• Lowering stress and negative emotions: Studies examining stress and affective states show that just 20 minutes of walking in natural environments can significantly lower cortisol levels (a stress hormone) by an average of 21.3% compared to walking in urban environments. In particular, spending time in forests is associated with short-term improvements in psychological states and reductions in stress levels.
• Green spaces reduce symptoms for anxiety and depression: Research by Bratman and colleagues (2015) demonstrated that individuals who walked in natural environments reported lower levels of rumination and negative self-focused thinking (patterns of thought commonly associated with depression), compared to those who walked in an urban environment.
• Improving thinking and attention: Taylor and Kuo (2009) found that children with ADHD showed improved concentration after spending time in parks compared to urban environments, without the side effects common to pharmaceuticals. Even brief nature exposure (having plants in offices) appears to enhance attention, working memory, and executive function. Further evidence suggests that nature exposure not only leads to improved cognitive performance, but also more positive reactions by participants in an experiment.
• Green spaces improve sleep, with research showing that people living in greener neighbourhoods have better sleep duration, though the mechanisms and population-specific effects continue to be investigated.
• Nature prescriptions are grounded in theory: such as the Biophilia Hypothesis, Attention Restoration Theory, and Stress Reduction Theory, which help explain why natural environments provide mental health benefits beyond simple relaxation
• Physical health benefits: Regular nature exposure can improve cardiovascular health through lower blood pressure and reduced risk of cardiovascular disease. One study has shown that spending a few days in forested areas can increase production of natural killer cells for up to 30 days – critical for defense against viruses and tumors. There is also ongoing research on the links between green spaces and metabolic function.

Assessment (Are nature prescriptions right for you?): Healthcare providers might consider a patient’s physical limitations affecting outdoor mobility, phobias or fears of outdoor environments, the safety of accessible natural spaces, the patient’s willingness to participate, the availability of accountability partners, the patient’s schedule, and the patient’s proximity to nature. Formal assessment tools include the Connectedness to Nature Scale and Nature Relatedness Scale.

Sample screening questions:

• “Do you have safe access to nature areas?”
• “How much time did you spend in nature last week?”
• “How often did you visit natural spaces last year?”
• “What activities do you enjoy outdoors?”
• “What’s the size/quality of accessible natural areas?”

Dosing recommendations:

• Minimum effective dose: 120 minutes per week
• Optimal dose: 200–300 minutes weekly
• Session length: At least 20–30 minutes for stress reduction benefits
• Enhanced benefits: Combine with physical exercise

Sample nature prescription activities: Forest bathing (shinrin-yoku) – mindful forest immersion; Wilderness therapy; Exercise in green settings; Therapeutic horticulture; Nature meditation; Water-based “blue mind” therapies; Stargazing; Taking part in a community garden; Virtual nature therapies (for limited access).

Support: Technology can support nature prescription adherence. Applications like NatureDose, NatureTime, AllTrails, and iNaturalist help patients track their nature time, find appropriate locations, and enhance their engagement with natural environments. Resources like Park Rx (US), PaRx (Canada), and Walk with a Doc provide structural support for nature prescriptions through programs that directly facilitate participants’ access to nature.

Safety considerations: Extreme weather, Wildlife encounters; Physical injuries from terrain; Allergic reactions; Phobias requiring graduated exposure. Some indoor alternatives include:

• Visual: Nature scenes, window views, virtual reality
• Auditory: Birdsong or water recordings
• Olfactory: Essential oils (pine, cedar, spruce)
• Environmental: Indoor plants, living walls, nature imagery

Example prescription: In practice, a nature prescription might look like this: “30-minute brisk morning walk in a park or natural area without sunglasses, 4 times weekly. This will provide cardiovascular exercise, exposure to healing benefits of nature, and improve sleep through both exercise and morning light exposure. Try to include a mindful minute such as noticing the beauty in a single leaf or practicing the 5-4-3-2-1 grounding technique.”

This prescription combines several evidence-based elements: the minimum effective duration (30 minutes), frequency to achieve weekly targets, morning light exposure to support circadian regulation, cardiovascular exercise, and a mindfulness component to enhance psychological benefits.

Beyond physical proximity to green spaces, research shows that perceived and experienced racism, cultural exclusion, and feelings of not belonging deter racialized communities from engaging with natural environments. Economic constraints, including transport costs, lack of appropriate gear, and paid park access, further limit participation. These barriers are compounded by a lack of culturally-relevant programming and underrepresentation of racialized individuals in promotional materials and staff roles within green spaces.

In addition to low-income communities and people of color, specific communities or populations might face more barriers, such as people with a disability, older adults, Indigenous communities, refugees, or children and youth, who may be dependent on adults for transportation to natural environments.

While the equity challenges outlined above are substantial, several nature prescription programs have emerged that begin to address both structural and interpersonal barriers to nature access. They offer insights into how healthcare systems can work toward more inclusive access to nature-based interventions.

ParkRx America:

Founded by pediatrician Dr. Robert Zarr in 2017, this US-based initiatives enables healthcare providers to prescribe nature through a digital platform. ParkRx America facilitates tailored outdoor prescriptions and tracks usage across local parks. A study is currently underway to test the effectiveness of park prescriptions to children compared to usual care.

PaRx Canada:

This nationwide program has engaged over 13,000 healthcare professionals across multiple Canadian provinces since its launch in 2020. Developed by the BC Parks Foundation, PaRx is Canada’s first national nature prescription initiative, providing clinicians with practical tools to prescribe nature as part of patient care. In collaboration with Parks Canada, the program enables health professionals registered with PaRx to prescribe 1 free Parks Canada Discovery Pass per month to eligible patients, reducing financial barriers and encouraging regular engagement with natural spaces.

It is important that these programs recognize existing land-based healing practices by Indigenous people and prioritize our relationship to nature (what is sometimes called “relationality“) to ensure culturally-relevant nature-based programs.

Scotland’s Nature Prescriptions:

In Scotland, “RSPB Nature Prescriptions” is an initiative that encourages patients to engage with nature to improve mental and physical wellbeing. It began as a partnership between the Royal Society for the Protection of Birds (RSPB) and NHS Shetland (National Health Service, the United Kingdom’s publicly funded healthcare system) to “link” patients with personalized opportunities to spend time with nature. An evaluation of the Edinburgh Pilot reported that 74% of patients benefited from their nature prescription, and 91% of healthcare professionals intended to continue offering RSPB Nature Prescriptions.

1. Integrate into medical practice: Incorporate nature prescriptions into curricula, training and practice guidelines.
2. Foster community partnerships: Collaborate with local parks, conservation groups, and Indigenous organizations to enhance program reach and relevance. For example healthcare providers can collaborate accredited nature therapists or community gardeners, or other professionals experienced in facilitating or guiding nature experiences.
3. Promote equity and accessibility: Provide transportation, equipment and clothing, and other supports to reduce barriers for marginalized communities, ensuring that nature prescriptions are available to all who could benefit.
4. Address climate challenges: Prioritize reforestation, pollution reduction, and sustainable urban planning to preserve the therapeutic potential of natural spaces for future generations. For example, local councils and state governments may increase the number of parks, support the greening of communities and active transport, and support community gardens.
5. Encourage research: Support cross-disciplinary studies to strengthen the evidence base and tailor interventions for diverse populations with varying needs and access limitations.

Prescribing Nature: A Clinician’s Guide to Ecotherapy by Patricia H. Hasbach, published by Norton Professional Books (forthcoming).

Nature Therapy, edited by Yonatan Kaplan and Petros Levounis, published by American Psychiatric Association Publishing in 2024.

Do people who experience more nature act more to protect it? A meta-analysis, published by the Children & Nature Network.

Nature Prescriptions: connecting to nature to boost health and wellbeing, published on November 5, 2024 by The Royal Society for the Protection of Birds (RSPB).

• Park Rx America, https://parkrxamerica.org/
• PaRx (Canada), https://www.parkprescriptions.ca/
• RSPB Nature Prescriptions (Scotland), https://www.rspb.org.uk/about-us/annual-report/nature-boosts-health-and-wellbeing

Tell us about nature prescriptions in your country!

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Published: June 30, 2025

Author: Alia Badawi (she/her/hers), MD Candidate
George Washington University School of Medicine, Class of 2025
GWID: G21669894
Climate Smart Healthcare Co-chair, Medical Students for a Sustainable Future

Editor: Colleen Rollins, PhD