August 23, 2021

Health Benefits of Hiking in Nature

Written by: Amanda Cheong, M.D.

Let’s face it. Exercise can be a chore.


We know that exercise is good for you. Regular physical activity can prevent heart disease, diabetes, hypertension, obesity, and several other chronic illnesses. The association between physical activity and health status is practically a straight line.[1] The American Heart Association recommends 150 minutes of moderate-intensity exercise or 75 minutes of vigorous exercise each week. That would be any activity that gets your heart pumping 50-60% faster than at rest for around 30 minutes, 5 days a week.[2]


It can be exhausting just thinking about that much exercise. It’s also daunting. A 2011 research conducted interviews to find out what the barriers and enablers to exercise are. The lack of confidence and perceived lack of confidence were among the barriers mentioned by the participants. When we think we can’t perform the exercise well, we tend to shy away from the act.[3]


And what are the enablers in this study? It’s when the exercise is seen as fun and when we’re with friends. Sometimes, it helps to make exercise a social activity. That way, it doesn’t feel like a chore.[3] Much of these enabling characteristics for exercise can be attained, we just need to think outside the gym.


In hiking, a person (or more often a group of people) would walk through a significant distance in the great outdoors. They hike up hills into slightly higher altitude, moving through obstacles like tree roots or rocky areas. In between, there may be talking with friends or stops to take in the view. This lets hiking fit snuggly into that space in between healthy exercise and fun social activity, with a splash of walking around nature in the mix.[4]


But once we’re sold on the idea of hiking for fitness-- how do we go about this?


How high should we go?


Certain activities done at higher altitudes would require more effort than the same activity done at sea-level.[5] This little bonus might help boost the cardiovascular effects of those who are just starting with this kind of exercise. A pilot study done in 2015 showed that those who went on a 2 week hiking vacation in a moderate altitude setting had significantly reduced their blood cholesterol levels. This study was done in those who already had metabolic syndrome-- that is, a set of diseases that include high blood pressure, high blood sugar, high blood cholesterol, and abdominal obesity.[6] Still, there are those who are less concerned about blood cholesterol and more concerned about blood pressure. Another study has shown that a 3 week hiking vacation, whether in moderate or low altitude, significantly reduced the blood pressure of those who participated. This regular exercise, even if you don’t start your climb high, still confers these benefits.[7]


The great outdoors vs indoor exercise


With regular exercise already giving these benefits, it may not sound as appealing to those who already have an established exercise routine. Definitely, everyone has their own preference and the best exercise routine is one that can be sustained in the long term. But there are some benefits that outdoor exercises have over indoor exercises.


This has to do with feelings.


Researchers recruited a group of participants to hike in a mountain outdoors, walk on an indoor treadmill, and engage in sedentary activity. The same participants were asked to do all three, just to make sure that no one’s personal preference affected the results. They found that hiking in the mountains outdoors resulted in much happier and calmer moods with significantly less fatigue compared with the two other activities.[8] Another study that compared walking in forest areas with nature, compared to the suburban areas, resulted in less depressive moods, less anxiety, less anger, and less fatigue.[9]


Hiking is not only for cardiovascular fitness. It is also for better psychological health and happier moods. But we are beginners in this field-- we don’t want to overstrain ourselves or carry more than we can handle. What are the ideal practices in hiking?


Hiking safely


While the great outdoors has some psychological benefits, it also comes with hazards to those who are unfamiliar with the terrain. It is imperative to choose hiking routes that are appropriate to everyone’s fitness level and experience. Before jumping head first into the hike, learn about how difficult the terrain is. Let friends and family know where you’re going, and when you’re likely going to be back. Especially if you’re new to this, do not hike alone. It’s best to stay with local hiking groups-- both for the company and for the safety that comes with it.[4]


Hiking itself doesn’t require a lot of equipment. At level terrain, a pair of sturdy shoes, a water bottle, and a small day pack might be enough to start with. [4] However, studies have also shown that some items can be useful in your trip.


As mentioned earlier, at a level terrain, a pair of sturdy shoes would do. But in time, we gain experience and start on less even terrain, trekking boots may be considered. However, it is important to note that using the much heavier trekking boots also necessitates a larger workload when hiking.[10] While we’re on the subject of footwear, technical socks might be another sound investment. A 2012 study showed that even on low-difficulty and short term activities, technical socks can prevent wounds on the feet and keep the temperature at a stable level.[11]


Taking a trekking pole with you also helps reduce the loading on the joints of your legs.[12] They keep you more balanced and stable while you go through your hike. Studies have shown that the trekking pole also increases the cardiovascular demands of hiking though participants did not report feeling this added demand.[13-14]


Hiking backpack weight and posture


We’ve talked about the things on your legs and your third leg with the trekking pole. But the load on your back while hiking is another important aspect of the journey.


There has been a lot of debate on what the ideal backpack weight is. Much of the anecdotal advice that the internet mentions is 30% of the hiker’s body weight. However, there is a paucity of medical studies that give a recommendation. Only that the heavier the backpack weighs, the less the lungs expand to take in oxygen as well.[15] Where medical articles stay mum, a physics article has created a formula to estimate the maximum backpack weight for these hikes.[16]


The article argues that body weight is not the best estimate of the ideal backpack weight. Someone who is heavier will carry not only their backpack’s weight but also their own. Also, a person’s strength does not increase together with their weight.[15] How heavy a load you should carry would more likely be dependent on experience and comfort. On your first shorter hikes, it might be best to stick with a lighter backpack.


What medical articles do comment on is how you carry your backpack in hiking, as this can affect your posture. A posture that’s continuously slouched forward can end up in muscle pains-- both immediately and for a prolonged time if the strain is constant.[17] When the backpack’s position is high, this results in a more upright posture with decreased strain on your calf muscles-- compared to when the backpack hangs below the lower back.[18]


When we think of getting exercise for better health, we picture long hours in the gym running on the treadmill or lifting weights. Perhaps, it is time to change that view on exercise. There is much to be gained, both physically and psychologically, when we walk to greater heights. Just remember to go slow, practice safety, and, most of all, to have fun.


Related: Back Straighteners: Posture Importance and How Tools can Help Achieve It


  1. Warburton DE, Nicol CW, Bredin SS. Health benefits of physical activity: the evidence. CMAJ. 2006;174(6):801-809. doi:10.1503/cmaj.051351
  2. Physical Activity and Public Health: Updated Recommendation for Adults From the American College of Sports Medicine and the American Heart Association. (2007). Circulation, 116(9), 1081–1093. doi:10.1161/circulationaha.107.185649
  3. Withall J, Jago R, Fox KR. Why some do but most don't. Barriers and enablers to engaging low-income groups in physical activity programmes: a mixed methods study. BMC Public Health. 2011;11:507. Published 2011 Jun 28. doi:10.1186/1471-2458-11-507
  4. Mitten D, Overholt JR, Haynes FI, D'Amore CC, Ady JC. Hiking: A Low-Cost, Accessible Intervention to Promote Health Benefits. Am J Lifestyle Med. 2016;12(4):302-310. Published 2016 Jul 9. doi:10.1177/1559827616658229
  5. Burtscher M. Effects of living at higher altitudes on mortality: a narrative review. Aging Dis. 2013;5(4):274-280. Published 2013 Dec 5. doi:10.14336/AD.2014.0500274
  6. Gutwenger I, Hofer G, Gutwenger AK, Sandri M, Wiedermann CJ. Pilot study on the effects of a 2-week hiking vacation at moderate versus low altitude on plasma parameters of carbohydrate and lipid metabolism in patients with metabolic syndrome. BMC Res Notes. 2015;8:103. Published 2015 Mar 28. doi:10.1186/s13104-015-1066-3
  7. Neumayr G, Fries D, Mittermayer M, et al. Effects of hiking at moderate and low altitude on cardiovascular parameters in male patients with metabolic syndrome: Austrian Moderate Altitude Study. Wilderness Environ Med. 2014;25(3):329-334. doi:10.1016/j.wem.2014.01.003
  8. Niedermeier M, Einwanger J, Hartl A, Kopp M. Affective responses in mountain hiking-A randomized crossover trial focusing on differences between indoor and outdoor activity. PLoS One. 2017;12(5):e0177719. Published 2017 May 16. doi:10.1371/journal.pone.0177719
  9. Song C, Ikei H, Park BJ, Lee J, Kagawa T, Miyazaki Y. Psychological Benefits of Walking through Forest Areas [published correction appears in Int J Environ Res Public Health. 2020 Feb 18;17(4):]. Int J Environ Res Public Health. 2018;15(12):2804. Published 2018 Dec 10. doi:10.3390/ijerph15122804
  10. Fattorini L, Pittiglio G, Federico B, Pallicca A, Bernardi M, Rodio A. Workload comparison between hiking and indoor physical activity. J Strength Cond Res. 2012;26(10):2883-2889. doi:10.1519/JSC.0b013e318242a61e
  11. Pérez Pico AM, Mingorance Álvarez E, Martínez Quintana R, Mayordomo Acevedo R. Importance of Sock Type in the Development of Foot Lesions on Low-Difficulty, Short Hikes. Int J Environ Res Public Health. 2019;16(10):1871. Published 2019 May 27. doi:10.3390/ijerph16101871
  12. Bohne M, Abendroth-Smith J. Effects of hiking downhill using trekking poles while carrying external loads. Med Sci Sports Exerc. 2007;39(1):177-183. doi:10.1249/01.mss.0000240328.31276.fc
  13. Saunders MJ, Hipp GR, Wenos DL, Deaton ML. Trekking poles increase physiological responses to hiking without increased perceived exertion. J Strength Cond Res. 2008;22(5):1468-1474. doi:10.1519/JSC.0b013e31817bd4e8
  14. Hawke AL, Jensen RL. Are Trekking Poles Helping or Hindering Your Hiking Experience? A Review. Wilderness Environ Med. 2020;31(4):482-488. doi:10.1016/j.wem.2020.06.009
  15. Dominelli PB, Sheel AW, Foster GE. Effect of carrying a weighted backpack on lung mechanics during treadmill walking in healthy men. Eur J Appl Physiol. 2012;112(6):2001-2012. doi:10.1007/s00421-011-2177-8
  16. O’Shea, M., 2014. Backpack Weight and the Scaling of the Human Frame. The Physics Teacher. 52(8), pp.479-481
  17. Kang JH, Park RY, Lee SJ, Kim JY, Yoon SR, Jung KI. The effect of the forward head posture on postural balance in long time computer based worker. Ann Rehabil Med. 2012;36(1):98-104. doi:10.5535/arm.2012.36.1.98
  18. Simpson KM, Munro BJ, Steele JR. Does load position affect gait and subjective responses of females during load carriage?. Appl Ergon. 2012;43(3):479-485. doi:10.1016/j.apergo.2011.07.005
Article written by Amanda Cheong, M.D.
Dr. Amanda Cheong spent her formative medical years within the walls of the Philippine General Hospital, a high-volume tertiary institution built to serve the underserved. After graduating with a degree in medicine, she went on to write, edit, and compile healthcare stories from the start of the COVID-19 pandemic for an online anthology. Currently, she is involved in medical research as well as volunteer telemedicine consults. She enjoys writing fiction on the side when she’s not tending to her plants and three pet turtles.

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