Nature-based health and therapy

There is an exponentially growing interest in the area of nature-based health and therapy for a variety of excellent reasons, from its potential to increase physical activity, reduce pain, improve mental health outcomes, reduce the environmental footprint of other approaches to healthcare and physical activity, and even contribute to environmental restoration. Sometimes going by the name of nature prescriptions, nature-based rehabilitation, outdoor exercise, greenspace exposure, and others, this page will collate and build on the growing evidence and resources to enable you to implement nature-based approaches in your day-to-day practice.

Putting nature-based health and therapy into practice – an international online symposium

Watch all four sessions of our international online symposium held on 16 November 2024 here:

PaRx Canada’s 5 simple steps to prescribe nature

1. Make nature time the fourth pillar of health. Whenever you do lifestyle counselling around diet, exercise and sleep habits, remember to add nature time as a recommendation.

2. Follow the 2/20 rule. Research shows that people who spend at least 2 hours in nature each week report significantly better health and wellbeing and that the most efficient drop in cortisol (stress hormone) levels happens between 20 to 30 minutes.

3. Personalize it. Health benefits start to add up whenever patients feel like they’ve had meaningful contact with nature. This makes the process of setting green-time goals patient-centered and self-directed.

4. Follow it up. Check in on your patient’s progress the next appointment after you prescribe it.

5. Be the change. Patients who see and hear evidence about their health-care providers putting their nature recommendations into action are more motivated to change their behaviours.

An initiative of the BC Parks Foundation, PaRx is driven by Canadian healthcare professionals who want to improve their patients’ health by connecting them to nature. Featuring practical resources like quick tips and patient handouts, its goal is to encourage patients to incorporate outdoor experiences in their local communities into their daily routines by formalizing an evidence-based recommendation in writing, giving it the same weight as a traditional prescription for medication. Since 2020, 15,000+ Canadian healthcare providers have issued one million nature prescriptions to Canadians.

Relevant publications

Eliassen, M., Hartviksen, T. A., Holm, S., Sørensen, B. A., & Zingmark, M. (2024). Aging in (a meaningful) place – appropriateness and feasibility of Outdoor Reablement in a rural Arctic setting. BMC Health Services Research, 24(1). https://doi.org/10.1186/s12913-024-12031-7

Steensma, R., van den Bogerd, N., Dijkstra, K., Janssen-Heijnen, M., Krabbendam, L., Vries, R. de, & Maas, J. (2025). How to implement nature-based interventions in hospitals, long-term care facilities for elderly, and rehabilitation centers: A scoping review. Urban Forestry & Urban Greening., 103. https://doi.org/10.1016/j.ufug.2024.128587

Struthers, N.A., Guluzade, N.A, Zecevic, A.A., Walton, D.M., Gunz, A. (2024). Nature-based interventions for physical health conditions: A systematic review and meta-analysis. Environmental Research, 258: 119421. https://doi.org/10.1016/j.envres.2024.119421

Stanhope, J., & Weinstein, P. (2023). What are green prescriptions? A scoping review. Journal of Primary Health Care, 15(2), 155–161. https://doi.org/10.1071/hc23007

Eliassen, M., Sørensen, B. A., Hartviksen, T. A., Holm, S., & Zingmark, M. (2023). Emplacing reablement: co-creating an outdoor recreation model in the rural Arctic. International Journal of Circumpolar Health, 82(1). https://doi.org/10.1080/22423982.2023.2273013

Wagenfeld, A., & Marder, S. (2023). Nature-Based Allied Health Practice: Creative and Evidence-Based Strategies. Jessica Kingsley Publishers. https://uk.jkp.com/products/naturebased-allied-health-practice

Doran-Sherlock, R., Devitt, S., & Sood, P. (2023). An integrative review of the evidence for Shinrin-Yoku (Forest Bathing) in the management of depression and its potential clinical application in evidence-based osteopathy. Journal of Bodywork and Movement Therapies., 35, 244–255. https://doi.org/10.1016/j.jbmt.2023.04.038

Busk, H., Ahler, J., Bricca, A., Mikal Holm, P., Varning Poulsen, D., Skou, S. T., & Tang, L. H. (2023). Exercise-based rehabilitation in and with nature: a scoping review mapping available interventions. Annals of Medicine, 55(2). https://doi.org/10.1080/07853890.2023.2267083

Hartl, A. J., Freidl, J., & Huber, D. (2023). Effects of Alpine Natural Health Resources on Human Health and Wellbeing. International Journal of Environmental Research and Public Health, 20(12), 6144. https://doi.org/10.3390/ijerph20126144

Huber, D., Freidl, J., Pichler, C., Bischof, M., Kiem, M., Weisböck-Erdheim, R., Squarra, G., De Nigris, V., Resnyak, S., Neberich, M., Bordin, S., Zechner, R., & Hartl, A. (2023). Long-Term Effects of Mountain Hiking vs. Forest Therapy on Physical and Mental Health of Couples: A Randomized Controlled Trial. International Journal of Environmental Research and Public Health, 20(2), 1469. https://doi.org/10.3390/ijerph20021469

Our courses on Plus by physiopedia

PaRx Canada – a prescription for Nature

Vibholm, A. P., Christensen, J. R., & Pallesen, H. (2022). Occupational therapists and physiotherapists experiences of using nature-based rehabilitation. Physiotherapy Theory and Practice, 1–11. https://doi.org/10.1080/09593985.2021.2023927

Huber, D., Mayr, M., Hartl, A., Sittenthaler, S., Traut-Mattausch, E., Weisböck-Erdheim, R., & Freidl, J. (2022). Sustainability of Hiking in Combination with Coaching in Cardiorespiratory Fitness and Quality of Life. International Journal of Environmental Research and Public Health, 19(7), 3848. https://doi.org/10.3390/ijerph19073848

Neberich, M., Gerner, N., Romodow, C., Freidl, J., Huber, D., Weisböck-Erdheim, R., Pichler, C., & Hartl, A. (2022). Positive Effects of Advanced Daylight Supply of Buildings on Schoolchildren—A Controlled, Single-Blinded, Longitudinal, Clinical Trial with Real Constructive Implementation. Buildings, 12(5), 600. https://doi.org/10.3390/buildings12050600

Pichler, C., Freidl, J., Bischof, M., Kiem, M., Weisböck-Erdheim, R., Huber, D., Squarra, G., Murschetz, P., & Hartl, A. (2022). Mountain Hiking vs. Forest Therapy: A Study Protocol of Novel Types of Nature-Based Intervention. International Journal of Environmental Research and Public Health, 19(7), 3888. https://doi.org/10.3390/ijerph19073888

Hernegger, S. (2022). Incorporating traditional Finnish Winter Swimming into Physiotherapy for treating Chronic Pain: a Systematized Literature Review (Bachelor Thesis). Satakunta University of Applied Sciences, Finland. https://urn.fi/URN:NBN:fi:amk-202304276636

Astell-Burt, T., Pappas, E., Redfern, J., & Feng, X. (2022). Nature prescriptions for community and planetary health: unrealised potential to improve compliance and outcomes in physiotherapy. Journal of Physiotherapy. https://doi.org/10.1016/j.jphys.2022.05.016

Stanhope, J., Maric, F., Rothmore, P., & Weinstein, P. (2021). Physiotherapy and ecosystem services: improving the health of our patients, the population, and the environment. Physiotherapy Theory and Practice, 1-14. https://doi.org/10.1080/09593985.2021.2015814

Garriga, A., Sempere-Rubio, N., Molina-Prados, M. J., & Faubel, R. (2021). Impact of Seasonality on Physical Activity: A Systematic Review. International Journal of Environmental Research and Public Health, 19(1), 2. https://doi.org/10.3390/ijerph19010002

Toner, A., Lewis, J. S., Stanhope, J., & Maric, F. (2021). Prescribing active transport as a planetary health intervention – benefits, challenges and recommendations. Physical Therapy Reviews, 26(3), 159–167. https://doi.org/10.1080/10833196.2021.1876598

Stanhope, J., Breed, M. F., & Weinstein, P. (2020). Exposure to greenspaces could reduce the high global burden of pain. Environmental Research, 187, 109641. https://doi.org/10.1016/j.envres.2020.109641

Freidl, J., Huber, D., Braunschmid, H., Romodow, C., Pichler, C., Weisböck-Erdheim, R., Mayr, M., & Hartl, A. (2020). Winter Exercise and Speleotherapy for Allergy and Asthma: A Randomized Controlled Clinical Trial. Journal of Clinical Medicine, 9(10), 3311. https://doi.org/10.3390/jcm9103311

Vibholm, A. P., Christensen, J. R., & Pallesen, H. (2020). Nature-based rehabilitation for adults with acquired brain injury: a scoping review. International Journal of Environmental Health Research, 30(6), 661–676. https://doi.org/10.1080/09603123.2019.1620183

Prossegger, J., Huber, D., Grafetstätter, C., Pichler, C., Weisböck-Erdheim, R., Iglseder, B., Wewerka, G., & Hartl, A. (2019). Effects of moderate mountain hiking and balneotherapy on community-dwelling older people: A randomized controlled trial. Experimental Gerontology, 122, 74–84. https://doi.org/10.1016/j.exger.2019.04.006

Niedermeier, M., Grafetstätter, C., Kopp, M., Huber, D., Mayr, M., Pichler, C., & Hartl, A. (2019). The Role of Anthropogenic Elements in the Environment for Affective States and Cortisol Concentration in Mountain Hiking—A Crossover Trial. International Journal of Environmental Research and Public Health, 16(2), 290. https://doi.org/10.3390/ijerph16020290

Huber, D., Grafetstätter, C., Proßegger, J., Pichler, C., Wöll, E., Fischer, M., Dürl, M., Geiersperger, K., Höcketstaller, M., Frischhut, S., Ritter, M., & Hartl, A. (2019). Green exercise and mg-ca-SO4 thermal balneotherapy for the treatment of non-specific chronic low back pain: A randomized controlled clinical trial. BMC Musculoskeletal Disorders, 20(1), 221. https://doi.org/10.1186/s12891-019-2582-4

Haslinger, S., Huber, D., Morawetz, D., Blank, C., Prossegger, J., Dünnwald, T., Koller, A., Fink, C., Hartl, A., & Schobersberger, W. (2019). Feasibility of Ski Mountaineering for Patients Following a Total Knee Arthroplasty: A Descriptive Field Study. International Journal of Environmental Research and Public Health, 16(9), 1582. https://doi.org/10.3390/ijerph16091582

Prossegger, J., Huber, D., Grafetstätter, C., Pichler, C., Braunschmid, H., Weisböck-Erdheim, R., & Hartl, A. (2019). Winter Exercise Reduces Allergic Airway Inflammation: A Randomized Controlled Study. International Journal of Environmental Research and Public Health, 16(11), 2040. https://doi.org/10.3390/ijerph16112040