Walking for well-being: are group walks in certain types of natural environments better for well-being than group walks in urban environments?

Effects of different natural soundscapes on human psychophysiology in national forest park

Most of the current soundscape research content is limited to the discussion of the restoration effect of single-element soundscapes, but it is the combination of sounds that is common in outdoor activities, and there is no evidence that the restoration of natural soundscapes is better with multi-element combinations. In this study, the Zhangjiajie National Forest Park in China was used as the research object, and the physiological indices of the subjects were collected through electroencephalogram signals, and the POMS short-form psychological scale was used to understand the subjective psychological responses of the subjects to the soundscape. The results showed that (1) The psychophysiological restorative ability of the natural soundscape of the National Forest Park was confirmed, and the subjects' psychological and physiological indices changed significantly and positively after listening to each section of the natural soundscape (p = 0.001). (2) The restorative effect of the multi-natural sound combination was ranked first in the overall ranking of the five natural soundscapes, and the multi-natural sound combination did indeed provide better restorative effects than the single-element sounds. (3) Gender does not usually have a significant effect on the restoration effect, and only Windy Sound among the four single-element nature sound landscapes and one multi-element combination of nature sound landscapes showed a significant gender difference, so in general, the effect of gender on the restoration effect of nature sound landscapes is not significant. In terms of research methodology, this study used cluster analysis to cluster the five types of natural soundscapes according to psychological and physiological recovery ability, and used ridge regression to construct mathematical models of the psychological and physiological recovery of each of the four natural soundscapes. The study of human physiological and psychological recovery from different types of natural soundscapes in China's national forest parks will provide a basis for soundscape planning, design, and policy formulation in national forest parks.

Implementation and mixed-methods evaluation of "Walk with a Doc" program at Stony Brook

CONTEXT

Walking groups run by trained individuals, lasting under an hour in a natural environment, may be a cost-effective way by which to encourage sustainable changes in physical activity as well as foster companionship and a shared experience of wellness among participants. Walk with a Doc (WWaD) is a national program that provides a platform for medical professionals, including physicians and medical students, to deliver a short talk on a health topic prior to walking side by side with patients and community members.

OBJECTIVES

To evaluate the WWaD Chapter at Stony Brook following implementation, a questionnaire was designed utilizing a mixed-methods approach (i.e., containing qualitative and quantitative items) and administered to all attendees monthly prior to the health discussion. The aim of the questionnaire was fourfold: first, to obtain participant demographics; second, to obtain information on attendees' own perceptions of their health status and the role exercise plays in their health; third, to gain data on physical activity levels, including lengths of exercise sessions and types of activities performed; and fourth, to learn more about attendees' motivations and goals for participating in the walks.

METHODS

We received an IRB exemption. Physician and medical student volunteers were recruited from Stony Brook University Hospital, a suburban tertiary care center, to oversee program logistics. WWaD was scheduled to take place on the third Sunday of every month for 1 h at Heritage Park in Mount Sinai, New York. The event was advertised by volunteers to colleagues, peers, patients, and community members utilizing word of mouth, printed flyers, emails to listservs, and social media outlets. Each month, a physician volunteer oversaw a brief discussion (approximately 10 min in length).

RESULTS

Over the course of the 5 month evaluation period, 91 individuals participated in the walks, including repeat attendees. After excluding duplicate or incomplete entries, data from 30 participants were included in this analysis. The majority of participants were female (n=24) with a mean age of 50 years (range, 23-98 years). Feedback on WWaD program elements was largely positive. Participants commended the monthly speakers for "informative talks" (n=6) on "interesting topics" (n=4), with plans to review the supplemental information in educational pamphlets following the walk (n=4). The brochures were also deemed "helpful." Overwhelmingly, patients referred to the community gathering and team building aspects of WWaD as the "most enjoyable" aspect of the program (n=8) and a key driver for participation.

CONCLUSIONS

This mixed-methods study of the WWaD chapter at Stony Brook contributes to a growing body of evidence highlighting the value of walking groups as effective avenues for collaboration in producing accessible healthy behavior.

Predictors of sustained physical activity: behaviour, bodily health, and the living environment

This study examined the determinants of sustained physical activity. Eighty-four participants undertook a 7-weeks walking regime (i.e., a 1-h biometrically-monitored walk, at least 5 days/week), with bioelectrical impedance (BIA) and total cholesterol capillary blood measurements performed before and after programme. To investigate behavioural habit formation, 7 weeks after walking termination, all participants were interviewed and (health) re-tested. Data were modelled with an artificial neural network (ANN) cascading algorithm. Our results highlight the successful prediction of continued physical activity by considering one's physical fitness state, the environmental living context, and risk for cardiovascular disease. Importantly, those artificial neural network models also taking body mass index (BMI) and blood cholesterol as predictors excel at predicting walking continuation (i.e., predictions with 93% predictability). These results are first to highlight the type and importance of available physiological drivers in maintaining a sustained physical activity regime such as walking. They are discussed within the framework of habit formation and the nowadays health and/or wellbeing focus.

Active Aging and Smart Public Parks

The global population is aging, with the percentage of people over 60 expected to rise from 12% to 22% and 33% residing in developed countries. However, most cities lack the appropriate infrastructure to support aging citizens in active aging and traversing the urban landscape, negatively impacting their quality of life. Studies have shown that public parks and green spaces can contribute to a higher quality of life and wellbeing. Also, smart cities are intended to improve the wellbeing and health of their inhabitants. However, most solutions are typically implemented indoors and tend to overlook the needs of older adults. A smart city should consider the increasing rate of aging and give more importance to outdoor environments as a key aspect of quality of life. The article's main purpose is to provide a comprehensive background to understand the current knowledge on smart public parks and highlight the significance of new research in the field to promote active aging. The article is expected to inspire new research ideas by identifying gaps in knowledge. Open and challenging issues in emerging smart park solutions are proposed for further work.

What are green prescriptions? A scoping review

Introduction Clear terminology is critical to allow accurate communication between practitioners, policy makers and the public. Aim We investigated how the term 'green prescription' has been used in the peer-reviewed literature. Methods We conducted a scoping review of the peer-reviewed literature that used the term 'green prescription(s)' and determined how this term was used. We then investigated how the term has been used over time, in different geographic locations and in different academic disciplines. Results We included 268 articles that used the term 'green prescription(s)'. We found that the phrase 'green prescription(s)' has been used since 1997 to mean a written prescription for a lifestyle change, most commonly physical activity, provided by a health practitioner. However, more recently (since 2014) the term has also been used to mean exposure to nature. Despite the emergence of this new meaning, 'green prescription' remains, in the health and medical science literature across all continents, most commonly used to describe a prescription for physical activity. Conclusion The use of the term 'green prescriptions' is inconsistent and has led to misuse of the research evidence regarding written prescriptions for exercise/diet being used to justify nature exposure to improve human health. We recommend that the term 'green prescriptions' continues to be used only as per its original definition, to refer to written prescriptions for physical activity and/or diet. For prescriptions to spend time in nature, we suggest use of the more appropriate term 'nature prescriptions'.

Effects of Forest Bath (Shinrin-Yoku) and Forest Therapy (Shinrin-Ryoho) on Women's Health

Forest bathing is an approach that uses the healing effects of forests to improve people's health and prevent disease through forest walks. Although the terms forest therapy and forest bath are used in the same sense, they are different applications. While the forest therapy application is carried out in the company of a professional trained in this subject, the therapist in the forest bath is the forest itself. Considering the positive effects of forest bathing on the cardiovascular system, nervous system, endocrine system, immune system and mental health, it is thought that it can be used as an approach to protect and improve women's health. In this context, the aim of the study is to examine the physiological and psychological effects of forest bathing and forest therapy on women's health. In this study, which was revealed by literature review, the results of national and international studies on the subject were compiled. Many positive effects of forest bathing and forest therapy on the protection of human health have been reported in the literature. There are limited studies on the effects of forest therapy and forest bathing on human health, and no scientific research has been found in the field of health in our country. It is thought that these practices can be used in our country, which is rich in forests, and that scientific studies on this subject can provide benefits for women's health.

Exercise Promotion in Saudi Arabia: Understanding Personal, Environmental, and Social Determinants of Physical Activity Participation and Well-Being

Physical activity promotion has received increasing attention globally due to the considerable benefits of regular activity for population health and well-being. In Saudi Arabia, government strategy explicitly aims to increase physical activity participation among residents. This study assessed the barriers to physical activity among the general Saudi population including any age and gender differences and examined the contribution of contextual factors and nature relatedness to health and well-being. A representative sample of 1046 Saudi adults (aged 18 years and above) completed an online survey that included four validated scales: the International Physical Activity Questionnaire-short form, the Exercise Benefits/Barriers Scale, the World Health Organization Five Well-Being Index and the Nature Relatedness Scale. Analyses indicated that young Saudi adults perceived more barriers than middle-aged and older adults, but few gender differences were observed. Furthermore, exercising outdoors, with other people and via sport predicted higher levels of mental well-being, as did nature relatedness. Therefore, developing a comprehensive strategy package that includes the development of outdoor environments for all age groups across regions and fostering a connection with nature may be particularly effective to improve the health and well-being of Saudi adults.

Library based walking groups in Scotland: Exploring benefits, challenges and opportunities

Public libraries support a range of health and wellbeing activities, however little research has been done into the provision of library adult walking groups. This paper reports on a unique study exploring how widely adult walking groups are provided through Scottish public libraries, as well as library staff perceptions of the benefits, challenges and opportunities of these services. A rich qualitative research approach was used, involving Freedom of Information requests to the 32 Scottish local authority regions, an online questionnaire with 106 complete responses, and 8 follow-up interviews with Scottish public library staff, with and without walking group experience. Thematic analysis was used to identify key themes from collected data. Results show that adult walking groups are not widely provided through Scottish public libraries. However, respondents identified benefits for user groups, including but not limited to: improvements to participants’ health and social wellbeing; and increased engagement with library services. A range of opportunities for public libraries were highlighted, including staff interest, partnership working and a current focus on health and wellbeing. Challenges encompass resource restrictions, variations in partnership working and lack of effective networking. This original study provides valuable insights into the provision of public library walking groups in Scotland. It suggests that many factors can potentially influence the success of this library health and wellbeing service, with a range of different possible approaches. Results indicate that successful provision of a public library walking group may require close partnership working; adequate networking and information-sharing between public library staff; as well as sufficient resources; and staff interest. This exploratory study provides transferable insights and a basis for future research.

The Effects of Outdoor versus Indoor Exercise on Psychological Health, Physical Health, and Physical Activity Behaviour: A Systematic Review of Longitudinal Trials

A growing body of research is exploring the potential added health benefits of exercise when performed outdoors in nature versus indoors. This systematic review aimed to compare the effects of exercise in outdoor environments versus indoor environments on psychological health, physical health, and physical activity behaviour. We searched nine databases from inception to March 2021 for English language, peer-reviewed articles: MEDLINE, Embase, PubMed, Scopus, Web of Science, CINAHL, SportsDiscus, GreenFile, and CENTRAL. We included randomized and non-randomized trials that compared multiple bouts of exercise in outdoor versus indoor environments, and that assessed at least one outcome related to physical health, psychological health, or physical activity behaviour. Due to minimal outcome overlap and a paucity of studies, we performed a narrative synthesis. We identified 10 eligible trials, including 7 randomized controlled trials, and a total of 343 participants. Participant demographics, exercise protocols, and outcomes varied widely. In the 10 eligible studies, a total of 99 comparisons were made between outdoor and indoor exercise; all 25 statistically significant comparisons favoured outdoor exercise. Interpretation of findings was hindered by an overall high risk of bias, unclear reporting, and high outcome heterogeneity. There is limited evidence for added health or behaviour benefits of outdoor exercise versus indoor exercise. Rigorous randomized controlled trials are needed with larger samples and clear reporting.

Green and blue spaces and lung function in the Generation XXI cohort: a life-course approach

BACKGROUND

Exposure to natural environments may affect respiratory health. This study examined the association of exposure to green and blue spaces with lung function in children, and assessed the mediation effect of air pollution and physical activity.

METHODS

The study used data from the Generation XXI, a population-based birth cohort from the Porto Metropolitan Area (Portugal). Residential Normalised Difference Vegetation Index (NDVI) at different buffers (100, 250 and 500 m), the accessibility to urban green spaces (UGS) within 400 and 800 m and the minimum distance to the nearest UGS and to the nearest blue spaces were assessed at birth, 4, 7 and 10 years of age. Three life-course measures were calculated: averaged exposure, early-life exposure (birth) and exposure trend over time (change in exposure). Forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1) and forced expiratory flow between 25% and 75% of FVC (FEF25-75%) at 10 years were used as outcomes. To assess associations, linear regression models and path analysis were used.

RESULTS

This study included 3278 children. The adjusted models showed that increasing the NDVI exposure over time within 100 m of the child's residence was associated with higher values of FEV1 (L) and FEF25-75% (L·s-1) (β 0.01, 95% CI 0.0002-0.03 and β 0.02, 95% CI 0.001-0.05, respectively). No significant associations were observed for the remaining measures of exposure, and no mediation effect was found for pollution or physical activity.

CONCLUSION

Increasing exposure to greenness at close proximity from residences was associated with improved lung function. While the mechanism remains unknown, this study brings evidence that city greening may improve children's respiratory health.

Impacts of Landscape Type, Viewing Distance, and Permeability on Anxiety, Depression, and Stress

Contact with nature is beneficial for mental health, including anxiety and stress. Exposure to virtual nature also has similar restorative traits with real nature. However, previous studies on the restorative environment mostly focus on ordinary people while caring less about patients with depressive disorders. Thus, the restorative impacts of virtual nature on patients with depression warrant examination. This research aims to study the restorative effects of virtual reality (VR) landscape type, viewing distance, and permeability on anxiety, depression, and stress in patients with depression. Study A revealed that the perceived restorative level of landscape type varies greatly: grassland > forest > water > undergrowth > urban square. Additionally, natural environments with higher openness, more green elements, more blue sky, and more sunshine exposure had higher restorative levels on perceived depression, anxiety, and stress relief. Study B found that the grassland landscape with a higher viewing distance and a medium vegetation edge permeability provides more restorative impacts for patients with depression.

Design and Evaluation of an Outdoor Exercise Program for Pediatric Cancer Survivors

Exercise programs for young people after cancer are not part of regular oncological care. This study describes and evaluates a regional outdoor exercise program and presents data with regard to the promoting and inhibiting factors for participation among pediatric cancer survivors. Exercise options, number of participants, and the cohort were evaluated descriptively for one year. A self-developed questionnaire was used to evaluate satisfaction, mood, motivations, and barriers to exercise. Overall N = 26 survivors (14.6 ± 5.5 years) participated in at least one activity in 2019 including try-out days (N = 10) and active weekend camps (N = 2). No adverse events occurred in 302 physical activity hours. Twenty-one survivors participated in the survey. The largest motivational aspect to participate was “to try out a new sport” (83.9%). Survivors reported “good mood”, and ‘being happy’ after exercising. The largest barrier was concern about ‘not being able to keep up with others’ (38.1%). Around one-third (try-out day) and 50% (active weekend camp) of survivors did not feel confident to continue exercising outside the supervised exercise oncology program. This survey shows high enthusiasm for this exercise program with different outdoor activities and suggests that similar interventions may be accepted by this population.

Mental health clinicians' perceptions of nature-based interventions within community mental health services: evidence from Australia

BACKGROUND

Mental health conditions are one of the largest burdens of disease in Australia and globally. There is a need to seek innovative and alternative interventions that can prevent and alleviate mental health symptoms. Nature-based interventions (NBIs), namely programs and activities where individuals engage with natural environments with the aim of improving their health and wellbeing (e.g., nature walking groups), may be such an alternative. This study aimed to explore the perceptions of mental health clinicians on the potential benefits of, and barriers to, implementing NBIs within a community mental health setting.

METHODS

This study used a qualitative, exploratory research design. Fifteen mental health clinicians were recruited from the Illawarra Shoalhaven Local Health District, Australia, and interviewed (September-October 2021) about their perceptions of NBIs within mental health settings. The semi-structured interviews were analysed using an inductive thematic approach and managed with NVivo.

RESULTS

Mental health clinicians viewed spending time in nature as relaxing, refreshing, and therapeutic. Many described it as part of their lifestyle and encouraged consumers to engage in nature-based activities on their own time. If NBIs were to be introduced as part of mental health services, clinicians expressed willingness to promote them to their consumers. Clinicians listed many potential benefits of NBIs for mental health consumers including improved mood, calmness and relaxation, a sense of empowerment, and social connections. Despite these benefits, clinicians were concerned about a variety of barriers to NBIs including consumers' mental health symptoms such as anxiety or lack of motivation, scepticism, and geographic accessibility, as well as organisational barriers such as policies around safety risk.

CONCLUSION

Responding to the individual and organisational factors that could hinder the implementation of NBIs while building on the existing evidence of the positive impact of nature on health and wellbeing and, as demonstrated in this study, mental health clinicians' interest and supportiveness of NBIs, mental health services should consider the implementation of NBIs as part of routine practice.

Influence of External Natural Environment Including Sunshine Exposure on Public Mental Health: A Systematic Review

The COVID-19 pandemic has been raging around the world and public health measures such as lockdowns have forced people to go out less often, reducing sunlight exposure time, green space use, and physical activity. It is well known that exercise has a positive impact on mental health, but the impact of external environmental factors such as sunlight exposure and green space use on mental health has not been systematically reviewed. In this review, we categorized the major factors that may affect people’s mental health into (1) external environmental factors such as exposure to sunlight and green spaces, (2) internal life factors such as physical activity and lifestyle, and (3) mixed external and internal factors, and systematically examined the relationship between each factor and people’s mental health. The results showed that exposure to sunlight, spending leisure time in green spaces, and physical activity each had a positive impact on people’s mental health, including depression, anxiety, and stress states. Specifically, moderate physical activity in an external environment with sunlight exposure or green space was found to be an important factor. The study found that exposure to the natural environment through sunbathing and exercise is important for people’s mental health.

The relationship between greenspace exposure and psychopathology symptoms: A systematic review

Greenspace exposure is associated with psychological benefits. In this systematic review, we summarized and critically evaluated the literature on the relationship between greenspace exposure (i.e., objective and subjective assessments of interactions with nature) and psychopathology incidence and symptom severity in those with and without a clinical diagnosis. A secondary aim of our review was to examine potential interactions between greenspace exposure and urban environmental features (e.g., pollution, population density) associated with poorer mental health. We identified 40 studies published between January 1, 1981, and July 31, 2020, from PubMed and PsycINFO electronic database search. Although heterogeneous in assessments of greenspace exposure and psychopathology symptom domain, the majority of cross-sectional and longitudinal evidence found that objectively assessed greenspace exposure (e.g., satellite measures of greenery) was related to less severe symptoms and lower incidence of psychopathology in children (e.g., attention-deficit/hyperactivity disorder symptoms) and adults (e.g., depression symptoms). In addition, five studies that assessed urban environmental features suggest that greenspace exposure may show a net positive relationship with psychopathology over and above the absence of urban features. We discuss limitations of the literature and future directions, including more mechanistic work to delineate the potential cognitive, affective, and behavioral factors that may contribute to the beneficial relationship between greenspace exposure and psychological health.

Support Life Club: A New Model Based on Social Media Group Chats and Social Activities That Can Improve Adherence and Clinical Outcomes in Patients Receiving Cardiac Rehabilitation

AIM

To describe a new model, the Support Life Club (SLC), for participants of Phase II cardiac rehabilitation (CR) programs and to evaluate this model for adherence, completion rates, and clinical outcomes.

METHODS

This retrospective study involved 391 consecutive patients who participated in an outpatient CR program between September 2016 and May 2020. The intervention group (SLC) was comprised of 198 patients who participated in education, WeChat-based group activity as well as outdoor activities, while the control group (non-intervention) was comprised of 193 cases. All patients attended a 12-week supervised outpatient CR program (three sessions per week, each lasting 40min). The intervention and control groups were compared for completion rates, Cardiopulmonary Exercise Test (CPET) results, Six-minute Walk Test (6MWT) distances, and Patient Health Questionnaire-9 (PHQ-9) scores.

RESULTS

Patients in the intervention group attended at least 75% of the exercise training sessions more often than those in the control group (72.5% vs 40.41%, adjusted odds ratio (OR): 27.385; 95% CI: 10.2 to 73.6; P = 0.0000). Analysis of variance (2 × 2 ANOVA) revealed a significant group-by-time interaction in PHQ9 and 6MWT test results (p = 0.000).

CONCLUSION

The addition of SLC to a cardiac rehabilitation program resulted in better outcomes for PHQ9 and 6MWT tests and may be a useful strategy to improve exercise adherence.

Nature-based outdoor activities for mental and physical health: Systematic review and meta-analysis

Mental health problems are associated with lower quality of life, increased unscheduled care, high economic and social cost, and increased mortality. Nature-based interventions (NBIs) that support people to engage with nature in a structured way are asset-based solutions to improve mental health for community based adults. However, it is unclear which NBIs are most effective, or what format and dose is most efficacious. We systematically reviewed the controlled and uncontrolled evidence for outdoor NBIs. The protocol was registered at PROSPERO (CRD42020163103). Studies that included adults (aged ≥18 years) in community-based settings with or without mental and/or physical health problems were eligible for inclusion. Eligible interventions were structured outdoor activities in green and/or blue space for health and wellbeing. We searched ASSIA, CENTRAL, Embase, Greenfile, MEDLINE, PsycINFO, and Web of Science in October 2019; the search was updated in September 2020. We screened 14,321 records and included 50 studies. Sixteen studies were randomised controlled trials (RCTs); 18 were controlled studies; and 16 were uncontrolled before and after studies. Risk of bias for RCTs was low to moderate; and moderate to high for controlled and uncontrolled studies. Random effects meta-analysis of RCTs showed that NBIs were effective for improving depressive mood -0.64 (95% CI: 1.05 to -0.23), reducing anxiety -0.94 (95% CI: 0.94 to -0.01), improving positive affect 0.95 (95% CI: 0.59 to 1.31), and reducing negative affect -0.52 (95% CI: 0.77 to -0.26). Results from controlled and uncontrolled studies largely reflected findings from RCTs. There was less evidence that NBIs improved physical health. The most effective interventions were offered for between 8 and 12 weeks, and the optimal dose ranged from 20 to 90 min. NBIs, specifically gardening, green exercise and nature-based therapy, are effective for improving mental health outcomes in adults, including those with pre-existing mental health problems.

Sports in Natural Environment, Sports in Urban Environment: An fMRI Study about Stress and Attention/Awareness

This study aimed to explore, on one side, the differences between a group of athletes exercising outdoor (OG) and another group exercising indoor (IG) in stress and awareness, and, on the other side, between-group differences in the fMRI activations during the visualization of natural environment images versus urban images. In addition, we aimed to analyze the associations between the resulting task-related brain activations and stress and attention-awareness in each group separately. All the participants (N = 49; OG = 21, 11 females, mean age = 40, SD = 6.49; and IG = 25, 11 females, mean age = 40; 6.19) underwent an fMRI scan and completed the Perceived Stress Scale and the Mindful Attention Awareness Scale. Besides, we collected a sample of hair cortisol. Participants viewed three types of images: water nature, green nature and urban images. Two-sample t-test with corrected p=0.001 values were carried out. Further correlational analyses were performed to estimate the associations between task-related brain activations and our pyscho-emotional measures in each group. Fisher tests were used to explore for potential between-group differences in the correlational indexes. In OG, compared to IG, we found a higher activation of the middle occipital cortex and a cluster comprising the supplementary motor area (SMA), the premotor cortex and the pre-SMA while viewing green nature images versus urban images. In OG, more than in IG, the higher activation of the left SMA cluster negatively correlated with perceived stress, while in the IG, more than in OG, the higher premotor cortex activation was positively related to the total score on MAAS. No significant association was found with the hair cortisol levels. Exercising outdoor would relate to better psycho-emotional outcomes, also for athletes. On the other side, the exposition to green nature led to higher activation of brain areas related to motor planning, but also to emotion regulation and emotional response.

Nature versus urban hiking for Veterans with post-traumatic stress disorder: a pilot randomised trial conducted in the Pacific Northwest USA

OBJECTIVES

To evaluate feasibility and acceptability of a group-based nature recreation intervention (nature hiking) and control condition (urban hiking) for military Veterans with post-traumatic stress disorder (PTSD).

DESIGN AND SETTING

A pilot randomised controlled trial conducted in the US Pacific Northwest.

PARTICIPANTS

Veterans with PTSD due to any cause.

INTERVENTIONS

Twenty-six participants were randomised to a 12-week intervention involving either six nature hikes (n=13) or six urban hikes (n=13).

PRIMARY AND SECONDARY OUTCOME MEASURES

Feasibility was assessed based on recruitment, retention and attendance. Questionnaires and postintervention qualitative interviews were conducted to explore intervention acceptability. Questionnaires assessing acceptability and outcomes planned for the future trial (eg, PTSD symptoms) were collected at baseline, 6 weeks, 12 weeks (immediately after the final hike) and 24 weeks follow-up.

RESULTS

Of 415 people assessed for eligibility/interest, 97 were interested and passed preliminary eligibility screening, and 26 were randomised. Mean completion of all questionnaires was 91% among those in the nature hiking group and 68% in those in the urban hiking group. Over the course of the intervention, participants in the nature and urban groups attended an average of 56% and 58%, respectively, of scheduled hikes. Acceptability of both urban and nature hikes was high; over 70% reported a positive rating (ie, good/excellent) for the study communication, as well as hike locations, distance and pace. Median PTSD symptom scores (PTSD Checklist-5) improved more at 12 weeks and 24 weeks among those in the nature versus urban hiking group.

CONCLUSIONS

This pilot study largely confirmed the feasibility and acceptability of nature hiking as a potential treatment for Veterans with PTSD. Adaptations will be needed to improve recruitment and increase hike attendance for a future randomised controlled trial to effectively test and isolate the ways in which nature contact, physical activity and social support conferred by the group impact outcomes.

TRIAL REGISTRATION NUMBER

NCT03997344.

“We Need such a Space”: Residents’ Motives for Visiting Urban Green Spaces during the COVID-19 Pandemic

Since the outbreak of the Novel Coronavirus Pneumonia in 2019, several cities have been blocked to prevent the expansion of the infection. This qualitative study aimed to determine the motives of urban residents for visiting urban green spaces during the epidemic (especially within the context of the city blockade), and what might weaken these motives. In total, 47 residents (17 men and 30 women) were recruited from Chengdu, in China, to participate in interviews. A thematic analysis was used to analyze the interview data. According to the results, the motives of the respondents were divided into strong motives and weak motives. These strong motives for visiting UGS can be divided into four themes: “A place for health”, “Escape”, “Social support”, and “A safe and important place for outdoor activities”. Residents classified as the weak motive primarily considered the reasons of “Keep distance with others”, “Potential infection risk” and “Seek compensation”. The results of this study are significant for current and future urban management, green space planning, and social well-being.

A Study of Leisure Walking Intensity Levels on Mental Health and Health Perception of Older Adults

Research suggests that different levels of intensity of leisure walking can affect the mental health of older adults. Unfortunately, insufficient evidence exists as to the recommended intensity levels of leisure walking for their health benefits. The purpose of this study was to investigate how leisure walking intensity levels are associated with the mental health and health perceptions of older adults. Using a purposive sampling method, the data of 4,737 adults over the age of 65 were drawn from the 2017 California Health and Interview Survey. The results of analysis of these data showed that older adults who engaged in moderate and vigorous leisure walking reported higher health perceptions than those involved in light leisure walking. In addition, older adults who participated in moderate leisure walking reported higher mental health than those who engaged in light leisure walking. This study suggests that moderate and/or vigorous leisure walking can increase the mental health and health perceptions of older adults.

Meaning in Life Mediates the Association between Environmental Engagement and Loneliness

Although the positive outcomes of human–environment interactions have been established, research examining the motivation between engagement in pro-environmental activities and psychological well-being is limited. In this mixed-methods study, the relationship between pro-environmental engagement, meaning in life, and well-being, including loneliness and depression, were investigated in a sample of 112 young adults in Canada. It was found that engaging in pro-environmental activities was negatively associated with loneliness. This association was mediated by meaning in life (e.g., an intrinsic motive of caring for future generations). In addition, qualitative analyses explored how engaging in pro-environmental activities has a meaningful impact on meaning in life, and on well-being. A thematic analysis generated three unique themes: (1) responsibility to teach the next generation about the environment, (2) deep appreciation for and connection to nature, and (3) renewed agency through self-directed learning. Overall, findings suggest that meaning in life is a core motive that underlies the association between environmental engagement and loneliness. The present study enriched the relationship between pro-environmentalism and well-being with a mixed-methods perspective.

Effects of Three Levels of Green Exercise, Physical and Social Environments, Personality Traits, Physical Activity, and Engagement with Nature on Emotions and Attention

The current study examined the effects of the three levels of green exercise on people’s psychological health using a randomized trial with a pretest and posttest design and further explored which variables of the physical environment (thermal comfort, noise, and air pollution), social environment (the number of companions and crowdedness), personality traits, physical activity (intensity and frequency), and engagement with nature may help explain experiences during the three levels of green exercise using a cross-sectional approach. Field studies were conducted to test the study’s hypotheses. The participants were 95 students from a technology university in Taiwan. The experiment comprised a 15-min green exercise in a park. No significant differences were found in emotions and attention between the three levels of green exercise. However, a 15-min green exercise of any level significantly improved emotions and attention. Furthermore, fatigue was significantly and negatively associated with daily transportation-related physical activity, agreeableness, and engagement with nature. Moreover, the total mood disturbance was significantly and negatively associated with engagement with nature and daily transportation-related physical activity. The degree of engagement with nature played a pivotal role in green exercise. This study provided the evidence that quantified engagement with nature is beneficial for quantified psychological health for the first time.

A Fitness App for Monitoring Walking Behavior and Perception (Runkeeper): Mixed Methods Pilot Study

BACKGROUND

Physical activity has a strong positive impact on both physical and mental health, and public health interventions often encourage walking as a means to promote physical activity. Social connectivity, such as that among spouses, families, friends, and colleagues, highly influences physical activity. Although technology-based interventions have some influence on human behavior, they have not been fully implemented and evaluated for their influence on walking through social connectivity.

OBJECTIVE

We aimed to pilot-test the organization of neighborhood walking clubs and use of a mobile app (Runkeeper) to encourage social connectedness and neighborhood cohesion, as well as to increase physical activity.

METHODS

We used a convenience sampling method to recruit 46 adults from an urban location in Greater Boston, Massachusetts. We assigned participants to teams based on their geographic location and neighborhood and required them to use the app (Runkeeper). Participants completed 2 self-administered web-based surveys before and after the intervention period. The surveys included standard measures to evaluate physical activity, social connectedness, perceived social support, and neighborhood cohesion (Buckner Neighborhood Cohesion Scale) before and after the intervention. Following the intervention, we randomly selected 14 participants to participate in postintervention, in-depth phone interviews to gain an understanding of their experiences.

RESULTS

This study was approved by the institutional review board in June 2018 and funded in January 2018. Recruitment started in May 2019 and lasted for 2 months. Data were collected from July 2019 to January 2020. In this study, Runkeeper was of limited feasibility as an app for measuring physical activity or promoting social connectedness. Data from the app recorded sparse and uneven walking behaviors among the participants. Qualitative interviews revealed that users experienced difficulties in using the settings and features of the app. In the questionnaire, there was no change between pre-post assessments in walking minutes (b=-.79; 95% CI -4.0 to 2.4; P=.63) or miles (b=-.07; 95% CI -0.15 to 0.01; P=.09). We observed a pre-post increase in social connectedness and a decrease in neighborhood cohesion. Both quantitative and qualitative results indicated that the psychosocial aspects of walking motivated the participants and helped them relieve stress. Interview results showed that participants felt a greater virtual connection in their assigned groups and enhanced connections with friends and family members.

CONCLUSIONS

Our study found that Runkeeper created a virtual connection among walking group members and its data sharing and ranking motivated walking. Participants felt that walking improved their mental health, helped to relieve stress, and made them feel more connected with friends or family members. In future studies, it will be important to use an app that integrates with a wearable physical activity device. There is also a need to develop and test intervention components that might be more effective in fostering neighborhood cohesion.

Natural or Urban Campus Walks and Vitality in University Students: Exploratory Qualitative Findings from a Pilot Randomised Controlled Study

Despite extensive evidence of the restorative effects of nature, the potential vitalizing effects of connecting with nature are yet understudied, particularly in higher education settings. University students face high levels of stress and anxiety, and may benefit from nature-based interventions that enhance positive states such as vitality. Using preliminary data from a pilot randomized controlled study with qualitative interviews, we explored the psychological experiences associated with a brief walk either in nature or an urban environment in a sample of 13 university students. The qualitative thematic analysis revealed that walking in nature was a more energizing and vitalizing experience than the urban walk. The nature walk was also found to have both affective and cognitive enhancing effects on participants. Our study highlights the usefulness of exploring subjective psychological experiences of interacting with nature, as well as supporting its restorative potential. Implications for further research and interventions are discussed.

Well-Being and Fear of Missing Out (FOMO) on Digital Content in the Time of COVID-19: A Correlational Analysis among University Students

The majority of research on the fear of missing out (FOMO) has focused on understanding how social media posts about attractive unattended experiences taking place in the physical world (e.g., a friend's vacation) influence individuals' affective states. With quarantine measures in place, and in the absence of travel and party photos on social media, do individuals feel they are missing out on enjoyable experiences? The current work shows that FOMO has not disappeared during the pandemic, even when socially distancing at home, but has been replaced by feelings towards new online activities (e.g., online concerts, virtual gatherings). As a consequence, we find that FOMO threatens well-being by causing important psychological and health issues, such as sleep deprivation, loss of focus, declined productivity, and finding relief in knowing that others have difficulty keeping up with abundant digital content. Importantly, we find these consequential effects both during the initial (May 2020) and late stages (December 2020) of the pandemic. With excessive Internet use and virtual FOMO likely to be a continuing reality of life, questions remain as to how one can refrain from its negative effects and stay healthy during the pandemic and in the post-pandemic era. We discuss remedies and suggest new research avenues that may help elevate the negative consequences of FOMO on well-being.

Not gendered… but different from each other? A structural equation model for explaining risky road behaviors of female and male pedestrians

As alternative transportation is getting more and more fashionable, and more people worldwide are "shifting" to walking trips, even for their daily commuting, traffic crashes suffered by pedestrians are still a great concern for road safety and public health researchers and practitioners. In this regard, risky or "aberrant" road behaviors have emerged, during the last few years, as a key issue to be considered for crash prevention. Nevertheless, the idea of a "generic pedestrian" is getting re-evaluated, and analyzing key features, such as gender, seems to be crucial for understanding pedestrians' performance and safety outcomes.

OBJECTIVE

The objective of this study was to examine the effect of gender on pedestrians' both deliberate (traffic violations) and undeliberate (errors) risky walking behaviors, considering a set of theoretically based demographic and psychosocial variables as their potential predictors.

METHOD

For this cross-sectional study, data from 1070 Spanish pedestrians (60 % females and 40 % males, aged between 16 and 79) from the 17 regions of Spain, responding to an electronic questionnaire, were analyzed through a multi-group structural equation modeling (MGSEM) approach.

RESULTS

Although age, handheld device-interaction, and sensation-seeking seem to have a similar effect on the errors and violations reported by both genders (similarities), factors such as risk perception, educational level and the misbehaviors observed in other road users are significant predictors only in the case of male pedestrians. On the other hand, road distractions have been shown to play a significant role in females' errors and violations, while males' road distractions seem to only affect their involuntary risky behaviors.

CONCLUSION

The findings of this study support the influence of gender in the statistical explanation of both deliberate and undeliberate walking risky road behaviors, also depicting the differential role of certain demographic and psychosocial factors when we compare male and female pedestrians.

Physical and mental health effects of repeated short walks in a blue space environment: A randomised crossover study

INTRODUCTION

Blue spaces may benefit mental health and promote physical activity, although the evidence is still scarce. And benefits on physical health are less consistent. The objective of this randomized crossover study was to assess psychological and cardiovascular responses to blue spaces' exposure.

METHODS

A sample of 59 healthy adult office workers was randomly assigned to a different environment (i.e. blue space, urban space, and control site) on 4 days each week, for 3 weeks. For 20 min per day, they either walked along a blue or an urban space or rested at a control site. Before, during and/or after the exposure, we measured self-reported well-being and mood, blood pressure, and heart rate variability parameters. For well-being, we also assessed the duration of these potential effects over time (at least 4 h after exposure).

RESULTS

We found significantly improved well-being and mood responses immediately after walking in the blue space compared with walking in the urban space or when resting in the control site. Cardiovascular responses showed increased activity of the sympathetic nervous system, both during and after walking along the blue and urban spaces. However, cardiovascular responses measured after the walks, showed no statistically significant differences between the blue and the urban space environments.

CONCLUSIONS

Short walks in blue spaces can benefit both well-being and mood. However, we did not observe a positive effect of blue spaces for any of the cardiovascular outcomes assessed in this study.

Comparing the Trail Users with Trail Non-Users on Physical Activity, Sleep, Mood and Well-Being Index

Background: The current study sought to understand whether trail users reported better wellness and health status compared to the non-users, and to recognize the associated factors. Methods: Eight trails from different locations and settings within Indiana were selected to sample trail users for the study. Additionally, areas surrounding these eight trails were included in the study as sample locations for trail non-users. Trail users and non-users were intercepted and asked to participate in a survey including demographics, socioeconomic status, physical activity, mood, smoking, nutrition, and quality of sleep. Information was collected and compared between the trail users and the non-users. Association of self-rated health, age, sex, race, marital status, employment, income, education, smoking, nutrition, sleep, and mood with trail use was evaluated by multivariable linear regression model. Results: The final sample size included 1299 trail users and 228 non-users. Environmental factors (access to nature and scenery) were important incentives for 97% and 95% of trail users, respectively. Age, sex, mood, and sleep quality were significantly associated with using the trail. Mean (SD) self-rated wellness and health out of 10 was 7.6 (1.4) in trail users and 6.5 (1.9) in non-users (p < 0.0001). Importantly, trail users were significantly more physically active outside of the trail compared to the non-users (207 vs. 189 min/week respectively, p = 0.01) and had better sleep qualities and mood scores. Using the trails was significantly associated with higher self-rated wellness and health score. The longer the use of trails, the higher the self-rated wellness and health index (β = 0.016, p = 0.03). Conclusion: Compared to not using the trails, trail use was significantly associated with more physical activity, better sleep quality, and higher self-rated wellness and health.

Can walking groups help with social isolation: a qualitative study

CONTEXT

In affluent areas, issues such as social isolation and mental health are often over-looked, neglected and stigmatised, especially in the elderly.

PROJECT AIM

This study aimed to test the feasibility of a weekly walking group to reduce loneliness within the community and to identify participants' motivations and reasons for taking part.

DESCRIPTION

The intervention was a 1-h lunch time walk along the River Thames. Searches for 'isolated' and 'lonely' were conducted in one general practice's medical records, to identify high-risk patients that would benefit most, and these patients contacted directly. Additionally, posters advertising the walk were placed around the waiting room and clinical areas.

OUTCOMES

The activity ran for 2 weeks and was attended by 12 participants. The walks were well received, however participants were attending for exercise rather than to meet new people and socialise as originally intended.

CONCLUSIONS

The pilots results seem to indicate that walking is generally associated with improved physical health rather than mental health in patients and that less physically involved methods may be more appropriate for reducing isolation. However, the study highlights the important factors that need to be considered when organising an intervention in primary care, namely stressing the purpose and recruitment.

The effect of green walking on heart rate variability: A pilot crossover study

We investigated the effects of regular walking in green and suburban environments on heart rate variability (HRV) and blood pressure (BP) in middle-aged adults. Twenty-three adults participated in a non-randomized crossover experiment comprised of once-weekly 50-min moderate-intensity walking sessions. Separated by a two-week washout period, participants walked for three weeks in each of two treatment conditions (green and suburban) in a local arboretum and suburban sidewalks of Chaska, MN. Eleven participants completed green walking first and 12 suburban walking first. Walks were split into 15-min intra-walk phases, with phases representing each walk's beginning, middle, and final 15-min. Repeated measures linear mixed models evaluated (1) HRV phase differences between treatments and HRV change within treatments, and (2) pre- and post-walk BP differences between treatments and pre-to post-walk BP changes. Intra-walk phase analyses revealed higher HRV during green walking vs. suburban walking during phase 2 (p < 0.0001) and phase 3 (p = 0.02). Less HRV reduction was seen between intra-walk phases 1 and 2 during green vs. suburban walking (p = 0.02). Pre-to post-walk changes revealed decreased mean systolic BP for both green (p = 0.0002) and suburban (p = 0.003) walking conditions, but not for diastolic BP. Post-walk BP results were similar after both green walking and suburban walking. In summary, walking sessions in a green environment elicited greater beneficial HRV responses compared to a suburban environment. Additionally, walking in either environment, green or suburban, promoted reductions in systolic BP.

Group Outdoor Health Walks Using Activity Trackers: Measurement and Implementation Insight from a Mixed Methods Feasibility Study

Outdoor walking groups are nature-based interventions (NBIs) that promote health and wellbeing by modifying individual behaviour. The challenges of such NBIs include the motivation of inactive adults to participate and measurement issues. This feasibility study investigates a 12-week group outdoor health walk (GOHW) incorporating activity trackers and use of a holistic health and wellbeing measure, the Self-sasessment of Change (SAC) scale. A mixed methods design explored participant recruitment and retention, programme delivery, and measures of physical activity and health and wellbeing. Walker data included: pre-post questionnaires, daily step counts, and interviews. Programme delivery information included: weekly checklists, staff reflections, stakeholder meeting minutes, and a report. Thirteen adults (age 63–81, 76% female) joined and completed the activity tracker GOHW. Activity trackers motivated walkers to join and be more active but complicated programme delivery. Activity trackers allowed the quantification of physical activity and the SAC health and wellbeing measure was easy to use. By week 12, all participants met national physical activity guidelines. Clinically relevant changes on the SAC scale included: sleeping well, experiencing vibrant senses, and feeling energised, focused, joyful, calm and whole. Results illustrate the feasibility of using activity trackers to motivate engagement in and provide a measure of physical activity from GOHWs. The SAC scale offers a promising measure for nature–health research. A conceptual model is provided for the development of future large-scale studies of NBIs, such as group outdoor health walks.

Inequities and inequalities in outdoor walking groups: a scoping review

Background

Outdoor walking groups are widely-used programmes aimed at improving physical activity and health outcomes. Despite being promoted as accessible and inclusive, emerging work highlights participation biases based on gender, age and socioeconomic status, for example. To explicate the impact of outdoor walking groups on physical activity inequities, we conducted a scoping review of published outdoor walking group literatures. Specifically, we critically examined: (a) equity integration strategies; (b) intervention reach; (c) effectiveness; and (d) potential social determinants of engagement relating to the World Health Organization’s conceptual framework.

Methods

Arksey and O’Malley’s scoping review protocol was used to develop a comprehensive search strategy and identify relevant academic and grey literatures, which were screened using pre-defined inclusion and exclusion criteria. Data were organised by Cochrane PROGRESS-Plus equity characteristics and a narrative summary was presented for each thematic area.

Findings

Sixty-two publications were included. Key findings were: (a) some evidence of targeted intervention trials. Large-scale national programmes were tailored to regional activity and health needs, which may contribute toward addressing inequities. However, participant demographics seldom informed reported analyses; (b) participation was more likely among white, more socioeconomically advantaged, middle-to-older aged, female and able-bodied adults; (c) positive physical and psychological outcomes were unlikely to extend along social gradients; and (d) interventions primarily addressed intermediary determinants (e.g. psychosocial barriers; material resource). Social capital (e.g. friend-making) was identified as potentially important for addressing physical activity inequalities.

Conclusions

The published literature on outdoor walking groups leaves unanswered questions regarding participation inequalities, with implications for future physical activity promotion. Currently, participation in outdoor walking groups is typically more prevalent among advantaged subpopulations. We make recommendations for research and practice to address these issues, as well as aid the translation of existing knowledge into practice. We advocate increased focus on the social determinants of engagement. A more consistent approach to collecting and analysing participant socio-demographic data is required. Our findings also support recommendations that appropriate tailoring of universal programmes to community needs and embedding strategies to increase social cohesion are important in developing equitable programmes.

Blue care: a systematic review of blue space interventions for health and wellbeing

There is increasing interest in the potential use of outdoor water environments, or blue space, in the promotion of human health and wellbeing. However, therapeutic nature-based practices are currently outpacing policy and the evidence base for health or wellbeing benefits of therapeutic interventions within blue space has not been systematically assessed. This systematic review aims to address the gap in understanding the impacts of blue space within existing interventions for targeted individuals. A systematic review was carried out, searching Google Scholar, SCOPUS, PubMed, etc. through to August 2017. Only blue space interventions were included that were specifically designed and structured with a therapeutic purpose for individuals with a defined need and did not include nature-based promotion projects or casual recreation in the outdoors. Thirty-three studies met the inclusion criteria and were assessed. Overall, the studies suggest that blue care can have direct benefit for health, especially mental health and psycho-social wellbeing. The majority of papers found a positive or weak association between blue care and health and wellbeing indicators. There was also some evidence for greater social connectedness during and after interventions, but results were inconsistent and mixed across studies with very few findings for physical health. This is the first systematic review of the literature on blue care. In summary, it has been shown that mental health, especially psycho-social wellbeing, can be improved with investment in blue spaces. Key areas for future research include improving understanding of the mechanisms through which blue care can improve public health promotion.

Wetlands for Wellbeing: Piloting a Nature-Based Health Intervention for the Management of Anxiety and Depression

Nature-based health interventions (NBIs) for the treatment of poor mental health are becoming increasingly common, yet evidence to support their effectiveness is lacking. We conduct a pilot study of a six-week intervention, aiming to engage individuals with wetland nature for the treatment of anxiety and/or depression. We employed a mixed methods design, using questionnaires, focus groups and semi-structured interviews to evaluate the intervention from the perspective of participants (n = 16) and healthcare professionals (n = 2). Results demonstrate significant improvements in mental health across a range of indicators, including mental wellbeing (Warwick and Edinburgh Mental Wellbeing Scale), anxiety (Generalised Anxiety Disorder-7), stress (Perceived Stress Scale) and emotional wellbeing (Positive and Negative Affect Schedule). Participants and healthcare professionals cited additional outcomes including improved physical health and reduced social isolation. The wetland site provided a sense of escape from participants’ everyday environments, facilitating relaxation and reductions in stress. Wetland staff knowledge of the natural world, transportation and group organisation also played a considerable role in the intervention’s success. These aspects should be considered in future and existing NBIs to maximise benefits to participants. We propose NBIs based in wetlands are an effective therapy option for individuals diagnosed with anxiety and/or depression.

Association between neighbourhood green space and biological markers in school-aged children. Findings from the Generation XXI birth cohort

BACKGROUND

There is considerable literature on the psychological and behavioural benefits of green space. However, less is known about its health-promoting effects, as expressed on biological markers. Additionally, incorporating biomarkers into pediatric research may help elucidate the links between exposures to environmental stressors and lifelong health.

OBJECTIVE

To measure the association between geographical accessibility to green spaces and allostatic load (AL), a measure of biological multi-system dysregulation.

METHODS

We used data from 3108 7-year old children enrolled in Generation XXI, a population-based birth cohort from the Porto Metropolitan Area (Portugal). We computed an AL index based on seven biomarkers representing four regulatory systems: immune/inflammatory system (high sensitivity C-reactive protein); metabolic system (high density lipoprotein; total cholesterol; glycated hemoglobin; waist-hip ratio) and cardiovascular system (systolic and diastolic blood pressure). Accessibility to green spaces was calculated using a Geographic Information System and crude and adjusted associations were estimated using mixed-effects regression models.

RESULTS

Among the 3108 children (51.7% male; mean age 87.3 months), the mean AL index was 0.00 (standard deviation 2.94). Adjusted models showed that having a green space within 400 m and 800 m from the child's school was inversely associated with AL (400 m: beta -0.29 95% CI -0.54 to -0.02; 800 m: -0.29 95% CI -0.51 to -0.07). Also, there was a 12% (0%; 23%) increase in the AL index for every 1 km increase in distance to the nearest green space. No significant associations with AL were observed with residential accessibility to green space or with the presence of a garden at home.

CONCLUSION

We found a cross-sectional negative association between accessibility to green space near schools and AL in children, suggesting that the provision of green space may contribute to improvements in population health beginning early in life.

Impact of Frequency of Visits and Time Spent in Urban Green Space on Subjective Well-Being

Exposure to green spaces can reduce the negative effects of stress. This study examines how frequency of visits and time spent in urban green spaces (UGS) affect urban dwellers’ subjective well-being. We also investigated the numbers of respondents visiting UGS, their primary motivation, and constraints on their ability to visit. Using quota sampling, an online survey was conducted of 400 residents of Daejeon City, South Korea. ANOVA results indicated no significant interactions between visit frequency and time spent in UGS. Respondents who had visited UGS within the past two weeks expressed higher positive and lower negative emotions than did non-visitors, regardless of visit frequency, and regular visitors showed higher general life satisfaction levels. These positive effects were confirmed by estimated structural equation models. However, the time spent in UGS did not affect emotions or life satisfaction in general. Heavy users mostly visited UGS to walk, and light/non-users cited the lack of urban green spaces near their home as the major constraint on visiting UGS. The estimated structural equation models clearly show positive effects from motivation and negative effects of constraints and access time to UGS on visit frequency. To improve urban dwellers’ subjective well-being, UGS should prioritize good walking environments and accessibility.

Effects of forest bathing (shinrin-yoku) on levels of cortisol as a stress biomarker: a systematic review and meta-analysis

Forest bathing is a traditional practice characterized by visiting a forest and breathing its air. This review aims to investigate the effects of forest bathing on levels of salivary or serum cortisol as a stress biomarker in order to understand whether forest bathing can reduce stress. Medline/PubMed, Embase, Scopus, Web of Science, Cochrane Library, and Google Scholar were systematically searched for relevant articles. The quality of included trials was assessed following the criteria of the NIH dedicated tools. Afterwards, a qualitative and quantitative synthesis of retrieved evidence was performed. A total of 971 articles were screened; 22 of them were included in the systematic review and 8 in the meta-analysis. In all but two included studies, cortisol levels were significantly lower after intervention in forest groups if compared with control/comparison groups, or a significant pre-post reduction of cortisol levels was reported in the forest groups. The main results of the meta-analysis showed that salivary cortisol levels were significantly lower in the forest groups compared with the urban groups both before (MD = - 0.08 μg/dl [95% CI - 0.11 to - 0.05 μg/dl]; p < 0.01; I² = 46%) and after intervention (MD = - 0.05 μg/dl [95% CI - 0.06 to - 0.04 μg/dl]; p < 0.01; I² = 88%). Overall, forest bathing can significantly influence cortisol levels on a short term in such a way as to reduce stress, and anticipated placebo effects can play an important role in it. Further research is advised because of the limited available data.

Growing Resilience through Interaction with Nature: Can Group Walks in Nature Buffer the Effects of Stressful Life Events on Mental Health?

Nature-based activities have been used as therapeutic interventions for those experiencing stress and mental ill health. This study investigates whether group walks could be a nature-based intervention to foster resilience, by buffering the effects of recent stressful life events on mental health. An observational research design with propensity score-matched samples compared the mental health of individuals who did (Nature Group Walkers, n = 1081) or did not (Non-Group Walkers, n = 435) attend nature group walks. A sub-sample of Frequent Nature Group Walkers (at least once per week, n = 631) was also investigated. Data were analyzed using multiple regression with an interaction term. All analyses were controlled for age, gender, and recent physical activity. Results showed that neither nature group walking, nor doing this frequently, moderated the effects of stressful life events on mental health. Using a main effects model, the positive associations of group walks in nature were at a greater magnitude than the negative associations of stressful life events on depression, positive affect, and mental well-being, suggesting an 'undoing' effect of nature group walks. Group walking schemes in natural environments may be an important public health promotion intervention for mental health.

Perceived Environmental, Individual and Social Factors of Long-Distance Collective Walking in Cities

Long-distance collective walking is a popular activity in cities across China. However, related research is limited, creating a research gap to explore participants' dynamic experience and related influential factors. Therapeutic mobilities theory explores the relationships among walking, health, and well-being from a qualitative perspective. Based on therapeutic mobilities theory, following a systematic process, this study develops a scale to quantitatively estimate the perceived environmental, personal, and social factors that may influence health and well-being. By applying construal level theory, this paper further hypothesizes that personality traits and familiarity moderate environmental, personal, and social perceptions. Data were collected with a paper survey (n = 926) from the "Shenzhen 100 km Walking" event. The findings highlight that long-distance collective walkers have comparatively greater experiences of health and well-being in three aspects: positive social interaction, individual development, and environmental understanding. Personality traits, familiarity, and gender moderate this well-being experience. Theoretical and managerial implications are discussed.

The relationship between greenspace and the mental wellbeing of adults: A systematic review

Introduction

The view that interacting with nature enhances mental wellbeing is commonplace, despite a dearth of evidence or even agreed definitions of ‘nature’. The aim of this review was to systematically appraise the evidence for associations between greenspace and mental wellbeing, stratified by the different ways in which greenspace has been conceptualised in quantitative research.

Methods

We undertook a comprehensive database search and thorough screening of articles which included a measure of greenspace and validated mental wellbeing tool, to capture aspects of hedonic and/or eudaimonic wellbeing. Quality and risk of bias in research were assessed to create grades of evidence. We undertook detailed narrative synthesis of the 50 studies which met the review inclusion criteria, as methodological heterogeneity precluded meta-analysis.

Results

Results of a quality assessment and narrative synthesis suggest associations between different greenspace characteristics and mental wellbeing. We identified six ways in which greenspace was conceptualised and measured: (i) amount of local-area greenspace; (ii) greenspace type; (iii) visits to greenspace; (iv) views of greenspace; (v) greenspace accessibility; and (vi) self-reported connection to nature. There was adequate evidence for associations between the amount of local-area greenspace and life satisfaction (hedonic wellbeing), but not personal flourishing (eudaimonic wellbeing). Evidence for associations between mental wellbeing and visits to greenspace, accessibility, and types of greenspace was limited. There was inadequate evidence for associations with views of greenspace and connectedness to nature. Several studies reported variation in associations between greenspace and wellbeing by life course stage, gender, levels of physically activity or attitudes to nature.

Conclusions

Greenspace has positive associations with mental wellbeing (particularly hedonic wellbeing), but the evidence is not currently sufficient or specific enough to guide planning decisions. Further studies are needed, based on dynamic measures of greenspace, reflecting access and uses of greenspace, and measures of both eudaimonic and hedonic mental wellbeing.

Walking on sunshine: scoping review of the evidence for walking and mental health

BACKGROUND/OBJECTIVES

Walking has well-established positive relationships with, and effects on, physical health. In contrast, while poor mental health contributes substantially to global health burden, an overview of the benefits from walking has not previously been published. We aimed to scope the literature and present what is known, and highlight what is not known, about walking and mental health.

METHODS

Design: Scoping review.

DATA SOURCES

Ovid (Medline), ProQuest, Web of Science.Screening and reporting: 13 014 records were identified and screened by a team of researchers. Included full texts were analysed and reported according to mental health outcome.

RESULTS

For the 8 mental health outcomes (identified a priori), there were a total of 5 systematic reviews and 50 individual papers included. Depression had the most evidence and existing systematic reviews were reported. Evidence for anxiety, psychological stress, psychological well-being, subjective well-being and social isolation and loneliness varied in volume and effectiveness, but no harmful effects were identified. There were no studies for walking and resilience. The setting and context of walking seems to be important variables.

CONCLUSION

The evidence base that suggests walking benefits mental health is growing, but remains fragmented and incomplete for some important outcomes. Policy and national guidelines should promote the known mental health benefits of increased walking and future research should directly address the gaps we have identified.

Environmental Strategies of Affect Regulation and Their Associations With Subjective Well-Being

Environmental strategies of affect regulation refer to the use of natural and urban socio-physical settings in the service of regulation. We investigated the perceived use and efficacy of environmental strategies for regulation of general affect and sadness, considering them in relation to other affect regulation strategies and to subjective well-being. Participants from Australia, Finland, Germany, Great Britain, Italy, India, the Netherlands, Portugal, and Sweden (N = 507) evaluated the frequency of use and perceived efficacy of affect regulation strategies using a modified version of the Measure of Affect Regulation Styles (MARS). The internet survey also included the Satisfaction with Life Scale (SWLS), emotional well-being items from the RAND 36-Item Health Survey, and a single-item measure of perceived general health. Environmental regulation formed a separate factor of affect regulation in the exploratory structural equation models (ESEM). Although no relations of environmental strategies with emotional well-being were found, both the perceived frequency of use and efficacy of environmental strategies were positively related to perceived health. Moreover, the perceived efficacy of environmental strategies was positively related to life satisfaction in regulating sadness. The results encourage more explicit treatment of environmental strategies in research on affect regulation.

Healthy Parks Healthy People as an Upstream Stress Reduction Strategy

One of the primary goals of the Healthy Parks Healthy People (HPHP) program, located in the San Francisco Bay Area, is to offer group-based physical activities in natural settings. These activities arefor racially and ethnically diverse groups of individuals as an "upstream" strategy for improving health. This study investigated the health impact of selected two-hour HPHP Bay Area events that targeted low-income racial and ethnic minority groups using physiological and self-reported measures of stress and related variables. Study participants (N=52) in the selected HPHP Bay Area events donated saliva and filled out psychological measures of perceived stress (PSS-4; Cohen et al.) and mood state (I-PANAS-SF; Thompson, 2007) at the beginning and the end ofa two-hour guided walk in green spaces. Moreover, a measure of perceived restoration (SRRS; Han, 2007) was completed at the end ofthe walk. Study participants wore a physical activity self-monitoring device (Garmin Vivofit 2) to capture their step count and heart rate during the event. Stress, both measured by the analysis of salivary cortisol and self-reported perceived stress, significantly decreased over the course of the event (p<.0$) and there was a significant increase in positive mood (p<.05). The monitoring device also indicated that individuals were engaged in moderate levels of physical activity during the guided walks (<di>x</di> =8,990 steps, HR 95 bpm). The results encourage further development of nature-based health interventions to mitigate stress. Such interventions may be especially appropriate for low-income, urban, racial and ethnic minority groups that likely experience increased levels of stress due to social inequities and poor living conditions.

Environmental Strategies of Affect Regulation and Their Associations With Subjective Well-Being

Environmental strategies of affect regulation refer to the use of natural and urban socio-physical settings in the service of regulation. We investigated the perceived use and efficacy of environmental strategies for regulation of general affect and sadness, considering them in relation to other affect regulation strategies and to subjective well-being. Participants from Australia, Finland, Germany, Great Britain, Italy, India, the Netherlands, Portugal, and Sweden (N = 507) evaluated the frequency of use and perceived efficacy of affect regulation strategies using a modified version of the Measure of Affect Regulation Styles (MARS). The internet survey also included the Satisfaction with Life Scale (SWLS), emotional well-being items from the RAND 36-Item Health Survey, and a single-item measure of perceived general health. Environmental regulation formed a separate factor of affect regulation in the exploratory structural equation models (ESEM). Although no relations of environmental strategies with emotional well-being were found, both the perceived frequency of use and efficacy of environmental strategies were positively related to perceived health. Moreover, the perceived efficacy of environmental strategies was positively related to life satisfaction in regulating sadness. The results encourage more explicit treatment of environmental strategies in research on affect regulation.