We aimed to examine the evidence for the proposed additive effect of exercise in the presence of nature (green exercise) by systematically reviewing studies that investigated the effects of outdoor or virtual green exercise compared with indoor exercise. Our review updates an earlier review, whose searches were conducted in April 2010. Trials were eligible if: (a) participants in an outdoor or virtual exercise condition were exposed to views of nature (green exercise); (b) green exercise was compared with indoor exercise with no exposure to nature; (c) included an outcome related to physical or mental health; (d) used comparative or crossover trial design. We searched the following databases from 1st January 2010 to 28th June 2018: PubMed, CENTRAL, EMBASE, PsycINFO, GreenFile, and Sports DISCUS. We assessed risk of bias using the Cochrane “risk of bias” tool. Where possible we conducted a meta-analysis using the inverse variance random-effects method, and where this approach was not possible we presented the results qualitatively and in harvest plots. We identified 28 eligible trials. In a meta-analysis of just three longitudinal trials, the only statistical finding was slightly lower post-intervention perceived exertion with green versus indoor exercise (mean difference: −1.02; 95% confidence intervals: −1.88, −0.16). Compared with indoor exercise, acute bouts of outdoor green exercise may favorably influence affective valence and enjoyment, but not emotion, perceived exertion, exercise intensity, and biological markers. No other consistent statistical differences were observed, apart from a higher enjoyment of outdoor green versus virtual green exercise. We found a high risk of bias across trials and an overall low quality of evidence. In conclusion, there was limited evidence to support the view that green exercise offers superior benefits to exercise without exposure to nature. The low quality of evidence prohibits clear interpretation of trial findings. Future robust and rigorously designed trials are needed to evaluate the effects of long-term and multiple-bout exposure to nature during exercise compared with exercise indoors.
Abstract.BACKGROUND: Stress and mental fatigue are major health threats to employees in office-based occupations. Physical activity is widely used as a stress-management intervention for employees. Moreover, experiences in contact with nature have been shown to provide stress-reduction and restoration from mental fatigue. OBJECTIVES: In a pilot study designed as a randomized controlled trial we investigated the impact of a green-exercise intervention on psychological and physiological indicators of stress in municipality employees. METHODS: Fourteen employees (7 females and 7 males, 49 ± 8 yrs) volunteered in an exercise-based intervention in workplace either outdoors in a green/nature area or in an indoor exercise-setting. The intervention consisted of an information meeting and two exercise sessions, each including a biking bout and a circuit-strength sequence using elastic rubber bands (45-minutes, at about 55% of HR reserve, overall). Main outcomes were perceived environmental potential for restoration, affective state, blood pressure (BP) and cortisol awakening response (CAR AUC G and CAR AUC I ) and cortisol levels in serum. Measurements were taken at baseline and in concomitance with the exercise sessions. Furthermore, affective state and self-reported physical activity levels were measured over a 10-weeks follow-up period. RESULTS: Compared with the indoor group, the nature group reported higher environmental potential for restoration (p < 0.001) and Positive Affect (p < 0.01), along with improved CAR AUC I (p = 0.04) and, marginally, diastolic BP (p = 0.05). The nature group also reported higher ratings of Positive Affect at follow-up (p = 0.02). Differences at post-exercise were not found for any of the other components of affective state, systolic BP, CAR AUC G and cortisol levels measured in serum. CONCLUSIONS: Green-exercise at the workplace could be a profitable way to manage stress and induce restoration among employees. Further studies on larger samples are needed in order to improve the generalizability of the results.
By combining physical activity and exposure to nature, green exercise can provide additional health benefits compared to physical activity alone. Immersive Virtual Environments (IVE) have emerged as a potentially valuable supplement to environmental and behavioral research, and might also provide new approaches to green exercise promotion. However, it is unknown to what extent green exercise in IVE can provide psychophysiological responses similar to those experienced in real natural environments. In this study, 26 healthy adults underwent three experimental conditions: nature walk, sitting-IVE, and treadmill-IVE. The nature walk took place on a paved trail along a large river. In the IVE conditions, the participants wore a head-mounted display with headphones reproducing a 360° video and audio of the nature walk, either sitting on a chair or walking on a manually driven treadmill. Measurements included environmental perceptions (presence and perceived environmental restorativeness – PER), physical engagement (walking speed, heart rate, and perceived exertion), and affective responses (enjoyment and affect). Additionally, qualitative information was collected through open-ended questions. The participants rated the IVEs with satisfactory levels of ‘being there’ and ‘sense of reality,’ but also reported discomforts such as ‘flatness,’ ‘movement lag’ and ‘cyber sickness.’ With equivalent heart rate and walking speed, participants reported higher perceived exertion in the IVEs than in the nature walk. The nature walk was associated with high enjoyment and enhanced affect. However, despite equivalent ratings of PER in the nature walk and in the IVEs, the latter were perceived as less enjoyable and gave rise to a poorer affect. Presence and PER did not differ between the two IVEs, although in the treadmill-IVE the negative affective responses had slightly smaller magnitude than in the sitting-IVE. In both the IVEs, the negative affective responses were mainly associated with cyber sickness, whereas PER was positively associated with enjoyment. From the qualitative analysis, it emerged that poor postural control and lack of a holistic sensory experience can also hinder immersion in the IVE. The results indicate that IVE technology might in future be a useful instrument in green exercise research and promotion, but only if image quality and cyber sickness can be addressed.
BackgroundAn understanding of how the living environment influences physical activity (PA) is of great importance for health promotion. Researchers have reported increased PA when there is a greater availability of nature within people’s living environment. However, little has been said about underlying motivational processes. The aim of this study was to review the existing literature on the relationship between the natural environment (NE) and PA, integrating it into a conceptual model that depicts the motivational process underlying this relationship.MethodsThrough a systematic literature search in line with PRISMA guidelines, peer-reviewed articles were sought using PubMed (search updated to October 2013) and scrutiny of reference lists. In addition, we contacted experts within our network. We reviewed papers in which the research question(s) concerned: 1) Effects of PA in NE on individuals’ feelings and beliefs; 2) Relationships between PA and availability of NEs; and 3) Motivational processes underlying visits to NEs in association with PA. Analysis and integration of the 90 selected studies were performed using the theory of planned behaviour (TPB).ResultsPeople’s experiences in using the NE can enhance attitudes toward PA and perceived behavioural control via positive psychological states and stress-relieving effects, which lead to firmer intentions to engage in PA. Individual and environmental barriers, as expressions of social support and actual behavioural control, impact the process via subjective norm and perceived behavioural control. Instrumental beliefs such as a desire to enjoy nature and the expected health benefits also influence the process via attitudes. Different patterns have been identified for neighbourhood-based PA and outdoor recreations that take place in a NE.ConclusionsThe availability of a NE and attractive views of nature within an individual’s living environment are important contributors to PA, yet attention should focus on personal characteristics and environmental barriers. Policy and infrastructural interventions should aim to guarantee access and maintenance of the NE, as well as information and programming of social activities. Social campaigns via media and health institutions should highlight how nature can be a source of motivation for maintaining a PA routine, reducing stress and achieving aesthetic and health goals.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2458-14-873) contains supplementary material, which is available to authorized users.
BackgroundDementia often eventually leads to dependency on others and finally to residential care. However, in Norway about half of the dementia population lives at home, due to individual and political wishes. There is scarce and inconclusive knowledge of how living in a nursing home differs from living at home for persons with dementia (PWDs) with regard to their quality of life (QoL). The first aim of the study was therefore to compare QoL, cognitive and physical functions, social contacts, sleep patterns, physical activity levels, exposure to light, and medication of PWDs in nursing homes and home-dwelling PWDs, and whether living in nursing homes was associated with a lower QoL than living at home for PWDs. A second aim was to examine if possible differences between residencies in QoL were consistent over time.MethodsThe cross-sectional study was based on baseline data from two RCT studies of PWDs. A total of 15 nursing homes with adapted units for PWDs and 23 adapted day care centres for home-dwelling PWDs recruited 78 and 115 participants respectively. Trained nurses scored sociodemographic data, level of dementia (on the Clinical Dementia Rating scale), amount of medication, and QoL (QUALID). Sleep patterns, physical activity levels, and light exposure were measured by actigraphy. A multiple regression analysis was used to test the association between residency and QoL. The association between residency and change in QoL over time was investigated by linear regression analysis of a subsample with follow-up data.ResultsHome-dwelling PWDs showed significantly higher QoL than PWDs in nursing homes. This difference was maintained even after stratifying on the severity of dementia. Home-dwelling PWDs with moderate dementia showed significantly less use of walking aids, more social contact, higher levels of activity and exposure to daylight, and less use of psychotropic medications. The regression model explained 28 % of the variance in QoL in persons with moderate dementia. However, only residency contributed significantly in the model. Residency also significantly predicted negative change over time in QoL.ConclusionThe study indicated that living at home as long as possible is not only desirable for economic or health political reasons but also is associated with higher QoL for persons with moderate dementia. More studies are needed to investigate how QoL could be increased for PWDs in nursing homes.
Exercise in natural environments (“green exercise”) confers numerous health benefits, but little is known about why people engage in green exercise. This study examined the importance of nature experiences as a motive for physical activity and the motivational profile of people who engage in green exercise compared to gym- and sports-based exercise. Physical activity motives and typical times spent in different domains of physical activity were reported by 2168 Norwegian adults in a survey. Experiencing nature was generally rated as the second-most important physical activity motive, exceeded only by convenience motives, and it was especially important for older adults and those who engage in greater amounts of instrumental physical activity. Green exercisers reported stronger motives concerning convenience and experiencing nature, whereas gym- or sports-based exercisers reported stronger motives for physical health and sociability. The motives associated with different leisure-time exercise domains may assist in understanding optimal promotion of green exercise.
According to attention-restoration theory (ART), natural environments can provide restorative experiences. In this pilot study, a mixed-methods approach was used to examine the potential of using exercise in a natural environment to enhance exercise behaviors. The study included an assessment study and an intervention study (overall n = 19). The participants underwent a standardized exercise program including biking and circuit strength training, either indoors or outdoors in nature. Measurements included connectedness to nature, perceived exertion, perceived environmental restorativeness, enjoyment, affect, future exercise intention, and self-reported exercise behavior. The participants also wrote a brief text describing the way in which the environment influenced their feelings while exercising. Quantitative data were analyzed using the Spearman rank correlation and linear mixed-effects modeling. The qualitative information was analyzed thematically. The integrated results indicated that, in accordance with ART, exercising in nature was associated with a greater potential for restoration and affective responses, which in some participants led to enhanced intention to exercise and increased exercise behavior. However, some perceived that the indoor exercise provided a more effective workout. Further studies on larger samples are needed.
Being exposed to natural environments is associated with improved health and well-being, as these environments are believed to promote feelings of "being away" from everyday struggles, positive emotional reactions and stress reduction. Despite these positive effects, humanity is becoming increasingly more distanced from nature due to societal changes, such as increased urbanization and the reduced accessibility of natural environments. Technology is also partly to blame, as research suggests that people replace nature contact with increased screen time. In this cross-section between nature and technology, we find technological nature which is progressing towards a point where we may be capable of simulating exposure to real nature. Concerns have been raised regarding this technology, as it is feared it will replace real nature. However, research suggests that virtual nature may have a more positive impact on society than a mere replacement of real nature, and this review propose several areas where virtual nature may be a beneficial addition to actual nature (Enable), help people reconnect with the real natural world (Reconnect) and "boost" human-nature interactions (Augment). Based on the current research and theoretical framework, this review proposes guidelines for future research within these areas, with the aim of advancing the field by producing high quality research.
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