Should You Add Outdoor Activities to Your Clients’ EPAPs (Exercise and Physical Activity Plans)?



Many Fitness Professionals will look to the American College of Sport Medicine (ACSM) and the Canadian Society for Exercise Physiology (CSEP) and their recommendations for what to include in an EPAP: a minimum of 150 minutes of cardio, resistance exercise at least twice a week and making sure to include flexibility and balance training, especially for older individuals. But should we also consider recommending at least 120 minutes of weekly nature exposure and include outdoor activities in the plan for even better overall health and wellbeing? There are studies that now support this!

Research into this area began nearly 40 years ago in Japan, with their practice of shinrin-yoku, literally translated as ‘forest bathing’. A body of evidence is growing that spending time in nature is responsible for many positive measurable changes in the body.

What happens when we spend time in a natural setting surrounded by trees and plants? A Professor at the Nippon Medical school in Tokyo, Dr. Qing Li, found that trees and plants emit aromatic compounds called phytoncides, that when inhaled, spurs a response in the body similar to the affects of aromatherapy. Li has shown, through multiple studies, that when people walk through or stay overnight in forests, they often exhibit changes in the blood that are associated with protection against cancer, better immunity, and lower blood pressure. Additional recent studies have also linked nature to symptom relief for health issues such as heart disease, depression, anxiety, attention disorders and technostress.

Phytoncides have been shown to increase natural killer cells (NK), which is a type of white blood cell that supports the immune system and is associated with a lower risk of cancer. NK cells are also thought to have a role in combatting infections and lowering inflammation. Systemic inflammation has been associated with many long-term chronic illnesses including heart disease, cancer, and diabetes.

A simple long walk in a forested park area, for two hours in the morning and the afternoon, was shown in a study to increase the number of NK cells and NK cell activity as well as to increase levels of anti-cancer proteins, and that the effects lasted for at least 7 days afterwards.

Li also found in a study, that infusing people’s hotel room with phytoncides had some of the same anti-cancer-cell effects as those seen amongst the forest walkers.

So, what is the mechanism that triggers these NK cells to increase? University of Illinois Environment and Behavior Researcher Ming Kuo believes the answer lies in nature’s ability to enhance the functioning of the body’s immune system.

One way to understand this relationship between nature, health, and the immune system, Kuo explains, is that exposure to nature switches the body into “rest and digest” mode, which is the opposite of the “fight or flight” mode. When the body is in “fight or flight” mode, it shuts down everything that is immediately nonessential, including the immune system.

“When we feel completely safe, our body devotes resources to long-term investments that lead to good health outcomes–growing, reproducing, and building the immune system,” Kuo said. “When we are in nature in that relaxed state, and our body knows that it’s safe, it invests resources toward the immune system.


Another recent study , conducted in Europe, examined the association between recreational nature contact and self reported health and well being for a period of 7 days. Almost 20,000 participants, weighted to be nationally representative, were asked to do the survey. The results: Compared to no contact with nature during the week, the likelihood of reporting good health or high well being became significantly greater with ≥120mins. Positive associations peaked between 200 to 300 minutes per week with no additional gain. Researchers found that the pattern was consistent, even amongst older adults with long term health issues. The affects were cumulative, it didn’t matter how the 120 mins of contact with nature was achieved, for example benefits were seen with one long exposure and with several shorter visits / exposures per week. The research suggest that additional studies may be the next critical step in developing weekly nature exposure guideline comparable to those for physical activity.

As you’re creating an EPAP (Exercise and Physical Activity Plans) for your clients, perhaps you should also consider time for them to spend in nature as well. Can they do some of their activities in a natural environment? Based on recent studies, including at least 120 minutes of activities involving nature exposure, will help to provide them a better overall health and wellness outcome.


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