The effects of nature-based vs. indoor settings on the adaptability, performance and affect of calisthenics exercisers. A registered report

Comparisons of the beneficial effects of nature-based versus indoor physical activity have been extensively reported, but existing research addresses mainly aerobic activity (running, jogging), not other types. It is unclear if the psychological effects extend to functionality, i.e., if participants perform their activities better in nature. The present study investigated how engaging in similar exercise in nature-based and indoor settings differs in affective valence, perceived exertion, visual attention, movement adaptability, heart rate variability, and performance. Nature-based exercisers (N = 51) showed increased performance output than indoor exercisers (N = 53) (p < 0.001). There were no group differences in affective valence, perceived exertion, or visual attention. However, psychological states of nature-based exercisers showed stronger associations to performance output (r < 0.33) than those from indoor exercisers (r < 0.03). Nature-based exercisers' movement variability and structure, measured by non-linear and fractal techniques (sample entropy and detrended fluctuation analysis), were more regular (p < 0.001) and more functionally adaptive (group difference in long-term detrended fluctuation analysis, p = 0.022) to achieve better performance output. Heart rate variability measures were not different between groups. Distinct environments can influence movement adaptability in a calisthenics exercise routine, and ultimately contribute to better performance. These results show how action is specific to task environment, and how action implies not only the task, but also the characteristics of the environment. TRIAL REGISTRATION: NCT05090501 (Clinicaltrials.gov). Registered 21 October 2021.

Evaluating the impact of aerobic and resistance green exercises on the fitness, aerobic and intrinsic capacity of older individuals

OBJECTIVE

Our study determined the impact of 12-week aerobic exercise (AE) and aerobic + resistance exercises (AE + RE) within the green exercise concept, on senior fitness, aerobic capacity, and intrinsic capacity (IC).

METHODS

The study was a multicenter, randomized controlled study conducted at two senior living facilities with individuals aged 65 and above whose cardiorespiratory and musculoskeletal conditions are suitable for moderate exercise and who have normal cognition levels. Block randomization was applied to 96 participants in a ratio of 1:1:1 to be assigned to AE, AE + RE, and control (C) groups. Intervention groups received exercise sessions led by physiotherapists within the senior living facilitiy gardens, with a frequency of once a week for 50 min, for 12 weeks. Also, they were prescribed additional exercise sessions on two additional days of the week. At the commencement of the study and 12th week, shuttle walking test, senior fitness test (SFT), intrinsic capacity assessment (with Timed Up and Go test, Mini Mental State Examination, Geriatric Depression Scale-15, Mini Nutritional Assessment, handgrip strength test) was conducted of all participants. The primary outcome was the Z score of IC, secondary outcomes were VO2max and SFT subparameters. The study was registered in the Protocol Registry and Results System (Clinicaltrials.gov PRS) with the registration number NCT05958745.

RESULTS

90 participants successfully completed the study, with 30 individuals in each of the AE, AE + RE, and C groups. By the end of the 12th week, the arm curl score was significantly higher in the AE + RE compared to the C (mean difference: 3.96, 95 % CI= 2.47 to 5.46, p = 0.01). There were significant differences in chair stand, two-minute step, 8-foot up-and-go, chair sit and reach, and back scratch tests in both AE and AE + RE compared to C. AE and AE + RE exhibited significantly higher shuttle test distances and VO2max values compared to the C (p < 0.0001). AE + RE achieved a significantly higher total IC score than the C (mean difference: 0.59, %95 CI= -0.07 to 1.26, p = 0.025).

CONCLUSION

In this study within the green exercise concept, both AE and AE + RE led to similar improvements in strength, flexibility, mobility, endurance, and aerobic capacity. Notably, AE + RE demonstrated an additional benefit by increasing the total IC, while AE alone did not exhibit the same effect.

In situ psycho-cognitive assessments support self-determined urban green exercise time

Prescribed nature walks frequently yield improvements to mood and cognition as observed in experimental studies. Research that uses real life settings such as self-determined time exercising outdoors for restorative health benefits may more accurately elicit effects than time-specified study protocols. This study examined in situ psycho-cognitive outcomes of routine walks in urban greenspace to test the concept that self-set exposure duration and not context alone is related to magnitude of psycho-cognitive benefit. Pre-post measurements taken on a diverse participant pool of individuals walking in urban parks and recruited on random days over a two-week period found significant associations between outdoor activity duration and cognitive and mood improvements. Greater outdoor walking duration linearly predicted stronger processing speeds but non-linearly in tests of other cognitive domains. Results of fixed effects model for mean mood change following green exercise show outdoor walking influenced mood change at highest levels of significance, even after accounting for individual level variability in duration. Mood improved for all durations of outdoor walking under a random effects model with high significance. Untethering fixed intervals of outdoor exercise from formal study design revealed briefer but more frequent nature engagement aligned with nature affinity. The influence of unmeasured factors, e.g., nature affinity or restorative conditioning, for prescriptive durations of urban green exercise merits further investigation toward designing wellbeing interventions directed at specific urban populations.

Can natural environments enhance acute effects of rehabilitation exercise for older adults? A pilot randomized controlled trial

The added value of natural environments in rehabilitation exercise is unclear. This study aimed to investigate whether there are more acute health benefits for older adults after a single rehabilitation exercise session performed in an outdoor natural environment compared with an indoor environment. Twenty-two nursing home residents were randomly assigned to the outdoor (n = 11, 79.5 ± 2.1 years) or indoor group (n = 11, 78.8 ± 5.2 years). Performance test outcomes were measured pre- and post-training session. The indoor group had a significantly higher blood pressure, greater increase in heart rate, higher perceived exercise intensity and physiological fatigue than the outdoor group. The combination of rehabilitation exercise with an outdoor natural environment may reduce exercise fatigue and improve cardiovascular health in older adults, with greater acute health benefits compared with an indoor environment. Rehabilitation exercise in the natural environments may be a highly valued environmental intervention for physiotherapy in older adults.

Green exercise, mental health symptoms, and state lockdown policies: A longitudinal study

Lockdown policies aimed at decreasing the transmission of COVID-19 showed unintended mental health consequences; however, natural settings may offer a respite for individuals suffering from depression or anxiety symptoms. Previous cross-sectional literature reports protective effects of outdoor exposure on mental health during the COVID-19 pandemic. We longitudinally assess whether green exercise corresponded with a decline in adverse mental health symptoms, controlling for state lockdown policies. We also examine whether the relation differed by state lockdown status. As our exposure variable, we specificized participation in an outdoor walk, jog, or hike (green exercise). We used, as the outcome variable, the 4-item Patient Health Questionnaire (PHQ-4) to measure anxiety and depression symptoms. We utilized the Understanding America Study (UAS), a nationally representative sample of 8253 adults across 50 states in the US, surveyed biweekly between March 10, 2020-May 26, 2021. Linear fixed effect analyses controlled for time-invariant individual factors, as well as employment status, and household income. Regression results indicate a modest decline in PHQ-4 scores of approximately 0.10 (less mental health symptoms) as a function of green exercise, controlling for state lockdown status. We also find a slightly greater protective effect of green exercise on mental health symptoms during state lockdown policies. Additionally, we find that green exercise, as opposed to indoor exercise, corresponds with a decrease in PHQ-4 scores during lockdown. Contact with nature may improve mood and decrease mental health symptoms, especially during stress-inducing periods such as the COVID-19 pandemic. Green exercise as a recommended behavioral intervention may hold relevance for greater public health.

Taking real steps in virtual nature: a randomized blinded trial

Studies show that green exercise (i.e., physical activity in the presence of nature) can provide the synergistic psychophysiological benefits of both physical exercise and nature exposure. The present study aimed to investigate the extent to which virtual green exercise may extend these benefits to people that are unable to engage in active visits to natural environments, as well as to promote enhanced exercise behavior. After watching a video validated to elicit sadness, participants either performed a treadmill walk while exposed to one of two virtual conditions, which were created using different techniques (360° video or 3D model), or walked on a treadmill while facing a blank wall (control). Quantitative and qualitative data were collected in relation to three overarching themes: "Experience," "Physical engagement" and "Psychophysiological recovery." Compared to control, greater enjoyment was found in the 3D model, while lower walking speed was found in the 360° video. No significant differences among conditions were found with respect to heart rate, perceived exertion, or changes in blood pressure and affect. The analysis of qualitative data provided further understanding on the participants' perceptions and experiences. These findings indicate that 3D model-based virtual green exercise can provide some additional benefits compared to indoor exercise, while 360° video-based virtual green exercise may result in lower physical engagement.

Effect of exercise in a desert environment on physiological and subjective measures

Green exercise is beneficial to emotional and physiological measures, however, the US has large desert areas. We aimed to determine if exercise in a desert (brown) environment extends similar benefits to green. Participants (N = 10) completed baseline measures (PRE), 30-min seated rest (SIT), and 30-min self-paced walking (WALK) in: indoor, outdoor urban, green, and two brown environments. Heart rate (HR), blood pressure (BP), and measures of stress, comfort, and calm were obtained. After SIT, HR was elevated in urban vs green (p = 0.05). Systolic BP was lower after SIT compared to PRE and WALK (p = 0.05). Brown and green returned greater comfort and calm scores (p = 0.001). Stress was lower following WALK than PRE and SIT (p < 0.01). Comfort and calm were greatest in natural environments, and exercise significantly reduced perceived stress. Taken together, these data provide evidence that exercise in a desert environment is just a beneficial as the exercise performed in a green environment. Abbreviations: ANCOVA: analysis of covariance; ANOVA: analysis of variance; AU: arbitrary units; BP: blood pressure; BSL: below sea level; DBP: diastolic blood pressure; HR: heart rate; PRE: baseline measurement; PS: perceived stress; SBP: systolic blood pressure; SIT: measurement following 30-min seated rest; WALK: measurement following 30-min self-paced walking.

Study of active neighborhoods in Detroit (StAND): study protocol for a natural experiment evaluating the health benefits of ecological restoration of parks

BACKGROUND

Individuals living in deprived inner cities have disproportionately high rates of cancers, Type 2 diabetes and obesity, which have stress- and physical inactivity-related etiologies. This study aims to quantify effects of ecological park restoration on physical activity, stress and cardio-metabolic health outcomes.

METHODS

The Study of Active Neighborhoods in Detroit is a quasi-experimental, longitudinal panel natural experiment with two conditions (restored park intervention (INT) and control (CNT)) and annual measurements at baseline and 3-years post-restoration. Individuals (sampled within 500 m of an INT/CNT park) serve as the unit of analysis. Restoration (n = 4 parks) involves replacing non-native plants and turf with native plants; creating trails; posting signage; and leading community stewardship events. The CNT condition (n = 5) is an unmaintained park, matched to INT based on specified neighborhood conditions. Recruitment involves several avenues, with a retention goal of 450 participants. Park measures include plant/avian diversity; usage of the park (SOPARC); signs of care; auditory environment recordings; and visual greenness using 360 imagery. Health outcomes include device-based physical activity behavior (primary outcome); salivary cortisol (secondary outcome); and several downstream health outcomes. Exposure to the INT will be assessed through visual contact time and time spent in the park using GPS data. Changes in health outcomes between years and INT versus CNT will be tested using generalized linear (mixed) models.

DISCUSSION

Our study will examine whether restored urban greenspaces increase physical activity and lower stress, with public health planning implications, where small changes in neighborhood greenspaces may have large health benefits in low-income neighborhoods.

STUDY REGISTRATION

Registration: OSF Preregistration registered March 31, 2020. Accessible from https://osf.io/surx7.

Effectiveness of stress-relieving strategies in regulating patterns of cortisol secretion and promoting brain health

Stress leads to ill-health and disease, and with today's fast-pace western society, engaging in strategies to relieve stress is crucial for good health across the life-course. Activities such as focusing on positive characteristics, art/music therapies, mindfulness, yoga and engaging with nature and/or physical activity have been shown to reduce stress and enhance well-being. It is thought that patterns of cortisol secretion, which are regulated by the brain, are a key mediator of stress-disease and well-being-health links. Measurement of cortisol in saliva is a non-invasive and ecologically valid tool for detecting early changes in brain health, as well as evaluating the effectiveness of strategies in relieving stress and improving brain health as well as monitoring stress-related brain changes. This chapter will review the evidence that engaging in stress-relieving strategies promotes regulation and/or restoration of patterns of cortisol secretion. If such strategies are found to be effective in healthy populations, they could potentially inform ways of promoting brain health and the prevention or delay of clinical disorders involving disorders in the brain (e.g., Parkinson's disease) and symptoms experienced with such disorders. To inform this field of research, recommendations are provided for the use of salivary cortisol as a marker of early monitoring of brain health and effectiveness of stress-alleviating interventions.

Neighbourhood blue space, health and wellbeing: The mediating role of different types of physical activity

BACKGROUND

Evidence suggests that living near blue spaces such as the coast, lakes and rivers may be good for health and wellbeing. Although greater levels of physical activity (PA) may be a potential mechanism, we know little about the types of PA that might account for this.

OBJECTIVES

To explore the mediating role of: a) 'watersports' (e.g. sailing/canoeing); b) 'on-land outdoor PA' in natural/mixed settings (e.g. walking/running/cycling); and, c) 'indoor/other PA' (e.g. gym/squash) in the relationships between residential blue space availability and health outcomes.

METHODS

Using data from the Health Survey for England (n = 21,097), we constructed a path model to explore whether weekly volumes of each PA type mediate any of the relationships between residential blue space availability (coastal proximity and presence of freshwater) and self-reported general and mental health, controlling for green space density and a range of socio-economic factors at the individual- and area-level.

RESULTS

Supporting predictions, living nearer the coast was associated with better self-reported general and mental health and this was partially mediated by on-land outdoor PA (primarily walking). Watersports were more common among those living within 5kms of the coast, but did not mediate associations between coastal proximity and health. Presence of freshwater in the neighbourhood was associated with better mental health, but this effect was not mediated by PA.

CONCLUSIONS

Although nearby blue spaces offer potentially easier access to watersports, relatively few individuals in England engage in them and thus they do not account for positive population health associations. Rather, the benefits to health from coastal living seem, at least in part, due to participation in land-based outdoor activities (especially walking). Further research is needed to explore the mechanisms behind the relationship between freshwater presence and mental health.

Green exercise and mg-ca-SO4 thermal balneotherapy for the treatment of non-specific chronic low back pain: a randomized controlled clinical trial

BACKGROUND

Non-specific chronic low back pain (nscLBP) has a high socio-economic relevance due to its high incidence, prevalence and associated costs. Therefore, it is essential to evaluate effective therapeutic strategies. This study examines the effects of moderate mountain exercise and spa therapy on orthopedic and psychophysiological parameters. Based on a three-armed randomized controlled trial, guided mountain hiking tours and balneotherapy in thermal water were compared to a control group.

METHODS

Eighty patients with diagnosed nscLBP were separated into three groups: The two intervention groups GE (green exercise) and GEBT (green exercise and balneotherapy) undertook daily mountain hiking tours, whereas the GEBT group got an additional treatment with baths in Mg-Ca-SO₄ thermal water. The third group (CO) received no intervention. GE and GEBT group were treated for 6 days; all groups were followed up for 120 days.

RESULTS

Compared to GE and CO group, the GEBT treatment showed significant improvements of pain, some orthopedic parameters, health-related quality of life and mental well-being in patients with nscLBP.

CONCLUSIONS

The results of this study confirmed a benefit of mountain hiking combined with Mg-Ca-SO₄ spa therapy as a multimodal treatment of patients with nscLBP. Further studies should focus on long-term-effects of this therapeutic approach.

TRIAL REGISTRATION

ISRCTN, ISRCTN99926592 . Registered 06. July 2018 - Retrospectively registered.

Place, green exercise and stress: An exploration of lived experience and restorative effects

This paper reports on inter-disciplinary research designed to investigate the stress-buffering effects of green exercise, and the importance of the context in which exercise takes place. This investigation of context effects examines both individual physiological responses (salivary cortisol) and the phenomenological interpretation of lived experiences of the intervention, reported by a subsample of participants in a randomized, controlled trial, in which healthy, physically inactive university students were randomly allocated to three activities: walking on a treadmill in a gym, walking in semi-natural recreational area, and sitting and watching nature-based videos on TV. The study found clear indications of context effects, notably in the connections between positive appraisals of perceived circumstances, enjoyment in the enacted context, and physiological stress-reduction.

Does waterfall aerosol influence mucosal immunity and chronic stress? A randomized controlled clinical trial

BACKGROUND

The specific microclimate of alpine waterfalls with high levels of ionized water aerosols has been suggested to trigger beneficial immunological and psychological effects. In the present three-armed randomized controlled clinical study, we focused on effects on (i) immunological reagibility, on (ii) physiological stress responses, and on (iii) stress-related psychological parameters.

METHODS

People with moderate to high stress levels (n = 65) spent an active sojourn with daily hiking tours in the National Park Hohe Tauern (Großkirchheim, Austria). Half of the group was exposed to water aerosol of an alpine waterfall for 1 h/day (first arm, n = 33), whereas the other half spent the same time at a distant site (second arm, n = 32). A third arm (control, n = 26) had no intervention (except vaccination) and stayed at home, maintaining their usual lifestyle. The effect of the interventions on the immune system was tested by oral vaccination with an approved cholera vaccine and measuring specific salivary IgA antibody titers. Lung function was determined by peak expiratory flow measurement. Electric skin conductance, heart rate, and adaption of respiration rate were assessed as physiological stress parameters. Psychological stress-related parameters were analyzed by questionnaires and scales.

RESULTS

Compared to the control group, both intervention groups showed improvement of the lung function and of most physiological stress test parameters. Analysis of the mucosal immune response revealed a waterfall-specific beneficial effect with elevated IgA titers in the waterfall group. In line with these results, exposure to waterfall revealed an additional benefit concerning psychological parameters such as subjective stress perception (measured via visual analog scale), the Global Severity Index (GSI), and the Positive Symptom Total (PST).

CONCLUSIONS

Our study provides new data, which strongly support an "added value" of exposure to waterfall microclimate when combined with a therapeutic sojourn at high altitude including regular physical activity.

Gardening is beneficial for health: A meta-analysis

There is increasing evidence that gardening provides substantial human health benefits. However, no formal statistical assessment has been conducted to test this assertion. Here, we present the results of a meta-analysis of research examining the effects of gardening, including horticultural therapy, on health. We performed a literature search to collect studies that compared health outcomes in control (before participating in gardening or non-gardeners) and treatment groups (after participating in gardening or gardeners) in January 2016. The mean difference in health outcomes between the two groups was calculated for each study, and then the weighted effect size determined both across all and sets of subgroup studies. Twenty-two case studies (published after 2001) were included in the meta-analysis, which comprised 76 comparisons between control and treatment groups. Most studies came from the United States, followed by Europe, Asia, and the Middle East. Studies reported a wide range of health outcomes, such as reductions in depression, anxiety, and body mass index, as well as increases in life satisfaction, quality of life, and sense of community. Meta-analytic estimates showed a significant positive effect of gardening on the health outcomes both for all and sets of subgroup studies, whilst effect sizes differed among eight subgroups. Although Egger's test indicated the presence of publication bias, significant positive effects of gardening remained after adjusting for this using trim and fill analysis. This study has provided robust evidence for the positive effects of gardening on health. A regular dose of gardening can improve public health.

A cross-sectional study examining predictors of visit frequency to local green space and the impact this has on physical activity levels

BACKGROUND

Lack of physical activity (PA) is a growing public health concern. There is a growing body of literature that suggests a positive relationship may exist between the amount of local green space near one's home and PA levels. For instance, park proximity has been shown to predict PA levels amongst certain populations. However, there is little evidence for the role of relatedness towards nature and perceptions of local green space on this relationship. The aim of this study was to examine, in a National UK sample, whether subjective indices associated with local green space were better predictors of visit frequency to local green space and PA levels compared to objectively measured quantity of local green space.

METHODS

A cross-sectional survey was designed. From a random sample, 2079 working age adults responded to an online survey in September 2011. Demographics, self-reported PA, objective measures of the local environment (including local green space, road coverage, and environmental deprivation), were assessed in conjunction with perceptions of local green space and nature relatedness. Quantity of local green space was assessed by cross-referencing respondents' home postcodes with general land use databases. Regression models were conducted to assess which of our independent variables best predicted visit frequency to local green space and/or meeting PA guidelines. In addition, an ordinal regression was run to examine the relationship between visit frequency to local green space and the likelihood of meeting national PA guidelines.

RESULTS

Nature relatedness was the strongest predictor for both visit frequency to local green space and meeting PA guidelines. Results show that perceived quality is a better predictor of visit frequency to local green space than objective quantity of local green space. The odds of achieving the recommended amount of PA was over four times greater for people who visited local green space once per week compared to never going (OR 4.151; 95 % CI, 2.40 to 7.17).

CONCLUSIONS

These results suggest that perceptions of local green space and nature relatedness play an important role in the relationship between local green space and PA. Considering the known health benefits of PA, our results are potentially important for public health interventions, policy making and environmental planning.

Mothers' perceived proximity to green space is associated with TV viewing time in children: the Growing Up in Scotland study

OBJECTIVE

The aim of this study is to investigate whether mothers' perception of distance from home to green/open spaces is associated with their child's screen time.

METHOD

We used mother-reported data from sweep six (2010-2011) of the Growing Up in Scotland study (n=3586 children aged 5.9yrs) to examine associations between walking distance from home to green/open space and screen time (TV viewing time/computer use). Analyses were adjusted for age, sex and other pre-specified covariates, including sport/exercise participation, mental and general health, birth weight, parental socio-economic group (SEG) and smoking status.

RESULTS

Children living the furthest distance from green/open spaces (>20minutes' walking distance) displayed over 2h (95% CI, 0.65 to 3.51) more weekly TV time than the reference category (<5minutes' walking distance). Compared to children in the reference category, those in the >20minute category had worse mental health (mean SDQ [Strengths and Difficulties Questionnaire] score±SD, 7.0±4.6 vs. 8.7±6.2) and general health (% fair-poor, 4.6 vs. 8.6), and were more likely to come from lower SEG households.

CONCLUSION

Mothers' perceived distance from home to green/open spaces was associated with child's TV time at age 5.9years.