Older people and nature: the benefits of outdoors, parks and nature in light of COVID-19 and beyond- where to from here?

Older people's views and usage of recreational spaces in parks with age-friendly outdoor exercise equipment

Recreational spaces are important public spaces for people of all ages to engage in leisure and physical activities, however older people remain one of the lowest users of park. This study investigated older people's perceptions and reasons for visiting parks that have undergone refurbishment with the installation of age-friendly outdoor exercise equipment, the Seniors Exercise Park. On-site intercept surveys took place in six parks in Victoria, Australia. Seniors Exercise Park equipment usage was audited over 12 months using on-site Quick Response (QR). A total of 139 older people were surveyed, 55.4% reported visiting to exercise, 25.9% for walking and 21.5% for fresh air/nature. Proximity to home/family (37.4%) and the availability of the Seniors Exercise Park equipment (36.7%) were the main reasons for visiting these parks. The availability of age-suitable exercise equipment in recreational spaces can support and encourage older people to access local parks and engage in physical activity.

COVID-19 Impacts on Physical Activity Among Community-Dwelling Older Adults With Memory Problems: The Moderating Role of Walkable Neighborhood Destinations

BACKGROUND AND OBJECTIVES

The number of people with memory problems who desire or are forced to age in place has been growing rapidly. Coronavirus disease 2019 (COVID-19) has brought significant challenges to the ability of those with memory problems to stay active and age in place. This study investigated the roles of neighborhood environments in helping community-dwelling people with memory problems maintain physical activity during the COVID-19 pandemic.

RESEARCH DESIGN AND METHODS

We used retrospective online survey data from 75 caregivers who responded on behalf of their care recipients with memory problems living in Texas communities. We used difference-in-difference (DID) estimations based on zero-inflated negative binomial regression models to examine the changes in recreational walking and moderate-to-strenuous exercise before and during the COVID-19 pandemic and whether such changes vary by diversity of walkable neighborhood destinations.

RESULTS

In the total sample, there was a significant reduction in both recreational walking (Δ change = -45.16 min/week, p < .001) and exercise (Δ change = -36.28 min/week, p = .03) after the COVID-19 outbreak. The pandemic's impact on exercise varied by diversity of neighborhood destinations (DID = 0.81, p = .03). Those living in neighborhoods with diverse walkable destinations experienced less decline in physical activity compared to those living in areas with limited destinations.

DISCUSSION AND IMPLICATIONS

These findings suggest that the impact of the COVID-19 pandemic on physical activity among people with memory problems may be partially explained by neighborhood land-use characteristics. Destination-rich, mixed-use neighborhood environments can help people with memory problems stay active even during pandemics such as COVID-19 in the United States and potentially elsewhere.

3D built virtual arctic environment increase vigor through connectedness in older people

While the life expectancy of older people has increased significantly, this is often related to more long-term care in healthcare residences and nursing homes. Staying in these facilities can lead to a reduction in the sense of connection with others and the world around, as well as in vigor, with significant psychophysical repercussions in the long term. Although previous studies have shown that the virtual nature can benefit both, there are no significant studies that have tested its effect in generating these positive outcomes in the older population. Therefore, our study sought to investigate, in a sample of 53 older people in care at a nursing home or healthcare residence, the indirect effect of a 3D built virtual arctic environment (vs. a 3D built virtual urban environment) exposure in virtual reality on vigor through connectedness. Both the virtual scenarios were designed with a first-person view, with no translation around the environment and only in-situ rotation. Results highlighted that exposure to the 3D built virtual arctic environment leads to higher connectedness than the 3D built virtual urban environment, and this, in turn, leads to an increase in vigor. Findings were discussed based on the potential of adopting virtual nature in facilities to improve older people's sense of connectedness and, in turn, improve their well-being.

Multigenerational spaces: the usage and activities of different age groups within six community parks in Victoria, Australia

BACKGROUND

This study investigated how different spaces within multigenerational local parks are being used by older people and other age groups.

METHODS

Observation of park visitors occurred in six Victorian parks one month after park refurbishment. Parks were classified into six spaces based on equipment/amenities and associated expected activity. Observations were summarized descriptively, and negative binomial regression models were used to examine the association between visitor counts and classified targeted areas.

RESULTS

A total of 12 501 people visited the parks with 4.1% older visitors. The number of older visitors in each park area was consistently less than other age groups, with counts of older visitors being 50% less in mixed spaces (95% confidence interval [CI] 0.38, 0.65), 40% less in adult exercise equipment areas (95% CI 0.46, 0.77) and 59% less in walking paths (95% CI 0.31, 0.55). The number of older visitors engaging in physical activity were significantly greater in walking paths (incidence rate ratios 1.75; 95% CI 1.16, 2.64) compared with children's play spaces.

CONCLUSION

The number of visitors across different age groups varied significantly between the park targeted areas. Most spaces were mainly used by the intended target age group/user, with no particular area used by all age groups in similar proportions.

Results from the ENJOY MAP for HEALTH: a quasi experiment evaluating the impact of age-friendly outdoor exercise equipment to increase older people's park visitations and physical activity

BACKGROUND

Recreational parks can play a significant role in older people's health, with emerging evidence suggesting that changes in the physical environment, such as refurbishments of local parks, can increase park visitations and physical activity engagement. The ENJOY MAP for HEALTH aimed to evaluate the impact of Seniors Exercise Park installations and associated capacity building activities on older people's park visitation, and park-based physical activity.

METHOD

The ENJOY MAP for HEALTH was a quasi-experiment study design that involved the installation of specialised Seniors Exercise Park equipment as part of park refurbishment, supported by promotion and community capacity building activities in six municipalities in Victoria, Australia. Direct observations of park users took place prior to park upgrades, one-month post upgrade and 12-months from baseline. The overall number and characteristics of park visitors, and the type and level of physical activity undertaken, were summarised descriptively. Generalised linear models were used to examine the impact of park refurbishment (equipment installation and site activation) on the total number of older people observed in the park, and their engagement in physical activity, accounting for site and seasonal effects.

RESULTS

Overall number of visits increased following park upgrades, with the largest number of visitors observed one-month post upgrade (n = 12,501). The proportion of older people observed at the parks remained relatively low prior to and one-month post upgrade compared to other age groups. However, after adjusting for site and seasonal effects, the number of older people observed in the parks increased significantly post upgrade and site activation compared to prior to the refurbishment (incidence rate ratios (IRR) 3.55; 95% CI 2.68, 4.70). The number of older people observed to be exercising at the Seniors Exercise Park also increased by 100% at 12-months post-installation relative to one-month post upgrade (IRR 2.00; 95% CI 1.26, 3.17).

CONCLUSION

Installation of the Seniors Exercise Parks and the supportive programs and activities following six park upgrades resulted in an increase in older people's park visitation and engagement in physical activity. Community engagement and training of volunteers with the support of local governments are likely to contribute to the increased park usage by older people.

TRIAL REGISTRATION

This trial was registered with the Australian New Zealand Clinical Trials Registry. Trial registration number ACTRN12621000965808. https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380745&isReview=true .

Social contact and the perceived impact of social distancing on health outcomes during the COVID-19 pandemic among community dwelling older adults taking part in the OPAL cohort study

BACKGROUND

During the COVID-19 pandemic, social distancing and reduced social contact may have affected older adults' health.

OBJECTIVES

To evaluate the perceived impact of social distancing on older adults' health and explore the association between social contact and health outcomes.

DESIGN

Cross-sectional and longitudinal analyses of the OPAL cohort study.

SUBJECTS

Community dwelling older adults.

METHODS

We sent questionnaires to participants of an existing cohort study (n = 4328). Questions included the amount and type of social contact, and how often they went outside. Participants rated the impact of social distancing on their health. Sociodemographic factors and quality of life were available from previous questionnaires. We examined quality of life prior to and during the pandemic and explored the cross-sectional relationship between social contact and health using logistic regression.

RESULTS

There were 3856/4328 (89%) questionnaires returned. EQ-5D scores changed little compared to pre-pandemic scores but 25% of participants reported their overall health had worsened. The telephone was the most used method of contact (78%). Video calls were used least with 35% of participants not using them or having no access to them. 13% of respondents never went outside. Lower levels of contact were associated with increased risk of reporting worse health (Odds ratio (OR) 1.04 (95% CI 1.01-1.08)). Those experiencing financial strain and who spent less time outside experienced the largest increase in risk of reporting perceived worsened overall health. Those reporting a strain to get by financially were 4 times more likely to report worsened health than those who described themselves as quite comfortably off (OR 4.00 (95% CI 1.86-8.16)). Participants who reported never going outside were twice as likely to report worsened health compared to those who went outside daily (OR 2.00 (95% CI 1.57-2.54)).

CONCLUSIONS

Less contact with other people was associated with perceived worsening in overall health. Although many older people reported using online technology, such as video calls, a substantial proportion were not using them. Older people facing financial strain were more likely to report worsened health, highlighting the impact of social inequalities during the pandemic. Going outside less was also associated with perceived worsened health.

Parks Visitation, Physical Activity Engagement, and Older People's Motivation for Visiting Local Parks

Despite the health benefits of parks and outdoor recreational spaces, small numbers of older people visit parks. This study identified older park visitors' perceptions of their local parks, visit motivation, health, and physical activity level in six parks in Victoria, Australia. Characteristics of general community park visitors and their physical activity engagement were also recorded. Fifty-five older people were surveyed onsite; 92.7% lived within a 5-km distance from the park. Walking was the most common reason for visiting (36.4%), followed by walking the dog (36.4%) and exercise (23.6%). Most older visitors (77.8%) were determined as being sufficiently active. Observation of parks visitors over 1 week recorded 3,770 park visitors, with <5% being older people. Half of all park visitors were inactive, and half of older people visitors (50.5%) engaged in walking. This study supports the importance of parks, park features, and their potential in helping older people to achieve levels of physical activity required for good health.

The ENJOY Seniors Exercise Park IMP-ACT project: IMProving older people's health through physical ACTivity: a hybrid II implementation design study protocol

INTRODUCTION

The health benefits of physical activity are well established; however, most older people are not sufficiently physically active. Despite the availability of various physical activity interventions and programs, implementation of effective prevention strategies to reduce older people's physical inactivity are lacking. The ENJOY IMP-ACT project is an implementation research project, based on a previous evidence-based physical and social activity program utilising specialised outdoor exercise equipment (the Seniors Exercise Park) for older people. The ENJOY IMP-ACT aims to increase participation in physical activity to improve health outcomes for older people in Victoria, Australia.

METHOD

The ENJOY IMP-ACT is a hybrid II implementation-effectiveness pre-post mixed method study design. Five local governments (6 public sites/parks) will undergo a 3-month control period followed by 9-months implementation intervention (TERM framework intervention: Training, Engagement, Resources development, Marketing and promotion), and a maintenance phase (3 months). Various methodologies will be employed throughout the project at each site and will include direct observations of park users, intercept surveys with park users, online access monitor platform (using an online app), interviews with stakeholders and exercise program leaders, a process evaluation of physical activity programs, a social return-on-investment analysis, and other related activities.

DISCUSSION

Through the implementation framework design, the ENJOY IMP-ACT is uniquely placed to translate an evidenced-based physical and social activity program into real world settings and increase physical activity among older people. If successful, this program will inform scale up across Australia with the goal of improving the health and wellbeing of older people.

TRIAL REGISTRATION

This registration trial is prospectively registered with the Australian New Zealand Clinical Trials Registry. Trial number ACTRN12622001256763 . Date registered 20/09/2022.

Advancing Population Health Through Open Environmental Data Platforms

Data stand as the foundation for studying, evaluating, and addressing the multifaceted challenges within environmental health research. This chapter highlights the contributions of the Canadian Urban Environmental Health Research Consortium (CANUE) in generating and democratizing access to environmental exposure data across Canada. Through a consortium-driven approach, CANUE standardizes a variety of datasets - including air quality, greenness, neighborhood characteristics, and weather and climatic factors - into a centralized, analysis-ready, postal code-indexed database. CANUE's mandate extends beyond data integration, encompassing the design and development of environmental health-related web applications, facilitating the linkage of data to a wide range of health databases and sociodemographic data, and providing educational training and events such as webinars, summits, and workshops. The operational and technical aspects of CANUE are explored in this chapter, detailing its human resources, data sources, computational infrastructure, and data management practices. These efforts collectively enhance research capabilities and public awareness, fostering strategic collaboration and generating actionable insights that promote physical and mental health and well-being.

Assessing health impact of COVID-19 and associated household socioeconomic factors in Papua New Guinea: evidence from the Comprehensive Health and Epidemiological Surveillance System

Introduction

The COVID-19 pandemic had an unprecedented impact on the health and well-being of populations worldwide. Few studies have used household data to explore the health risks associated with COVID-19 in low-income and middle-income countries. This study assessed population vulnerability to COVID-19 by examining household socioeconomic factors related to COVID-19 health risks in Papua New Guinea (PNG).

Methods

Using household socioeconomic surveillance data from 2020, encompassing 37 880 residents living within the catchment areas of the Comprehensive Health and Epidemiological Surveillance System, the study assessed COVID-19 health risks based on the socioeconomic demographic characteristics of the surveillance population. Multinomial logistic regression analyses were conducted to determine associated factors and to estimate predictors of COVID-19 health risks.

Results

Among the surveillance population, more than 9% reported experiencing COVID-19 health risks, including home-based quarantine (9.6%), centre-based quarantine (0.5%), positive COVID-19 test (0.1%), hospitalisation due to COVID-19 (0.3%) and death from COVID-19 (0.3%). People living in semimodern houses (OR 1.47 (95% CI 1.35 to 1.61)) (verse permanent houses), individuals living in houses with 1-2 bedrooms (OR 1.12 (95% CI 1.01 to 1.25)) (verse houses with 4+ bedrooms) and those belonging to the poorest wealth quintile (OR 1.16 (95% CI 1.024 to 1.314)) (verse the richest) were more susceptible to COVID-19 health risks. Protective factors against COVID-19 health risks included urban residence (OR 0.65 (95% CI 0.59 to 0.71)) (verse rurality), aged 0-4 years (OR 0.76 (95% CI 0.64 to 0.91)) (verse aged 55+ years), households with 7-8 members (OR 0.84 (95% CI 0.74 to 0.96)) (verse 10+ members), handwashing with soap (OR 0.3 (95% CI 0.28 to 0.33)) (verse without soap).

Conclusions

The study provides insights into the susceptibility to COVID-19 health risks across socioeconomic groups in PNG. These findings have implications for development of public health policies and interventions that can be extrapolated to similar settings for enhancing preparedness for future public health emergencies.

Green space and the health of the older adult during pandemics: a narrative review on the experience of COVID-19

Introduction

Aging is an inevitable process that leads to changes in various dimensions of older adult life, including physical, psychological, and social aspects. Unfortunately, older adults are more susceptible to health problems caused by adverse experiences such as the Corona outbreak.

Aim

The current study examines the lived experience of older adults in facing the conditions of the Corona epidemic to see how green spaces at various scales can influence the physical and mental health of this group.

Method

Relevant articles published, from 2019 to February 17, 2023, were searched using in the Scopus and Web of Science databases. Eligible studies published in English and all studies passed a quality evaluation.

Result

In the final search, 40 articles were selected and analyzed. The majority of studies conducted during the pandemic categorized the impact of green spaces on the health of older adults into three main categories: Place-based attribute, Process, and Function.

Conclusion

The findings of this study demonstrated that people were using private green spaces (gardens, balconies, etc.), small local green public spaces, sitting and gathering spaces in the neighborhood, nearby open spaces, and urban green-blue spaces throughout the epidemic era. They visited green spaces outside the city and urban areas, including urban gardens, agricultural areas, forestlands, and pastures. In this research, we investigated the characteristics of these spaces and classified them into four physical categories: urban landscape, land use, activity, movement, and accessibility. The results showed that exposure to nature or green space improved physical and mental health and increased attention and decision-making quality in older people. We have proposed design implications recommendations for crises to improve safety, security, and social capital by increasing the safe access of older adults to diverse and high-quality green spaces on different scales, which will ultimately enhance the physical and mental health of people in different age groups.

Cost-Effectiveness of the ENJOY Seniors Exercise Park for Older People: A Pre-Post Intervention Study

BACKGROUND

The Exercise interveNtion outdoor proJect in the cOmmunitY (ENJOY) Seniors Exercise Park program uses specialized outdoor equipment and a physical activity program to engage older people in physical activity, with multiple health benefits. We determined the cost-effectiveness of the ENJOY program.

METHODS

The economic evaluation compared health care utilization costs 6 months prior to and 6 months post ENJOY program participation. Incremental cost-utility analysis for the primary aim (quality of life) and incremental cost-effectiveness analysis for the secondary aim (falls) were used. Analyses took a societal perspective inclusive of Australian government-funded health care and pharmaceuticals in addition to hospitalizations, community-based nursing and allied health, and community services. Productivity costs were also calculated.

RESULTS

Fifty participants (average age 72.8 y [SD 7.4] and 78.0% [n = 39/50] women) were included. Participation in the ENJOY program reduced health care costs in the 6 months following the program: preintervention, $9764.49 (SD $26,033.35); postintervention, $5179.30 (SD $3826.64); observed postintervention reduction -$4.585.20 (95% confidence interval, -$12,113.99 to $2943.59; P = .227) without compromising quality of life (mean difference [MD] 0.011; 95% confidence interval, -0.034 to 0.056; P = .631) or increasing the likelihood of a fall (-0.5; 95% confidence interval, 0.00 to -0.50; P = .160). The ENJOY intervention is likely cost-effective.

CONCLUSIONS

Planning for shared community spaces should consider the benefits of a Seniors Exercise Park as part of the built environment.

The COVID-19 Mortality Rate Is Associated with Illiteracy, Age, and Air Pollution in Urban Neighborhoods: A Spatiotemporal Cross-Sectional Analysis

There are different area-based factors affecting the COVID-19 mortality rate in urban areas. This research aims to examine COVID-19 mortality rates and their geographical association with various socioeconomic and ecological determinants in 350 of Tehran's neighborhoods as a big city. All deaths related to COVID-19 are included from December 2019 to July 2021. Spatial techniques, such as Kulldorff's SatScan, geographically weighted regression (GWR), and multi-scale GWR (MGWR), were used to investigate the spatially varying correlations between COVID-19 mortality rates and predictors, including air pollutant factors, socioeconomic status, built environment factors, and public transportation infrastructure. The city's downtown and northern areas were found to be significantly clustered in terms of spatial and temporal high-risk areas for COVID-19 mortality. The MGWR regression model outperformed the OLS and GWR regression models with an adjusted R2 of 0.67. Furthermore, the mortality rate was found to be associated with air quality (e.g., NO2, PM10, and O3); as air pollution increased, so did mortality. Additionally, the aging and illiteracy rates of urban neighborhoods were positively associated with COVID-19 mortality rates. Our approach in this study could be implemented to study potential associations of area-based factors with other emerging infectious diseases worldwide.

Nature-based interventions for vulnerable youth: a scoping review

Nature-based interventions hold promise for vulnerable youth experiencing mental, emotional, developmental, behavioral, or social difficulties. This scoping review examined wilderness therapy, animal assisted therapy, care farming, and gardening and horticultural therapy programs to raise awareness and guide future development of research and treatment options. Studies included in this review were identified through a systematic search of the literature informed by a scoping review framework. Studies were examined by design, sample, intervention, and key findings. The majority of studies were quantitative using repeated measures designs and were conducted primarily in the United States. Sample sizes were generally small. Interventions were residential and community based with varying degrees of duration. Outcomes were largely positive across a wide range of psychosocial and behavioral measures and often maintained post-treatment. We emphasize the importance of robust empirical designs, comprehensive description of the interventions and surrounding therapies, and identification of target groups.

An overview and trend analysis of research on the relationship between urban streets and residents' health in China pre- and post COVID-19 pandemic

Introduction

After the outbreak of COVID-19, the international community has been faced with various problems it has brought to cities. A large number of research projects and corresponding management measures were launched globally, trying to reduce the impact of COVID-19 on society. Among them, exploring how to maintain the health of residents by managing and updating the design of urban streets is one of the important issues regarding urban sustainability in the post-epidemic era.

Methods

This study uses bibliometric analysis techniques to obtain an overview of the knowledge structure of 898 Chinese urban streets and residents' health relationship studies from the China National Knowledge Infrastructure (CNKI) database for two periods (1999-2019 and 2020-2022). Five aspects were analyzed in terms of the keyword domain co-occurrence network, topic evolution path, emergent terms, hierarchical clustering, and confusion matrix.

Results and discussion

The findings revealed that studies focused on six broad themes: community residents, health surveys, health education, COVID-19, healthy city, and public health. Based on these findings, the paper compares and discusses research priorities before and after the outbreak and highlights areas for further research and attention.

Aging in Rural Communities

Purpose of Review

Population aging is occurring worldwide, particularly in developed countries such as the United States (US). However, in the US, the population is aging more rapidly in rural areas than in urban areas. Healthy aging in rural areas presents unique challenges. Understanding and addressing those challenges is essential to ensure healthy aging and promote health equity across the lifespan and all geographies. This review aims to present findings and evaluate recent literature (2019-2022) on rural aging and highlight future directions and opportunities to improve population health in rural communities.

Recent Findings

The review first addresses several methodological considerations in measuring rurality, including the choice of measure used, the composition of each measure, and the limitations and drawbacks of each measure. Next, the review considers important concepts and context when describing what it means to be rural, including social, cultural, economic, and environmental conditions. The review assesses several key epidemiologic studies addressing rural-urban differences in population health among older adults. Health and social services in rural areas are then discussed in the context of healthy aging in rural areas. Racial and ethnic minorities, indigenous peoples, and informal caregivers are considered as special populations in the discussion of rural older adults and healthy aging. Lastly, the review provides evidence to support critical longitudinal, place-based research to promote healthy aging across the rural-urban divide is highlighted.

Summary

Policies, programs, and interventions to reduce rural-urban differences in population health and to promote health equity and healthy aging necessitate a context-specific approach. Considering the cultural context and root causes of rural-urban differences in population health and healthy aging is essential to support the real-world effectiveness of such programs, policies, and interventions.

An overview and thematic analysis of research on cities and the COVID-19 pandemic: Toward just, resilient, and sustainable urban planning and design

Since early 2020, researchers have made efforts to study various issues related to cities and the pandemic. Despite the wealth of research on this topic, there are only a few review articles that explore multiple issues related to it. This is partly because of the rapid pace of publications that makes systematic literature review challenging. To address this issue, in the present study, we rely on bibliometric analysis techniques to gain an overview of the knowledge structure and map key themes and trends of research on cities and the pandemic. Results of the analysis of 2,799 articles show that research mainly focuses on six broad themes: air quality, meteorological factors, built environment factors, transportation, socio-economic disparities, and smart cities, with the first three being dominant. Based on the findings, we discuss major lessons that can be learned from the pandemic and highlight key areas that need further research.

Physical activity and subjective well-being of older adults during COVID-19 prevention and control normalization: Mediating role of outdoor exercise environment and regulating role of exercise form

Since the outbreak of the COVID-19 pandemic, the physical and mental health of older adults has been threatened. Promoting physical and mental health through physical activity has therefore become a strategy for healthy aging. In order to better understand the impact of the participation of older adults in physical activity, this paper selects different types of physical activity, and examines the relationship between them and subjective well-being through the analysis of the mediation effect of outdoor exercise environment and the regulating effect of exercise form. In this cross-sectional study, a questionnaire survey was conducted in mainland China. The main data come from 903 older adults in five urban areas in Chengdu, Sichuan Province. The surveys were carried out using the Physical Activity Rating Scale, Newfoundland Subjective Well-Being Scale, Exercise Environment Scale, and Exercise Form Scale. SPSS was used for statistical analysis, linear regression analysis was adopted for processing data, and AMOS was used to establish a mediation model. The mediating variable is the outdoor exercise environment, and the moderating variable is exercise form; gender, age, education level, and monthly income were used as control variables. The study results showed that different physical activities (tai chi; health qigong; walking and jogging) were significantly, positively correlated with the subjective well-being of older adults (tai chi: R = 0.351, p < 0.01; health qigong: R = 0.340, p < 0.01; walking and jogging: R = 0.245, p < 0.01); among the activities, tai chi had the strongest effect on the subjective well-being of older adults (R = 0.351, p < 0.01). Outdoor exercise environment played a mediating role between different physical activity types and subjective well-being of older adults [tai chi: β = 0.030, 95% CI (0.005, 0.031); health qigong: β = 0.018, 95% CI (0.000, 0.021); walking and jogging: β = 0.034, 95% CI (0.008, 0.035)]. Exercise form moderated the subjective well-being of older adults in different physical activities (tai chi: 0.006, p < 0.05; health qigong: 0.006, p < 0.05; walking and jogging: 0.009, p < 0.001). The results of this study demonstrate that the outdoor exercise environment plays a mediating role between different physical activities and the subjective well-being of older adults, and the form of exercise can also moderate the impact of different physical activities on the subjective well-being of older adults. This study has enlightening significance for psychological intervention with older adults facing stress, anxiety and depression.

Tourism as a Tool in Nature-Based Mental Health: Progress and Prospects Post-Pandemic

The healthcare sector recognises the role of nature in mental health. The tourism sector is equipped to take people to national parks. The conservation sector gains support from visitors. Theoretical frameworks for mental health benefits from nature tourism include: tourism destinations and activities; tourist personalities and life histories; sensory and emotional components of tourist experiences; and intensity and duration of memories. Mental health deteriorated worldwide during the COVID-19 pandemic. Recovery of global economic productivity requires immediate, accessible, affordable mental health measures at national scales, and nature-based approaches provide the best option. Different countries have adopted a variety of public, private, or voluntary mechanisms. Some focus on design of activities, others on provision of facilities. Costs and implementation depend on key research questions: marginal benefits of nature tour guides or psychologists compared to self-guided nature experiences; comparisons between repeated brief visits and one-off nature holidays; effects of biodiversity, flagship species, and scenic or wilderness quality; and differences between individuals, depending on personalities, life histories, and mental health status and symptoms.

Physical and Functional Clinical Profile of Older Adults in Specialized Geriatric Rehabilitation Care Services in Saguenay-Québec: A Retrospective Study at La Baie Hospital

Musculoskeletal disorders, cardiovascular and neurological diseases were the most commonly debilitating conditions and risk factors associated with pain, mobility limitations, increased risk of falls and disability. Studies barely address the profile of older adults in care within a specialized geriatric rehabilitation service (SGRS) to provide subsidies for new actions within the public healthcare to reduce falls and improve management in health investments. This study aimed to establish a clinical physical and functional profile of the patients with neuromusculoskeletal and cognitive disorders and fallers in interventions within SGRS. From a retrospective study design, 127 medical records were compiled and analyzed to determine the physical and functional profile of older adults and differences according to sex, age groups and the benefits for local physical therapy intervention. The users were between 76 and 85 years of age, with diverse clinical diagnoses and debilitating conditions and impairments. A higher proportion presented gait and balance impairments and had two or more falls in 12 months. A significant effect for advanced age was observed. Overall, real benefits were reported with intervention for functional improvement, although the absence of a control group. These results have direct implications for a better understanding of a local SGRS and provide subsidies for developing new approaches for the assessment and treatment of older adults with high a risk of falls in order to reduce costs for the public health system.

COVID-19 triggered a physically active lifestyle of people with cardiovascular diseases: Results of a small Austrian qualitative study

Objective

This paper explores physical activity patterns and compensation strategies of people with cardiovascular diseases. The aim is to provide insights into the factors and their relationships that may affect physical activity levels positively or negatively during the pandemic.

Methods

We adopted a qualitative approach with 35 participants who were purposively sampled from different provinces in Austria, including rural and urban areas. Semi-structured interviews were conducted during the second COVID-19 wave in autumn/winter 2020 and the fourth wave in autumn/winter 2021. Content analysis was applied to explore physical activity patterns, the perceived impact of the pandemic on physical activity as well as strategies adopted by participants to maintain physically active during the pandemic waves.

Results

Results show encouraging signs of a recovery or even increase in physical activity during the pandemic waves. The main drivers for maintaining or even increasing physical activity were intrinsic motivation and self-determined motivation relating to the pursue of individual health goals. Furthermore, analysis suggests a reinforcing effect of exercising in green natural areas by decreasing perception of effort and increasing motivation. There was also one group who experienced difficulties in adapting physical activity behaviors. Study participants who were used to exercise indoors struggled to replace accustomed activity patterns with alternatives that were not impacted by lockdown restrictions.

Conclusions

This study provides novel qualitative evidence on the effect of COVID-19 lockdowns on physical activity patterns of people with cardiovascular diseases. Public health interventions to enhance a physically active lifestyle during and beyond the COVID-19 pandemic are recommended to target moderate outdoor exercising and enhance adaptive capacities of people with cardiovascular diseases.

Age Differences in Preferred Methods of Obtaining and Understanding Health Related Information During the COVID-19 Pandemic in Australia

Methods of communications and the nature of messaging are critically important in influencing public behavior. The COVID-19 pandemic has resulted in major disruptions to all aspects of life globally and has triggered multiple approaches of health messaging to the general public to communicate COVID-19 preventative measures. This study aimed to identify: (1) differences between age groups in the main avenues used by people to obtain COVID-19 related information; and (2) whether age and information sources were associated with correct interpretation of government messaging relating to how people understand or interpret the terms “self-isolation” and “social distancing.” An online survey was conducted in 2020. Participants were aged over 18 years and grouped into age group decades. Differences in sources of COVID-19 information were compared visually between age groups. Logistic regression was used to determine whether age and each of the various methods of communication of COVID-19 information were independently associated with correct response to the self-isolation, or the social distancing statements. There were 3,300 survey respondents 85% female; age sub-groups: 18–29 (7.4%); 30–39 (10.6%); 40–49 (17.6%); 50–59 (22.9%); 60–69 (25.9%); 70–79 (13.9%); and 80+ (1.7%). People accessed public health messaging information from a wide variety of sources that changed as they aged (e.g., older people were more likely to be exposed to COVID-19 information via television news programs and less likely via social media platforms). Age was frequently associated with whether the message key terms were interpreted correctly or incorrectly, but in some cases, it promoted more correct responses whereas in others, fewer correct responses. There was no difference between being exposed to COVID-19 information via mainstream media, compared with social media, or compared with Government sources of information, in terms of whether COVID-19 messages were interpreted correctly. In order to improve future public health messaging, there is a need for multiple avenues of communication to meet the needs and preferences across and within age groups. Further investigation is warranted into the clarity of the content and method of delivery of public health messages, to ensure optimal understanding of public health messages by vulnerable populations and across the community.

Processes underpinning survival in gay men living with HIV and a history of suicidality

Gay men living with HIV represent a particularly high risk group for suicide; however, little is known about suicidality, specifically, resiliencies in the context of suicidality among this particular group of men. The current study draws on photovoice and grounded theory methods to examine the processes that underpin survival for gay men living with HIV who have experienced suicidality. Twenty-two Canadian-based gay men participated, taking photographs to depict and discuss their perspectives on resiliencies. Analyses revealed three processes that supported men's survival: (1) connecting to key supports, (2) finding sanctity in the outdoors, and (3) giving help as purposeful value-adding. Connecting to key supports highlighted the utility of connection and therapeutic communication, listening and support provided by friends, family and professionals. Finding sanctity in the outdoors emphasised the healing capacity of outdoor green spaces, and giving help as purposeful value-adding illustrated the meaning and purpose men derived from supporting others. These findings can inform public health and primary care interventions to foster gay men's resilience and coping, and ultimately suicide prevention efforts.

A transformative mission for prioritising nature in Australian cities

Australia is experiencing mounting pressures related to processes of urbanisation, biodiversity loss and climate change felt at large in cities. At the same time, it is cities that can take the leading role in pioneering approaches and solutions to respond to those coupling emergencies. In this perspective piece we respond to the following question: What are the required transformations for prioritising, valuing, maintaining and embracing nature in cities in Australia? We adopt the mission framework as an organising framework to present proposed pathways to transform Australian cities as nature-positive places of the future. We propose three interconnected pathways as starting actions to steer urban planning, policy and governance in Australian cities: First, cities need to establish evidence-based planning for nature in cities and mainstream new planning tools that safeguard and foreground urban nature. Second, collaborative planning needs to become a standard practice in cities and inclusive governance for nature in cities needs to prioritise Aboriginal knowledge systems and practices as well as look beyond what local governments can do. Third, for progressing to nature-positive cities, it is paramount to empower communities to innovate with nature across Australian cities. Whilst we focus on Australian cities, the lessons and pathways are broadly applicably globally and can inspire science-policy debates for the post COP15 biodiversity and COP26 climate change implementation processes.

The ENJOY MAP for HEALTH: Exercise interveNtion outdoor proJect in the cOmmunitY for older people-More Active People for HEALTHier communities: a study protocol

Background

Physical activity is important to maintain health in older age, with physical activity in the outdoors providing mental and physical health benefits for all age groups. One way by which older people can engage in physical activity in the outdoors is through using suitable age-friendly outdoor exercise equipment, the Seniors Exercise Park. The ENJOY MAP for HEALTH aims to evaluate the effect of the Seniors Exercise Park installation and associated capacity building activities on park visitation, park-based physical activity by older people and delivery of community physical activity programs.

Method

This study is a quasi-experimental (natural experiment) with pre and post study design evaluating the effect of age-friendly outdoor spaces with specialised outdoor exercise equipment on older people’s physical activity and wellbeing in six Victorian municipalities (local governments/councils). Each council will undergo four stages (site construction and development, promotion and marketing, capacity building and training, evaluation and sustainability). Several activities and methods will be employed from stage one through stage four to evaluate the potential impact of the age-friendly outdoor spaces on physical activity and wellbeing and will comprise the following elements: site observation and equipment utilisation, face to face intercept surveys, development of an online access monitor and community building activities.

Discussion

The project is expected to result in a significant change in the physical outdoor environment for the participating councils and communities whereby older people and other community members will be able to engage in safe physical and social activity programs, socialise more and hence improve the overall wellbeing of older people.

Trial registration

This trial is retrospectively registered with the Australian New Zealand Clinical Trials Registry. Trial registration number ACTRN12621000965808. Date registered 23/07/2021.

The Text4HealthyAging Program: An Evidence-Based Text Messaging Innovation to Support Healthy Urban Aging in Canada and Australia

Age-friendly cities are crucial to achieve the WHO goal of healthy aging. Such cities promote opportunities for health, participation, and security, thus enhancing quality of life as people age. Older people commonly experience psychosocial challenges such as anxiety, depression, substance abuse, loss of autonomy, grief, fear, and loneliness. Australian and Canadian cities continue to seek innovation to improve healthy urban aging and create more age-friendly environments for older adults. There is increasing evidence on the effectiveness and feasibility of mobile technology in health promotion and closing psychological treatment gaps. Older adults have been demonstrated to engage frequently with mobile devices, particularly text messaging. In this article, we conceptualize the Text4HealthyAging, an evidence-based text messaging innovation to support healthy urban aging in Canadian and Australian cities.

Spatial statistical analysis of the relationship between self-reported mental health during the COVID-19 lockdown and closeness to green infrastructure

The COVID-19 pandemic has produced alterations in the behaviour and psychological health of people, who have had to learn living under uncertain circumstances escaping their control. This situation has been aggravated in those countries applying strict home confinement rules to try bending their epidemic curve. This is the case of Spain, where the stringent lockdown period was extended over three months. This study aimed at proving a research hypothesis whereby living close to Green Infrastructure (GI) during the confinement period was beneficial for mental health. To this end, La Palma (Canary Islands) and Zaragoza (Peninsular Spain) were taken as case studies, since both locations distributed a questionnaire to address citizenry's self-reported mental health under strict lockdown conditions. A spatial statistical analysis of the responses collected by these questionnaires revealed that variables such as stress, anger, medication use, alcohol consumption or visits to the doctor significantly decreased if citizens were close to GI, whereas people having very high expectations of enjoying the city after the confinement were positively correlated to proximity of green areas. Although these outcomes are limited by the inferential capacity of correlation analysis, they point out to a sense of relief derived from having visual contact with vegetated landscapes and feeling stimulated about using them for recreation, aesthetical or sporting purposes. The joint consideration of these psychological gains with the social and environmental benefits provided by GI emphasizes the importance of approaching urban regeneration through the design and implementation of interconnected green spaces.

Parks and the Pandemic: A Scoping Review of Research on Green Infrastructure Use and Health Outcomes during COVID-19

Green infrastructure (GI) has long been known to impact human health, and many academics have used past research to argue for the potential importance of GI as a mechanism for maintaining or improving health within the context of the COVID-19 pandemic. This scoping review addresses the question: What evidence, if any, have researchers found of a relationship between green infrastructure use and health during the COVID-19 pandemic? Specifically, evaluating the (a) association of GI use with COVID-19 disease outcomes and (b) association of GI use with other health outcomes as impacted by the COVID-19 pandemic. Twenty-two studies were identified that measured GI use and studied it in relation to health outcomes during the pandemic. The studies were reviewed for the specific measures and types of GI use, level of analysis, specific types of health outcomes, and the conclusions reached with regard to GI use and health. Studies exploring COVID-19-specific health outcomes showed mixed results, while non-COVID health outcomes were more consistently improved through GI use, particularly with regard to improved mental health. While the evidence strongly suggests that GI use has played a protective role in non-COVID-19 physical and mental health during the pandemic, questions remain with regard to possible impacts on COVID transmission and mortality.

Challenges and lessons learnt from the ENJOY project: recommendations for future collaborative research implementation framework with local governments for improving the environment to promote physical activity for older people

BACKGROUND

The physical environment has been shown to have a positive effect on the promotion of physical activity of older people. Outdoor environments that incorporate specialised exercise equipment suitable for older people are uniquely placed to promote physical activity and social connectedness amongst older people. The ENJOY project included the installation of specialised outdoor exercise equipment (the Seniors Exercise Park) and the delivery of a physical and social activity program for older people as part of a prospective pre-post research design. The installation of the specialised equipment in public sites and an aged care facility was also aimed at increasing usage of the equipment by older people from the wider community and to increase physical and social activities.

METHOD

A conceptual framework for implementation and several engagement methods were utilised to guide the research and to support the participating partners throughout the project. This paper is a reflective narrative describing the collaborative process and approach utilised to engage local governments and community, and reports the challenges and the lessons learnt to inform future strategies for implementation.

RESULTS

The conceptual framework for the implementation process that guided the conduct and delivery of the ENJOY project included the core elements of the Interactive Systems Framework and the ecologic framework. These models incorporate elements of research-to-practice and community-centred implementation to accommodate the unique perspectives of a range of stakeholders.

CONCLUSION

Partner characteristics such as local governments' structure and policy as well as community factors can impact on implementation. Partnership with local governments with effective communication, strategic planning and community and seniors engagement approaches are recommended for successful implementation. The lessons learnt can further assist public health research design around changes to the built environment to positively impact on older people's physical activity levels.

TRIAL REGISTRATION

Trial registration number ACTRN12618001727235. Date of registration 19th October 2018, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375979.