Strengthening immunity through movement and nature

Photo Cred: Oziel Gómez/Pexels

By Wendy Pecoraro, MSN, APRN, DipACLM

The novel coronavirus (COVID-19) has led to several unprecedented challenges, from social distancing and isolation to supporting immunity and fear of infection. While stay-at-home mandates are in place across the globe, it is clear from a mental health perspective that confinement can have many negative effects on immunity.  

Glucocorticoids such as cortisol are elevated during periods of isolation and can inhibit many crucial functions of our immune system. When we are stressed, the ability of our T-cells to multiply in response to infectious agents is markedly reduced, as is the ability of specific lymphocytes to recognize and kill cells in our body that have become infected.

It is important that our immune cells maintain their ability to quickly mobilize, so that they can watch over vulnerable areas in the body, including the upper respiratory tract and lungs, to prevent viruses and other pathogens from gaining access. This process is also important to minimize the impact of the virus and to accelerate healing should we become infected. Both exercise and getting outdoors decrease the fight or flight response by downregulating the sympathetic nervous system.

The immune cells that are mobilized with exercise are primed and “looking for a fight.” Their near-constant circulation between the blood and tissues serves to increase immune surveillance, which, in theory, makes us more resistant to infection and better equipped to deal with infectious agents. Exercise also releases various proteins that can help maintain immunity, particularly muscle-derived cytokines such as IL-6, IL-7, and IL-15:

• IL-6 has been shown to direct immune cells toward areas of infection
• IL-7 promotes the production of new T-cells from the thymus
• IL-15 helps to maintain the peripheral T-cell and NK-cell storage areas

These cytokines work together to increase resistance to infection. Exercise is especially beneficial for older adults who are more susceptible to infection and have been identified as an especially vulnerable population.

Exercise and spending time in nature has an additive effect. Better vitamin D production due to more sunlight exposure is known as beneficial for the immune system, but the importance is being highlighted by recent findings showing COVID-19 mortality is higher in those patients deficient in vitamin D.

Nature exposure seems to help in other ways, too. Many plants put substances, including organic compounds called phytoncides, into the air that seem to boost immune function. Sunlight, when contacting skin, is postulated to enhances the function of T cells.

Here are a few tools to encourage patients to socialize, exercise, and get outdoors:

Walk with a Doc

Walk with a Doc is a grassroots effort where practitioners give a brief presentation on a health topic and lead participants on a walk at their own pace. This is the first model I used in my practice. I met patients on Saturday mornings for a 10-minute chat and a 30-minute walk. The walk ended about 10 minutes before a yoga class hosted by my facility, offering additional opportunity to engage patients in physical activity.

The original Walk with a Doc was started in 2005 by David Sabgir, MD, a cardiologist in Columbus, Ohio. Frustrated with his inability to affect behavior change in the clinical setting, Sabgir invited his patients to go for a walk with him in a local park on a spring Saturday morning. To his surprise, over 100 people showed up.

Since that first event Walk with a Doc has grown with a model based on sustainability and simplicity. Healthy snacks, coffee, and blood pressure checks are an optional part of a Walk with a Doc event. 

While this model may provide some challenges with social distancing recommendations, it is something practitioners can consider developing in the future.

Plalking and Plogging

Picking Up Litter While Walking (Plalking) and Picking Up Litter While Jogging (Plogging) is a combination of walking or jogging while picking up litter in local parks or trails. It started as an organized activity in Sweden and has since become popular in several countries throughout the world. Patients reap the benefits of exercise while giving back to the community and the environment.

I am planning on incorporating plalking in my clinic by partnering with my local parks and recreation department to create a Walk with a Purpose initiative, where patients will visit a park or trail nearby and pick up litter while we walk. The parks department will provide bags and tools and arrange for collecting the bags at the end of the day.

World Walking

World Walking is a free phone application that allows people to connect remotely for virtual group walks. We created a group at our clinic that patients can join. Patients sign on and walk on their own time, near their homes or on a treadmill, and use the app to track progress and connect with their peers.

The application allows you to choose a virtual trail to “walk” anywhere in the world and tracks individual patients’ steps and distance traveled. Participants can message one another to stay engaged even while physically apart.

ParkRx

ParkRx is a California-based organization of park agencies, healthcare providers, and community organizations that developed the National ParkRx Initiative, an effort to prescribe nature to patients to improve physical and mental health.

Since its founding in October 2013, the number of Park Prescription programs has increased nationwide. While it is not fully functional in our area, I connected with our local parks and recreation department to get the process started.

ParkRx provides several resources, including posters and prescription pads, as well as case studies for implementation.