposure to the natural environment.
HIKING AND WELLNESS Mitten 21"
"
Prescription for Outdoor Activity Form"
Health Care Practitioner Directions:"
"
1. Do an internet search of local nature programs and natural places."
● City, County, and State parks within a ~10 miles radius."
● Programs such as Rails to Trails, Parks and People, National Scenic Trails."
● Hiking and outdoor adventure clubs on Meetup, Facebook, etc."
● Family Nature Clubs such as those listed with the Children & Nature Network."
"
2. Visit several natural areas close to your office so you can make personal
recommendations. What are the top five local places/programs you can suggest?"
1.
2.
3.
4.
5.
3. Make copies of the Prescription for Outdoor Activity for use during your
appointments."
4. Fill out the prescription form with each patient’s name, recommended local
places/programs, the initial dose of outdoor activity, particular issue you are
recommending hiking for, and your signature and date."
5. Make note of this prescription in the patient’s file and follow-up on it at the next visit."
" "
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References"
"
1. Eastep BT, Goldenberg M. Going hiking and backpacking. In: Goldenberg M, Martin
B, eds. Hiking and backpacking. Champaign, IL: Human Kinetics; 2008;3-21.
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progress, pitfalls, and prospects. Lancet. 2012;380(9838), 247-257.
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Accessed September 4, 2015.
4. Kohl HW, Craig CL, Lambert EV, et al. The pandemic of physical inactivity: global
action for public health. Lancet. 2012;380(9838), 294-305.
5. The Outdoor Foundation. Outdoor Participation Report. www.outdoorfoundation.org.
Published 2013. Accessed September 4, 2015.
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inactivity on major non-communicable diseases worldwide: an analysis of burden of
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9. Ebbeling CB, Pawlak DB, Ludwig, DS. Childhood obesity: public-health crisis,
common sense cure. Lancet. 2002;360(9331), 473-482.
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10. Dunstan DW, Howard B, Healy GN, Owen N. Too much sitting–a health
hazard. Diabetes Res Clin Pract. 2002;97(3), 368-376.
11. Hallal PC, Lee IM. Prescription of physical activity: an undervalued
intervention. Lancet. 2013;381(9864), 356-357.
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