Doctor's orders: Take a hike, you'll feel better

Bukit Jambul, Penang

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 While more doctors are looking at using time outside as a medical strategy, park prescription programmes face issues of access. Photo: Unsplash/Jon Flobrant 

 When Annette Coen went for a health check-up last summer in Washington state, she and her doctor discussed concerns around her weight and asthma. Then her doctor offered a novel prescription: regular hikes in the woods.

He gave Coen a one-year pass to Washington's state park system and told her to "go for walks, go camping, do what you need to do," Coen, now 53, told the Thomson Reuters Foundation.

A year on, she said the park prescription was a "great experience" for her and her whole family. "I have lost 13.6 kg since April this year... just being out and about," she said.

With the Covid-19 pandemic highlighting the health benefits of spending more time outdoors, a growing faction of the US medical community is prescribing time outside the same way they would traditional medication.

The idea of writing out park or nature prescriptions has taken hold particularly among pediatricians.

"It all came together" during the pandemic, said Maya Moody, president-elect of the Missouri chapter of the American Academy of Pediatrics (AAP), pointing to spikes in childhood anxiety and pediatric obesity since the coronavirus outbreak started.

With lockdowns keeping children indoors, "we were seeing 30-, 50-, 60-pound weight gains," said Moody, who attends to around 3,000 low-income children in the St. Louis area.

This April, she became one of about a dozen pediatricians across the state who have started offering nature prescriptions.

"When I give a prescription, it's

specific, just like an antibiotic. They use it for this many days, and I say go to this park," she explained. Buy-in has differed with different age groups, Moody noted, with younger children and their parents being more open to the approach but teenagers expressing skepticism.

"Sixteen- and 17-year-olds look at me and say, 'You want me to get off TikTok and get an actual tick in the woods?'" she said.

But Moody said the fact that doctors and health experts are now seriously looking at how something as simple as a walk in the park can help patients is exciting.

A spokesperson for the AAP said the group is forming a committee on the issue of nature prescriptions but declined to offer additional details.

Take a walk

Nature prescriptions are still new, so there is little data on their effectiveness, but one 2018 analysis by researchers from Britain's University of East Anglia did find they "may have substantial benefits".

There has been much more research done on the general benefits of being outdoors - in one example, starting next month, a study supported by the Welsh government will look at the benefits of treating hospital patients outside.

In more than 500 scientific studies in recent years, researchers have linked time spent in nature with decreased anxiety, reduced risk of obesity and even reduced overall mortality, said Maryland-based pediatrician Stacy Beller Stryer.

Stryer is also associate medical director with Park Rx America, an online platform that helps medical professionals write nature prescriptions.

Using its database of thousands of parks and public lands, prescribers can filter by activity, distance from a patient's home and amenities such as playgrounds.

"Once (the patient) decides on where to go, the prescriber talks about what they should do - maybe walk a dog? And how often - maybe every Monday, Wednesday and Friday for 30 minutes?" she said.

Writing out an actual prescription for time in nature gives patients a useful extra push, said Brent A. Bauer, research director of integrative medicine and health at the Mayo Clinic in Minnesota.

"More than half of my patients who receive a 'prescription' for time in nature go ahead and do so successfully," he said.

A census of park prescription programmes last year estimated that there were more than 100 nationwide.

The Pittsburgh Parks Conservancy began a pilot programme in collaboration with the UPMC Children's Hospital of Pittsburgh in 2016, after a pediatric resident was leading patients in a weight management clinic, said Kathryn Hunninen, a senior manager with the conservancy.

"He wanted to encourage patients to get outside but didn't know where to send them," she said.

"This started with an inquiry from him to the parks system and has blossomed from there."

In a 2018 survey, more than 80% of personnel at participating Pittsburgh clinics said they were frequently recommending that patients visit parks.

Last year, Salt Lake County in Utah offered park prescriptions to its employees "to improve or maintain physical and mental health while building sustainable health behaviors," Sarah Kinnison, who oversaw the programme, said in an email.

That first year, 335 employees participated, and the county is running the program again this fall.

Financial stability

While more doctors are looking at using time outside as a medical strategy, park prescription programmes face issues of access.

In low-income neighborhoods, parks are four times smaller and more crowded on average than parks in high-income areas, said a study released last year by the Trust for Public Land, a nonprofit that analysed government data from 14,000 US towns and cities.

It also remains unclear how to keep the programmes financially sustainable. Currently they have to rely on ad hoc funding, often cobbled together from grants, philanthropy or as publicly funded pilot projects.

The costs involved are not particularly high, but they do exist, said Bradford S. Gentry, co-director of the Center for Business and the Environment at Yale University.

They could include the costs of park passes, the salaries of community health workers and park workers to coordinate and lead programmes, and transportation to and from the green space, he said.

"If there are all of these (health) benefits, how do we move from grant funding or public funding to health systems funding?" asked Gentry, who focuses on the intersection of health and land conservation. "I haven't found an answer yet."

The US Department of Health and Human Services did not respond to a request for comment.

Gentry pointed to Oregon, where work is underway to try to address the funding issue by requesting that certain federal rules be waived involving Medicaid, the US government's health care programme for low-income people.

Every five years states have the opportunity to request such a waiver, if they can show it will result in better care and cost no extra money, said Lori Coyner, who was the state's Medicaid director until July and is now senior Medicaid policy adviser at the Oregon Health Authority.

The state's waiver request is due in December, when it plans to ask for more flexibility in how local organisations address health issues.

"We believe there is real opportunity to use some of these Medicaid dollars... to promote spending more time outdoors," Coyner said. - Thomson Reuters Foundation

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Healing through hiking mountains

The arduous Pacific Crest Trails offered the author of The Girl In The Woods the chance to take back control of her life after being raped.

The first time I heard of the Pacific Crest Trail was at the recent George Town Literary Festival, when a friend expressed interest in hiking it. Stretching across mountains running along the western coast of the United States, it is a challenging trail that should be attempted by only the hardiest of hikers.

My own experience with hiking is limited to beginner trails in national parks and forest reserves. Hiking is fun, but I know well enough of its dangers – years ago, another friend of mine had gone hiking and disappeared. The friend at the festival who wanted to hike the Pacific Crest is a man in his 30s. In Girl In The Woods, the hiker, who goes by the name “Wild Child”, is a young woman of 19 and a survivor of rape.

Wild Child grew up as Deborah “Debby” Parker, a sheltered child who lived under the wing of her protective mother and influential, high-achieving brother. On the second night of her stay at college, she was raped.

The emotional and psychological effects of the rape, compounded with the lack of empathy from her college and her family, became the catalyst for her decision to hike the entire Pacific Crest Trail.

For Wild Child, the hike was both a method of escaping a society that made her feel vulnerable and of confronting danger and, through that, regaining her sense of control and trust.

Author: Aspen Matis Publisher : William Morrow/HarperCollins, non-fictionNature and the wilderness is often portrayed as a place of peace and isolation, but any illusion that the wilderness of the Pacific Crest Trail is isolated and peaceful is proven false in Wild Child’s experiences along the trail. The Pacific Crest Trail hiking line is a male-dominated environment, peopled with strange men and women, and offers very little protection from physical or verbal violence stemming from racism, misogyny, or sheer sadism.

Following Wild Child’s journey along the trail brings us to very close intimacy with her personality, her decisions, and her pain. Although survivor accounts and articles on the way rape affects psychology exist in abundance, Girl In The Woods vividly shows how rape shatters one’s sense of safety, trust, and control over one’s body and environment; more importantly, the book allows readers to witness the challenges of regaining that lost sense of security and control.

As we follow her journey, we are also made to confront rape culture – both when it is perpetrated by the people around Wild Child and when we are tempted to criticise her lack of self-preservation. Wild Child exposes herself (at times literally) to strangers and dangers, and readers may find themselves finding fault and blaming her for “tempting rape”. We are made to confront and encouraged to unshackle from our own preconceived, perhaps subconscious, perpetuation of victim blaming and rape culture.

The topic of rape may frighten some readers away from the book, but the harsh desert beauty of the Pacific Crest Trail and Wild Child’s own personal resilience tames its violence, so the experience of reading the book is not unpleasant.

Girl In The Woods is a powerful testament of nature’s healing qualities and an intimate examination of surviving rape.

It is an elegant narrative of loss of innocence, regaining of strength, and finding love and self-acceptance.

It is not merely an account of a survivor but an adventure book, a record of a coming-of-age, and a story of personal growth as the protagonist transforms from the insecure Debby Parker to Wild Child the hiker, before finally emerging as Aspen Matis (the name that she answers to now, and the pseudonym used to pen the book), a fully fledged survivor.

The only arguable weakness of Girl In The Woods is that the description of the landscape along the Pacific Crest Trail is rather sparse.

Perhaps this was omitted because it was unnecessary to the narrative, but I would have appreciated more details on the desert, mountains and forests that were traversed.

I tend to notice the beauty of natural landscapes when I travel, and keenly felt the omission of detailed descriptions on the beautiful American rural landscape.

But this is a minor complaint in an otherwise outstanding memoir.


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Hiking with children is good for the whole family

Hiking as a family has built strong bonds, made beautiful memories and improved health. And everyone has learnt to be more creative in tackling obstacles as they are no longer couch potatoes!

THE day I traded my high heels for hiking shoes, the malls for hills and the stale city air for fresh jungle air, my life was never the same again.

It all began when my dear hubby Adrian Yeong took up hiking. He had been hiking close to six months to improve his health and fitness when I saw the changes in him: he had shed 13 kilos and was much fitter and healthier than before. Finally one day, I agreed to join him.

Wasting no time, he got me my first pair of hiking shoes. I had my first taste of hiking at the Challenger trail in Gasing Hill, Petaling Jaya, on August 1, 2010. Since then, Gasing Hill has become our regular training ground.

Friends who heard of our hiking activities thought we were crazy to hike three times a week and when they learnt that we also brought our younger four children along with us, in their dictionary, we were well...insane. Why bother doing such tiring activities?

Many would not consider hiking with kids, supposedly because: “They will complain!”, “They will cry!”, “They will not want to walk!”

Our children being city kids were no angels either. They were always trying to find excuses to escape from hiking so that they could spend time at home instead, watching television and playing computer games. But as parents, we had the last say and so our hiking journey began...

The writer carrying her youngest son, Joseph, on her back, while climbing Gunung Datuk.

By training our children, who were then one-plus, three, seven and ten years old to hike, all of us eventually got fitter and stronger. Our speed and endurance improved. In a short span of five months, Adrian and I did 50 hikes while our kids went on 30 hikes with us.

We had explored almost all the hills and a few waterfalls in the Klang Valley. After a while, it felt a bit boring hiking the same hills. I dreamt of exploring further but often doubted if we were up to the challenge of hiking more than an hour plus with our young kids.

Little did I know that one day I would get to know a Facebook friend, Michael Mui, and that our feet would soon hit real mountains. Mui got to know of our family hiking activities and invited us to join him to hike Gunung Angsi and Gunung Datuk (both in Negri Sembilan).

In his own words, he described these mountains as “a stroll in the park!” That was our first event with the Freewill Hikers Club, a dynamic hiking group based in Johor led by Captain Richard Yeoh. My husband, being an adventurous guy, took up the idea immediately and the rest is history.

On August 11, 2012, Adrian and I, together with our young hikers, hiked our first two mountains Gunung Angsi and Gunung Datuk, on consecutive days. My two kids Audrey (then aged 12) and Dylan (nine) hiked on their own accompanied by our new friends while I carried Joshua (five) on and off as he happened to be a bit moody in the beginning.

The writer with her husband, Adrian Yeong, and their kids on the peak of Broga Hill, Selangor.

My capable hubby backpacked Lil Joseph (three years old and 12kg in weight) up to the peak of Gunung Angsi and back. Hiking more than an hour with heavier loads than other hikers made it tough.

To make matters worse, wearing the new hiking boots I got him as a surprise, he twisted his ankle during the hike. Despite having applied some ointment over the night, he still had not recovered from the injury and so I volunteered to backpack Lil Joseph up Gunung Datuk the next day.

I remembered assuring my dear hubby that I would hand the little boy over to him should the going get too tough. My hubby agreed to my suggestion. That was my first hike carrying my son up a mountain.

It was my first experience and I found Gunung Datuk to be a steep mountain, with endless roots along the way. Carrying my little boy up weighed me down though I found it quite easy to go on all fours, pulling myself up by tree roots.

Our new friends from Freewill Hikers were very helpful and took care of our two older kids, Audrey and Dylan. While Audrey was slow and steady, Dylan flew up with them and managed to reach the peak in 1 hour 40 minutes; whereas, with my load, we took about 30 minutes more.

It was tiring and our friends kept bluffing us — “You are almost there”, “15 minutes more to the peak”, “Just another 15 minutes more” — in the name of encouragement.

To reach the actual peak of Gunung Datuk, the writer’s family had to clamber up these ladders.

Nevertheless, we made it. At the false peak, I told my husband: “Darling, you take over. I am too tired!”

I handed my little boy over to my hubby to tackle the metal ladder that leads to the actual peak of Gunung Datuk as I was just too exhausted. We had all made it up to Gunung Datuk!

Those were our first two mountains — tough but rewarding. The next few months that followed saw us at Gunung Lambak, Gunung Belumut and Gunung Panti (all three in southern Johor, near Kluang).

Our toughest hike with Lil Jo was Gunung Belumut. Our little boy now weighed 15 kilos and he had not been trained as he was small. He also often pretended to be a 4WD stuck in the mud whilst hiking with his siblings, an idea he got from the multiple off-road trips we had gone for.

I uttered a prayer in the morning, “Dear God, I don’t know how we are going to make it hiking up Belumut but I ask for your help and enablement, in Jesus’ name.”

I came up with a plan. Conserve our energies, get the boy who normally walked only for half an hour to hike as far and as fast as he could. Motivating him, I said, “Jo, you need to look for 10 ant trails and you will get an ice-cream.”

The writer (centre) with her children, husband (right) and Lee Keam Keong of Freewill Hikers at the peak of Gunung Belumut (1,010m) in Kluang, Johor.

So I promised him and we went hunting all the way. He played with twigs, pretending they were rifles and he was soon blasting and shooting away, chasing his brother Joshua and another a new friend, a boy about six, named Rain, who was the grandson of Captain Richard Yeoh of the Freewill Hikers Club.

He played all the way and when he was tired, I gave him some drinks to boost his energy. I also talked, joked and laughed with him in order to distract him from the distance we had to cover. Lo and behold, my four-year-old boy successfully hiked up to the peak in four hours without being carried. It was a miracle indeed. My prayers were answered.

On the way down, Lil Joseph was now tired and had to be carried by his strong daddy. Adrian later shared that it was easier to carry a 15kg bagpack rather than our little boy as he kept swaying to and fro in the baby carrier as he tackled the tough steep terrain, squeezing through tight spots and at times jumping over gullies and large tree roots. After descending for over two hours, his neck and shoulders were stiff.

Nothing worthwhile comes easy, and we’ve had to build up our strength as well as our endurance in hiking. Being positive has made us conquerors. With sufficient training and preparations, we’ve tackled various mountains.

Our conclusion on hiking with kids: it’s not easy and did not happen overnight. But it’s not mission impossible either as kids have new engines and are fast learners.

By clocking the hours and allowing them to master hiking skills, we’ve built up their fitness and confidence. After time, they have become capable hikers.

Hiking together as a family has been rewarding as we’ve built strong bonds and made beautiful memories. We’ve inculcated healthier lifestyles and our children have learnt to tackle obstacles, to never give up and be optimistic.

It has taught them outdoor skills and built their appreciation of nature. It has made them strong, courageous and creative. This is a win-win situation and I strongly encourage families to take up hiking as a regular family activity. Just make a change in your life and that of your family. Bring them out hiking. All you need is a good pair of hiking shoes, determination and motivation.

Go for it folks, don’t be a coach potato!

Backpacks, trekking poles, head lamps, a dry bag, a sleeping bag and a poncho are among the prizes being offered for those who write in about their Star2 Adventure Challenge.

By JESSY PHUAH The Star/Asian News Network

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The life force to Koreans: hiking the fabulous Koreas' mountains

The life force to Koreans: hiking the fabulous Koreas' mountains

More spell-binding Korean landscapes are found beyond Seoul in the Seoraksan mountain range.

Mountain culture and customs are hot-wired into the lives of each Korean. What better way to get under their skin than to hike together with them?

SOUTH Korea lies along a peninsula that is hugely mountainous, with a spinal ridge running for 735 km from the DMZ boundary in the north to the East China Sea down south.

This mountain range has monumental relevance to the people of Korea as it is believed to provide the life force to the nation: its arterial rivers drain seawards, bearing sustenance for the inhabitants living in the lowlands. Many historical events that occurred on these mountains have been documented whilst just as many myths and folklore have been re-told over generations.

For the tourist, hiking the mountains of the Korean peninsula would seem like a natural activity, to immerse in the culture of this dynamic country.

The terrain is not high, the tallest peak being Cheonhwangbong at 1,915m, in Jirisan National Park, at the southern tip of the range. The next highest peak is Daecheongbong, 1,708m in altitude, squatting on Seoraksan National Park diametrically to the north.

The ranges are inter-linked through a series of hiking trails, following the ridge line closely and crisscrossing valleys and rivers. Temples, villages, farms and shelters dot the hills.

Soothing: The scenic mountain ranges of Korea are rich in bio-diversity. The N Seoul Tower is a popular tourist attraction. Go early to avoid the long queues for the cable car.

Such an eco-system has made mountain hiking a national pastime that is likely to overtake taekwando in popularity as a sport. There’s also a whole line of Korean celebrity fashion wear for hikers. Unfortunately, for the tourist, not much promotional information on hiking is available from official tourism literature.

It would take a lifetime to explore the legendary mountains of Korea and we had limited time to spare before our wedding anniversary celebration back in Seoul.

Day trip to Seoraksan

We took a 3-hour bus ride to Sokcho, a tourist town on the north-eastern coast of the Korean peninsula and an entry point into Seoraksan National Park.

The park showcases the Seorak mountain range, and is loved by the locals for its natural beauty and bio-diversity. Hikers come to marvel at the uncanny ruggedness of the “Dinosaur Ridge” and soak up the fables of the mountains’ origins.

There are many trails up picturesque Seoraksan, numerous short ones requiring half-day’s effort and several longer routes that are more than 10km in distance.

A good option for tourists is to hop on the cable car, not far from the Visitor Information Office, and catch a ride up to Gwongeumseong Fortress at a height of about 900 m. This was the option we selected together with a long queue of like-minded tourists. We reached the counter at 10.30am but all tickets were sold out.

Without wasting any more time, we opened the map, picked out what looked like an easy route and headed out to Biseondae Cliff.

It was only 2.3km one-way and took us through a forested area, tracing a path beside a gushing stream. The fresh air and fine drizzle made the pace invigorating.

 Many eateries are found along the trails of the park. Many eateries are found along the trails of the park.

We skirted a pool of crystalline water at the bottom of a huge rock face, which I took to be Biseondae Cliff, and crossed a short bridge whereupon the trail ended abruptly at a locked gate. Beyond laid wilderness that could be experienced only with a permit from the ranger’s office. We clambered up a rocky slope and joined some hikers on a break.

“Where are you from?” queried the ajeossi (middle-aged man). I told him we were from Malaysia, as I shared a chocolate bar with his 10-year old son. I remarked that the scenery here had a mystical and mysterious air.

He nodded, “Ah, as mysterious as the disappearance of your airplane”. I guess he was referring to MH370. We both nodded and sighed. They wished us a good trip and moved on. We stayed a while to admire the view of the distant peaks framed in by the hillside trees. On our way down we stopped by a tea house. Bibimbap downed with a hot bowl of miso soup tasted a lot better here than in the lowlands.

We dozed on the bus back to Seoul. That chilly night in Seoul, we captured our last “high” at the N Seoul Tower, atop Namsan. Standing 236m tall, the tower accords a night scene of the city.

We were feeling pretty tired, but fulfilled. So, I suggested we take the cable car up instead of climbing the stairs. I didn’t hear any objections.

Hiking near Seoul

THE view from Bugaksan might have been more panoramic if not for the faint haze hanging over the “ancient quarters” of Seoul that April morning.

To the south-west, we could just make out the hillock of Inwangsan and the colourful string of hikers inching up its summit trail, while afar north, the rocky peaks of Bukhansan glared in the sun.

Seoul, the 600-year old capital city of South Korea, is encircled by a fortress wall that links four surrounding hills, Bugaksan, Ingwangsan, Namsan and Naksan. Of these, Bugaksan is the tallest at 342m and is located in the neighbourhood of Samcheong-dong, majestically overlooking Cheongwadae (Blue House), the President’s official residence and office.

We had taken the northern route of the fortress wall, entering through Hyehwamun Gate, muddling through a residential area up a steep incline, and, with some orienteering instinct, located the path that followed the ancient stone wall, leading us up a hill of cherry trees.

Due to its proximity with the Blue House, this section of the trail requires foreigners (who are called “aliens” in official documents here) to sign in at Malbawi Station with their passports (or “Alien Registration Card”) and sign-out at Changuimun Station.

Guards are posted at intervals within eye-shot of hikers. One young cadet approached me to view my camera photos and requested some to be deleted. The pictures were mainly landscape shots, mostly bird’s eye views of the city, which didn’t look pretty anyway, back-lit by the morning sun.

It was a quarter past eleven when we arrived at the top of Bugaksan. The guard, more militia than forest ranger, had been monitoring the growing crowd at the plot, and sternly ushered any lingerers to move on. No picnic here, literally, just pictures.

The Koreans are actually a helpful and friendly lot. On the way up we had approached more than a few ajumma (“aunty”) for directions and they were profuse with their assistance; expressive hand gestures and finger pointing, and a continuous barrage of verbal directions, delivered in Korean.

We nodded our gamsa-hamnida (“thank you”) and they gleefully let us off. Still clueless, we were comforted to know that at least we were in hospitable country.

The descent to Changuimun was unexpectedly steep, and the high steps slowed the pace somewhat. Overall, the hike was enjoyable, requiring just three hours, which left us plenty of time to slip back downtown for another helping of sumptuous Korean spicy soup.

By Lee Meng Lai The Star/Asia News Network

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