Cancer survivors exercise at higher intensity in outdoor settings: The GECCOS trial

Abstract

Purpose : This randomized cross‐over group pilot trial assessed feasibility of recruiting survivors from a long‐term follow‐up clinic to an exercise group and measured whether outdoor or indoor exercise sessions better supported exercise motivation and behaviors in survivors of cancer. Methods : Sixteen adolescent and young adult survivors of any cancer completed indoor and outdoor exercise sessions in this randomized cross‐over pilot trial. Measures of physical activity, motivation, and fatigue were taken 2 weeks before and 2 weeks after indoor sessions and 2 weeks before and 2 weeks after outdoor sessions. Measures of physical activity and fatigue were also taken during each exercise session. Results : Initial recruiting of 19 participants met recruiting goals. Survivors who attended the most sessions lived an average of 8.7 km closer to the clinic. Objectively measured physical activity intensity was 0.63 metabolic equivalents of a task (METs) per minute greater during outdoor exercise sessions as compared to indoor exercise sessions. There were no meaningful differences in long term, habitual physical activity behavior, motivation, or fatigue in the weeks following the outdoor exercise sessions as compared to the indoor exercise sessions. Conclusions : This study shows the feasibility of recruiting survivors from a long‐term follow‐up clinic to community‐based exercise groups. Although this brief pilot intervention did not show significant effects on habitual physical activity behavior or motivation in adolescent and young adult survivors of cancer, the greater exercise intensity during the outdoor exercise sessions indicate that holding group exercise sessions for survivors outdoors may promote greater intensity during exercise.

Nature prescriptions: a scoping review with a nested meta-analysis

“…Similar benefits were observed in community gardening programme for obese adults 40 or farm-based day care for patients with dementia 41 . In a study of cancer survivors, however, outdoor exercises did not have greater impact on long-term physical activities than indoor exercises 42 . Among school students, nature-based activities did not increase moderate physical activity during play time more than playground sports 43 .…”

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

“…For all parallel-group trials, we used the RoB 2 version designed for individually randomized parallel-group trial designs, assessing the effect of assignment to interventions, i.e., "intention-to-treat". For one cluster-randomized, crossover trial [17], we used the RoB 2 tool supplements for cluster-randomized trials and for crossover trials.…”

“…Six of the ten included trials were parallel-group randomized controlled trials [18,20,[27][28][29][30][31][32], whereas three studies were parallel-group controlled trials with no reporting of randomization [19,33,34]. One study was a cluster-randomized, counterbalanced crossover trial [17].…”

“…Since 2019, the increase in green exercise studies has continued (Figure A1), including an increase in longitudinal green exercise studies, e.g., [17][18][19][20]. Additionally, while this growing body of research suggests that outdoor green exercise may have greater health benefits than exercise performed in built environments, previous green exercise reviews [15,16] have not explored (1) the potential moderating effect of the extent of natural versus built elements in the outdoor environment, and (2) the relative effects of outdoor versus indoor built environments.…”

Students’ Intention of Visiting Urban Green Spaces after the COVID-19 Lockdown in China

“…Seeking solutions for mental restoration, researchers have demonstrated the benefits gained from natural environments and time spent outdoors [2,23,24]. There is increasing evidence concerning the positive effects of frequent exposure to natural environments [28,47,48]. For example, some have found that the increase of views toward nature can restore people from mental stress and fatigue and potentially improve their health and well-being [49,50], and this gives rise to additional benefits, such as attention restoration, sense of connectedness, companionship, and self-esteem [51].…”