Nature Prescriptions: What Doctors Are Now Recommending

In 2017, the Shetland Islands NHS Board published something unusual for a health service document: a pad of prescription forms on which doctors could write "visit the beach" or "spend time in nature" as a formal clinical recommendation, complete with a suggested dose and notes on local natural environments.

The Shetland Nature Prescriptions project was ahead of most health systems, but it was not alone. By the early 2020s, nature prescription programmes had launched in Canada, the US, Japan, South Korea, Australia, and across Europe. The concept was attracting serious attention from public health researchers and health system administrators: if time in nature demonstrably reduces cortisol, blood pressure, anxiety, and depression symptoms, then recommending it systematically — as a first-line intervention before medication, or alongside it — makes both clinical and economic sense.

In the US, the Park Rx America programme has trained over 1,000 healthcare providers to write formal park prescriptions, often specifying particular parks, trails, or green spaces near the patient's home. In Canada, the PaRx programme — launched in 2021 with backing from the British Columbia Parks Foundation — has enrolled thousands of patients. In Japan, where shinrin-yoku has been part of the national health strategy since the 1980s, forest therapy is prescribed for stress-related illness and covered in some health plans.

This is not alternative medicine. It's evidence-based practice catching up to the research — and it represents a significant shift in how clinicians are being trained to think about the role of environment in health.

Nature prescription programmes vary considerably in structure, but the best-documented ones share several features that the evidence supports.

The Park Rx model In the US, Park Rx prescriptions are written on dedicated prescription forms that specify: • A recommended dose in minutes per week (typically 20–30 minutes daily or 120+ minutes weekly, matching the White et al. 2019 thresholds) • A specific local park or green space recommended for the patient's situation • An activity suggestion (walking, sitting, observing) matched to the patient's physical condition • A follow-up check-in at the next appointment

Research on the Park Rx programme has found that patients who receive formal park prescriptions show increased green space visitation, higher physical activity levels, and in some studies, measurable improvements in blood pressure and mental health measures compared to standard care.

The PaRx evidence A 2023 evaluation of Canada's PaRx programme found that among participants who completed follow-up surveys, 93% reported spending more time in nature after receiving a prescription, and the majority reported improved mood and reduced stress. While self-reported outcomes have limitations, the engagement effects — getting people who weren't visiting parks to visit them — are robust.

Japan's forest therapy Japan's Ministry of Agriculture, Forestry and Fisheries certified 62 "Forest Therapy Bases" by 2020 — specific forests that had been assessed for their physiological benefits and equipped with guided trails. Forest therapists lead sessions specifically structured to maximise phytoncide exposure and parasympathetic activation. Controlled trials conducted at these sites have produced some of the best evidence in the field for reductions in cortisol, blood pressure, and NK cell activity.

Most GPs and internists are not yet trained in nature prescription — but the conversation is easier to initiate than most patients assume, and the research gives you a foundation to stand on.

When to raise it: Nature prescription is most relevant for: • Stress, anxiety, and mild-to-moderate depression — where dose-response evidence is strongest • Cardiovascular risk factors: elevated blood pressure, mild hypertension, metabolic syndrome • Chronic fatigue and immune-related conditions (the NK cell and inflammation data) • ADHD and attention difficulties, particularly in children

How to frame the conversation: You don't need your doctor to be familiar with nature prescription research — you need to raise the topic and provide the opening. A simple framing: "I've been reading about nature exposure and stress reduction. Is that something I could try alongside my current management?" Most clinicians will engage positively with a patient who is motivated to take a non-pharmacological approach to a chronic condition.

What to ask for specifically: • A note in your record that nature exposure is part of your management plan (this makes it easier to track at follow-up) • A referral to a physiotherapist, health coach, or occupational therapist who may be more familiar with nature-based prescriptions • Direction to local Park Rx or nature prescription programmes in your area — many hospitals and health systems now have affiliated programmes

The evidence you can bring: The White et al. 2019 study in Scientific Reports (120 minutes per week and good health outcomes) and the Park et al. 2010 study of 24 Japanese forests are accessible, peer-reviewed papers that any clinician can read.

The clinical value of nature prescription is enhanced when patients can bring objective data to appointments rather than subjective impressions.

What your nature tracker data can show a clinician: • Whether you're consistently meeting the 120-minute weekly threshold • Seasonal patterns — whether your nature exposure drops in winter and whether your symptoms correlate • Changes in exposure pattern before and after clinical events (a flare-up, a medication change) • Comparison of weeks with higher vs. lower nature exposure alongside any symptom diary you keep

The symptom-nature correlation Many people who track nature exposure alongside a simple mood or symptom diary find correlations they weren't consciously aware of — weeks with more outdoor time coinciding with better sleep, lower anxiety scores, or better energy. These patterns, even anecdotally, can support a clinical conversation about nature exposure as a therapeutic variable.

Setting your baseline Before starting a formal nature prescription programme or raising nature therapy with your doctor, track your current baseline for four weeks using PollutionProfile's Nature Exposure tracker. Most people discover they're well below the evidence-based thresholds — and the gap between current and recommended is the opportunity. A clinician is far more likely to take a nature prescription seriously when a patient arrives with four weeks of data showing a consistent pattern and a specific goal.