Nature and outdoor recreation are important for public health. As a health promotion endeavor, physiotherapists should engage in public health work and policymaking to secure the public (and thereby patients) easy access to green and blue environments.
This piece builds on an article published by the authors in Fysioterapeuten, the Norwegian Journal of Physiotherapy (1).
The positive health effects of nature
It is well documented that nature and outdoor recreation have positive effects on both physical and mental health (2, 3). The positive effects of nature can be attributed to three main aspects: physical activity in nature, social activities in nature and just being present in nature. Physiotherapists are perhaps the occupational group most concerned with physical activity and its effect on health (4). The positive effects of good social relationships (5) are also well-known and focused on in physiotherapy. The positive effects of being in nature for patients and the public are far less in focus.
Nature experiences reduce stress and promote mental recovery, improve mood, promote well-being and strengthen the immune system (6, 3). It has been shown that exposure to nature reduces the level of stress hormones and blood pressure (7) and that surgery patients who are exposed to nature recover faster and use less pain medication than patients without such exposure (8). The reason for these positive effects may be that the demanding “focused” attention that people need for their activities in urban environments, gets rest when being in nature (9) or/and that the body and mind respond positively to the mere sight of wonderful and natural environments.
Easily accessible areas for outdoor recreation are diminishing
Compared to other countries, Norway has many rural areas and much nature, and Norwegians use their nature more than in many other cultures. In a study on lay perspectives of what health is, Norwegians regard nature as one important part of good health (10). One reason for this may be that Norway has for long had a law securing laypeople the right to use private rangeland for transport (walking and skiing), berry picking, hiking, and recreation (11). Nevertheless, we have lately seen that rich people buy properties in popular outdoor recreation areas, “privatize” them, and try to hinder people’s legal right to use nature. Seen from an outdoor recreation perspective, municipalities have not been very concerned about this negative and illegal development (12). In the most populated regions of Norway, the area for outdoor recreation has diminished greatly in the past years (13).
Steffen Torp (PT, PhD)
Steffen is a physiotherapist, professor and member of the research group for health promotion in settings at the Department of health-, social- and welfare studies at the University of South-Eastern Norway.
Catherine Lorentzen (PhD)
A/Prof and Sports scientist
Catherine is a member of the research group for health promotion in settings at the department of health-, social- and welfare studies at the University of South-Eastern Norway.
The role of physiotherapists in health promotion and public health
Since 2012 Norway has, as one of very few countries, had a Public Health Act (14) with the aim of “contributing to a community development that promotes public health, including leveling social inequities in health”. To make nature easily accessible for the public seems to fit well with this aim. The act gives the municipalities and counties a particular responsibility for this community development, but our preliminary research indicates that this access to nature has not much focus in their public health plans. Many physiotherapists work in municipalities and should relate their work to the public health act.
Physiotherapists should engage in policymaking
WHO defines health promotion as the process of enabling people, individually and collectively, to increase control over the determinants of health, and points out that this is best achieved through a combination of health education and healthy public policy (15). Since health is primarily created outside the traditional health services, health personnel, including physiotherapists, should engage in (political) processes that may create a development that promotes public health. For many, this is difficult, and we do not mean that physiotherapists necessarily must engage in the work of political parties (although this would be good). Nevertheless, we hold that physiotherapists should, as part of their health promotion activities, influence their colleagues, local leaders, managers, and politicians by arguing for the importance easily accessible nature may have for the health of fellow citizens.
(1) Torp S, Lorentzen C. Ulovlige stengsler og bygging i strandsonen – en sak også for fysioterapeuter. Norwegian Journal of Physioterapy. 2022.
(2) Maller C, Townsend M, Pryor A, Brown P, St Leger L. Healthy nature healthy people: ‘contact with nature’ as an upstream health promotion intervention for populations. Health Promot Int. 2006;21(1):45-54.
(3) Bowler DE, Buyung-Ali LM, Knight TM, Pullin AS. A systematic review of evidence for the added benefits to health of exposure to natural environments. BMC Public Health. 2010;10:456. doi:10.1186/1471-2458-10-456.
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(8) Ulrich RS. View through a window may influence recovery from surgery. Science. 1984;224(4647 ):420-1.
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(11) Klima- og miljødepartementet. Lov om friluftslivet (friluftsloven). Oslo: Klima- og miljødepartementet,; 1957.
(12) Sivilombudsmannen. Sivilombudsmannens undersøkelser av dispensasjoner i strandsonen. Oslo: Sivilombudsmannen; 2021.
(13) Statistisk sentralbyrå. 70 prosent av strandsonen i Indre Oslofjord utilgjengelig for allmennheten. 2020. https://www.ssb.no/natur-og-miljo/artikler-og-publikasjoner/70-prosent-av-strandsonen-i-indre-oslofjord-utilgjengelig-for-allmennheten.
(14) Helse- og omsorgsdepartementet. Lov om folkehelsearbeid (folkehelseloven). oslo: Helse- og omsorgsdepartementet; 2012.
(15) Nutbeam D, Muscat DM. Health Promotion Glossary 2021. Health Promot Int. 2021. doi:10.1093/heapro/daab067.
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