Why Spending Time in Nature Is Important When You Have Rheumatoid Arthritis

A growing body of evidence shows that spending time in nature has many mental and physical benefits. But getting out into nature can feel daunting if rheumatoid arthritis (RA) has affected your mobility or energy levels.

RA is an autoimmune disease in which the immune system attacks the joints and soft tissues in your body. That inflammation is what can make RA so painful, but it’s also one reason that getting outside could possibly help.

“Spending time in nature can help people with rheumatoid arthritis by reducing stress, which in turn reduces inflammation and pain,” says Trevor Petrie, OTR/L, CHT, an occupational therapist and certified hand therapist who works with people with rheumatoid arthritis in the Seattle area.

Benefits of Spending Time in Nature

Imagine the peace you feel when walking through a forest listening to the rustle of leaves. Or the joy you experience when dipping your toes into a cool lake. These aren’t just coincidences. Research shows that there are numerous health and well-being benefits to spending time in nature, whether or not a person has RA. These include:

• Reduced Stress One of the top benefits of time spent in nature is lowered stress. Research shows that spending time in nature can reduce self-reported stress and anxiety as well as physiological measures of stress like cortisol, blood pressure, and heart rate variability.

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• Improved Mental Health Having RA can contribute to depression, low self-esteem, and other mental health challenges.

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  There’s an abundance of evidence that spending time in nature improves mental health.

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• Better Physical Health Spending time in nature can also improve your physical health (for example, better lung function, weight management, cardiovascular health, and even eyesight), especially if it leads to more physical movement, such as long walks, hikes, swimming, tai chi, and more.

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• Higher Vitamin D Getting outside means more sun exposure, which your body converts to vitamin D. “Exposure to vitamin D is good for joint health and mental health,” says Petrie. Just be sure to wear sunscreen.
• Better Sleep Spending time outside may improve your sleep quality, possibly due to a combination of lowered stress and outdoor light regulating your circadian rhythm.

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  Getting moderate to vigorous physical activity during your time spent outside can also improve sleep.

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• More Social Connection Evidence shows that spending time with other people in nature could improve feelings of social connection as compared with spending time with them indoors.

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  RA can be an isolating disease, and joining an outdoor social activity like a walking group or gardening club could help.
• Sense of Meaning One underrated benefit of spending time in nature is that it can give you a sense of meaning, purpose, and even identity. “Spending time outside in natural environments can improve well-being and perspective,” says Rosi Raine, PhD, an occupational therapist and associate dean and deputy head of the School of Health Professions, University of Plymouth, in the United Kingdom. “[This is] through connection with nature and other people, which can be meaningful and encourage people to continue to take part in outdoor activities again.” For example, you might start thinking of yourself as not just “someone with RA,” but a gardener, hiker, swimmer, or other positive identity.

Why Outdoor Activities Can Help People With RA

When it comes to RA specifically, the benefits of spending time in nature come down to minimizing cortisol (a stress hormone), inflammation, and stress while maximizing gentle movement and a sense of calm.

1. Stress elevates cortisol, and over time this can trigger inflammation. Chronically elevated cortisol can also make the nerves involved in pain response overactive.

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2. This can trigger an RA flare.
3. An RA flare, which includes pain, joint swelling, and fatigue, can be stressful.
4. Stress, in turn, increases cortisol, and the cycle continues.

“Getting outside into nature and away from stressful environments can help break up this cycle, calming pain nerves and reducing inflammation” says Petrie.

Barriers to Outdoor Recreation When You Have RA

Unfortunately for people with RA, the answer isn’t as simple as just going outside and spending more time in nature. There are numerous barriers to getting outside that others who don’t live with RA won’t have to consider.

• Fatigue Up to 74 percent of people with RA experience fatigue on a regular basis.

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  The effort of getting outside can feel energy-sapping, even if you know you might enjoy it.
• Mobility Pain, inflammation, and fatigue can all affect your mobility with RA. It can be challenging to walk, swim, bike, or simply negotiate uneven terrain like you might encounter outdoors.
• Lack of Transportation Some people with RA may avoid or limit driving because of RA-related mobility issues.

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  Relying on others to pick you up or having to navigate public transportation are additional barriers.
• Grip Strength and Fine Motor Control For many people, RA affects their hands. This means that sports gear or equipment that requires a strong grip (like holding a bike handle or grasping hiking poles) can be challenging.
• Weather RA can cause heat intolerance, which means the heat and humidity can affect your joints and make them more painful.

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  In many cases, so can cold temperatures, rain, and snow. This can compound the difficulties of getting outdoors.

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Tips for Getting Started

Spending time in nature isn’t just for outdoorsy people. Anyone can get outside. It just might take a bit more planning if you have RA.

“As human beings, our bodies are programmed to relax in nature,” says Petrie. “Just 20 minutes in nature can reduce inflammation and improve mood, all of which is beneficial for rheumatoid arthritis, so get outside daily if you can.”

Here are some tips that can help you make that happen:

• Start at Home If trekking to your nearest forest or beach sounds intimidating, then start at home. Drink a coffee in your backyard or take a slow stroll through your neighborhood.
• Look Local When you’re ready to branch out, start by looking at nearby options like local parks, paths, rail trails, botanical gardens, university grounds, beaches, and public squares.
• Get the Right Gear Set yourself up for success with supportive footwear, trekking poles or walking sticks for stability, or portable seating. Petrie also suggests considering joint-health wearables like compression sleeves, orthopedic braces, or stick-on cold patches.
• Pace Yourself Chances are that if you have RA, you might already be familiar with energy conservation techniques from your daily life. The key is to proceed at your own pace and not overdo it. “Whether you are hiking, paddling, or just having a walk in a park, it’s sensible to pace yourself so you don’t get caught out by fatigue,” says Petrie. This can also help you avoid an energy crash the next day.
• Stay Hydrated Be sure to drink water before, during, and after your outdoor adventure. Good hydration can help maintain joint health.
• Join a Group RA can be an isolating disease. Joining an outdoorsy group can help you feel connected to others, relieve stress, stay accountable, and may even help with transportation issues.

Where to Find Accessible Outdoor Spaces

If you’re concerned about mobility, start by looking for accessible outdoor spaces near you. Some helpful resources include:

• State or Municipal Parks Departments These organizations should have information on accessibility. Consider contacting them directly, in addition to using their websites, for detailed suggestions.
• National Park Service In the United States, it’s mandatory for national parks to have accessible areas. Look at your chosen park’s website to learn more about its most accessible trails and spaces.
• State or City Tourism Bureaus These local organizations are gold mines of information. Consider contacting them for information on accessible outdoor spaces or groups near you.
• National Center on Health, Physical Activity and Disability This is a great resource for finding accessible outdoor recreation, parks, trails, fitness facilities, and more.
• Wheel the World This is a good resource for anyone who is a wheelchair user, especially if you’re traveling and looking for outdoor activities in a new city or country.
• AllTrails This is a useful navigation app for hiking trails and provides user-generated reviews. You can change your settings to show wheelchair-friendly or accessible options only.
• AccessNow This geolocation app displays the accessibility of both indoor and outdoor spaces around the world.

There are plenty of other resources out there, too. “Try asking at your local sports center or outdoor shop, or search online for beginners’ clubs, such as Couch to 5K,” suggests Dr. Raine. She also suggests asking a friend or family member to go with you for support.

Outdoor Activities With RA: Consider Your Symptoms

There’s no single best way to spend time in nature if you have RA. The best activity for you will be tailored to your individual symptoms.

“If rheumatoid arthritis mainly affects your fingers and hands, then a hike could be a sensible option,” suggests Petrie. And if your knees are your most painful joint, then he suggests paddling in water, where you use your arms more than your legs, as a better fit.

These are some suggestion for outdoor activities that have health and well-being benefits:

• Bird-watching
• Gardening
• Outdoor tai chi
• Outdoor yoga
• Walking
• Hiking
• Biking
• Swimming
• Outdoor water aerobics
• Boating
• Sitting on a park bench or in your yard
• Forest bathing
• Nature photography
• Volunteering for an environmental group, park, or preserve

Keep in mind that these activities may or may not work with your RA, and what suits you best can also change over time as your symptoms fluctuate.

“As long as you are outside in natural surroundings, you will get those stress-relieving, anti-inflammatory benefits,” says Petrie.

The Takeaway

• Spending time in nature has numerous benefits for both physical health and mental health.
• For people with RA, spending time outdoors could theoretically reduce stress and inflammation and potentially ease RA flares (although research hasn’t directly proven this link yet).
• Work with your body and your personal symptoms to find an outdoor activity that’s best for you. Even sitting in your backyard or on a park bench — just by being outside — could help promote health and well-being.