Can Simulated Green Exercise Improve Recovery From Acute Mental Stress?

The effects of combining visual-auditory stimuli with exercise on short-term affect improvement: a randomized controlled trial

ABSTRAC T

Prior research has explored the effects of engaging with real or virtual natural landscapes and listening to music during aerobic exercise on short-term affect, however, the specific differences in the improvement of short-term affect by different combinations of Virtual Reality (VR) and music rhythm require further investigation. The objective of this study is to investigate the effects of various combinations of VR and music on short-term mood, thereby providing a reference for future research on public fitness. This study recruited 132 valid participants (mean age 24.0 ± 0.9 years), with a gender distribution of 68 males and 64 females. Participants were randomly assigned to one of four groups: Visual-Music (V-M), Music-Visual (M-V), Visual-only (V), and Music-only (M). The exercise mode was 15 min of aerobic power cycling with 2 min of low-intensity power cycling intervals in the middle. After the exercise, the participants were asked to sit and then performed either a VR intervention or a music intervention for 15 min. The collected indicators included blood pressure, positive/negative affect, and heart rate variability indicators (RMSSD, SDNN, LF/HF). Data analysis included descriptive statistics, repeated measures ANOVA, and multifactor ANOVA. The effect of different VR and Music combined with exercise interventions on the improvement of short-term affect was analyzed based on the effect size (ɳp2) and combined with the significance p-value. Intra-group results showed that DBP, positive and negative affect, SDNN, RMSSD indicators in V-M group were significant differences (p < 0.05), while SBP, positive affect, negative affect, SDNN, RMSSD, LF/HF indicators in M-V group were significant differences (p < 0.05). Only SDNN and RMSSD indicators in M group had significant differences (p < 0.05), and only SBP and RMSSD indicators in V group had significant differences (p < 0.05). The results between groups showed that only SDNN and LH/HF groups had a significant difference (p < 0.05), other indicators had a trend of improvement or positive promotion to a certain extent, but the statistical difference was not significant (p > 0.05). Aerobic exercise with consistent intensity and the combined visual-auditory interventions (M-V and V-M) significantly improved blood pressure, and the short-term affect of physiological responses (LF/HF, SDNN, RMSSD), along with subjective affect measures, compared to other groups. These findings suggest that incorporating VR and music with exercise can effectively enhance short-term affect, recommending an integrated approach to aerobic exercise and relaxation through music and visual exposure to natural environments.

Influence of exercise prescription intervention based on WeChat on glycolipid metabolism and fitness of suboptimal-health teachers

Exercise is an effective means to promote health, but adherence is low. Due to the advantages of immediacy, economy and effectiveness, the use of WeChat social software has permeated into every aspect in daily life in China. To explore the influence of WeChat-based exercise prescription intervention mode on glycolipid metabolism and fitness of suboptimal-health teachers. 293 suboptimal-health teachers with senior professional titles were randomized to a control group (CG) or an experimental group (e.g.). The CG exercised on its own, while the e.g. adopted the exercise prescription intervention based on WeChat. The intervention period was 6 months. Finally, 264 cases were adhered to and completed, including 132 cases in the CG and 132 cases in the e.g.. The Suboptimal-Health Status Questionnaires-25 scores (SHSQ-25 scores), exercise adherence, subjective feelings, physical fitness, blood glucose and blood lipids were detected before and after intervention and compared between 2 groups. After the intervention, the SHSQ-25 scores in the e.g. was significantly decreased than those in the CG (P < .01). The complete exercise adherence in the e.g. was significantly higher than those in the CG (P < .01). After intervention, the subjective feelings of e.g. were significantly improved compared to CG (P < .05). The body shape, body function and physical quality in the e.g. was higher than those in the CG (P < .05). Total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C) decreased significantly in the e.g. but not in the CG (P < .05). Fasting blood glucose (FBG) decreased significantly in the e.g. but not in the CG, with a significant difference between groups (P < .05). The subjects in the e.g. were very satisfied with WeChat management. WeChat-based exercise prescription intervention could improve SHS, exercise adherence, subjective feelings, physical fitness and glycolipid metabolism.

Exercise-based rehabilitation in and with nature: a scoping review mapping available interventions

INTRODUCTION

Exercise is an effective component in rehabilitation of a range of chronic conditions. There is a growing interest in the use of exercise-based nature interacted rehabilitation (EBNIR), but an overview of current evidence is missing. The objective of this scoping review was to map existing exercise-based rehabilitation interventions conducted with incidental or intentional nature interaction focusing on its populations, types of outcomes, and theoretical rationale for people with physical and mental disabilities.

METHODS

This scoping review identified peer-reviewed publications, registered upcoming trials and grey literature. To map all available knowledge, a comprehensive search of selected databases (MEDLINE; EMBASE; CINAHL; Cochrane; Web of Science; Pedro) from inception to October 2022. Data were synthesized in a thematic presentation guided by TIDieR, supplemented by a checklist developed for this study accounting nature incidental or intentional interaction.

RESULTS

Twelve studies including 856 participants met the inclusion criteria. Eleven were completed trials and one was registered in clinicaltrials.gov to be run in 2023. A total of 856 patients were enrolled in the 12 studies (range 18-262, median 50). The included studies had great variation. The incidental or intentional interacted exercise-based interventions consisted of outdoor walks, neck exercises and surfing interventions in patients with physical or mental health conditions.

CONCLUSIONS

This scoping review presents an overview of limited and diverse evidence within the field of EBNIR, in patients with physical or mental health conditions. Our review provides an overview that will be helpful in the design of future EBNIR trials.

Mechanism and implications of pro-nature physical activity in antagonizing psychological stress: the key role of microbial-gut-brain axis

Appropriate physical activities and a biodiversity-rich environment are conducive to the relief of psychological stress, and pro-nature physical activities are a combination of the two, which has good application potential in antagonizing psychological stress, but the intervention mechanism is still unclear. The microbiota-gut-brain axis is cyclically associated with psychological stress, and psychological stress can affect the microbiota through the gut-brain pathway, and conversely, the microbiota can also affect the psychological stress-induced symptoms. It is suggested that the microbe-gut-brain axis may provide a new perspective and target for the treatment of psychological stress-related diseases. Pro-nature physical activity can improve the number of Firmicutes, short-chain fatty acids, Akkermansia bacteria, and the gut-brain barrier and further affect the HPA axis, BDNF, and serotonin pathways of gut-brain two-way communication, thereby maintaining the body's homeostasis and reducing antagonistic psychological stress. According to the comprehensive influence of physical activities on the microbiota-gut-brain axis, a "green + exercise prescription hypothesis" in line with the holistic medical concept is revealed, which is expected to be effective in the prevention, alleviation, and treatment of irritable bowel syndrome and neurodegenerative diseases. It provides new means for treating psychological stress-related diseases such as mental disorders and mood disorders. In addition, it enlightens the construction of green infrastructure that is conducive to the diversified contact of microorganisms in outdoor physical activities venues and induces healthy interaction between the human body and the microbial population in the natural ecology. However, the current research is still in its early stages, and the intervention effect and mechanism of pro-nature physical activities need further demonstration in the future.

Coping with COVID: risk and resilience factors for mental health in a German representative panel study

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic might affect mental health. Data from population-representative panel surveys with multiple waves including pre-COVID data investigating risk and protective factors are still rare.

METHODS

In a stratified random sample of the German household population (n = 6684), we conducted survey-weighted multiple linear regressions to determine the association of various psychological risk and protective factors assessed between 2015 and 2020 with changes in psychological distress [(PD; measured via Patient Health Questionnaire for Depression and Anxiety (PHQ-4)] from pre-pandemic (average of 2016 and 2019) to peri-pandemic (both 2020 and 2021) time points. Control analyses on PD change between two pre-pandemic time points (2016 and 2019) were conducted. Regularized regressions were computed to inform on which factors were statistically most influential in the multicollinear setting.

RESULTS

PHQ-4 scores in 2020 (M = 2.45) and 2021 (M = 2.21) were elevated compared to 2019 (M = 1.79). Several risk factors (catastrophizing, neuroticism, and asking for instrumental support) and protective factors (perceived stress recovery, positive reappraisal, and optimism) were identified for the peri-pandemic outcomes. Control analyses revealed that in pre-pandemic times, neuroticism and optimism were predominantly related to PD changes. Regularized regression mostly confirmed the results and highlighted perceived stress recovery as most consistent influential protective factor across peri-pandemic outcomes.

CONCLUSIONS

We identified several psychological risk and protective factors related to PD outcomes during the COVID-19 pandemic. A comparison of pre-pandemic data stresses the relevance of longitudinal assessments to potentially reconcile contradictory findings. Implications and suggestions for targeted prevention and intervention programs during highly stressful times such as pandemics are discussed.

Effects of immersion in a simulated natural environment on stress reduction and emotional arousal: A systematic review and meta-analysis

Background

Although the mental health benefits of exposure to simulated natural environments are well established by researchers from environmental psychology, landscape architecture, and public health, it is unclear whether and to what extent technological immersion affects these benefits.

Methods

Systematical literature searches were conducted in May 2022 from six databases. The risk of bias was evaluated using the Cochrane's Risk of Bias tool 2.0 and the Risk of Bias in Non-randomized Studies of Interventions tool. We performed a random-effects meta-regression to investigate the heterogeneity. The immersion levels of included studies were classified by projection devices and motion capture, and then subgroup analysis was conducted.

Results

Twenty-six publications were included. Exposure to simulated nature was confirmed to be associated with increased positive affect 0.40 [95% confidence interval (CI): 0.22, 0.58], vigor 0.58 (95% CI: 0.30, 0.86), calmness 0.54 (95% CI: 0.17, 0.92) and decreased perceived stress -0.38 (95% CI: -0.71, -0.06), total mood disturbance -0.87 (95% CI: -1.17, -0.57), tension -0.70 (95% CI: -0.99, -0.41), fatigue -0.60 (95% CI: -0.91, -0.28), anxiety -0.72 (95% CI: -1.43, -0.02), depression -0.33 (95% CI: -0.52, -0.14), confusion -0.79 (95% CI: -1.19, -0.40), and anger -0.54 (95% CI: -0.76, -0.31). Gender, health status, study design, mean age, and single exposure duration were not significant when entered in a meta-regression. For positive affect, medium immersion was observed to produce a larger effect than low and high immersion. All included studies had a moderate to high risk of bias.

Conclusion

Audio-visual exposure to simulated nature contributes to stress relief and emotional arousal. The immersion level explains the heterogeneity of positive affect triggered by simulated nature. Focusing on the technical features will open up new possibilities for combining actual and simulated nature's mental health benefits.

Effects of Vegetation Structure on Psychological Restoration in an Urban Rooftop Space

Connectedness to nature has been recognized as an important factor for well-being, with rooftop green spaces being used for stress reduction in modern cities. This study aimed to examine psychological and physiological responses to three different vegetation models on an urban rooftop. An analysis of psychological parameters indicated that the existence of vegetation in rooftop spaces could have positive effects on mood states, and the size of the effect was greater in a structured vegetation design than in a monotonous one. An analysis of the physiological parameters of heart rate variability and systolic blood pressure indicated that greater restorative effects are elicited from the use of vertical elements, such as shrubs and trees, added to grassy areas than from concrete environments. However, a fully enclosed vegetation with trees was not associated with higher parasympathetic activities than a half-open vegetation model. Based on these findings, an open and structured vegetation design that includes both grass and shrubs may have more potential for stress reduction than a monotonous vegetation model. A larger volume of vegetation was not necessarily linked to higher psychological and physiological benefits.

Green and Pleasant Lands: The Affective and Cerebral Hemodynamic Effects of Presence in Virtual Environments During Exercise

Pleasant exercise experiences increase the likelihood of exercise adherence, and innovative strategies to promote consistently pleasant exercise experiences are needed. In this study we compared a novel nature-based virtual reality environment, a nature-based 360° video, and a control condition to test the hypothesis that greater presence in virtual space would promote positive affective experiences during exercise. Moreover, we assessed prefrontal cerebral hemodynamics using near infrared spectroscopy to explore possible neural underpinnings of dissociative strategies during exercise. Twelve participants ( M = 26.2, SD = 7.7 years; M BMI = 25.5, SD = 5.2 kg/m2) completed a maximal aerobic test and three exercise conditions (Control, Virtual Reality [VR], and 360° video). The two experimental conditions differed in terms of the participants’ sense of presence (VR eliciting greatest presence), and all conditions utilized similar exercise intensity. The VR condition setting was a virtual mountain forest trail, and the 360° video was of a forest road. The 360° video was perceived as the most distracting ( p = .023, d = 1.07), pleasant ( p = .007, d = .75), and enjoyable ( p = .029; d = .82) condition. ΔHbDiff data indicated that the control condition caused the greatest prefrontal brain activation ( p = .008, d = .84). Presence was not a salient factor in distracting participants from bodily sensations during exercise, but immersion in a stimulus was. These results provide support for using head-mounted displays during exercise as a strategy to increase pleasure, with practical implications for practitioners, researchers, and individuals.

Horticultural activities can achieve the same affect improvement effect of green exercise: A randomized field controlled trial

OBJECTIVES

With the deepening of non-drug intervention research on human mental health, more and more attention has been paid to the benefits of horticultural activities and green exercise on physical and psychological health. This study compared the affect improvement between horticultural activities with the same intensity and green exercise and that with or without green plants to verify the value of horticultural activities and green exercise in improving human affect and the importance of green plants.

METHODS

A total of 160 subjects aged 18-26 years (average age 22.5 years) were recruited and randomly divided into a control group, a horticultural activity group with green plants, a horticultural activity group without green plants, and a green exercise group. Demographics, sociological variables, and daily physical activity levels were investigated. Green space at Zhejiang Normal University was selected as the test site. After finishing the preparation work, the subjects sat quietly for 8 min before the pre-test. The horticultural group completed 20 min of horticultural activities {8 min of digging [40%*HRR(heart rate reserve) + RHR(resting heart rate)] + 8 min of transplantation [(50%*HRR + RHR) + 4 min of watering (30%*HRR + RHR)]}. The group returned to a calm state (no less than 20 min) for the post-test. The green exercise group completed a 20-min power bike ride. The activity intensity and activity time of the green exercise group were determined according to the activity intensity and time of the horticultural group. Dependent variables were collected, including blood pressure, positive/negative affects, heart rate variability (RMSSD, SDNN, and LF/HF), and controlled covariate environmental parameters (field temperature, humidity, and noise).

RESULTS

(1) A significant difference was observed in the improvement effect except for negative affect between the green horticultural activity group and the green exercise group (F = 3.310; ɳp²  = 0.046; p = 0.037). No significant difference was observed in other affect indicators. (2) In the same pattern of with and without green plant horticultural activity group, the green plant horticultural activity group had a better effect on the improvement of affect, and the two groups had a better negative affect (F = 3.310; ɳp²  = 0.046; p = 0.037), SDNN index of heart rate variability(F = 1.035; ɳp²  = 0.015; p = 0.039), and RMSSD index (F = 2.225; ɳp²  = 0.032; p = 0.014), and no significant difference was observed in the improvement effect of other affect indicators between the two groups.

CONCLUSIONS

Having green horticulture can give the same intensity as green exercise and affect improvement. Findings suggest that people can choose green exercise or horticultural activities according to their preferences and physical characteristics in the two physical activities. Under the same pattern of horticultural activities, green plants are the key factor in improving the affect of horticultural activities. Choosing suitable plant types in horticultural activities is positively significant in enhancing affect.

Investigating How Auditory and Visual Stimuli Promote Recovery After Stress With Potential Applications for Workplace Stress and Burnout: Protocol for a Randomized Trial

Background

Work-related stress is one of the top sources of stress amongst working adults. Relaxation rooms are one organizational strategy being used to reduce workplace stress. Amongst healthcare workers, relaxation rooms have been shown to improve perceived stress levels after 15 min of use. However, few studies have examined physiological and cognitive changes after stress, which may inform why relaxation rooms reduce perceived stress. Understanding the biological mechanisms governing why perceived stress improves when using a relaxation room could lead to more effective strategies to address workplace stress.

Objective

The purpose of this research study is to understand how physiological measures, cognitive performance, and perceived stress change after acute stress and whether certain sensory features of a relaxation room are more effective at promoting recovery from stress.

Methods

80 healthy adults will perform a stress induction task (Trier Social Stress Test, TSST) to evaluate how physiological and cognitive responses after stress are affected by sensory features of a relaxation room. After the stress induction task, participants will recover for 40 min in a MindBreaks™ relaxation room containing auditory and visual stimuli designed to promote relaxation. Participants will be randomized into four cohorts to experience auditory and visual stimuli; auditory stimuli; visual stimuli; or no stimuli in the room. Measures of heart rate and neural activity will be continuously monitored using wearable devices. Participants will perform working memory assessments and rate their perceived stress levels throughout the experiment. These measures will be compared before and after the stress induction task to determine how different sensory stimuli affect the rate at which individuals recover.

Results

Recruitment started in December 2021 and will continue until December 2022 or until enrollment is completed. Final data collection and subsequent analysis are anticipated by December 2022. We expect all trial results will be available by early 2023.

Discussion

Findings will provide data and information about which sensory features of a relaxation room are most effective at promoting recovery after acute stress. This information will be useful in determining how these features might be effective at creating individualized and organizational strategies for mitigating the effects of workplace stress.

Benefits to Performance and Well-Being of Nature-Based Exercise: A Critical Systematic Review and Meta-Analysis

Prior reviews point to the superior benefits of exercising in nature vs in conventional indoor venues, particularly in terms of well-being. However, physical exercise performance, neither in terms of efficacy nor efficiency, has not been sufficiently addressed by past reviews of this topic. Therefore, we conducted both a systematic review and meta-analysis of the experimental literature that relates to differences in exercise performance and well-being between exercising in nature and in conventional indoor venues. Forty-nine relevant studies─the outcome data of which were used for the systematic review─were located within the Web of Science, PubMed, and Scopus databases. The meta-analyses, using data from twenty-four of the relevant studies, revealed no significant overall environmental effect on task performance efficacy outcomes (p = 0.100). For nature-based exercise, however, marginally positive cognitive performance outcomes (p = 0.059), lower ratings of perceived exhaustion (p = 0.001), and higher levels of vigor (p = 0.017) were observed, indicating higher performance efficiency. As for the effects of environment on well-being, positive affect was significantly higher for nature-based exercise (p = 0.000), while perceived stress was significantly higher for indoor exercise (p = 0.032). These results must, however, be interpreted with caution. High levels of bias and between-study heterogeneity were observed. Nonetheless, given several noticeable trends in the results, it may be that exercising in nature enhances the efficiency of exercise task performance to a greater extent than does indoor exercise.

Exercise in the Park or Gym? The Physiological and Mental Responses of Obese People Walking in Different Settings at Different Speeds: A Parallel Group Randomized Trial

Evidence shows that physical activity has multiple health benefits for the body and mind of oneself, but little is known about the impacts of the setting and the intensity on exercise experience, especially for obese people. This study investigated the physiological and psychological effects of four walking conditions with different settings (park vs. gym) and intensity (slow vs. fast) on young obese adults. Subjects were 18–21 years old Chinese university students (N = 77), who were diagnosed as obese. They were randomly assigned to participate in one of the four activities in the field: slow walk in the park (2.8 km/h), fast walk in the park (5.5 km/h), slow walk in the gym, and fast walk in the gym. Physiological indices, including blood pressure and heart rate, were measured before and after the walk. Psychological responses were measured by the Symbol Digit Modalities Test, the mood states scale, and the semantic differential scale. This study of obese people aged 18–21 years confirmed the previous findings that exercising in natural environments better relieved stress and restored attentional level than indoor activities. The results suggested that the mood states of the participants and their environmental perceptions may be influenced by the walking conditions with different setting and speed. The findings can be used in planning and designing urban green spaces for promoting physical activity and making exercise plans for obese people.

Access to Nature via Virtual Reality: A Mini-Review

Nature exposure is known to promote physical and mental health. However, actual nature exposure may be difficult to achieve for the population of people with physical disabilities or chronic conditions. Therefore, many attempts have been made to duplicate nature exposure via media devices, and virtual reality (VR) is deemed as a promising technology due to its advantage in creating a sense of immersion. Generally, current studies suggest that being exposed to virtual nature may contribute to psychological and physiological relaxation. Besides, some pieces of evidence indicate that virtual nature may improve attentional resources, cognitive performance, and pain experience. Although VR is deemed as an advanced media, insufficient evidence was found concerning the advantages of VR over traditional two-dimensional media when it comes to simulated nature exposure. On the other hand, computer-generated (CG) scenarios were found to be more beneficial than 360° videos, and mini-games may be useful in creating an interactive VR format for simulated nature exposure. Further research is needed because of the limited relevant studies.

Green Exercise: Can Nature Video Benefit Isometric Exercise?

Green exercise is the combination of physical activity and nature exposure, which has been associated with positive effects on psychophysiological health. This study aimed to investigate the effects of nature video viewing on isometric exercise and find a useful practice for green exercise in urban living. In the current study, 18 male subjects were recruited in a randomized crossover trial and underwent a sequence of wall squat exercises. The whole experiment contained three periods of baseline (before exercise), exercise, and recovery (after exercise), and each period lasted for 2 min. A video of forest walking was played in the exercise and recovery periods as treatment, while a black screen was set as control. The Rate of Perceived Exertion Scale (RPE) and Feeling Scale (FS) were employed to measure perceived exertion and affective responses in the exercise period; heart rate (HR) and heart rate variability (HRV) including the standard deviation of normal-to-normal RR intervals (SDNN), the root mean square of successive differences (RMSSD), and the standard deviations of the Poincaré plot (SD1), were recorded in the three periods. Heart rate recovery (HRR) in the recovery period was further calculated based on 30 s and 60 s time frames. Results demonstrated that during the exercise period nature video viewing was associated with better affective responses (median of 1.00 and an interquartile (IQR) of 2.00, p = 0.017), lower perceived exertion (median = 6.00, IQR = 2.00, p = 0.021), and lower HR (median = 89.60, IQR = 20.94, p = 0.01), but the differences in HRV indices between the experimental settings were not statistically significant. In the recovery period, significantly higher values of RMSSD (median = 34.88, IQR = 24.52, p = 0.004), SD1 (median = 24.75, IQR = 17.41, p = 0.003), and HR (median = 84.18, IQR = 16.58, p = 0.001) were observed in the treatment setting, whereas no statistically significant difference was found for HRR. In general, our findings support that nature video viewing may help reduce perceived exertion, increase exercise pleasure, buffer heart rate, and improve cardiac autonomic recovery for wall squat exercising, which implies the potential of nature-based stimuli in green exercise. However, due to the limited research sample, further study may need to include female participants and focus on various populations to confirm the effectiveness of using virtual and environments depicting nature at home or in public exercise places to promote positive exercise experience.

A Thematic Analysis of Multiple Pathways Between Nature Engagement Activities and Well-Being

Research studies have identified various different mechanisms in the effects of nature engagement on well-being and mental health. However, rarely are multiple pathways examined in the same study and little use has been made of first-hand, experiential accounts through interviews. Therefore, a semi-structured interview was conducted with seven female students who identified the role of nature engagement in their well-being and mental health. After applying thematic analysis, 11 themes were extracted from the data set, which were: “enjoying the different sensory input,” “calm nature facilitates a calm mood,” “enhancing decision making and forming action plans,” “enhancing efficiency and productivity,” “alleviating pressure from society's expectations regarding education,” “formation of community relations,” “nature puts things into perspective,” “liking the contrast from the urban environment,” “feel freedom,” “coping mechanism,” and “anxious if prevented or restricted.” The results indicate complementary mechanisms for how nature-related activities benefit mental health and well-being that may occupy different levels of experience within a hierarchical framework informed by perceptual control theory.

The Effects of Green and Urban Walking in Different Time Frames on Physio-Psychological Responses of Middle-Aged and Older People in Chengdu, China

Nighttime walking is becoming a popular exercise for many middle-aged and older people in Asian countries. However, the health benefits of nighttime walking in urban areas and green spaces are still unclear. This study evaluated the physiological and psychological responses of 48 middle-aged and older people who walked 1.6 km through a green space and an urban area during daytime and nighttime. The Positive and Negative Affect Schedule (PANAS), Profile of Mood States (POMS), Perceived Restorativeness Scale (PRS), and Restorative Outcome Scale (ROS) were employed to measure the psychological responses, and pulse rate and blood pressure (SBP, DBP and MAP) were measured to evaluate the physiological responses. The results showed that the daytime green walking induced psychological improvements and lowered blood pressure (p < 0.05), while the daytime urban walking resulted in slight deterioration of all the measured parameters (p > 0.05). On the other hand, the nighttime green walking induced lowered blood pressure (p < 0.05), whilst the nighttime urban walking resulted in psychological improvements and lowered blood pressure (p < 0.05), and no significant difference was found in any measured parameter between the two nighttime walking groups. In conclusion, urban areas are noisy and irritating in the daytime, and not suitable for walking, but may become pleasurable and attractive at night. The psychological benefits of green walking may decrease at night, and nighttime walking in either an urban area or a green space may achieve similar health benefits. Therefore, we recommend that urban citizens start nighttime walking in a green space or an urban area to keep fit when the air is less polluted.

Effects of biophilic indoor environment on stress and anxiety recovery: A between-subjects experiment in virtual reality

Previous research has demonstrated the positive associations between outdoor nature contact and stress reduction. However, similar effects of incorporating natural elements into indoor environment (i.e. biophilic design) have been less well studied. We hypothesize that exposure to biophilic indoor environments help people recover from stress and anxiety and those effects differ among different types of biophilic elements. To test these hypotheses, we conducted a between-subjects experiment with 100 participants using virtual reality (VR). Participants were randomly assigned to experience one of four virtual offices (i.e. one non-biophilic base office and three similar offices enhanced with different biophilic design elements) after stressor tasks. Their physiological indicators of stress reaction, including heart rate variability, heart rate, skin conductance level and blood pressure, were measured by bio-monitoring sensors. Their anxiety level was measured by using State-Trait Anxiety Inventory test (short version). We found that participants in biophilic indoor environments had consistently better recovery responses after stressor compare to those in the non-biophilic environment, in terms of reduction on stress and anxiety. Effects on physiological responses are immediate after exposure to biophilic environments with the larger impacts in the first four minutes of the 6-minute recovery process. Additionally, these restorative effects differ among three different types of indoor biophilic environments. This research provides evidence that biophilic design elements that impact stress recovery and anxiety. It also demonstrated the potential that virtual reality may be a way to bring nature and its therapeutic benefits to patients in hospitals.

3-Dimensional nature-based therapeutics in pediatric patients with total pancreatectomy and islet auto-transplant

BACKGROUND

Virtual Reality (VR) has been increasingly employed as a therapeutic means to help patients reduce stress, anxiety, and pain. While it has been shown to be effective in multiple settings, there is still scant literature referencing its use in the pediatric intensive care unit (ICU) and none using VR longitudinally as a vehicle for mindful focus utilizing natural environments.

OBJECTIVES

This proof of concept study aims to demonstrate that the use of 3-D Nature-Based Therapy (NBT) glasses will lead to a reduction in pain, nausea, and anxiety in children and adolescents undergoing Total Pancreatectomy Islet Auto-Transplant (TPIAT).

METHODS

Six pediatric patients (8-18 yr.) scheduled to receive TPIAT were recruited over a one-year period. Patients rated their symptoms using various scoring methods, including a novel nature-based anxiety scale. If VR was used prior to a physical therapy session, this was also noted. Patients then utilized the Oculus ™ VR device and re-scored their symptoms. Interviews were performed at entry to study, post-ICU, and at hospital discharge.

RESULTS

Four of six recruited patients utilized the VR device, three of whom completed pre- and post-use scores during 11 encounters, though many other encounters occurred without scoring. Of the two patients not utilizing the device, one chose to use other means of distraction and the other reported nausea and chose not to use device. Of the patients who utilized the device, there was a net decrease in symptom scores after use, including the use of the nature-based scale which mimicked both validated scales. On survey results, all patients who utilized the device found it to be "enjoyable" and "helpful", either "would" or "might use" it again, and "would recommend it to others" for use.

CONCLUSIONS

In this proof of concept study, children in a critical care setting were able to utilize VR devices for NBT after extensive surgical procedures. Initial quantitative scoring systems suggest overall improvement in symptom management, and reactions by both patients and their parents were overall positive.

Psychosocial and Physiological Health Outcomes of Green Exercise in Children and Adolescents-A Systematic Review

Both physical activity (PA) and nature exposure are associated with several youth health benefits. However, the health outcomes when being physically active in nature, called Green Exercise (GE), are less clear. Thus, the purpose of this systematic review was to provide an overview of the psychosocial and physiological outcomes of GE in children and adolescents and to outline future GE research directions. The PRISMA statement guided the review. Web of Science, PubMed, ERIC, and APA PsychNET were systematically searched in February 2019, including studies between 2000 and 2019. Fourteen of 1175 identified publications were included, which reported 15 different psychosocial and six different physiological outcomes, with some studies reporting more than one outcome. For 16 outcomes, studies reported either similar or no effects for both GE and comparison groups. For six outcomes, studies reported stronger effects for GE, for three outcomes, studies reported stronger effects in the comparison group. Evidence was rated as weak, using the EPHPP tool. Thus, GE does not have deleterious effects for children and adolescents compared to PA in other settings. GE might be beneficial; however, due to the study's heterogeneity and quality, it is premature to make definite conclusions. Future research should build the quality of evidence for GE, use more rigorous research designs, and investigate the underlying effects and mechanisms of GE.