Managing Arthritis

What is forest therapy?

a path in a forest with a bright light in the back

Picture sunlight filtering through leaves, the feel of springy moss, colourful wildflowers or mushrooms, birds calling and the wind rustling: that’s what comes to mind for many of us when we think of nature. For many, spending time in nature is relaxing and restorative, whether it’s something we’ve always done or have recently rediscovered.

The practice of forest therapy—mindfully spending time outdoors, especially in a wooded setting—is something that is gaining increased attention recently, for both its physical and mental health benefits. Some Canadian health care providers have even begun writing “nature prescriptions,” designed to get patients spending more time in green spaces. Read on if you’re interested in learning more.

The origins of forest therapy

Forest therapy first gained attention in North America about 40 years ago, when Japan introduced the concept of shirin-yoku (which translates to “forest bathing”) for stressed-out citizens. However, the idea of a connected relationship with nature is something that Indigenous peoples around the world have practiced for untold years, points out Carolynne Crawley, a certified forest therapy guide in Toronto who has Mi’kmaw ancestry. “The practice of forest therapy is not a new practice…These are new words, to describe an ancient practice of being in relationship with all the lands, all the waters and all the beings.”

Forest therapy and health effects

The health effects of forest therapy have been studied since the 1980s, and while there is currently limited data on the benefits of forest therapy for arthritis specifically,  the results are intriguing nevertheless. A 2017 article in the International Journal of Environmental Research and Public Health provides a summary review of 64 research studies on the physiological and psychological effects of forest bathing.  The article reports that “In general, from a physiological perspective, significant empirical research findings point to a reduction in human heart rate and blood pressure and an increase in relaxation for participants exposed to natural green spaces.” A separate review of 28 studies found that “the studies demonstrated that forest therapy is effective in improving depression, particularly for adults with health problems,” although more rigorous study and methodologies are needed. These studies included both self-reporting of depression as well as physiological measures like heart rate and levels of the stress hormone cortisol.  

Another study published in 2016 found that people with chronic, widespread pain who participated in a forest therapy group had significant decreases in self-reported pain and depression, better quality of life, and measurable differences in heart rate and immune system cell activity, compared to a control group who did not do forest therapy.

Why might forest therapy have these effects? The authors of a 2020 study in Environmental Research point to possible factors like exposure to sunlight and compounds released by plants, as well as the relaxing effect of natural sights and sounds, and simply engaging in physical activity and socializing.

What happens in forest therapy?

A forest therapy walk is different from a simple walk in the woods, in that a certified forest therapy guide leads the walk, with stops along the way and suggestions for mindfully engaging the senses. There are online directories for certified forest therapy guides or you may find events listed for your local conservation area, or municipal, provincial or national park. In response to pandemic restrictions, some forest therapy guides have begun offering downloadable prompts instead of guided walks or can even guide you over the phone or computer as you look out the window or sit in your yard or on a balcony.

Each certified forest therapy guide will have a slightly different approach. For Crawley, it begins with advising people to dress for the weather, to bring water and something to sit on (if you don’t want to sit directly on the ground) and letting them know they will be moving slowly over a fairly short distance for two to three hours. At their meeting place, she briefly provides context about the natural setting they are in and the science behind forest therapy. Then, the walk begins. 

She starts by giving people verbal cues to slow down the rhythm of their breath and tune into their senses, followed by slow walking or slow movements to get the mind and body to slow down as well. “I guide them through their senses [and] kind of do a sensory experience, to get them in the present moment. And then I lead a series of invitations. And they're called invitations, because they mean just that: they are suggestions for people to experience and explore in whatever way that feels comfortable for them. So, you know, people might choose to do that, some people might not, it's whatever feels right for the individual. And there's no right or wrong way of doing it,” says Crawley. After 15 or 20 minutes, she asks the group to gather again and share those experiences if they wish, and then they move to a different area of the natural setting. “All the invitations are building on top of each other,” she explains. “It creates that supportive experience for them to be able to be fully in the present moment.” At the end of the walk, the group meets again for a conversation over tea crafted from local plants.

If you’ve had enough screen time, consider some green time! There are many healthful ways to spend time outdoors to refresh both body and mind.