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Evidence for Incorporating Green Exercise into Clinical and Public Health Practice

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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601).

Deadline for manuscript submissions: closed (30 September 2019) | Viewed by 84081

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Dr. Teresa Horton

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Department of Anthropology, Northwestern University, 1810 Hinman Avenue, Evanston, IL 60208, USA
Interests: salutary effects of high quality green and blue spaces; nature as an environmental determinate of health and the contributions of natural landscapes health, wellbeing, and resilience of humans
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Dear Colleagues,

The International Journal of Environmental Research and Public Health is preparing a Special Issue entitled “Evidence for Incorporating Green Exercise into Clinical and Public Health Practice”, for publication in September 2019. Recent years have seen an increase in the scientific evidence supporting the hypothesis that the mental and physical health of humans benefits from living near or having access to natural environments. As reviewed by Frumkin and colleagues [1], the scope of the research in terms of duration of exposure and in the diversity of natural areas with which people engage is wide. This breadth of scope can make it difficult for health-care practitioners to grasp the salient information they need to justify incorporating nature-based therapies into clinical and public health practices. To facilitate the transfer of information from basic researchers to practitioners, this Special Issue of the International Journal of Environmental Research and Public Health solicits reports of studies that investigate the practice of Green Exercise, defined as physical activity undertaken in natural areas, which can inform the use of Green Exercise in improving health outcomes of individuals and populations.

Frumkin, H., G.N. Bratman, et al., Nature Contact and Human Health: A Research Agenda. Environ Health Perspect, 2017. 125(7): p. 075001.

Prof. Dr. Teresa Horton
Guest Editor

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Keywords

Green Exercise
Ecopsychology
Shinrin yoku
Health care
Nature and health
Nature-based
Nature Rx
Nature Prescription
Park Prescription
Park Rx
Physical activity

Published Papers (12 papers)

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Research

18 pages, 3781 KiB

Open AccessArticle

Walking Green: Developing an Evidence Base for Nature Prescriptions

by Elizabeth P.D. Koselka, Lucy C. Weidner, Arseniy Minasov, Marc G. Berman, William R. Leonard, Marianne V. Santoso, Junia N. de Brito, Zachary C. Pope, Mark A. Pereira and Teresa H. Horton

Int. J. Environ. Res. Public Health 2019, 16(22), 4338; https://doi.org/10.3390/ijerph16224338 - 07 Nov 2019

Cited by 43 | Viewed by 7234

Abstract

Although the health benefits of exercise and exposure to nature are well established, most evidence of their interaction comes from acute observations of single sessions of activity. However, documenting improved health outcomes requires ongoing interventions, measurement of multiple outcomes, and longitudinal analyses. We conducted a pilot study to guide the development of a protocol for future longitudinal studies that would assess multiple physiological and psychological outcomes. Herein, we report psychological outcomes measured from thirty-eight participants before and after three conditions: a 50 min walk on a forest path, a 50 min walk along a busy road, and a period of activities of daily living. Changes in positive and negative affect, anxiety, perceived stress, and working memory are reported. We benchmark these results to existing studies that used similar protocols and also identify elements of the protocol that might impair recruitment or retention of subjects in longer-term studies. Linear mixed-models regression revealed that walking improved psychological state when compared to activities of daily living, regardless of walk environment (p < 0.05). Comparison of mean differences showed that forest walks yielded the largest and most consistent improvements in psychological state. Thus, despite a protocol that required a 3.5 h time commitment per laboratory visit, the beneficial effects of walking and exposure to a forested environment were observed. Full article

(This article belongs to the Special Issue Evidence for Incorporating Green Exercise into Clinical and Public Health Practice)

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16 pages, 2221 KiB

Open AccessArticle

Green Exercise: How Are Characteristics of Urban Green Spaces Associated with Adolescents’ Physical Activity and Health?

by Abdullah Akpınar

Int. J. Environ. Res. Public Health 2019, 16(21), 4281; https://doi.org/10.3390/ijerph16214281 - 04 Nov 2019

Cited by 27 | Viewed by 5303

Abstract

This study investigates associations between characteristics of urban green spaces (UGSs) and adolescents’ self-reported green exercise (GE), general health, and body mass index (BMI). Data were collected through face-to-face personal interviews with 384 adolescents ages 13–19 between 1 March and 31 May, 2018 in UGSs in Aydın, Turkey. Multivariate regression analyses were conducted to examine associations controlling for confounding factors. Stratified analyses were also conducted to determine differences between boys and girls. Positive associations with the duration of GE included many trees, lawns, soccer fields and basketball courts, play equipment, and self-reported general health. Whereas increased BMI was associated with increased benches/ seating, lawns and exercise trails were positively associated with self-reported general health. Negative relationships with increased BMI included many trees, open areas, and outdoor fitness equipment. Increased distance from UGSs was negatively associated with the frequency of GE. In stratified analyses, positive associations between boys’ duration of GE and self-reported general health were found. Whereas soccer fields and basketball courts were associated with girls’ frequency of GE, exercise trails and play equipment were correlated with girls’ self-reported general health. Negative associations with the boys’ frequency of GE included increased BMI and screen time. Whereas increased distance from UGSs was negatively associated with girls’ frequency of GE, many trees, lawns, exercise trails, play equipment, open areas, flowerbeds, and outdoor fitness equipment were negatively correlated with girls’ increased BMI. Findings suggest that adolescents’ GE and health could be promoted with many trees, lawns, flowerbeds, open areas, play and outdoor fitness equipment, exercise trails, and soccer fields and basketball courts. Findings of this study should be tested with longitudinal or intervention studies in future research. Full article

(This article belongs to the Special Issue Evidence for Incorporating Green Exercise into Clinical and Public Health Practice)

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14 pages, 369 KiB

Open AccessArticle

A Study of Perceived Nature, Shade and Trees and Self-Reported Physical Activity in Denver

by Sara Tabatabaie, Jill S. Litt and Amanda Carrico

Int. J. Environ. Res. Public Health 2019, 16(19), 3604; https://doi.org/10.3390/ijerph16193604 - 26 Sep 2019

Cited by 15 | Viewed by 3167

Abstract

(1) Background: Current evidence on the association between greenery and physical activity (PA) remains inconsistent. Most studies on this association use objective measures of greenness, which do not reveal people’s perceptions of greenness in neighborhoods, or the role of quality components of greenness, such as shade, trees, and the presence of nature on this association. (2) Methods: Drawing on data from the Neighborhood Environment and Health Survey—a cross-sectional population-based survey of Denver residents in 2007—we examined which measures of greenness (perceived and objective) correlated with the self-reported PA. We also assessed how components of perceived greenness, shade, trees and the presence of nature, correlated with PA. (3) Results: Perceived greenness, reflecting perception of trees, shade and the presence of nature, was positively associated with reported moderate–vigorous PA. Conclusion: Findings provide evidence that quality aspects of greenness affect people’s perception of the neighborhood in a way that relates to PA. The individual contributions of shade, trees, and the presence of nature in this association should be analyzed in future studies. Understanding the link between shade and trees and PA has implications for how to plan for walkability and sun safety at the neighborhood scale. Full article

(This article belongs to the Special Issue Evidence for Incorporating Green Exercise into Clinical and Public Health Practice)

12 pages, 739 KiB

Open AccessArticle

Changes in Psychological and Cognitive Outcomes after Green versus Suburban Walking: A Pilot Crossover Study

by Junia N. de Brito, Zachary C. Pope, Nathan R. Mitchell, Ingrid E. Schneider, Jean M. Larson, Teresa H. Horton and Mark A. Pereira

Int. J. Environ. Res. Public Health 2019, 16(16), 2894; https://doi.org/10.3390/ijerph16162894 - 13 Aug 2019

Cited by 27 | Viewed by 3898

Abstract

This study investigated the acute effects of repeated walking sessions within green and suburban environments on participants’ psychological (anxiety and mood) and cognitive (directed-attention) outcomes. Twenty-three middle-aged adults (19 female) participated in a non-randomized crossover study comprised of once-weekly 50-min moderate-intensity walking sessions. Participants walked for three weeks in each of two treatment conditions: green and suburban, separated by a two-week washout period. Eleven participants completed green walking first and 12 suburban walking first. For each walk, we used validated psychological questionnaires to measure pre- and post-walk scores for: (1) mood, evaluated via the Positive and Negative Affect Schedule (PANAS); (2) anxiety, assessed by the State-Trait Anxiety Inventory (STAI-S); and (3) directed-attention, measured using the visual Backwards Digit Span test (BDS). Repeated measures linear mixed models assessed pre- to post-walk changes within-treatment conditions and post-walk contrasts between-treatment conditions. Results indicated that anxiety decreased after green walking and increased after suburban walking (−1.8 vs. +1.1 units, respectively; p = 0.001). For mood, positive affect improved after green walking and decreased after suburban walking (+2.3 vs. −0.3 units, respectively; p = 0.004), and negative affect decreased after green walking and remained similar after suburban walking (−0.5 vs. 0 units, respectively; p = 0.06). Directed-attention did not improve from pre- to post-walk for either condition. Our results suggested that green walking may be more effective at reducing state anxiety and increasing positive affect compared to suburban walking. Full article

(This article belongs to the Special Issue Evidence for Incorporating Green Exercise into Clinical and Public Health Practice)

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13 pages, 2522 KiB

Open AccessArticle

Physiological and Psychological Effects of Forest and Urban Sounds Using High-Resolution Sound Sources

by Hyunju Jo, Chorong Song, Harumi Ikei, Seiya Enomoto, Hiromitsu Kobayashi and Yoshifumi Miyazaki

Int. J. Environ. Res. Public Health 2019, 16(15), 2649; https://doi.org/10.3390/ijerph16152649 - 24 Jul 2019

Cited by 43 | Viewed by 6091

Abstract

Exposure to natural sounds is known to induce feelings of relaxation; however, only few studies have provided scientific evidence on its physiological effects. This study examined prefrontal cortex and autonomic nervous activities in response to forest sound. A total of 29 female university students (mean age 22.3 ± 2.1 years) were exposed to high-resolution sounds of a forest or city for 60 s, using headphones. Oxyhemoglobin (oxy-Hb) concentrations in the prefrontal cortex were determined by near-infrared spectroscopy. Heart rate, the high-frequency component of heart rate variability (which reflects parasympathetic nervous activity), and the ratio of low-frequency to high-frequency (LF/HF) components (which reflects sympathetic nervous activity) were measured. Subjective evaluation was performed using the modified semantic differential method and profiles of mood states. Exposure to the forest sound resulted in the following significant differences compared with exposure to city sound: decreased oxy-Hb concentrations in the right prefrontal cortex; decreased ln(LF/HF); decreased heart rate; improved feelings described as “comfortable,’’ “relaxed,” and “natural”; and improved mood states. The findings of this study demonstrated that forest-derived auditory stimulation induced physiological and psychological relaxation effects. Full article

(This article belongs to the Special Issue Evidence for Incorporating Green Exercise into Clinical and Public Health Practice)

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9 pages, 1439 KiB

Open AccessArticle

Guest Perceptions of Physical Activity Point-of-Decision Prompts at a Conservatory with Botanical Gardens

by Corinne Natale, Mary Kathryn Poole, Emily A. Kalnicky and Sharon E. Taverno Ross

Int. J. Environ. Res. Public Health 2019, 16(12), 2074; https://doi.org/10.3390/ijerph16122074 - 12 Jun 2019

Viewed by 2685

Abstract

Point-of-decision prompts are cost-effective strategies to promote physical activity in public spaces. This study explored how adult and child guests of a conservatory with botanical gardens perceived point-of-decision prompts that aimed to promote physical activity. Seven point-of-decision prompts were developed and displayed throughout the conservatory. Adult guests (n = 140) were invited to complete a voluntary and anonymous survey to assess awareness of point-of-decision prompts, adult–child interactions, and physical activity engagement. Descriptive statistics were calculated using SPSS version 23. Sixty-one percent of guests (n = 86) who responded to the survey noticed the point-of-decision prompts. Over 65% (n = 56) of those guests completed at least one of the physical activities, and 53% (n = 46) completed one to three. Of guests attending with (a) child(ren) (n = 17) who completed the survey, over half (n = 9) engaged in at least one physical activity together. In sum, the point-of-decision prompts were noticed by some guests in this public space. More research is needed to determine whether point-of-decision prompts are able to lead to sustainable behavior change. Full article

(This article belongs to the Special Issue Evidence for Incorporating Green Exercise into Clinical and Public Health Practice)

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13 pages, 1209 KiB

Open AccessArticle

Active and Passive Use of Green Space, Health, and Well-Being amongst University Students

by Elizabeth W. Holt, Quinn K. Lombard, Noelle Best, Sara Smiley-Smith and John E. Quinn

Int. J. Environ. Res. Public Health 2019, 16(3), 424; https://doi.org/10.3390/ijerph16030424 - 01 Feb 2019

Cited by 89 | Viewed by 20187

Abstract

Frequent exposure to green space has been linked to positive health and well-being in varying populations. Yet, there is still limited research exploring the restorative benefits associated with differing types of green space use among students living in the university setting. To address this gap, we explored green space use amongst a population of undergraduate students (n = 207) attending a university with abundant opportunities to access the restorative properties of nature. The purpose of this study was to examine the type and frequency of green space interactions that are most strongly associated with indicators of health and well-being, and investigate student characteristics associated with frequent use of green space. Results revealed that students who frequently engage with green spaces in active ways report higher quality of life, better overall mood, and lower perceived stress. Passive green space interactions were not strongly associated with indicators of health and well-being. Having had daily interactions with green space in childhood was associated with frequent green space use as a university student, and identified barriers to green space use included “not enough time,” and “not aware of opportunities” These results could assist in the tailoring of “green exercise” interventions conducted in the university setting. Full article

(This article belongs to the Special Issue Evidence for Incorporating Green Exercise into Clinical and Public Health Practice)

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12 pages, 2244 KiB

Open AccessArticle

Effects of Walking in a Forest on Young Women

by Chorong Song, Harumi Ikei, Takahide Kagawa and Yoshifumi Miyazaki

Int. J. Environ. Res. Public Health 2019, 16(2), 229; https://doi.org/10.3390/ijerph16020229 - 15 Jan 2019

Cited by 98 | Viewed by 11055

Abstract

The effects of forest activities on health promotion have received increasing attention. The aim of this study was to evaluate the physiological and psychological effects of brief walks in forests on young women. The experiments were conducted in 6 forests (test) and 6 city areas (control). Overall, 12 participants in each area (60 participants in total, mean age: 21.0 ± 1.3 years) were instructed to walk in a forest and a city area for approximately 15 min; simultaneously, their heart rate variability, heart rate, blood pressure, and pulse rate were measured to quantify their physiological responses to walking. The modified semantic differential method, Profile of Mood States (POMS), and the State–Trait Anxiety Inventory (STAI) were used to determine their psychological responses. Walking in a forest was associated with significantly higher parasympathetic nervous activity and lower sympathetic nervous activity and heart rate. In addition, scores for the comfortable, relaxed, and natural parameters and vigor subscale of POMS were significantly higher, whereas scores for negative feelings, such as tension–anxiety, depression–dejection, anger–hostility, fatigue, and confusion, were significantly lower, as were the total mood disturbance of POMS and the anxiety dimension of the STAI. The subjective evaluations were generally in accordance with the physiological responses. A brief walk in a forest resulted in physiological and psychological relaxation effects in young women. Full article

(This article belongs to the Special Issue Evidence for Incorporating Green Exercise into Clinical and Public Health Practice)

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19 pages, 1744 KiB

Open AccessArticle

Engaging with and Shaping Nature: A Nature-Based Intervention for Those with Mental Health and Behavioural Problems at the Westonbirt Arboretum in England

by Liz O’Brien

Int. J. Environ. Res. Public Health 2018, 15(10), 2214; https://doi.org/10.3390/ijerph15102214 - 10 Oct 2018

Cited by 16 | Viewed by 6101

Abstract

Mental health problems have become one of the leading causes of disease burden worldwide. This study used qualitative mixed methods including in-situ ‘being and doing’ activities with participants, interviews, and participant observations to explore participant’s experiences of a multi-visit nature-based intervention at Westonbirt Arboretum in England. The research found that three engagement types: (1) social, (2) woodland craft, and (3) creative and sensory, provided a meaningful programme to engage those with mental health, addiction, autism and behavioural problems. These types of engagement conferred a wide range of well-being benefits on participants. The study highlights key elements of the programme that were effective including the importance of repeat visits to nature to enable familiarity, using creative, sensory and craft activities, creating a supportive environment, involving the volunteers, and understanding the needs of participants and the organisations that work with them. The research suggests that nature-based programmes can be designed to be flexible and adaptable to meet the needs of participants with mental health and behavioural problems. Small numbers of participants can be involved in an intensive and immersive way that encourages an emotional affinity with nature. Inclusive and supportive programmes are particularly important for those who are vulnerable, as they are less likely to engage with nature than the wider population. Full article

(This article belongs to the Special Issue Evidence for Incorporating Green Exercise into Clinical and Public Health Practice)

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12 pages, 355 KiB

Open AccessArticle

The Effects of an Urban Forest Health Intervention Program on Physical Activity, Substance Abuse, Psychosomatic Symptoms, and Life Satisfaction among Adolescents

by Riki Tesler, Pnina Plaut and Ronit Endvelt

Int. J. Environ. Res. Public Health 2018, 15(10), 2134; https://doi.org/10.3390/ijerph15102134 - 28 Sep 2018

Cited by 14 | Viewed by 4089

Abstract

Background: At-risk adolescents have been defined as youth who are or might be in physical, mental, or emotional danger. An Urban Forest Health Intervention Program (UFHIP) was formed at a center for at-risk adolescents in Israel, in order to promote physical activity and reduce risky behavior. Objective: To evaluate the intervention’s effect on physical activity, smoking, alcohol consumption, psychosomatic symptoms, and life satisfaction. Methods: From 2015 to 2016, at-risk youth were nonrandomly selected to participate in the UFHIP. Questionnaires were administered to both intervention and control groups before and after the intervention. Univariate and multivariable analyses evaluated the intervention’s effect. Results: The study participants (n = 53) showed 0.81 more sessions per week of 60 min of physical activity than did the control group (n = 23; p = 0.003). Among the intervention group, smoking frequency reduced from a mean of 2.60 (SD = 1.30) to 1.72 (SD = 1.08), whereas that in the control group increased from 3.17 (1.03) to 3.39 (1.03). In both groups, there was a reduction in alcohol consumption, with a greater change among intervention participants: −1.08 (SD = 1.30), compared with −0.09 (SD = 1.79) in the control group. Conclusions: Findings indicate that the environmental intervention was efficacious in increasing physical activity and reducing risky behaviors among youth. The effectiveness of this intervention among larger samples is warranted in future prospective studies. Full article

(This article belongs to the Special Issue Evidence for Incorporating Green Exercise into Clinical and Public Health Practice)

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11 pages, 625 KiB

Open AccessArticle

The Effects of a Health Promotion Program Using Urban Forests and Nursing Student Mentors on the Perceived and Psychological Health of Elementary School Children in Vulnerable Populations

by Kyung-Sook Bang, Sungjae Kim, Min Kyung Song, Kyung Im Kang and Yeaseul Jeong

Int. J. Environ. Res. Public Health 2018, 15(9), 1977; https://doi.org/10.3390/ijerph15091977 - 11 Sep 2018

Cited by 40 | Viewed by 7148

Abstract

As problems relating to children’s health increase, forest therapy has been proposed as an alternative. This study examined the effects of a combined health promotion program, using urban forests and nursing student mentors, on the perceived and psychosocial health of upper-grade elementary students. The quasi-experimental study ran from June to August 2017, with 52 upper-grade elementary students from five community after-school centers. With a purposive sampling, they were assigned to either an experimental group (n = 24), who received a 10-session health promotion program, or to a control group (n = 28). Seven undergraduate nursing students participated as mentors. Running over 10 weeks, each weekly session consisted of 30 min of health education and 60 min of urban forest activities. Data were analyzed by independent t-test, Mann-Whitney U-test, paired t-test, or Wilcoxon signed rank test. General characteristics and outcome variables of both groups were homogeneous. The experimental group showed significant improvement in self-esteem (p = 0.030) and a significant decrease in depressive symptoms (p = 0.020) after the intervention, compared to the control group. These results suggest that forest healing programs may contribute to the spread of health promotion programs that make use of nature. Full article

(This article belongs to the Special Issue Evidence for Incorporating Green Exercise into Clinical and Public Health Practice)

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11 pages, 1578 KiB

Open AccessArticle

Physical and Mental Health Impacts of Household Gardens in an Urban Slum in Lima, Peru

by Abigail Korn, Susan M. Bolton, Benjamin Spencer, Jorge A. Alarcon, Leann Andrews and Joachim G. Voss

Int. J. Environ. Res. Public Health 2018, 15(8), 1751; https://doi.org/10.3390/ijerph15081751 - 15 Aug 2018

Cited by 19 | Viewed by 6177

Abstract

Rural poverty and lack of access to education has led to urban migration and fed the constant growth of urban slums in Lima, Peru. Inhabitants of these informal settlements lack land rights and access to a public water supply, resulting in poor sanitation, an inability to grow food, and suboptimal health outcomes. A repeated measures longitudinal pilot study utilizing participatory design methods was conducted in Lima between September 2013 and September 2014 to determine the feasibility of implementing household gardens and the subsequent impact of increased green space on well-being. Anthropometric data and a composite of five validated mental health surveys were collected at the baseline, 6-months, and 12-months after garden construction. Significant increases from the baseline in all domains of quality of life, including: physical (p < 0.01), psychological (p = 0.05), social (p = 0.02), environmental (p = 0.02), and overall social capital (p < 0.01) were identified 12 months after garden construction. Life-threatening experiences decreased significantly compared to the baseline (p = 0.02). There were no significant changes in parent or partner empathy (p = 0.21), BMI (p = 0.95), waist circumference (p = 0.18), or blood pressure (p = 0.66) at 6 or 12 months. Improved access to green space in the form of a household garden can significantly improve mental health in an urban slum setting. Full article

(This article belongs to the Special Issue Evidence for Incorporating Green Exercise into Clinical and Public Health Practice)

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