The importance of getting outside

Going outside makes us feel much better, relieves stresses of everyday living and is a valuable source of vitamin D.

We take it for granted that we can go outside when we want to, enjoying fresh air, sunlight, plants and trees – and it generally makes us feel much better, relieving stresses of everyday living. Yet people in hospital, people in care homes and especially those with dementia are all too often not able to do this. It seems that the benefits of being able to go outside need to be robustly justified for anyone to take them seriously and provide suitable outdoor space.

There is good evidence that being outside is essential for our physical and mental health

Vitamin D is vital for building strong bones and muscles, and its deficiency is most commonly associated with rickets . It is also associated with an increased risk of malignancies as well as several chronic inflammatory and autoimmune diseases. Its deficiency is due mainly to lack of exposure to sunshine. Daylight too is important and is equally effective as sunlight in regulating our body clock and helping us sleep at night.

Getting outside also allows us to exercise in fresh air at the same time as benefitting from sunshine and daylight – and here again, research has shown that the health of people with dementia who spent as little as 10 to 15 minutes of activity a day outside improved significantly . Walks outside, ‘green’ walks, reduce stress levels and increase people’s self esteem, allowing for activity and sociability as well as contact with nature – whereas a walk in a shopping mall may show no improvement in mood at all! 

Of even greater significance for people with dementia, evidence has indicated that keeping the brain exercised and active contributes towards preventing or lessening cognitive decline. Higher levels of aerobic fitness are associated with greater hippocampal volumes in elderly humans and larger hippocampal volumes translate to better spatial memory function . Studies have shown that planned walking three times a week for people with Alzheimer’s disease resulted in significant benefits in their ability to communicate . In addition, being in bright light has a modest benefit in improving one’s cognitive and non-cognitive symptoms of dementia .

Many people in the northern hemisphere suffer from Seasonal Affective Disorder (SAD), which is linked to lack of bright sunlight during the winter months. Sue Pavlovich of the Seasonal Affective Disorder Association (UK) notes that we should:

1. Keep active: 
Research has shown that a daily one-hour walk, in the middle of the day, could be as helpful as light treatment for coping with the winter blues.

2. Get outside: Go outdoors in natural daylight as much as possible, especially at midday and on bright days.

There are so many things too that we can do outside – active and messy activities such as potting, planting, digging, pruning, harvesting produce and looking after animals (chickens, rabbits). There is such satisfaction in seeing things grow, through our own efforts.

And for those who are less active – just watching and enjoying the activity of others and the daily changes of light, shade, sun and clouds, growth of plants, wildlife and so on is just as beneficial.  Eating outside, reading a newspaper (the light is so much brighter outside for old eyes to see well), enjoying a cup of tea and chatting or being on one's own are all so very life-affirming – yet cost little or nothing. All that needs to be done is to create a safe, secure garden with seats to sit on and things to do – and an easy and visible way out to the garden and back in again. 

In short, there is no better place to be on a nice day, than outside – and it is good for us all – and especially for people with dementia for whom so many choices in life can no longer be made.

References

Holick, F.H. (2007) Vitamin D deficiency New England Journal of Medicine 2007;357:266-81.

Galbraith, J. & Westphal, J. (2003) Therapeutic garden design: Martin Luther Alzheimer Garden [Juried abstract and presentation]. Charleston, SC: Proceedings of the Council of Educators in Landscape Architecture.

Mind (2007) Ecotherapy: the green agenda for mental health London: Mind.

Erickson, K.I. et al. (2009) Aerobic fitness is associated with hippocampal volume in elderly humans Hippocampus 19(10) 1030–1039. 

Friedman, R. & Tappen, R.M. (1991) The effect of planned walking on communication in Alzheimer’s disease Journal of the American Geriatrics Society 39(7) 650–654.

Riemersma-van der Lek, R.F.et al. (2008) Effect of bright light and melatonin on cognitive and noncognitive functioning elderly residents of group care facilities: a randomized controlled trial Journal of the American Medical Association 299(22) 2642-2655.