The Alternative NHS: ‘Natural Health Service’ by Dr Mark Christie, Sports Lecturer, University of Cumbria

Submitted by Dr Mark Christie 15th Aug 2022

Being in intermittent lockdown over the  

past couple of years has given us a  

chance to reflect more deeply on our own  

personal circumstances and the things  

that matter most, such as family, and set  

ourselves new purposeful, realistic goals.  

For some, working from home, and not 

always having the drudgery of the daily  

commute to work by car or train, was an  

added bonus. The other upside to this has  

been the potential for a re-awakening of  

our connection with nature – taking  

walks in green spaces for example - 

indeed, nature itself has been noticed  

reclaiming lost ground, with many people citing more frequent encounters with  hedgehogs, stoats, field mice, squirrels and deer, and a renewed interest in birdwatching.  This response to nature – and an affinity for nature – has, for some people, always been  an important part of their lives, but for many others it had previously been somewhat  suppressed by man-made influences that continue to encroach on our everyday existence  – from the subtle pressure of social media to the fact we spent so much time of our lives  indoors. 

Living near Kendal, in such close proximity to the Lake District National Park, provides  me (and my family) with a perfect context for engaging in numerous outdoor activities. I  have always utilised to maximum effect the local footpaths, parks, cycle trails and wild  swimming spots on my doorstep. As a longstanding sport and fitness proponent, I have  consistently been a passionate advocate of green exercise - defined as different modes of  physical exercise in the presence of nature (including running, cycling, gardening,  conservation work, archery, horse riding, orienteering, and hiking) and the associated  label of ‘blue exercise’ (including kayaking, paddleboarding and wild swimming) (Pretty  et al 2007). 

My ‘keep fit’ classes over the years have included outdoor boot camps, personal training sessions in parks or countryside, and ‘walk and tone’ groups using footpath trails. Not  

only was the act of exercising of value to those participating in these varied outdoor  physical activity pursuits, but also the utilisation of natural assets was a major factor in  their enjoyment. This was further manifested in the social interactions generated amongst  exercisers, with comments often including how participants felt uplifted not only by the  activities per se, but by their surroundings, including the sights and sounds that  accompany these – imagine the buzz of seeing buzzards flying over when doing outdoor  circuits in a park! These effects have been well documented in both quantitative and  qualitative research studies in recent years, that show how exercising in nature can have  beneficial impacts upon both physiological and psychological markers, including lowered blood pressure, stress reduction and improved mood states - and can even be as effective  as consuming Prozac for some people! And you don’t necessarily have to be active  (although stronger effects if you are for your health of course) - even simply looking at,  or being in nature in a more passive sense, has been shown to facilitate lowered stress  levels and promote restoration, as posited by Stress Reduction Theory (Ulrich et al, 1991)  and Attention Restoration Theory (Kaplan and Kaplan 1989). Whether active or passive,  connecting with nature can make us more resilient when we re-engage with sources of 

stress in our lives, such as workload, family responsibilities and study (Wood et al, 2016). 

My interest in the power of nature – akin to a Natural Health Service – has extended to  researching the benefits that accrue to people as part of a PhD by Published Works, where  I have focused upon three specific green exercise modes: gardening, horticultural and  conservation activities. Using interviews whilst people are actively engaged in green  exercise, known as ‘reflect aloud’, as well as use of photographs and reflective diaries, I  have researched the experiences of varied groups of people, including older adults; people  presenting with long-term mental health conditions; NHS medium secure unit service  users presenting with personality disorder, learning disability, and offending behaviour; and employees in a HE institution. Insight into the mechanisms and processes  underpinning health benefits can be provided with some participant responses from the  research: 

“Digging and stuff, getting the stress out of you, and you come back in and you have  released all the stress.” (NHS Study participant) 

“…whatever you do here, whether it be fruit picking or weeding or dry-stone walling…at the end of the day you look and you can say, ‘yeah I did that’ and so it’s a  nice thing to take home with me” (Woodlands Mental Health Study participant) 

“It’s a natural thing. It’s like if I go away somewhere one day, somewhere nice, a nice  environment, and it just makes you feel good…And coming into the park, it does the  same thing. Being in a place with trees, plants, landscaping—It just makes you feel  good” (Conservation-themed Greenfingers Project participant) 

“It (gardening) gives you time to switch off, like you’ve got a lot on your mind and I  can come here and it’s like you don’t think about it!” (Employee Study participant) 

My more recent research with young people excluded from education, using therapeutic  agriculture and therapeutic horticulture at schools and care farms in the North of  England, including Cumbria, has demonstrated similar impacts, helping young people find a safe space to discuss their worries and develop skills that can help them on a path 

to a better, more inclusive future. Connecting with nature was an essential component in  their journey. 

However we categorise engagement with the natural world, researchers and proponents  of such engagement cite the evidence that strongly associates such contact with positive  contributions to health and wellbeing - as well as nature’s potential to inoculate against  

future stressful episodes, restore attention for the busy lives we lead in a fast-paced  technologically driven world, and provide us with resilience, and the ability to  effectively recover from pre-existing conditions and problems (Loureiro & Veloso,  2017). Even interaction with plants indoors can prove helpful from a wellbeing  perspective, although the dividends are considered to be much higher with more natural  outdoor settings (Grinde and Patil, 2009). Green (and blue) spaces offer special  properties that enable such outcomes to occur, at an emotional, spiritual, physical, and  psychological level, as opposed to urban life, where there can be a profound disconnect  and separation of people from nature, which can be associated with higher stress levels  and reduction in health status (Barton et al, 2009).  

Thus, embracing the outdoors – in whatever way you choose, from gardening to hill 

treks and lots more - can clearly have a positive impact on our lives. So, the message  from the research and my own experiences is clear: the great outdoors is a powerful  antidote to the pressures of our everyday existence, and is a natural thing to do – it’s an  innate calling. 

Mark’s research can be found here: 

Christie, M. Hulse, L. & Miller, P.K. (2020). Time for a (Gardening) Break: Impacts of a  Green Exercise Initiative for Staff Health and Wellbeing in a Corporate Environment.  Journal of Therapeutic Horticulture, 30 (1), 1-24. American Horticultural Therapy  Association (AHTA). 

Christie, M., Cole, F. & Miller, P.K. (2020). A Piloted Think Aloud Method within an  Investigation of the Impacts of a Therapeutic Green Exercise Project for People Recovering  from Mental Ill-Health: Reflections on Ethnographic Utility. Journal of Therapeutic  Horticulture, 30 (1), 36-55. American Horticultural Therapy Association (AHTA). 

Christie, M., Miller, P. K., & Dewhurst, S. (2015). Green Exercise and Cardiovascular  Health: Quantitative Evidence from a Community Conservation Intervention in the UK.  European Scientific Journal, 11, 343-356.  

Christie, M., Thomson, M., Cole, F. & Miller, P. K. (2016a). Personality Disorder and  Intellectual Disability: The Impacts of Horticultural Therapy within a Medium-Secure Unit.  Journal of Therapeutic Horticulture, 26 (1), 3-17. American Horticultural Therapy  Association (AHTA).

Christie, M. & Cole, F. (2016b). The Impact of Green Exercise on Volunteers' Mental Health  and Wellbeing-Findings from a Community Project in a Woodland Setting. Journal of  Therapeutic Horticulture, 26 (2), 16-32. American Horticultural Therapy Association  (AHTA). 

Christie, M. (2017). Benefit Nature, Benefit Self - and Others: Older Adults and their  Volunteer Experiences of Engagement in a Conservation Themed Urban Park. Journal of  Therapeutic Horticulture, 27 (2), 19-38. American Horticultural Therapy Association  (AHTA). 

Mark is also currently researching open water swimmers’ experiences and has recently  completed a co-authored paper investigating how therapeutic agriculture and therapeutic  horticulture can assist young people at risk of exclusion from education (and wider society).