Effect of resilience on the relationship between physical activity in an alpine environment and QOL—results of mediation analysis. Numbers shown in the diagram are standardized regression coefficients. Solid lines indicate statistically significant effects, dashed lines indicate non-significant effects. MET metabolic equivalent, Min minutes, PA alpine physical activity in an alpine environment, WHOQOL-BREF World Health Organization Quality of Life Score-short form. a = effect of PA alpine on the mediator RS-13 score. b = effect of resilience (RS-13 score) on WHOQOL-BREF total score, adjusted PA alpine. c = total effect of PA alpine on WHOQOL-BREF total score. c′ = direct effect of PA alpine on WHOQOL-BREF total score, after adjusting for resilience (RS-13 score). c − c’: Indirect effect of resilience on the relationship between PA alpine and WHOQOL-BREF total score

Effect of resilience on the relationship between physical activity in an alpine environment and QOL—results of mediation analysis. Numbers shown in the diagram are standardized regression coefficients. Solid lines indicate statistically significant effects, dashed lines indicate non-significant effects. MET metabolic equivalent, Min minutes, PA alpine physical activity in an alpine environment, WHOQOL-BREF World Health Organization Quality of Life Score-short form. a = effect of PA alpine on the mediator RS-13 score. b = effect of resilience (RS-13 score) on WHOQOL-BREF total score, adjusted PA alpine. c = total effect of PA alpine on WHOQOL-BREF total score. c′ = direct effect of PA alpine on WHOQOL-BREF total score, after adjusting for resilience (RS-13 score). c − c’: Indirect effect of resilience on the relationship between PA alpine and WHOQOL-BREF total score

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Objective: Physical activity (PA) in an outdoor environment has been shown to exert positive effects on mental well-being beyond those found for PA indoors. The specific effect of an alpine environment has not been investigated so far. Here we evaluate the association of PA in an alpine environment with resilience and quality of life (QOL) in pati...

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... Contrary to previous literature [54], we found that location does not influence resilience and QOL. The research on how location effects exercise and resilience is in its infancy, with studies having focused on the attachment between the self and environment, drawing on Bowlby and Ainsworth attachment theory [55]. ...
... Therefore, research has mostly focussed on infants, and it is unknown whether this can be applied to adult's attachment with the environment. In-line with our hypothesis on the relationship between location exercise, QoL and resilience, and previous literature [54,56,57], this was reversed during lockdown, where more people began to exercise in rural locations and demonstrated higher resilience levels. However, this was not statistically significant. ...
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Background: Resilience is central to positive mental health and well-being especially when faced with adverse events. Factors such as exercise, location, sleep, mental health, and personality are moderators and mediators of resilience. However, the impact of these factors on resilience during severe adverse events are unknown. The present study examined how the COVID-19 pandemic affected resilience and its moderators and mediators by investigating whether there was a difference in resilience and quality of life between people with varying levels of exercise, including those who changed their exercise levels pre and during a COVID-19-related lockdown, and whether location affected the relationship between levels of exercise and resilience and quality of life. Methods: Following ethical approval, a cross-sectional online survey capturing data on self-reported key moderators and mediators of resilience before and during the COVID-19 lockdown imposed on the 23rd March 2020 in the UK was distributed via social media and completed over a three week time period during July 2020 via a self-selecting sample of the general population (N = 85). The key moderators and mediators of resilience the survey assessed were exercise, location, life-orientation, mental health, and sleep quality. All data were self-reported. Results: Participants' exercise intensity level increased as resilience increased (F(2,82) = 4.22, p = .003: Wilks' lambda = .82, partial n2 = 0.09). The relationship between exercise, and resilience and quality of life was independent of sleep and mental health status pre-lockdown (p = .013, p = .027 respectively). In the face of the COVID-19 pandemic, this relationship was dependent on mental health but not sleep quality (p = <.001 for resilience p = .010 for quality of life). There were no statistically significant differences between participants living in urban or rural locations. Conclusion: Exercise is strongly correlated to resilience and during a pandemic such as COVID-19 it becomes a mechanism in which to moderate resilience. The relationship between exercise and resilience is supported by this study. The influence that a pandemic had on mental health is mediated by its effect on quality of life.
... Three observational studies were identified, although none recruited a clinical sample restricted to participants with clinical depression [21][22][23]. In a web-based, cross-sectional survey, Ower et al. [21] compared levels of physical activity (PA) developed indoors, outdoors, or in an alpine environment in healthy controls and patients with psychosomatic disorders, mostly somatoform disorder, and major depressive disorder (MDD). ...
... Three observational studies were identified, although none recruited a clinical sample restricted to participants with clinical depression [21][22][23]. In a web-based, cross-sectional survey, Ower et al. [21] compared levels of physical activity (PA) developed indoors, outdoors, or in an alpine environment in healthy controls and patients with psychosomatic disorders, mostly somatoform disorder, and major depressive disorder (MDD). In addition, possible mediating variables such as an individual's resilience and quality of life were analyzed. ...
... Several intervention studies were identified [24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39]. Of them, a minority included patients with MDD only [24][25][26][27][28][29], and the majority [21,[30][31][32][33][34][35][37][38][39] recruited mixed samples including patients with depressive disorders, although separate results for that group were not reported. ...
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Recent lifestyles changes have favored increased time in contact with screens and a parallel reduction in contact with natural environments. There is growing awareness that nature exposure and screen time are related to depression. So far, the roles of how these environmental lifestyles affect depressive symptoms and disorders have not been reviewed simultaneously. The aim of this review was to gather the literature regarding the role of nature exposure and screen time in depression. An emphasis was made on clinical samples of patients with well-defined depression and the different methodological approaches used in the field. A second goal was to suggest an agenda for clinical practice and research. Studies were included if they assessed depressive symptoms in patients with a clinical diagnosis of depression. An overview of the published literature was conducted using three scientific databases up to December 2021. Several interventions involving nature exposure have shown positive effects on depressive symptoms and mood-related measures. The most consistent finding suggests that walks in natural environments may decrease depressive symptoms in patients with clinical depression. Less researched interventions, such as psychotherapy delivered in a forest or access to natural environments via virtual reality, may also be effective. In contrast, fewer observational studies and no experimental research on screen time have been conducted in patients with clinical depression. Thus, recommendations for practice and research are also discussed. Scarce research, diverse interventions, and several methodological shortcomings prevent us from drawing conclusions in this area. More high-quality experimental research is needed to establish interventions with proven efficacy in clinical depression. At this stage, it is too early to formulate practice guidelines and advise the prescription of these lifestyles to individuals with depression. The present findings may serve as a basis to develop strategies based on nature exposure and screen time targeting clinical depression.
... Time in nature supports physical health, mental health and overall quality of life. 1 Historically used as a therapeutic modality, 2 nature-based interventions (NBI) have seen a resurgence in the modern era. 3 As medicine has evolved, so have NBI. For example, treating tuberculosis with fresh air in the countryside has transformed into treating an array of maladies, including, but not limited to, high blood pressure, 4 psychosomatic disorders 5 and post-traumatic stress disorder 6 in a variety of settings ranging from city parks 7 to wildland areas. 4 8 With the emergence of NBI in the modern era, researchers are currently working to build empirical support and guidance for these interventions, including the NBI locations, outcomes and dose-response relationship. ...
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Introduction Nature provides an array of health benefits, and recent decades have seen a resurgence in nature-based interventions (NBI). While NBI have shown promise in addressing health needs, the wide variety of intervention approaches create difficulty in understanding the efficacy of NBI as a whole. This scoping review will (1) identify the different nomenclature used to define NBI, (2) describe the interventions used and the contexts in which they occurred and (3) describe the methodologies and measurement tools used in NBI studies. Methods and analysis Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols Extension for Scoping Reviews, four databases will be searched (PubMed, Web of Science, Scopus, ProQuest Dissertations and Theses Global) as well as cross-referencing for published and unpublished (masters theses and dissertations) studies on NBI in humans. Eligible studies must employ intervention or observational designs, and an English-language abstract will be required. Database searches will occur from inception up to the date of the search. Animal-based therapies and virtual-reality therapies involving simulated nature will be excluded. Independent dual screening and data abstraction will be conducted. Results will be analysed qualitatively as well as with simple descriptive statistics (frequencies and percentages). Ethics and dissemination Since this is a scoping review of previously published summary data, ethical approval for this study is not needed. Findings will be published in a peer-reviewed journal. This protocol has been registered with Open Science Framework ( https://osf.io/mtzc8 ).
... Resilience to stress, is a condition theoretically correlated with 'acute stress' [26][27][28] and 'psychosomatic symptoms'. [29][30][31] Therefore, in the present study, the proposed a specified interest in individuals with health-related stress. [13][14] As a result, these scales are identified as less suitable for a study interested in researching the resilience level of the gen- ...
... The results provided by the validation testing indicate a negative correlation between resilience, acute stress and psychosomatic symptoms. These results are in line with previous findings supporting the negative correlation between resilience and 'acute stress'[26][27][28] and 'psychosomatic symptoms'.[29][30][31] Evidently, a high resilience score is associated with reduced levels of 'acute stress' and reduced psychosomat-ic symptoms. ...
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Introduction: ‘Psychological Resilience’ is one of the key elements in human behavior that interplays with stress in mental disorders and physical illnesses in both healthy and unhealthy populations, regardless of their biopsychosocial background. Therefore, a reliable and valid resilience questionnaire for clinical and research use is of great necessity.Aim: Hence, the present study was conducted in order for the original English version of ‘Nicholson McBride Resilience Questionnaire’ (NMRQ) to be adapted in the Greek population.Methods & Materials: The original English NMRQ consists of 12 items measuring resilience. It is a self-reported questionnaire, while each respective item is measured through a 5-Likert scale point system. The design of the study was developed to firstly translate the original English questionnaire in Greek, and secondly to test the new version upon its ‘item consistency’, ‘internal correlation’, ‘internal consistency’, ‘consistency validity’, and finally perform a ‘factor analysis’ after recruiting a Greek sample.Results: The results show 80% validity (Cronbach’s alpha=.800) of the new Greek version. The number of participants (N= 1,158) provided to the study an ‘a priori’ odds ratio of 1.274, a critical z of 1.6448 and an actual power of 95%. The Greek translation was considered accurate, while the new version maintained a good item consistency.Conclusion: It is proposed that the Greek version of NMRQ may be adapted in the Greek population in clinical and research related to resilience and stress, as well as for any future studies to test-retest its validity and reliability.
... Together with a regional above average participation in winter sport activities (13), due to effects of climate change on exercise behavior are believed to be large in Austria. Given the importance of outdoor exercise and previous findings of additional physical and mental health benefits of exercising in alpine environments in various populations (5,(14)(15)(16)(17)(18), it seems important to analyze determinants of exercise behavior in the context of climate change. ...
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Exercise, including winter sport activities, shows positive effects on physical and mental health, with additional benefits when participating in natural environments. Winter sport activities are particularly vulnerable to climate change, since global warming will decrease the duration and amount of snow. In the context of climate change in alpine environments, little is known on the determinants of winter sport behavior. Thus, the following study primarily aimed at comparing the effect of being exposed to a climate change affected scenario (CCA) or to a climate change unaffected scenario (CCU) on the intention to engage in recreational winter sport activities. Secondly, we aimed to analyze the role of anticipated affective responses during exercising based on the Theory of Planned Behavior (TPB). An experimental cross-sectional web-based study design was used. Participants were randomly allocated to pictures of either CCA or CCU. TPB variables and affective responses with regard to the displayed scenarios were assessed. Statistical analyses included Mann-Whitney- U Tests, linear regression, and mediation analyses. Significant group differences were seen in all TPB variables, p < 0.038; −0.13 < r < −0.30, as well as in affective responses, p < 0.001; −0.24 < r < −0.85. Lower intention to engage in winter sport activities and lower anticipated affective valence during exercising was found in CCA compared to CCU. Attitude toward winter sport was significantly positively associated with intention to engage in winter sport, beta = 0.66, p < 0.001. The effect of group allocation on attitude was mediated by anticipated affective valence, indirect effect = 0.37, p < 0.001. Intention to engage in recreational winter sport activities was lower in participants exposed to the climate change affected winter sport scenario. Since affective valence seems to influence attitude and consequently intention to exercise, the role of non-cognitive variables with regard to climate change related exposure should be considered in future studies. Therefore, winter sport resorts may consider altered winter sport behaviors due to the consequences of climate change as well as the importance of providing an optimal framework to enhance affective valence of their guests in order to mitigate potential changes in winter sports behavior.
... Research in outdoor recreation has focussed on healthy individuals, rather than clinically diagnosed patients, though a few studies have compared healthy and unhealthy subjects (Ower et al., 2018). Mental health benefits from activities in outdoor nature have been summarised in several recent reviews and meta-analyses (Bratman et al., 2019;Buckley & Brough, 2017a;Frumkin et al., 2017;Kondo et al., 2018;Oh et al., 2017;Seymour, 2016;Shanahan et al., 2016). ...
... Our participants are drawn from the clientele of an Australian tourism enterprise that offers three relevant products. The first consists of one-day hiking tours, now a widespread tourism product (Davies, 2018;Ower et al., 2018). The second consists of multiweek wilderness hiking and trekking tours worldwide, part of the global adventure tourism sector. ...
Article
Mental and social health outcomes from a portfolio of women's outdoor tourism products, with ~100,000 clients, are analysed using a catalysed netnography of >1000 social media posts. Entirely novel outcomes include: psychological rescue; recognition of a previously missing life component, and flow-on effects to family members. Outcomes reported previously for extreme sports, but not previously for hiking in nature, include psychological transformation. Outcomes also identified previously include: happiness, gratitude, relaxation, clarity and insights, nature appreciation, challenge and capability, and companionship and community effects. Commercial outdoor tourism enterprises can contribute powerfully to the wellbeing of women and families. This will be especially valuable for mental health recovery, following deterioration during COVID-19 coronavirus lockdowns worldwide.
... Resilience can be defined as one's ability to cope with and recover from adverse life events. Resilience is improved by physical activity performed in a natural outdoor environment but is not associated with physical activity performed indoors [32]. When the natural environment is used to perform physical activity the positive effects of physical activity and natural environments can be combined: there is evidence that exercising outdoors results in greater improvements of mental well-being than exercising indoors with greater feelings of delight, energy and revitalization, as well as decreases in frustration, tiredness and anger [38]. ...
... It was not possible to skip one question or a questionnaire. The current data is part of a larger study examining the effect of physical activity in an alpine environment on mental health, part of which has been published [32]. Innsbruck is one of few urban spaces located directly within the Alps and thus allows for easy access to the alpine environment. ...
... Participants and recruiting procedure are described in [32], participant numbers vary slightly compared to the previous publication due to missing data in individual participants. In brief, a total of 1029 individuals participated in an open online-only survey. ...
Article
Full-text available
Background: Patients with somatoform, depressive or anxiety disorders often don't respond well to medical treatment and experience many side effects. It is thus of clinical relevance to identify alternative, scientifically based, treatments. Our approach is based on the recent evidence that urbanicity has been shown to be associated with an increased risk for mental disorders. Conversely, green and blue environments show a dose-dependent beneficial impact on mental health. Methods: Here we evaluate the effect of viewing stimuli of individuals in an alpine environment on emotional analytics in 183 patients with psychiatric disorders (mostly somatoform, depressive and anxiety disorders) and 315 healthy controls (HC). Emotional analytics (valence: unhappy vs happy, arousal: calm vs excited, dominance: controlled vs in control) were assessed using the Self-Assessment Manikin. Further parameters related to mental health and physical activity were recorded. Results: Emotional analytics of patients indicated that they felt less happy, less in control and had higher levels of arousal than HC when viewing neutral stimuli. The comparison alpine>neutral stimuli showed a significant positive effect of alpine stimuli on emotional analytics in both groups. Patients and HC both felt attracted to the scenes displayed in the alpine stimuli. Emotional analytics correlated positively with resilience and inversely with perceived stress. Conclusions: Preventive and therapeutic programs for patients with somatoform, depressive and anxiety disorders should consider taking the benefits of natural outdoor environments, such as alpine environments, into account. Organizational barriers which are preventing the implementation of such programs in clinical practice need to be identified and addressed.
... Resilience is improved by physical activity performed in a natural outdoor environment but is not associated with physical activity performed indoors (Ower et al. 2018). When the natural environment is used to perform physical activity the positive effects of physical activity and natural environments can be combined: there is evidence that exercising outdoors results in greater improvements of mental well-being than exercising indoors with greater feelings of delight, energy and revitalization, as well as decreases in frustration, tiredness and anger (Thompson Coon et al. 2011). ...
... Sociodemographic characteristics of patients and healthy controls (adapted with participant numbersfor the current analysis fromOwer et al. 2018) ...
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Background: Patients with stress-related psychiatric (psychosomatic) disorders often don´t respond well to medical treatment and experience many side effects. It is thus of clinical relevance to identify alternative, scientifically based, treatments. Our approach is based on the recent evidence that urbanicity has been shown to be associated with an increased risk for mental disorders. Conversely green and blue environments show a dose-dependent beneficial impact on mental health. Methods: Here we evaluate the effect of viewing stimuli of individuals in an alpine environment on emotional analytics in 183 patients with stress-related psychiatric disorders and 315 healthy controls (HC). Emotional analytics (valence: unhappy vs happy, arousal: calm vs excited, dominance: controlled vs in control) were assessed using the Self-Assessment Manikin. Results: Patients showed significantly lower levels of resilience and significantly higher scores of self-perceived stress. Emotional analytics of patients indicated that they feel less happy, less in control and had higher levels of arousal than HC when viewing neutral stimuli. The comparison alpine>neutral stimuli showed a significant a positive effect of alpine stimuli on emotional analytics in both groups. Patients and HC both felt attracted to the scenes displayed in the alpine stimuli. Emotional analytics correlated positively with resilience and inversely with perceived stress. Conclusions: Preventive and therapeutic programs for patients with stress-related psychiatric disorders should take benefits of outdoor natural environments into account. Organizational barriers which are preventing the implementation of such programs in clinical practice need to be identified and addressed.
... Resilience can be de ned as one's ability to cope with and recover from adverse life events. Resilience is improved by physical activity performed in a natural outdoor environment but is not associated with physical activity performed indoors (Ower et al. 2018). When the natural environment is used to perform physical activity the positive effects of physical activity and natural environments can be combined: ...
... It was not possible to skip one question or a questionnaire. The current data is part of a larger study examining the effect of physical activity in an alpine environment on mental health, part of which has been published (Ower et al. 2018). Innsbruck is one of few urban spaces located directly within the Alps and thus allows for easy access to the alpine environment. ...
... Participants and recruiting are described in Ower et al. 2018, participant numbers vary slightly compared to the previous publication due to missing data in individual participants. In brief, a total of 1029 individuals participated in an open online-only survey. ...
Preprint
Full-text available
Background: Patients with stress-related psychiatric (psychosomatic) disorders often don´t respond well to medical treatment and experience many side effects. It is thus of clinical relevance to identify alternative, scientifically based, treatments. Our approach is based on the recent evidence that urbanicity has been shown to be associated with an increased risk for mental disorders. Conversely green and blue environments show a dose-dependent beneficial impact on mental health. Methods: Here we evaluate the effect of viewing stimuli of individuals in an alpine environment on emotional analytics in 183 patients with stress-related psychiatric disorders and 315 healthy controls (HC). Emotional analytics (valence: unhappy vs happy, arousal: calm vs excited, dominance: controlled vs in control) were assessed using the Self-Assessment Manikin. Further parameters related to mental health and physical activity were recorded. Results: Emotional analytics of patients indicated that they feel less happy, less in control and had higher levels of arousal than HC when viewing neutral stimuli. The comparison alpine>neutral stimuli showed a significant a positive effect of alpine stimuli on emotional analytics in both groups. Patients and HC both felt attracted to the scenes displayed in the alpine stimuli. Emotional analytics correlated positively with resilience and inversely with perceived stress. Conclusions: Preventive and therapeutic programs for patients with stress-related psychiatric disorders should consider taking the benefits of outdoor natural environments into account. Organizational barriers which are preventing the implementation of such programs in clinical practice need to be identified and addressed.
... Resilience can be de ned as one's ability to cope with and recover from adverse life events. Resilience is improved by physical activity performed in a natural outdoor environment but is not associated with physical activity performed indoors (Ower et al. 2018). When the natural environment is used to perform physical activity the positive effects of physical activity and natural environments can be combined: there is evidence that exercising outdoors results in greater improvements of mental well-being than exercising indoors with greater feelings of delight, energy and revitalization, as well as decreases in frustration, tiredness and anger (Thompson Coon et al. 2011). ...
... It was not possible to skip one question or a questionnaire. The current data is part of a larger study examining the effect of physical activity in an alpine environment on mental health, part of which has been published (Ower et al. 2018). Innsbruck is one of few urban spaces located directly within the Alps and thus allows for easy access to the alpine environment. ...
... Participants and recruiting are described in Ower et al. 2018, participant numbers vary slightly compared to the previous publication due to missing data in individual participants. In brief, a total of 1029 individuals participated in an open online-only survey. ...
Preprint
Full-text available
Background: Patients with somatoform, depressive or anxiety disorders often don´t respond well to medical treatment and experience many side effects. It is thus of clinical relevance to identify alternative, scientifically based, treatments. Our approach is based on the recent evidence that urbanicity has been shown to be associated with an increased risk for mental disorders. Conversely, green and blue environments show a dose-dependent beneficial impact on mental health. Methods: Here we evaluate the effect of viewing stimuli of individuals in an alpine environment on emotional analytics in 183 patients with psychiatric disorders (mostly somatoform, depressive and anxiety disorders) and 315 healthy controls (HC). Emotional analytics (valence: unhappy vs happy, arousal: calm vs excited, dominance: controlled vs in control) were assessed using the Self-Assessment Manikin. Further parameters related to mental health and physical activity were recorded. Results: Emotional analytics of patients indicated that they feel less happy, less in control and had higher levels of arousal than HC when viewing neutral stimuli. The comparison alpine>neutral stimuli showed a significant a positive effect of alpine stimuli on emotional analytics in both groups. Patients and HC both felt attracted to the scenes displayed in the alpine stimuli. Emotional analytics correlated positively with resilience and inversely with perceived stress. Conclusions: Preventive and therapeutic programs for patients with somatoform, depressive and anxiety disorders should consider taking the benefits of natural outdoor environments such as alpine environments, into account. Organizational barriers which are preventing the implementation of such programs in clinical practice need to be identified and addressed.