Openmind issue 145, May/June 2007
Green exercise should be a mainstream treatment option, says Marcus Roberts 'Green exercise' is the term used to describe getting active while simultaneously being exposed to or interacting with nature. Walking, running, cycling, horse riding, gardening, conservation work and care farms are all effective forms of green exercise. It is not a new idea that being in touch with nature makes us feel relaxed and revived or that taking part in physical exercise can help focus the mind and combat stress. What is less widely accepted is that green exercise could be a clinically valid treatment option that can be more effective than drugs and, for some people, as effective as talking treatments like cognitive behavioural therapy. But can green exercise make it into the mainstream as a treatment option for people with mental distress? I believe it should. The treatment options considered for people with mental distress are often limited to drugs or psychological therapies. But there is a growing body of evidence that shows that green exercise has comparable outcomes in improving psychological health and mental wellbeing. When people take part in green exercise they report feeling less stressed, more alert and alive, happier and more relaxed. Unlike antidepressant drugs that cost £750 million a year, green exercise is free and does not carry the potential for negative side effects. It is also immediately accessible for most people. We're not saying that green exercise can replace either of these treatments, but that the debate needs to be broadened. The best treatment for most people visiting GP surgeries will combine different interventions, including green exercise and psychological therapy, and in many cases medication too. Even the Department of Health's Chief Medical Officer has recognised the therapeutic power of exercise: 'Physical activity is effective in the treatment of clinical depression and can be as successful as psychotherapy or medication, particularly in the longer term.'1 So if we have an evidence-based, clinically valid treatment option for people with mental health problems available on our doorstep, then why are health and social care professionals currently reluctant to employ it? Perhaps they do not yet have the knowledge needed to convince them of its benefits, or maybe they are not aware of how to access existing green exercise projects in their area as they are not incorporated into mainstream health and social care practice. Whatever the reason, the UK is lagging behind the rest of Europe in recognising the benefits of green exercise. In Norway, the Netherlands, Italy, Germany, Austria, Belgium and Slovenia, care farms are well established as a treatment option for people with mental distress. These farms are formally tied to local social and health services, and are a key component of care in the community. Patients are referred to work on a farm, and over a period of time it helps them to build up their self-esteem and gives them new work skills. Farmers get paid for providing a health service and benefit from the additional labour power. Unfortunately, in the UK the concept of care farming is still relatively new. Care farming could help rural regeneration, build the skills base and confidence of participants and break down the stigma surrounding mental health problems in some rural communities. The Mind Week report will bring together the existing evidence base and the personal testimonies of people who have experienced mental distress who say they have gained substantial social, health and wellbeing benefits from green exercise. It will also present the findings of two new research studies undertaken on behalf of Mind by a research team from the internationally renowned green exercise programme at the University of Essex. In the first study, feedback was received from 108 service users who are taking part in a variety of green exercise projects run by Local Mind Associations throughout the country. Projects vary in scale, from small walking groups that meet once a month to allotment projects that provide work skills for participants as well as produce to sell to the local community. An example of this is Mid Warwickshire Mind's allotment project. Margaret Turner explains: 'We have several allotments that are open to service users two days a week. People don't just come for the activity but to experience the beauty and tranquillity of the place. It offers a quiet haven away from the town where people can reconnect with the natural environment.' The second study compares the effects of a walk in the countryside and a walk in a shopping centre. As industrialised society has become disconnected with nature, choosing to spend leisure time at retail parks rather than country parks, mental distress has become an increasing social concern. The World Health Organisation predicts that depression will be the second largest cause of ill health by 2020. For some people, accessing green space is not a lifestyle choice. For example, for people who do not own their own car or are on a low income or benefits, getting out of the city and into the countryside can be expensive. Groups with particularly low participation rates include young people, low income groups, black and minority ethnic groups and people with physical disabilities. Town planners and architects must consider access to quality green space in inner city areas when designing new developments, and we must take steps to protect and conserve existing green city environments. Hospitals have long been aware of the therapeutic value of nature and many offer healing gardens for patients. They provide a pleasant, relaxing environment for the ill to recuperate and aid recovery free from stress. However, inpatients in mental health hospitals who are likely to benefit significantly from access to green space are sometimes disadvantaged. Mind is aware of cases where access to hospital gardens is used as a reward or punishment for behaviour. In primary care it can be hard to attract funding for green exercise projects and even more difficult to retain funding, especially when times are tight in the NHS. But, green exercise has been shown to be extremely economical, especially as it has such high success rates. 1. Professor Sir Liam Donaldson in Department of Health (2004) At least five a week: Evidence on the impact of physical activity and its relationship to health.