Does Physical Activity in Natural Outdoor Environments Improve Wellbeing? A Meta-Analysis

Outdoor physical activity is more beneficial than indoor physical activity for cognition in young people

BACKGROUND

Substantial evidence demonstrates the beneficial acute effect of physical activity and the outdoor environment independently on cognitive function. However, evidence for their potential synergistic effects remain unknown.

METHODS

Following familiarisation, forty-five children (aged 11-13 years) took part in an identical physical activity session outdoors and indoors; and completed a battery of cognitive tests (Stroop test, Sternberg paradigm, and Flanker task) before, immediately post-, and 45 min post-physical activity.

RESULTS

Following outdoor, compared to indoor, physical activity response time was improved more immediately post-physical activity on the 3-item level of the Sternberg Paradigm (-34 ms vs +14 ms; P = 0.001), at 45 min post-physical activity on the complex level of the Stroop test (-94 ms vs -20 ms; P = 0.002), the 1-item (-9 ms vs +71 ms; P = 0.026) and 3-item level of the Sternberg paradigm (-37 ms vs +69 ms; P < 0.001), and the congruent level of the Flanker test (-44 ms vs -14 ms; P = 0.001). Accuracy was also improved more outdoors (compared to indoors) immediately post-physical activity (+2.0 % vs +0.4 %; P = 0.036) and 45 min post-physical activity (+2.0 % vs +0.1 %; P = 0.043) on the complex level of the Stroop test and on the incongruent level of the Flanker test (no change vs -3 %; P = 0.008).

DISCUSSION

This is the first study to demonstrate superior cognitive benefits of outdoor, compared to indoor, physical activity. The overarching finding of this investigation is that physical activity performed outdoors significantly improves cognitive function more than when performed indoors, suggesting a synergistic effect between physical activity and the outdoor environment.

[Current State of Research on Surf Therapy and its Possible Application as an Intervention for Adolescent Depression]

Current State of Research on Surf Therapy and its Possible Application as an Intervention for Adolescent Depression Abstract: Depression is one of the most common mental health disorders experienced in adolescence. Because of its high prevalence rates and significant impact on affected individuals, alternative and complementary interventions are being explored. In recent years, physical activity has received increasing attention as a form of treatment. Current reviews highlight the potential benefits of this therapeutic approach in reducing depressive symptoms. Surf therapy is an innovative approach in the field of physical activity that additionally utilizes the therapeutic effects of the ocean. It combines surfing with structured exercises to promote mental and physical well-being. Internationally, surf therapy is already being applied to children and adolescents dealing with mental health problems as well as to adults diagnosed with conditions such as depression and posttraumatic stress disorder. Initial studies suggest positive effects of surf therapy in terms of symptom reduction, although the research is limited and requires further investigation. We present our pilot study investigating the feasibility and effectiveness of surf therapy for the treatment of adolescent depression in Germany.

Effect of Exercise on Mental Health and Health-related Quality of Life in Adults With Spinal Cord Injury: A Systematic Review and Meta-analysis

OBJECTIVES

To determine the effect of exercise interventions on mental health and health-related quality of life (HRQoL) in individuals with SCI.

DATA SOURCES

We searched Embase, CINAHL, Medline, PsychINFO, and SPORTDiscus from inception to September 2023.

STUDY SELECTION

We included randomized controlled trials that (1) involved participants ≥18 years old with a SCI; (2) administered an exercise intervention; and (3) measured subjective well-being, psychological well-being, social well-being, and/or HRQoL as outcomes. We reported standardized means differences (d) with a 95% confidence interval (CI), assessed the risk of bias by using the Revised Cochrane Risk-of-bias Tool for Randomized Trials (RoB 2), and the certainty of the evidence using GRADE.

DATA SYNTHESIS

Nineteen studies (797 participants, mean age <65 years in every study) were included. Exercise improved overall well-being (d=0.494; 95% CI 0.268, 0.720; low certainty evidence), subjective well-being (d=0.543; 95% CI 0.270, 0.816; low certainty evidence), psychological well-being (d=0.499; 95% CI 0.193, 0.805; low certainty evidence), social well-being (d=0.452; 95% CI 0.151, 0.752; low certainty evidence), and HRQoL (d=0.323; 95% CI 0.072, 0.574; low certainty evidence). Four serious adverse events probably attributable to the interventions were reported in 3 studies.

CONCLUSIONS

Exercise interventions can improve well-being and HRQoL in adults with SCI <65 years of age. Additional research is needed to determine effectiveness in adults ≥65 years of age.

The relationship between physical activity environment, mental wellbeing, flourishing and thriving: A mixed method study

Research shows that mental wellbeing contributes to a greater quality of life and longevity, superior overall health, life success, and fulfillment. High mental wellbeing, such as flourishing and thriving, is associated with a sense of meaning and purpose, mastery and accomplishment, social connectedness, optimism, and contribution to society. Nature-based physical activity participation has been linked with mental wellbeing enhancement over and above the impact of physical activity alone. The present study sought to address a gap in the research by exploring whether the environment in which physical activity takes place and one's gender moderate the relationship between activity time and various indices of mental wellbeing. Using a mixed methods design, participants (N = 235) aged 18 to 76 (M = 33.41, SD = 13.41) completed an online survey. We divided participants into three groups based on their preferred type of physical activity: indoor, outdoor non-nature-based, and outdoor nature-based physical activity. The moderation analyses highlight the importance of the environment in physical activity, with outdoor nature-based settings consistently showing positive associations with flourishing and thriving. These findings suggest that engaging in physical activities in natural environments can significantly predict an individual's mental wellbeing, for both males and females. Qualitative data supported the findings and also revealed that nature-based physical activity achieves these benefits through developing positive affect, social closeness and engagement, purpose, enhanced experiences, and interests beyond oneself. Findings from this study demonstrate the importance of nature-based physical activity for mental wellbeing promotion and protection, indicating that opportunities for nature-based physical activity should be more effectively provided, perhaps across multiple domains of life such as education, sport, public health, and urban planning.

Credibility of the evidence on green space and human health: an overview of meta-analyses using evidence grading approaches

BACKGROUND

Green space is an important part of the human living environment, with many epidemiological studies estimating its impact on human health. However, no study has quantitatively assessed the credibility of the existing evidence, impeding their translations into policy decisions and hindering researchers from identifying new research gaps. This overview aims to evaluate and rank such evidence credibility.

METHODS

Following the PRISMA guideline, we systematically searched PubMed, Web of Science, and Embase databases for systematic reviews with meta-analyses concerning green spaces and health outcomes published up to January 15, 2024. We categorized the credibility of meta-analytical evidence from interventional studies into four levels (i.e., high, moderate, low, and very low) using the Grading of Recommendation, Assessment, Development and Evaluations framework, based on five domains including risk of bias, inconsistency, indirectness, imprecision, and publication bias. Further, we recalculated all the meta-analyses from observational studies and classified evidence into five levels (i.e., convincing, highly suggestive, suggestive, weak, and non-significant) by considering stringent thresholds for P-values, sample size, robustness, heterogeneity, and testing for biases.

FINDINGS

In total, 154 meta-analysed associations (interventional = 44, observational = 110) between green spaces and health outcomes were graded. Among meta-analyses from interventional studies, zero, four (wellbeing, systolic blood pressure, negative affect, and positive affect), 20, and 20 associations between green spaces and health outcomes were graded as high, moderate, low, and very low credibility evidence, respectively. Among meta-analyses from observational studies, one (cardiovascular disease mortality), four (prevalence/incidence of diabetes mellitus, preterm birth, and small for gestational age infant, and all-cause mortality), 12, 22, and 71 associations were categorized as convincing, highly suggestive, suggestive, weak, and non-significant evidence, respectively.

INTERPRETATION

The current evidence largely confirms beneficial associations between green spaces and human health. However, only a small subset of these associations can be deemed to have a high or convincing credibility. Hence, future better designed primary studies and meta-analyses are still needed to provide higher quality evidence for informing health promotion strategies.

FUNDING

The National Natural Science Foundation of China of China; the Guangzhou Science and Technology Program; the Guangdong Medical Science and Technology Research Fund; the Research Grant Council of the Hong Kong SAR; and Sino-German mobility program.

Comparison of Estonian Schoolchildren's Physical Activity and Fitness Indicators before and after the COVID-19 Pandemic's Period of Restricted Mobility

It is recognized that the time adolescents spend on physical activity, and the corresponding physical fitness indicators, have diminished over time. However, the exact impact of the COVID-19 pandemic restriction period on physical activity and health-related physical fitness indicators remains unclear. This study sought to determine if and to what degree the primary indicators of physical activity (exercise frequency, exercise intensity, and outdoor physical activity) and health-related physical fitness (strength and endurance) among schoolchildren have shifted, by comparing data from before and after the coronavirus pandemic period. Students aged 12-17 years took part in the study. The physical activity questionnaire and fitness tests were conducted in the autumn of 2017 and spring of 2022. The main results show that moderate- and vigorous-intensity physical activity time and time spent actively outdoors have decreased among adolescents (p < 0.05). There were no significant changes in exercise frequency (p > 0.05). However, there was a statistically significant decline in strength (standing broad jump, bent arm hang) (p < 0.05) and endurance (20 m shuttle run, curl-up) (p < 0.01) when comparing results from before and after the COVID-19 pandemic restriction period. In conclusion, restricted mobility had the greatest impact on the time spent outdoors and, in turn, on physical fitness.

A randomised controlled trial assessing the effects of weather sensitivity profile and walking in nature on the psychophysiological response to stress in individuals with coronary artery disease. A study protocol

BACKGROUND

The following protocol pertains to a pioneer study, aiming to investigate how weather sensitivity and walking in different environments affects the psychophysiological responses to the stress of individuals with coronary artery disease (CAD) during rehabilitation (WE_SENSE_THE_NATURE). This randomised control trial will provide fresh insight on the influence of the environmental exposure in CAD patients, as it is seldom investigated in association to the disease. Additionally, findings on the link between personality traits and cognitive functions (especially cognitive flexibility), and weather sensitivity may help reveal a fine-grained perspective on the treatment possibilities for individuals with CAD at risk to stress-vulnerability.

METHODS

The proposed protocol is for a randomised control trial among individuals attending a cardiac rehabilitation program. We aim to recruit 164 individuals, collecting information related to demographic characteristics, weather sensitivity, functional capacity, personality traits, subjective mental health status, cognitive function, and basal cortisol level of participating individuals. Basal cortisol level refers to cortisol concentration in saliva and will be tested in the morning and the afternoon prior to the day of the experiment. After baseline measurements, the patients will be randomly assigned to either walking outdoors or walking indoors. All measures and their sequential order will remain the same within each group, while the treatment condition (i.e., walking environment) will vary between groups. On the day of the experiment, hemodynamic parameters (assessed via 6-hour blood pressure measurements), stress level (consisting of assessments of cortisol level), and mood (assessed using visual analogues scale) will be registered. Cold stress test will be administered to evaluate the effect of walking in different environments.

DISCUSSION

The outcomes of this study may have direct clinical applications for the use of different types of exercise environments in cardiac rehabilitation programs. Awareness about the potential influence of weather sensitivity on the psychophysiological reactions to stress in individuals with CAD may contribute to a timely planning and implementation of actions leading to improved medical care services and preventive measures, especially considering the expected weather oscillations and extreme weather events due to unfolding of the climate change.

TRIAL REGISTRATION

This protocol has been retrospectively registered in ClinicalTrials.gov with identifier code: NCT06139705 on November 20, 2023.

The Impact of an Outdoor Motor-Cognitive Exercise Programme on the Health Outcomes of Older Adults in Community Settings: A Pilot and Feasibility Study

Physical and cognitive exercises can prevent or at least mitigate the symptoms of certain diseases and help older adults perform a range of daily functions. Yet, most seniors do not meet the World Health Organisation's recommended guidelines for physical activity. The objective of this study is to promote and maintain the physical and cognitive capacity of older adults by implementing a feasible and effective low-threshold, age-appropriate, motor-cognitive training outdoors. In the German city of Chemnitz, citizens aged 60 years and older participated in a quasi-randomised intervention trial. Exercises to train coordination, strength, endurance, and cognition were integrated into a 12-week outdoor motor-cognitive exercise programme. Both the physical (e.g., 6MWT) and cognitive skills (e.g., TMT B) of the intervention group (n = 41) and control group (no intervention, n = 58) were measured before (T1) and after (T2) completion of the exercise programme. Some of the participants' physical and all their cognitive measures improved. Neurocognitive performance (DSST) showed a significant time × group interaction effect (F(1,95) = 6.943, p = 0.010, ηp2 = 0.068). Sex and age were found to be influencing factors. We consider our exercise programme to be successfully implemented, well received by the participants, and feasible and useful to promote the continued exercise of daily functions as part of healthy aging in community-dwelling older adults.

Better together? Comparing physical activity of parents walking outdoors with and without their child

This study compares the physical activity levels and enjoyment of parents (n ​= ​50; age ​= ​41.8 ​± ​4.0 years) during outdoor, self-paced walking sessions while walking alone and when walking with their 6-to-12-year-old child. Step counts, moderate-to-vigorous physical activity (MVPA), vigorous physical activity, and enjoyment were compared using paired t-tests. Regression modeling was used to examine the impact of children's age and adults' and children's body mass index on the disparity in step counts experienced by adults. Adults attained high percentages of time spent in MVPA while walking alone (99.8%) and when walking with their child (96.6%). However, more of this time was categorized as vigorous physical activity when walking alone (13.6% vs. 3.0%, p ​= ​0.006). Adults' step counts decreased by an average of 6.4% while walking with their child compared to walking alone (p ​< ​0.001). This reduction was greater for parents of younger children (p ​= ​0.004). In obese adults, the reduction in step counts experienced while walking with their child was not as great as the reduction experienced by normal-weight adults (p ​= ​0.042). Although adults obtained higher step counts and vigorous physical activity while walking alone, they enjoyed walking more with their child (p ​< ​0.001). Health practitioners should be aware of this tradeoff when making recommendations for parent-child co-participation in physical activity, and parents may wish to supplement their physical activity obtained while walking with their child(ren) with additional activities that result in vigorous physical activity.

Differential Magnitude of Resilience between Emotional Intelligence and Life Satisfaction in Mountain Sports Athletes

The field of mountain sports has its own characteristics, different from other sports modalities. Emotional intelligence and resilience not only refer to the adaptive capacity that can be developed after an adverse experience, but can also be factors that positively affect sporting performance in extreme conditions. In this study, 4818 athletes from the Spanish Federation of Mountain Sports and Climbing participated; 2696 were men (67.1%) and 1322 were women (32.9%), with a mean age of 49.42 years (±11.9). The Resilience Scale (RS-14), Wong Law Emotional Intelligence Scale (WLEIS-S) and Satisfaction with Life Scale (SWLS) were used. The aim was to provide evidence for the potential for resilience (personal competence and acceptance of self and life) among EI and life satisfaction in mountain and climbing athletes. The results showed that the coefficients of determination of personal competence [(Q2 = 0.286); (R2 = 0.578)], acceptance of self [(Q2 = 0.310); (R2 = 0.554)] and life satisfaction [(Q2 = 0.299); (R2 = 0.421)] for the estimation of the measurement model indicated a good model fit. In the future, it would be necessary to carry out specific studies discriminating by sport modality and methods for this area, with a large number of athletes and disciplines, as well as evaluating its possible applications for the improvement of emotional factors.

Green spaces for mental disorders

PURPOSE OF REVIEW

Mental illness is a global challenge, exacerbated by the coronavirus pandemic. Research suggests access to local green spaces is associated with better mental health, yet access is not always equitable. Evaluation of how nature-based interventions protect and support mental health is therefore required.

RECENT FINDINGS

Accessible local green spaces are associated with better mental health. They encourage active behaviours and social interaction, reduce loneliness and stress. Green views from the home are associated with increased self-esteem, life satisfaction and happiness and reduced depression, anxiety and loneliness. Nature-based interventions and green social prescriptions effectively target vulnerable groups, resulting in significant reductions in depression, anxiety and anger alongside positive mental health outcomes.

SUMMARY

Although existing evidence is encouraging, robust, high-quality research that strengthens the evidence base and informs future clinical practice and policy decision making is needed. Evidence of the long-term effectiveness in individuals with diagnosed mental illness is also required to ascertain the potential social and wider returns on investment. Barriers to use of green social prescriptions like mental health symptoms and geographical accessibility need to be overcome to increase accessibility and uptake of green social prescriptions for the prevention and treatment of mental illness.

"Virtual Surf Booth": Assessment of a Novel Tool and Data Collection Process to Measure the Impact of a 6-Week Surf Programme on Mental Wellbeing

Surf therapy is increasingly used as a health intervention, but evidence of its mental health benefits remains unclear. This longitudinal mixed-method study assessed the usability and acceptability of a novel online data collection tool and process to measure the impact of a surf programme on acute and chronic mental wellbeing. Fifteen women attending a 6-week surf programme in the UK were asked to complete a tool consisting of video recordings, word association and the Short Warwick-Edinburgh Mental Well-Being scale (SWEMWBS). Usability and acceptability were assessed through focus groups and quantitative data. The data generated in the focus groups, video recordings and word association were analysed via reflexive thematic analysis, and SWEMWBS presented descriptively. Participants perceived the tool as easy to use due to the completion time and its functionalities, and useful for self-reflection. Facilitating conditions such as timing and location, areas for improvement such as increased privacy, accessibility, incentivisation, and factors impacting data generated were further identified. Data collected covered both acute and chronic mental wellbeing and showed a positive relationship between surf and mental wellbeing. Further research is needed to confirm these findings in diverse populations, identify potential moderators, and confirm the validity of this tool and process.