1. More Trails = A Healthier, Happier US Presented by Susan Stormer, Ph.D. – Owner, S&S Trail Services, L.L.C. – PTBA Board Member Picture by Scott Frey 2009

2. Acknowledgments Dr. Bill Kohl, School of Public Health, UT Health Science Center (Austin regional campus) The internet, specifically – www.google.com www.google.com And last but not least…

3. Ryan Spates, Co-Owner S&S Trail Services, L.L.C. Business Partner Husband Company photographer Best Friend “Partner in Crime”

4. Personal Background Trail user

5. Personal Background Trail builder

6. Other user groups in audience? (Start of audience participation segment—please ask questions or make comments throughout talk) Hikers Skiers Climbers Birders OHVers Others?

7. Trail runners in East Burke, VT

8. Personal Background, Clinical Licensed Clinical Psychologist Specialty in Behavioral Medicine – Using psychological principles to change physical health behaviors Areas of clinical experience include – Eating disorders – Smoking cessation – Obesity/weight management – Type II Diabetes – Depression/Anxiety – Substance abuse – Chronic pain

9. Personal Background, Research Conducted Master’s and Doctoral research on sociocultural influences in mass media & how they affect personal body image Managed clinical research projects at University of Texas at Austin, American Cancer Society, and Baylor College of Medicine in Houston Best advice from graduate school advisors: – Stealing ideas from one person is plagiarism – Stealing ideas from many people is research

10. Clarification of talk title: Healthier, happier ‘us’, meaning us as individuals Healthier, happier US meaning the United States as a whole Two main ideas to cover – Positive effects of exercise – Positive effects of nature

11. Athens, Greece

12. State of the Union, Our Health Behavioral Risk Factor Surveillance System (BRFSS)

13. Could it possibly be related to the fact that… More than 25% of the American population remains completely inactive despite the well-known positive effects of physical activity? Interestingly, the prevalence of inactivity is highest in rural areas of the United States. Any ideas why? (Hint, not enough of something we take for granted in cities.) Centers for Disease Control and Prevention. Self-reported physical inactivity by degree of urbanization--United States, 1996. MMWR Morb Mortal Wkly Rep 1998;47:1097–100.

14. Scientifically proven benefits of exercise Longevity – People who are physically active live longer Cardiovascular health – Lack of physical activity is a major risk factor for CAD Cholesterol lowering effect – Raises HDL and lowers LDL Prevention and control of diabetes – 50-60% reduction in risk

15. Scientifically proven benefits of exercise Reduced risk of stroke – Moderate to high levels of activity particularly effective Muscle strength – Increase muscle mass/decrease fat tissue Bone strength Lowering of blood pressure – Exact mechanism unclear, but all forms of exercise seem to work – Weight bearing exercise promotes bone density and prevents osteoporosis

16. Scientifically proven benefits of exercise Weight control – Raises metabolic rate, offsets calorie intake New brain cell development, improved cognition, and memory – Stimulates formation of new brain cells Better night sleep – Dip in body temp 5-6 hrs later may help Exercise is a powerful antidepressant – Comparable to Zoloft!

17. Case example of “Mary” Patient I counseled during postdoctoral training Mid-30’s white female Presenting complaints included – Depression – Anxiety – Poor sleep – Weight gain – Stress, no time to exercise Implemented individual CB Therapy – Adjunct modality of in-session exercise Progress was gradual, but significant If no other motivator works, maybe last one will…

18. Scientifically proven benefits of exercise Improved sexual function and better sex life (for both men and women) – Due to improved muscle tone, endurance, and cardiovascular function

19. U.S. Surgeon General’s Report on Physical Activity and Health (1996) Physically active people tend to have better mental health Compared with inactive people, the physically active had higher scores for positive self-concept, more self-esteem and more positive "moods" and "affects." Findings seem similar in both young people and adults. Physical activity has also been used to treat mental health problems such as depression

21. Cognitive and neurological benefits of exercise Physical exercise leads to significant improvements in: – Memory ability – Critical thinking skills – Balanced mood – Increased learning potential – Finding is more pronounced in people over age 60

22. What seems to be the mechanism for improved brain function as a result of exercise? Improved blood flow to the brain Increased production of neurotransmitters Activation of acetylcholine pathways Combats the effects of aging: – Positive effect on nerve cell health – Extends life of nerve cells – Maintains already healthy cells – Enhances activity of antioxidants & reduces free radicals – Prevents cell damage related to aging process

23. Chat with Ted at the FATS

24. Now if we could only put exercise in a bottle… Duke University researchers studied people suffering from depression for 4 months 60% of the participants who exercised for 30 minutes 3X/week overcame their depression without using antidepressant medication. This is the same percentage rate as for those who only used medication in their treatment for depression.

25. In Summary… Improved self-esteem is one of the top benefits of regular physical activity. Exercise leads to endorphin release that can improve your mood and the way you feel about yourself. Exercise helps people to cope with stress Exercise can help to ward off anxiety and depression

26. Overall, research data indicate that exercise does improve mental health. However… Antidepressant and anxiolytic effects have been demonstrated most clearly in subclinical disorder – (i.e. there’s something to be said for neurotransmitters in the treatment of Axis I Depressive and Anxiety disorders) Clinically, exercise training continues to offer clinical psychologists a vehicle for nonspecific therapeutic social and psychological processes. May be particularly effective for patients for whom more conventional psychological interventions are less acceptable. (i.e. psychotropic medications, regular individual psychotherapy) Effects of Physical Exercise on Anxiety, Depression, and Sensitivity to Stress: A Unifying Theory Salmon P Clin Psychol Rev 2001 Feb;21(1):33-61

27. Let’s contemplate this scene…

28. Photos by Scott Frey

29. The effects of nature on physical and mental health The notion of nature as medicine is centuries old, and has numerous proponents – Thoreau, philosophers, artists, environmentalists – Personal stories – Who here has ever used nature as an escape from a stressful situation? Kid Trips in Austin Tyler State Park; office work vs. field work Research is fairly recent

30. Summary of research on benefits of nature exposure by Anna Jorgensen (2001) Views of natural scenes from hospital windows aided patients' recovery from gall bladder surgery (Ulrich, 1984). Grahn found that children from a kindergarten in a natural setting had fewer absences due to sickness than children from an urban kindergarten (1997). Exposure to natural scenes reduces stress (Ulrich et al, 1991). This is likely to have long-term physiological health benefits, as medical evidence suggests that stress has an adverse effect on health by reducing immunocompetence or resistance to illness (Parsons, 1991). A recent American study confirmed that green play settings improved children's concentration: children with ADD were found to function better than usual after activities in green settings (Faber Taylor et al, 2001).

31. Greenery lowers aggression and crime (Frances Kuo, 2001) Study examined the relationship between levels of vegetation and crime rates in 98 apartment buildings in a Chicago public housing development Housing blocks with high levels of greenery had 48% fewer property crimes and 56% fewer violent crimes Greenery helps people to relax and renew, reducing aggression Green spaces also bring people together outdoors, which increases surveillance and discourages criminals

32. Richard Louv, author of “Last Child in the Woods” Chairman of Children & Nature Network – www.childrenandnature.org www.childrenandnature.org Coined the term ‘nature deficit disorder’ Summarizes research that demonstrates numerous positive effects of nature on children’s mental and physical health “Time in nature is not leisure time; it’s an essential investment in our children’s health. Reducing that deficit - healing the broken bond between our young and nature - is in our self-interest, not only because aesthetics or justice demands it, but also because our mental, physical, and spiritual health depends upon it”.

33. Nature Exposure Leads to Mental Health Benefits For Adults Too University of Essex and UK mental health charity “Mind” compared the benefits of – 30-minute walk in a country park – 30-minute walk in an indoor shopping center 45% of sample experienced a decrease in depression after the shopping center walk 71% reported decreased levels of depression after the country walk – Participants also said they felt less tense after country walk – 90% reported increased self-esteem. In its report on Ecotherapy, Mind recommends that ‘green exercise’ be considered as a clinically valid treatment option for people experiencing mental distress.Ecotherapy

34. Doris Mager of SOAR (Save Our American Raptors) and her co-instructor E.T.

35. Case example of Woodlands Healthcare Center Long term care facility in planned community north of Houston, Texas Supervising psychologist 2001-2002 Carried caseload of 8-10 individual patients – Supervised Master’s level therapists on additional 20-30 patients Majority of residents stayed inside 24 hours/day Center was surrounded by green space and paved walking/cycling trails Began conducting sessions outdoors Residents showed improved mood and brighter affect as a result of spending time in nature

36. If some nature is good, more is better Biological diversity in city parks and green spaces can have psychological benefits for humans – visitors to city parks with a greater diversity of birds, butterflies, plants, and other organisms reported feeling better than visitors to less-diverse green spaces Fuller, R.A., Irvine, K.N., Devine-Wright, P., Warren, P.H. & Gaston, K.J. 2007. Psychological benefits of greenspace increase with biodiversity. Biology Letters 3, 390–394.

37. Perceptions of nature influence people’s choice to spend time there Many people report uneasiness with what appear to be ‘wild’ or ‘untamed’ spaces Preference for woodland with a dense understory varies according to the spatial configuration of the woodland (Jorgensen et al, in press; Purcell and Lamb, 1998). Dense understory was considered safer and was preferred when placed in a more open spatial configuration i.e. it’s not the case that people dislike dense understory per se; in general they do not want to be forced to come into contact with it. This is what I call The ‘Woodlands Effect’, or “I like to be out in nature, I just don’t want it to touch me.”

39. In Summary… Contact with nature can – decrease mental fatigue and accidents – enhance mood, concentration and problem solving Exposure to wildlife, horseback riding, hiking, camping and farms can be therapeutic for a variety of health conditions in adults and children An entire movement has begun to connect kids with the healing power of nature – No Child Left Inside legislation (2008) Experts emphasize that you don’t have to trek to wilderness preserves to enjoy nature’s benefits– simply strolling in a city park or tending a rooftop garden can make a difference

40. Why should land managers and trail professionals care about these findings? 1. To promote physical activity, more environmental and policy strategies are needed to change the physical and sociopolitical environments. Examples of environmental and policy approaches to increase physical activity include walking and bicycle trails 2. Establishing walking trails is a relatively low-cost intervention that may facilitate walking by reducing barriers related to convenience and accessibility and encouraging ongoing physical activity maintenance because trails become a permanent fixture in the community 3. This suggests that recreational trails may be a powerful vehicle for physical activity promotion, particularly among previously inactive individuals. In our study, data suggest that convenient, safe, and proximal community walking trails provide an incentive for community residents to engage in regular physical activity 4. Community trails facilitate physical activity, and almost half of frequent trail users report that access to trails and other green space is important in choosing a place to live Citations 1 Schmid TL, Pratt M, Howze E. Policy as intervention: environmental and policy approaches to the prevention of cardiovascular disease. Am J Public Health. 1995;85:1207–11. 2 Ross C. Brownson, PhD, Robyn A. Housemann, MPH, et al. Promoting Physical Activity in Rural Communities Walking Trail Access, Use, and Effects American Journal of Preventive Medicine, Volume 18, Number 3 3 Gordon PM, Zizzi SJ, Pauline J. Use of a community trail among new and habitual exercisers: a preliminary assessment. Prev Chronic Dis [serial online] 2004 Oct 4 John J. Librett, PhD, Michelle M. Yore, MSPH,et al. Physical Activity Levels Among Trail Users in a U.S. National Sample (Am J Prev Med 2006;31(5):399–405) © 2006

41. John and Nancy Stormer, my parents and cycling trail advocates

42. Cost of trails vs. cost of inactivity A case study in Lincoln, Nebraska Annual cost in 2002 dollars ranged from $25,762 to $248,479 (mean = $124 927; median = $171 064) Cost per mile ranged from $5,735 to $54,017 (mean = $35 355; median = $37 994). Annual cost per user was $235 (range = $83–$592) Per capita annual medical cost of inactivity was $622. Cost Analysis of the Built Environment: The Case of Bike and Pedestrian Trails in Lincoln, Nebraska by Guijing Wang, PhD, Caroline A. Macera, PhD et al., (2003) Centers for Disease Control and Prevention

43. Trail builders as partners in public health promotion Participation in regular physical activity depends in part on the availability and proximity to such resources as community recreation facilities and walking and bicycling trails, so building such environments holds much promise in health promotion. Task Force on Community Preventive Services. Recommendations to increase physical activity in communities. Am J Prev Med. 2002;22:(4, suppl 1):67–72.

44. Let’s get outside and move!

45. S&S Trail Services, L.L.C. Susan Stormer, Ph.D., Owner 512 Eberhart Lane #1303 Austin, TX 78745 713-448-0161 www.sstrails.com Professional Trailbuilding Consultation Design Education Construction