Sunshine, Forests, and Fresh Air
By Theresa Curry
John La Puma, MD, a physician, chef, and farmer, tells the story of Sarah, a woman who came to him feeling trapped and exhausted by her role as her mother’s care partner. La Puma, author of The Indoor Epidemic, shared the story during an interview with Joe and Terry Graedon, authors and longtime hosts of the nationally syndicated radio program The People’s Pharmacy.
Sarah had little time and few resources, but she followed La Puma’s advice and began sitting outside, starting with as little as five minutes each day. The small investment in time in the outdoors had surprising results. Her blood pressure dropped, her heart rate slowed, she was better able to focus, and she simply began to feel better. Eventually, as she felt more control over her own life, she even managed to find another caregiver to provide occasional respite for her.
The results were not surprising to La Puma, a leading advocate of Outdoor Rx, the evidence-based response to the indoor epidemic. He notes that the world we live in now has drastically changed our connection with nature. Americans now spend an estimated 93% of their lives indoors. This shift has changed our circadian rhythms and exposure to natural light, narrowed our focus to progressively smaller screens, and caused problems with sleep, mood, metabolic health, and immune function. He argues that clinicians should suggest time outdoors as a legitimate prescription.
La Puma’s advice helped Sarah, but it also touches on truths many care partners learn the hard way. Popular culture often promotes self-care as spa visits, massages, manicures, and shopping. Those experiences can certainly be enjoyable, but research suggests that advice to simply “’take a break” is not enough. Care partners need rituals and habits that help them recover from stress every day.
In addition to restorative time in nature, care partners benefit from simple everyday habits like coffee with a friend, gardening, reading, meditation, artwork, writing, or any activity that previously brought meaning and perspective. The dilemma, of course, is finding time for this when you are responsible for someone who requires constant care.
One approach is to build protected time for care partners into the initial care plan, giving it the same priority as physician appointments, therapy, and medication. Researchers describe one helpful framework as “dyadic coping,” a concept from health psychology.
Dyadic coping views illness as a challenge the relationship faces together. Partners continually adapt, communicate, divide responsibilities, and support one another emotionally while planning for both the patient’s and the care partner’s needs.
A small qualitative study of people living with IBM supports this notion, noting that couples who adapt together appear to maintain better quality of life and stronger relationships despite progressive disability.
Besides the important boost that making time for nature provides, there are less tangible spiritual and philosophical benefits, writes Barry J. Jacobs, PsyD. He’s a clinical psychologist who has written extensively about family caregiving. In an article for AARP, he describes how nature can not only affect a care partner’s mood but also be a reminder of the part we all play in the vastness of the universe.
When things are especially difficult, he says, “For some family caregivers, greater awareness of nature leads to a deeper personal connection with the larger living world that surrounds us.”
In his experience, that connection with the rhythm of life outside the day-to-day restrictions of providing care can be profound: “Caregiving, too, doesn’t seem so overwhelming when caregivers see their challenging work as a vital piece of the living and striving and even beauty of this natural world.”
