ArticlePDF Available

Physical Activity: Does Environment Make a Difference for Tension, Stress, Emotional Outlook, and Perceptions of Health Status?

Authors:

Abstract and Figures

The importance of physical activity for health is well-established. Questions remain whether outdoor exercise additionally benefits overall mental and physical well-being. Using cross-sectional data from the Aerobics Center Longitudinal Study, we examined relationships of physical activity environment (PAE) with reported tension, stress, emotional outlook, and health. 11,649 participants were included. 18% exercised indoors, 54% outdoors, and 28% in both. Participants who exercised partially or entirely outdoors exercised more. In fully-adjusted models, for women combined PAE was protective for worse emotional outlook (OR: 0.72; 95%CI: 0.52, 0.98). Combined PAE was also protective for reported poor health (OR for women: 0.63; 95%CI: 0.44, 0.91; OR for men: 0.75; 95%CI: 0.61, 0.92). Amount of physical activity modified PAE relationships with outcomes. Combined and outdoor PAE were more consistently protective for worse outcomes among high activity participants. Regardless of PAE, better outcomes were observed in active versus inactive participants. The current study suggests addition of outdoor PAE may be linked with better stress management, outlook and health perceptions for more active populations, whereas indoor PAE may be more important for low active populations. Further research should examine the order of causation and whether type of outdoor PAE (e.g., urban, natural) is important.
Content may be subject to copyright.
Physical Activity: Does Environment Make a Difference for Tension, Stress, Emotional Outlook, and Perceptions of Health
Status?” by Puett R et al.
Journal of Physical Activity & Health
© 2014 Human Kinetics, Inc.
Note: This article will be published in a forthcoming issue of
the Journal of Physical Activity & Health. This article appears
here in its accepted, peer-reviewed form, as it was provided by
the submitting author. It has not been copy edited, proofed, or
formatted by the publisher.
Section: Original Research
Article Title: Physical Activity: Does Environment Make a Difference for Tension, Stress,
Emotional Outlook, and Perceptions of Health Status?
Authors: Robin Puett1, Jane Teas2, Vanesa España-Romero3, Enrique Garcia Artero4, Duck-chul
Lee5, Meghan Baruth4, Xuemei Sui4, Jessica Montresor-López1, and Steven N. Blair4
Affiliations: 1Maryland Institute for Applied Environmental Health, University of Maryland,
College Park, MD. 2Thomas Cooper Library, University of South Carolina, Columbia, SC.
3MRC Epidemiology Unit, Institute of Public Health & Institute of Metabolic Science,
Cambridge, UK. 4Department of Exercise Science, University of South Carolina, Columbia, SC.
5Department of Kinesiology, Iowa State University, Ames, IA.
Running Head: Physical activity environment, stress and outlook
Journal: Journal of Physical Activity & Health
Acceptance Date: September 21, 2013
©2014 Human Kinetics, Inc.
DOI: http://dx.doi.org/10.1123/jpah.2012-0375
Physical Activity: Does Environment Make a Difference for Tension, Stress, Emotional Outlook, and Perceptions of Health
Status?” by Puett R et al.
Journal of Physical Activity & Health
© 2014 Human Kinetics, Inc.
Title: Physical Activity: Does environment make a difference for tension, stress, emotional
outlook, and perceptions of health status?
Running Head: Physical activity environment, stress and outlook
Manuscript Type: Original research
Abstract word count: 200
Manuscript word count: 6,980 including tables, figures, acknowledgements, funding sources,
and references
Physical Activity: Does Environment Make a Difference for Tension, Stress, Emotional Outlook, and Perceptions of Health
Status?” by Puett R et al.
Journal of Physical Activity & Health
© 2014 Human Kinetics, Inc.
Abstract
Background: The importance of physical activity for health is well-established. Questions
remain whether outdoor exercise additionally benefits overall mental and physical well-being.
Methods: Using cross-sectional data from the Aerobics Center Longitudinal Study, we
examined relationships of physical activity environment (PAE) with reported tension, stress,
emotional outlook, and health. Results: 11,649 participants were included. 18% exercised
indoors, 54% outdoors, and 28% in both. Participants who exercised partially or entirely
outdoors exercised more. In fully-adjusted models, for women combined PAE was protective for
worse emotional outlook (OR: 0.72; 95%CI: 0.52, 0.98). Combined PAE was also protective for
reported poor health (OR for women: 0.63; 95%CI: 0.44, 0.91; OR for men: 0.75; 95%CI: 0.61,
0.92). Amount of physical activity modified PAE relationships with outcomes. Combined and
outdoor PAE were more consistently protective for worse outcomes among high activity
participants. Regardless of PAE, better outcomes were observed in active versus inactive
participants. Conclusion: The current study suggests addition of outdoor PAE may be linked
with better stress management, outlook and health perceptions for more active populations,
whereas indoor PAE may be more important for low active populations. Further research
should examine the order of causation and whether type of outdoor PAE (e.g., urban, natural) is
important.
Keywords: exercise, outside, psychosocial, epidemiology
Physical Activity: Does Environment Make a Difference for Tension, Stress, Emotional Outlook, and Perceptions of Health
Status?” by Puett R et al.
Journal of Physical Activity & Health
© 2014 Human Kinetics, Inc.
Introduction
The importance of physical activity for the prevention of cardiovascular disease, diabetes
and other health outcomes is well-established1. Psychosocial stress, emotional outlook, and
perceptions of overall health are important factors for chronic disease prevention and
prognosis1-3. Additionally, physical activity has been linked with emotional well-being and
resilience to psychosocial stress. Cross-sectional and longitudinal studies conducted in various
countries have shown associations between increases in physical activity and reductions in
depression, neuroticism, anxiety, hostility, and stress; as well as improvements in social
coherence and overall psychological health4-7. Intervention studies have also demonstrated the
importance of physical activity in providing psychological benefits (e.g., stress
reduction/resilience, lower depression) directly related to the prevention of and rehabilitation
from adverse cardiovascular and cancer outcomes8,9. A meta-analysis of 40 studies showed an
association between exercise training and anxiety reduction, with a stronger relationship
apparent among those with more stressful lifestyles10.
With the recognition of widespread physical inactivity and the growth of related adverse
chronic health outcomes, researchers have begun investigating the contribution of the built and
natural environment to these significant public health problems11-13. Lack of access to indoor
physical activity facilities, such as gyms and fitness centers; as well as limited opportunities for
outdoor exercise, including lack of sidewalks and distance to parks, have been related to
physical inactivity, obesity, and related chronic diseases (e.g., cardiovascular disease,
diabetes)14-16. Though studies in land use planning, health and psychology have shown human
preferences and benefits for exposure to greenspace 17-20, few studies have examined whether
the environment in which exercise occurs (physical activity environment) modifies the impact of
physical activity on well-being. The limited number of studies addressing this topic have been
difficult to compare as the populations, exposures, and outcomes examined have differed; and
Physical Activity: Does Environment Make a Difference for Tension, Stress, Emotional Outlook, and Perceptions of Health
Status?” by Puett R et al.
Journal of Physical Activity & Health
© 2014 Human Kinetics, Inc.
many studies have focused on acute time periods or interventions with small study populations.
However, the majority of findings point to the added benefit of better psychological well-being
from outdoor physical activity environment, beyond the physical fitness achieved by indoor
physical activity 21-24.
To address the paucity of information on self-selected, regular physical activity
environment, we used cross-sectional data from a large population of adults enrolled in the
Aerobics Center Longitudinal Study (ACLS) to examine the relationship of physical activity
environment (indoor, outdoor, or a combination) with tension, stress, emotional outlook, and
perceptions of health status. A previously published study with this population has already
shown that emotional well-being was associated with cardiorespiratory fitness and regular
physical activity 6. Therefore, this population provided a valuable opportunity to use data
collected on routine, participant-selected physical activity to investigate the importance of
physical activity environment to tension, stress, emotional outlook and perceptions of health.
Methods
Study Population
The ACLS is a prospective study that has been described in detail elsewhere 25-27.
Briefly, it is a study of men and women over 20 years of age, who completed a baseline
examination at the Cooper Clinic, Dallas Texas. Data were collected via a questionnaire and a
clinical evaluation that included a physical examination, maximal exercise treadmill test, blood
chemistry analyses, anthropometry, and health histories. Participants were predominantly
Caucasian (>95%) and of middle and upper socioeconomic status (about 80% graduated from
college). Written informed consent was obtained from all participants, and the Institutional
Review Board at the Cooper Institute annually reviewed and approved the study protocol.
Physical Activity: Does Environment Make a Difference for Tension, Stress, Emotional Outlook, and Perceptions of Health
Status?” by Puett R et al.
Journal of Physical Activity & Health
© 2014 Human Kinetics, Inc.
The present study included men and women from the ACLS with a medical examination
(using the earliest examination if more than one was completed) between 1987 and 2006
(N=28,439), who had complete data on the outcomes (N=22,084), exposures (N=14,291) and
covariates (N=11,649). Exposures (physical activity environment) were assessed by
questionnaire items asking the participant to consider the three months prior to questionnaire
completion and respond whether they had performed any of the following activities, as well as
their frequency, intensity and duration per week: 1) walked/jogged/ran on a treadmill or rode a
stationary cycle (categorized as indoor activity), 2) walked/jogged/ran or cycled outside
(categorized as outdoor activity), or 3) participated in both indoor and outdoor activities.
Participants who engaged in other types of physical activity (e.g., dancing or swimming) were
excluded because no information was provided regarding whether these activities occurred
inside or outside. In sensitivity analyses, we included participants who reported being inactive
(N=17,783), though the comparison of inactivity versus activity is further described in Galper et
al 6. The study was limited to participants who achieved at least 85% of their age-predicted
maximal heart rate (220 minus age in years) during the treadmill exercise test.
The outcomes for the current study were stress and emotional factors from the ACLS
medical history questionnaire. Specifically, we focused on specific individual questions
regarding overall tension and anxiety (five possible responses from no to very tense and
categorized for analysis as: no, slight or moderate tension versus high tension or very tense),
general presence or absence of stress and tension symptoms (irritability, headache, abdominal
discomfort, sleeplessness, fatigue and other and categorized for analysis as 1 or less compared
to more), stress management (three possible responses from not well to very well most of the
time and categorized as: not well most of the time versus fairly well and very well most of the
time) general emotional outlook (five possible responses from often very depressed to usually
very happy and optimistic and categorized as generally happy or usually very happy versus
Physical Activity: Does Environment Make a Difference for Tension, Stress, Emotional Outlook, and Perceptions of Health
Status?” by Puett R et al.
Journal of Physical Activity & Health
© 2014 Human Kinetics, Inc.
happy and sad equally, generally sad, often very depressed), and overall health (four possible
responses from poor to excellent and categorized as excellent or good versus fair or poor) . For
the emotional outlook question, we used the same cut point as reported by Baruth et al 28. For
the remaining outcomes, given the lack of previously established cutpoints in the literature we
conducted descriptive statistics to evaluate the distribution and selected cut points which would
provide a large enough sample size for each category, as well as an obvious positive and
negative outcome.
Potential confounders and effect modifiers included information from the anthropometry
and the standard medical history questionnaire. Height and weight were measured on a
stadiometer and standard scale and were used to calculate body mass index (BMI) (weight in
kilograms/height in meters squared). Data on other covariates were collected via the
questionnaire, including: age; gender, total metabolic equivalent (MET)-minutes per week of
leisure-time physical activity; and history of cardiovascular disease, asthma, chronic obstructive
pulmonary disease (COPD), or joint leg problems (at least one of the following: chronic joint,
muscle, or low back pain, swollen or stiff joints, arthritis, gout). Given asthma, COPD, and
cardiovascular disease exacerbation have been associated with outdoor air pollutant exposures
as well as tension, outlook and overall health29-33, these variables were considered as
confounders. In addition, joint and leg problems may contribute to worse outlook and health as
well as deterring individuals from outdoor physical activity environments due to the challenges
of exercising on uneven surfaces34. Lastly, a question on the use of medication to relieve stress
was included (categorized as: seldom or almost never versus occasionally or frequently).
Statistical Analyses
Descriptive analyses summarized characteristics of participants, by gender and physical
activity environment. Multiple logistic regression was used to estimate odds ratios (ORs) and
95% confidence intervals (CIs) for the relationship of tension and anxiety, stress management,
Physical Activity: Does Environment Make a Difference for Tension, Stress, Emotional Outlook, and Perceptions of Health
Status?” by Puett R et al.
Journal of Physical Activity & Health
© 2014 Human Kinetics, Inc.
symptoms of stress and tension, emotional outlook and overall health with physical activity
environment (indoor, outdoor, both). Multivariate analyses adjusted for age (years), BMI,
baseline examination year, cardiovascular diseases, asthma, chronic obstructive pulmonary
disease (history or not for each), leg/joint problems (chronic joint or muscle pain, low back pain,
swollen/stiff joints, arthritis or gout), and medication use to relieve stress. We conducted
analyses with additional adjustment for total MET-minutes/week of the five physical activity
variables, as total physical activity may confound the associations of physical activity
environment with tension, stress, emotional outlook and overall health perception. Potential
effect modification by amount of total physical activity was examined through statistical
significance of interaction terms and likelihood ratio tests. An additional sensitivity analysis
included participants who were inactive. Analyses were executed with SAS version 9.2 (Cary,
NC). All P values are 2-sided with an alpha level of 0.05.
Results
The current study included 11,649 ACLS participants. About 18% of participants
reported indoor physical activity environment only, 28% reported indoor and outdoor physical
activity environments and 54% exercised outdoors only. Table 1 shows descriptive
characteristics for participants stratified by physical activity environment. For the entire sample,
the mean age was about 46 years and BMI about 26 kg/m2. Total physical activity was the
greatest for participants reporting both indoor and outdoor physical activity environment (1441.6
MET-minutes per week) and the least for those with indoor only (684.0 MET-minutes per week).
Men represented about 74% of participants overall, but they composed a lower percentage of
participants reporting both indoor and outdoor physical activity environment (70.7%). Among the
three physical activity environments, percentages of participants with asthma and COPD were
similar. Less than 2% of participants in each physical activity environment reported previous
Physical Activity: Does Environment Make a Difference for Tension, Stress, Emotional Outlook, and Perceptions of Health
Status?” by Puett R et al.
Journal of Physical Activity & Health
© 2014 Human Kinetics, Inc.
cardiovascular disease, but about half of participants in each physical activity environment
reported at least one joint or leg problem.
Percentages of stress and emotional factors by type of physical activity environment,
gender and amount of physical activity are displayed in Table 2. The majority of participants
reported no to moderate tension; managed their stress fairly well or very well; had few stress
symptoms; had a generally optimistic outlook; and perceived they were in good to excellent
health. Physical activity environment was significantly associated with overall health perception,
with the greatest percentage of participants reporting positive overall health perception in the
combined physical activity environment and the least in the indoor only group. Gender was
significantly associated with managing stress well, with men reporting fewer symptoms of stress
and/or tension and better emotional outlook. Participants with physical activity of at least 500
MET minutes per week reported lower tension and better stress management, emotional
outlook and overall health.
Table 3 shows the relationships of stress and outlook with physical activity environment
in fully adjusted models stratified by gender, for ACLS participants with complete data. Higher
odds ratios are indicative of worse outcomes. For example, women who reported both outdoor
and indoor physical activity environments and women with outdoor only were 15% and 11%,
respectively, less likely to report high or very high tension and anxiety compared with women
who reported indoor physical activity environment alone (referent group). However, the
associations were not statistically significant (respective 95%CIs: 0.65, 1.11 and 0.70, 1.14). For
tension and anxiety as well as for stress management, no significant differences by physical
activity environment were apparent for men or women, however ORs for combined and outdoor
only physical activity environments were protective against worse tension and stress
management compared with indoor only. No statistically significant differences were evident for
stress symptoms, but the results differed among men and women. For men, outdoor or
Physical Activity: Does Environment Make a Difference for Tension, Stress, Emotional Outlook, and Perceptions of Health
Status?” by Puett R et al.
Journal of Physical Activity & Health
© 2014 Human Kinetics, Inc.
combined physical activity environment increased risks for higher stress symptomology, while
the same addition of outdoor physical activity environment was protective among women. A
combination of indoor and outdoor physical activity environment was significantly protective for
worse emotional outlook (OR: 0.72, 95%CI: 0.52, 0.98) among women and for worse perception
of overall health for both genders (male OR: 0.75, 95%CI: 0.61, 0.92; female OR: 0.63, 95%CI:
0.44, 0.91). Models adjusting for total physical activity were similar with a few exceptions. The
relationship between indoor and outdoor physical activity environment and overall health
perception among men and women attenuated to non-significance, and the increased risk of
worse perception of overall health associated with outdoor physical activity environment
increased to significance (OR: 1.24, 95%CI: 1.03,1.48).
Level of physical activity modified the relationship of physical activity environment with
tension, emotional outlook and overall health. Table 4 presents results stratified by gender and
level of physical activity. Notably, among men and women in the low total physical activity group
(<500 MET minutes per week), increased risks for worse tension, stress management,
emotional outlook and overall health are observed with outdoor exercise alone compared to
indoor exercise alone. However, outdoor physical activity environment appears protective
compared to indoors for worse outcomes among men and women in the high total physical
activity group. Among both men and women in the high physical activity group, outdoor and a
combined physical activity environment appear to be more consistently protective for higher
levels of tension and worse stress management, emotional outlook and overall health.
Finally, we compared the relationships of stress and outlook with activity in the three
physical activity environment categories (indoor, outdoor, and combination) to inactive
participants (N=6,134, 75% male). In fully adjusted models of participants with complete data,
stratified by gender, we found that exercise in any of the three environments was protective for
tension, stress management and symptoms, poor emotional outlook and poor overall health
Physical Activity: Does Environment Make a Difference for Tension, Stress, Emotional Outlook, and Perceptions of Health
Status?” by Puett R et al.
Journal of Physical Activity & Health
© 2014 Human Kinetics, Inc.
perception compared to inactivity. Risks for poor emotional outlook (OR: 1.39, 95%CI:
1.06,1.82) and poor perceptions of overall health (OR: 1.96, 95%CI: 1.45,2.65) were
significantly higher among inactive women compared to women who exercised indoors alone
(referent physical activity environment). Among men, risks of greater stress symptomology (OR:
1.17, 95%CI: 1.03, 1.34), worse emotional outlook (OR: 1.12, 95%CI: 1.03,1.44) and overall
health (OR: 2.25, 95%CI: 1.90,2.66) were significantly greater among inactive men than for
those with indoor physical activity.
Discussion
To summarize our overall findings in one of the largest US studies conducted to date on
the relationship of routine, participant-selected physical activity environment with stress,
emotional outlook and overall health perception; a combination of outdoor and indoor or outdoor
physical activity environment alone, compared to indoor alone, suggested protection against
tension, stress, poor emotional outlook and poor overall health perception among women.
Relationships were weaker and less consistent for men. Outdoor physical activity environment
also appears more beneficial with respect to the outcomes examined for men and women who
are more active.
Though the combination of outdoor and indoor physical activity environment has not yet
been addressed by much of the literature, our findings are suggestive of a relation of positive
health perception, affect and tension levels with inclusion of outdoor physical activity in a
physical activity regimen, particularly among women and more active adults. This finding is
consistent with several studies which have reported benefits of outdoor physical activity
environment. However, direct comparability is limited due to differences between our
observational epidemiology study and previous research, much of which uses an intervention
design. In a review of eleven studies, Thompson Coon et al 24 reported that most found reduced
tension, depression and better energy for outdoor exercise compared to indoor exercise.
Physical Activity: Does Environment Make a Difference for Tension, Stress, Emotional Outlook, and Perceptions of Health
Status?” by Puett R et al.
Journal of Physical Activity & Health
© 2014 Human Kinetics, Inc.
Intervention studies conducted among adults in the United Kingdom, Australia and Switzerland
reported lower tension, positive affect and psychological restoration (respectively) associated
with outdoor physical activity compared to indoor35,36. However, a series of intervention studies
among college students reported mixed results, with women reporting outdoor activity as most
enjoyable or satisfying but the least calming37,38, and no strong differences in tension for a trial
conducted among women38. One study of outdoor activity alone reported a significant linear
relationship between decline in anxiety and perception of a green exercise environment among
101 members of outdoor exercise groups39 suggesting perhaps that differences in the outdoor
environment in which the physical activity occurred (i.e. natural versus urban setting) may
partially explain the inconsistencies in these findings. Unfortunately, this level of detail was not
measured in the ACLS.
One of our strongest findings was a possible protective effect of combined physical
activity environment with respect to poor emotional outlook among women. Other studies have
also indicated improved affective states for outdoor compared to indoor physical activity
environment, but information regarding impact of combined physical activity environment is
sparse. A study of 35 physically active college women40 and a study of 34 young men and
women 41 found more positive affective states following an outdoor walk compared with an
indoor treadmill walk. Reduced depression and anger was observed among male athletes
following outdoor runs versus indoor runs35. Our findings differed in that we found no strong
differences with respect to emotional outlook between indoor and outdoor or a combination of
physical activity environments for men. Though our ORs for women were lower for depressed
mood (not statistically significant) for outdoor compared to indoor physical activity environment,
the strongest protection was from a combination of indoor and outdoor environments. The
emotional benefits of outdoor exercise environment among women were also supported by a
study of 19 physically active postmenopausal women who reported greater pleasure and delight
Physical Activity: Does Environment Make a Difference for Tension, Stress, Emotional Outlook, and Perceptions of Health
Status?” by Puett R et al.
Journal of Physical Activity & Health
© 2014 Human Kinetics, Inc.
following outdoor walking and more frustration and worry after a treadmill walk42. However,
similar to most other studies on physical activity environment, the study did not address
combined physical activity environment as it was focused on understanding the acute impacts of
outdoor versus indoor physical activity environment on affect through an intervention trial.
In the current study, the amount of physical activity differed among physical activity
environment. For both men and women, the greatest MET-minutes per week of total physical
activity occurred in a combination of outdoor and indoor environments, whereas the least MET-
minutes per week occurred indoors. Some previous research has suggested more intense
physical activity occurs indoors, but physical activity outdoors is of longer duration. In a large
study of self-selected physical activity focusing on intensity and exercise duration, Dunton and
colleagues showed that vigorous intensity physical activity was more likely to occur indoors43.
But the mean duration of time was higher for physical activity outside among the 7,700 adults
who reported exercising the day prior to completing the American Time Use Survey. Longer
duration of outdoor exercise may be related to greater compatibility with personal preferences 36
and more satisfaction and enjoyment among participants38,44.
The amount of total physical activity also modified the relationship of physical activity
environment with several outcomes explored in this study. Outdoor and combined physical
activity environments appeared more consistently protective against tension and stress, poor
emotional outlook and poor overall health perception among more active individuals. Indoor and
combined activity environments showed potential for more benefit among less active individuals.
Adding to the findings of better emotional outlook for habitual physical activity reported by
Galper et al 6 in the same study population, we found for both men and women that each
physical activity environment was better than inactivity. Unfortunately the cross-sectional design
of this study prevents our ability to examine the chronological order of physical activity amount,
physical activity environment preference, and the outcomes we explored. Further research is
Physical Activity: Does Environment Make a Difference for Tension, Stress, Emotional Outlook, and Perceptions of Health
Status?” by Puett R et al.
Journal of Physical Activity & Health
© 2014 Human Kinetics, Inc.
needed to understand, for example, whether a positive outlook and positive health perception
encourage higher amounts of physical activity outdoors or whether individuals who enjoy the
outdoors exercise longer which in turn elevates their mood and health perception.
Evidence from the literature supports a physiological basis for physical activity’s benefit
on stress and emotional outlook45-47, and exposure to natural settings has been shown to lower
stress and improve mood48-50. However, less is known regarding the biological mechanisms
through which outdoor exercise environment may influence stress and affect. For example,
some studies have shown improved physiological stress recovery associated with sensory
stimuli provided by natural environments compared with urban environments. Ulrich and
colleagues 51 have suggested that the parasympathetic nervous system may be influenced by
natural visual stimuli, and Alvarsson and co-authors52 suggested the sympathetic nervous
system may respond to sounds of nature. Other physiologic pathways may also be involved.
Given much of our vitamin D levels are obtained through sunlight exposure, perhaps vitamin D
plays a physiologic role, particularly as there is some evidence vitamin D deficiency is
associated with mood disorders, worse cognitive performance, mental health related quality of
life, chronic tension headaches and fatigue53-57. Many studies of outdoor versus indoor physical
activity environment have indirectly controlled for the influence of vitamin D. However, two
studies used more direct control by presenting participants with natural and urban scenes and
found physiological recovery and improved executive attention performance after a stressful
event were faster after views of natural settings20, suggesting health impacts of nature cannot
be fully explained through vitamin D exposure. Another potential explanation from the
psychological literature rises from Attention Restoration Theory, where directed attention,
integral to human effectiveness, can be restored through exposure to natural settings58. For
example, natural settings resonate with humans and provide a sense of extent or openness and
being away from stressful activities, which can reduce fatigued directed attention 58-60. A recently
Physical Activity: Does Environment Make a Difference for Tension, Stress, Emotional Outlook, and Perceptions of Health
Status?” by Puett R et al.
Journal of Physical Activity & Health
© 2014 Human Kinetics, Inc.
published study61 provided additional support for the restoration theory. Systematic differences
were observed in EEG recordings between walkers' exposure to green space and urban
development.
To our knowledge, this is the largest study of the relationship self-selected physical
activity environment with stress, emotional outlook and overall health perception published to
date. However, limitations of generalizability to less affluent populations and to non-white
race/ethnicities should be noted. This study is a cross-sectional design with limitations inherent
to this type of design, including the inability to examine the order of causation in the
associations observed between physical activity environment and the outcomes of emotional
outlook and overall health perceptions. Individual questionnaire items were used to assess
tension, emotional outlook and overall health. Nonetheless, this study offers an important
opportunity to examine the relationships of tension, stress, emotional outlook, and perceived
health with routine, participant-selected physical activity environment compared to previous
intervention studies which were limited to acute measures of mental and physical well-being.
Similar to previous observational research43, we were unable to examine other factors, such as
climate or perceptions of safety, which have been associated with locational preferences for
exercise62-64. In addition, information on the greenness or aesthetics of the outdoor activity
environments or how the participants interacted with these environments (e.g., running with
headphones versus hearing natural sounds or traffic) was unavailable. Thus potential
confounding by these important factors could not be addressed. Lastly, we focused on
perceived outcomes, rather than physiological measures. Very few studies have explored
biomarker differences for indoor and outdoor exercise environments, with somewhat
inconsistent findings35, highlighting the need for additional research in this area.
In conclusion, the current study suggested that a combination of indoor and outdoor
physical activity environments as well as outdoor alone physical activity environment may be
Physical Activity: Does Environment Make a Difference for Tension, Stress, Emotional Outlook, and Perceptions of Health
Status?” by Puett R et al.
Journal of Physical Activity & Health
© 2014 Human Kinetics, Inc.
linked with lower risks of self-reported stress, poor emotional outlook and poor overall
perceptions of health for women and individuals who have higher levels of physical activity.
Further research is needed to understand better the order of causation and any modification of
these associations by greenness or urbanicity of outdoor activity environment. Tension, stress,
emotional outlook and health perception were better compared to inactivity regardless of activity
environment; thus underscoring the importance of physical activity regardless of environment.
Acknowledgements:
We thank the Cooper Clinic physicians and technicians for collecting the data, and staff at the
Cooper Institute for data entry and data management.
Funding Sources:
This study was supported by the National Institutes of Health grants (AG06945, HL62508, and
R21DK088195), an unrestricted research grant from The Coca-Cola Company, and a
postdoctoral fellowship from the Spanish Ministry of Education (EX-1008-2010). The content is
solely the responsibility of the authors and does not necessarily represent the official views of
the National Institutes of Health.
Physical Activity: Does Environment Make a Difference for Tension, Stress, Emotional Outlook, and Perceptions of Health
Status?” by Puett R et al.
Journal of Physical Activity & Health
© 2014 Human Kinetics, Inc.
References
1. Physical Activity Guidelines Advisory Committee. Physical activity guidelines advisory committee
report, 2008. In: Department of Health and Human Services, ed. Washington, DC: U.S.2008.
2. Taylor CB, Sallis JF, Needle R. The relation of physical activity and exercise to mental health.
Public Health Rep. Mar-Apr 1985;100(2):195-202.
3. Paluska SA, Schwenk TL. Physical activity and mental health: current concepts. Sports Med. Mar
2000;29(3):167-180.
4. De Moor MH, Beem AL, Stubbe JH, Boomsma DI, De Geus EJ. Regular exercise, anxiety,
depression and personality: a population-based study. Preventive medicine. Apr 2006;42(4):273-
279.
5. Dishman RK, Sui X, Church TS, Hand GA, Trivedi MH, Blair SN. Decline in cardiorespiratory fitness
and odds of incident depression. American journal of preventive medicine. In Press.
6. Galper DI, Trivedi MH, Barlow CE, Dunn AL, Kampert JB. Inverse association between physical
inactivity and mental health in men and women. Medicine and science in sports and exercise. Jan
2006;38(1):173-178.
7. Hassmen P, Koivula N, Uutela A. Physical exercise and psychological well-being: a population
study in Finland. Preventive medicine. Jan 2000;30(1):17-25.
8. Lavie CJ, Milani RV, O'Keefe JH, Lavie TJ. Impact of exercise training on psychological risk factors.
Progress in cardiovascular diseases. May-Jun 2011;53(6):464-470.
9. Segar ML, Katch VL, Roth RS, et al. The effect of aerobic exercise on self-esteem and depressive
and anxiety symptoms among breast cancer survivors. Oncology nursing forum. Jan-Feb
1998;25(1):107-113.
10. Long BC, Stavel Rv. Effects of exercise training on anxiety: A meta-analysis. Journal of Applied
Sport Psychology. 1995/09/01 1995;7(2):167-189.
11. Lamichhane AP, Puett R, Porter DE, Bottai M, Mayer-Davis EJ, Liese AD. Associations of built
food environment with body mass index and waist circumference among youth with diabetes.
The international journal of behavioral nutrition and physical activity. 2012;9:81.
12. Lopez RP, Hynes HP. Obesity, physical activity, and the urban environment: public health
research needs. Environmental health : a global access science source. 2006;5:25.
13. Sallis JF, Floyd MF, Rodriguez DA, Saelens BE. Role of built environments in physical activity,
obesity, and cardiovascular disease. Circulation. Feb 7 2012;125(5):729-737.
14. 2008 Physical activity guidelines for Americans. In: Services UDoHaH, ed2009.
15. Gordon-Larsen P, Nelson MC, Page P, Popkin BM. Inequality in the built environment underlies
key health disparities in physical activity and obesity. Pediatrics. Feb 2006;117(2):417-424.
Physical Activity: Does Environment Make a Difference for Tension, Stress, Emotional Outlook, and Perceptions of Health
Status?” by Puett R et al.
Journal of Physical Activity & Health
© 2014 Human Kinetics, Inc.
16. Mier N, Medina AA, Ory MG. Mexican Americans with type 2 diabetes: perspectives on
definitions, motivators, and programs of physical activity. Preventing chronic disease. Apr
2007;4(2):A24.
17. Kjellgren A, Buhrkall H. A comparison of the restorative effect of a natural environment with
that of a simulated natural environment. Journal of Environmental Psychology. 2010;30:464-
472.
18. Swanwick C. Society’s attitudes to and preferences for land and landscape. Land Use Policy.
2009;26S:S62-S75.
19. van den Berg AE, Maas J, Verheij RA, Groenewegen PP. Green space as a buffer between
stressful life events and health. Soc Sci Med. Apr 2010;70(8):1203-1210.
20. Berman MG, Jonides J, Kaplan S. The Cognitive Benefits of Interacting With Nature. Psychol Sci.
Dec 2008;19(12):1207-1212.
21. Barton J, Griffin M, Pretty J. Exercise-, nature- and socially interactive-based initiatives improve
mood and self-esteem in the clinical population. Perspectives in public health. Mar
2012;132(2):89-96.
22. Barton J, Pretty J. What is the best dose of nature and green exercise for improving mental
health? A multi-study analysis. Environmental science & technology. May 15 2010;44(10):3947-
3955.
23. Mitchell R. Is physical activity in natural environments better for mental health than physical
activity in other environments? Soc Sci Med. May 8 2012.
24. Thompson Coon J, Boddy K, Stein K, Whear R, Barton J, Depledge MH. Does participating in
physical activity in outdoor natural environments have a greater effect on physical and mental
wellbeing than physical activity indoors? A systematic review. Environmental science &
technology. Mar 1 2011;45(5):1761-1772.
25. Blair SN, Goodyear NN, Gibbons LW, Cooper KH. Physical fitness and incidence of hypertension
in healthy normotensive men and women. JAMA : the journal of the American Medical
Association. Jul 27 1984;252(4):487-490.
26. Blair SN, Kampert JB, Kohl HW, 3rd, et al. Influences of cardiorespiratory fitness and other
precursors on cardiovascular disease and all-cause mortality in men and women. JAMA : the
journal of the American Medical Association. Jul 17 1996;276(3):205-210.
27. Blair SN, Kohl HW, 3rd, Paffenbarger RS, Jr., Clark DG, Cooper KH, Gibbons LW. Physical fitness
and all-cause mortality. A prospective study of healthy men and women. JAMA : the journal of
the American Medical Association. Nov 3 1989;262(17):2395-2401.
28. Baruth M, Lee DC, Sui X, et al. Emotional outlook on life predicts increases in physical activity
among initially inactive men. Health Educ Behav. Apr 2011;38(2):150-158.
Physical Activity: Does Environment Make a Difference for Tension, Stress, Emotional Outlook, and Perceptions of Health
Status?” by Puett R et al.
Journal of Physical Activity & Health
© 2014 Human Kinetics, Inc.
29. Theoharides TC, Enakuaa S, Sismanopoulos N, et al. Contribution of stress to asthma worsening
through mast cell activation. Annals of allergy, asthma & immunology : official publication of the
American College of Allergy, Asthma, & Immunology. Jul 2012;109(1):14-19.
30. Belfer MH, Reardon JZ. Improving exercise tolerance and quality of life in patients with chronic
obstructive pulmonary disease. The Journal of the American Osteopathic Association. May
2009;109(5):268-278; quiz 280-261.
31. Pope CA, 3rd, Dockery DW. Health effects of fine particulate air pollution: lines that connect. J
Air Waste Manag Assoc. Jun 2006;56(6):709-742.
32. Puett RC, Hart JE, Yanosky JD, et al. Chronic fine and coarse particulate exposure, mortality, and
coronary heart disease in the Nurses' Health Study. Environmental health perspectives. Nov
2009;117(11):1697-1701.
33. Player MS, Peterson LE. Anxiety disorders, hypertension, and cardiovascular risk: a review.
International journal of psychiatry in medicine. 2011;41(4):365-377.
34. Shumway-Cook A, Patla AE, Stewart A, Ferrucci L, Ciol MA, Guralnik JM. Environmental demands
associated with community mobility in older adults with and without mobility disabilities.
Physical therapy. Jul 2002;82(7):670-681.
35. Harte JL, Eifert GH. The effects of running, environment, and attentional focus on athletes'
catecholamine and cortisol levels and mood. Psychophysiology. Jan 1995;32(1):49-54.
36. Hug SM, Hartig T, Hansmann R, Seeland K, Hornung R. Restorative qualities of indoor and
outdoor exercise settings as predictors of exercise frequency. Health & place. Dec
2009;15(4):971-980.
37. Plante TG, Cage C, Clements S, Stover A. Psychological benefits of exercise paired with virtual
reality: Outdoor exercise energizes whereas indoor virtual exercise relaxes. International Journal
of Stress Management. 2006;13(1):108-117.
38. Plante TG, Gores C, Brecht C, Carrow J, Imbs A, Willemsen E. Does exercise environment
enhance the psychological benefits of exercise for women? International Journal of Stress
Management. 2007;14(1):88-98.
39. Mackay GJ, Neill JT. The effect of “green exercise” on state anxiety and the role of exercise
duration, intensity, and greenness: A quasi-experimental study. Psychology of Sport and
Exercise. 2010;11(3):238-245.
40. Focht BC. Brief walks in outdoor and laboratory environments: effects on affective responses,
enjoyment, and intentions to walk for exercise. Research quarterly for exercise and sport. Sep
2009;80(3):611-620.
41. Dasilva SG, Guidetti L, Buzzachera CF, et al. Psychophysiological responses to self-paced
treadmill and overground exercise. Medicine and science in sports and exercise. Jun
2011;43(6):1114-1124.
Physical Activity: Does Environment Make a Difference for Tension, Stress, Emotional Outlook, and Perceptions of Health
Status?” by Puett R et al.
Journal of Physical Activity & Health
© 2014 Human Kinetics, Inc.
42. Teas J, Ph.D, Hurley T, et al. Walking Outside Improves Mood for Healthy Postmenopausal
Women. Clinical Medicine Insights: Oncology. 2007;1(CMO-1-Teas-et-al):35.
43. Dunton GF, Berrigan D, Ballard-Barbash R, Graubard BI, Atienza AA. Environmental influences on
exercise intensity and duration in a U.S. time use study. Medicine and science in sports and
exercise. Sep 2009;41(9):1698-1705.
44. Plante TG, Aldridge A, Su D, Bogdan R, Belo M, Kahn K. Does Virtual Reality Enhance the
Management of Stress When Paired With Exercise? An Exploratory Study. International Journal
of Stress Management. 2003;10(3):203-216.
45. Esch T, Stefano GB. Endogenous reward mechanisms and their importance in stress reduction,
exercise and the brain. Archives of medical science : AMS. Jun 30 2010;6(3):447-455.
46. Hamer M. Exercise and psychobiological processes: implications for the primary prevention of
coronary heart disease. Sports Med. 2006;36(10):829-838.
47. Rimmele U, Seiler R, Marti B, Wirtz PH, Ehlert U, Heinrichs M. The level of physical activity
affects adrenal and cardiovascular reactivity to psychosocial stress. Psychoneuroendocrinology.
Feb 2009;34(2):190-198.
48. Maller C, Townsend M, Pryor A, Brown P, St Leger L. Healthy nature healthy people: 'contact
with nature' as an upstream health promotion intervention for populations. Health promotion
international. Mar 2006;21(1):45-54.
49. Kaplan R. The nature of the view from home - Psychological benefits. Environ Behav. Jul
2001;33(4):507-542.
50. Thompson CW. Linking landscape and health: The recurring theme. Landscape Urban Plan. Mar
15 2011;99(3-4):187-195.
51. Ulrich RS, Simons RF, Losito BD, Fiorito E, Miles MA, Zelson M. Stress recovery during exposure
to natural and urban environments. Journal of Environmental Psychology. 1991;11(3):201-230.
52. Alvarsson JJ, Wiens S, Nilsson ME. Stress Recovery during Exposure to Nature Sound and
Environmental Noise. International journal of environmental research and public health.
2010;7(3):1036-1046.
53. Knutsen KV, Brekke M, Gjelstad S, Lagerlov P. Vitamin D status in patients with musculoskeletal
pain, fatigue and headache: a cross-sectional descriptive study in a multi-ethnic general practice
in Norway. Scandinavian journal of primary health care. Sep 2010;28(3):166-171.
54. Motsinger S, Lazovich D, MacLehose RF, Torkelson CJ, Robien K. Vitamin D intake and mental
health-related quality of life in older women: the Iowa Women's Health Study. Maturitas. Mar
2012;71(3):267-273.
55. Prakash S, Mehta NC, Dabhi AS, Lakhani O, Khilari M, Shah ND. The prevalence of headache may
be related with the latitude: a possible role of Vitamin D insufficiency? The journal of headache
and pain. Aug 2010;11(4):301-307.
Physical Activity: Does Environment Make a Difference for Tension, Stress, Emotional Outlook, and Perceptions of Health
Status?” by Puett R et al.
Journal of Physical Activity & Health
© 2014 Human Kinetics, Inc.
56. Prakash S, Shah ND. Chronic Tension-Type Headache With Vitamin D Deficiency: Casual or
Causal Association? Headache: The Journal of Head and Face Pain. 2009;49(8):1214-1222.
57. Wilkins CH, Sheline YI, Roe CM, Birge SJ, Morris JC. Vitamin D deficiency is associated with low
mood and worse cognitive performance in older adults. The American journal of geriatric
psychiatry : official journal of the American Association for Geriatric Psychiatry. Dec
2006;14(12):1032-1040.
58. Kaplan S. The Restorative Benefits of Nature - toward an Integrative Framework. Journal of
Environmental Psychology. Sep 1995;15(3):169-182.
59. Kaplan R, Kaplan S, Brown T. Environmental Preference - a Comparison of 4 Domains of
Predictors. Environ Behav. Sep 1989;21(5):509-530.
60. Herzog TR, Maguire CP, Nebel MB. Assessing the restorative components of environments.
Journal of Environmental Psychology. Jun 2003;23(2):159-170.
61. Aspinall P, Mavros P, Coyne R, Roe J. The urban brain: analysing outdoor physical activity with
mobile EEG. British journal of sports medicine. Mar 6 2013.
62. Chan CB, Ryan DA. Assessing the effects of weather conditions on physical activity participation
using objective measures. International journal of environmental research and public health. Oct
2009;6(10):2639-2654.
63. Foster S, Giles-Corti B. The built environment, neighborhood crime and constrained physical
activity: an exploration of inconsistent findings. Preventive medicine. Sep 2008;47(3):241-251.
64. Zoellner J, Hill JL, Zynda K, Sample AD, Yadrick K. Environmental perceptions and objective
walking trail audits inform a community-based participatory research walking intervention. The
international journal of behavioral nutrition and physical activity. 2012;9:6.
Physical Activity: Does Environment Make a Difference for Tension, Stress, Emotional Outlook, and Perceptions of Health
Status?” by Puett R et al.
Journal of Physical Activity & Health
© 2014 Human Kinetics, Inc.
Figure 1.
Physical Activity: Does Environment Make a Difference for Tension, Stress, Emotional Outlook, and Perceptions of Health Status?” by Puett R et al.
Journal of Physical Activity & Health
© 2014 Human Kinetics, Inc.
Table 1 Baseline characteristics of all participants and according to type of physical activity environment
Type of Physical Activity
Characteristic Indoor Indoor and Outdoor Outdoor
(n=2107) (n=3221) (n=6321)
Mean (SD):
Age (years) 46.8 ± 9.1 46.0 ± 9.7 46.7 ± 9.4
BMI (kg/m2) 26.7 ± 4.5 26.0 ± 4.2 26.0 ± 4.0
Total Physical Activity (MET-min/week) 684.0 ± 544.0 1441.6 ± 1179.9 1056.6 ± 1135.0
Outdoor Walking (MET-min/week) -- 346.5 ± 411.4 355.6 ± 473.5
Outdoor Jogging/Running (MET-min/week) -- 357.6 ± 740.2 572.5 ± 979.3
Indoor Treadmill (MET-min/week) 417.7 ± 519.9 372.6 ± 488.9 --
Outdoor Bike (MET-min/week) -- 127.5 ± 536.5 128.5 ± 657.9
Indoor Cycle (MET-min/week) 266.3 ± 423.0 237.3 ± 442.8 --
Tension and Anxiety 2.9 + 0.9 2.9 +0 .9 2.9 + 0.8
Stress Management 2.3 + 0.6 2.3 + 0.6 2.3 + 0.6
Symptoms of Stress and/or Tension 1.1 +. 0.2 1.0 + 0.2 1.1 + 0.2
General Emotional Outlook 4.2 + 0.7 4.2 + 0.7 4.2 + 0.7
Overall Health 3.1 +0.6 3.2 + 0.6 3.2 + 0.7
Number (%):
Male* 1590 (75.5) 2278 (70.7) 4789 (75.8)
Low Total Physical Activity (<500 MET-min/week) 929 (44.1) 360 (11.2) 2129 (33.7)
Cardiovascular diseases* 27 (1.3) 42 (1.3) 49 (0.8)
Asthma 184 (8.7) 270 (8.4) 504 (8.0)
COPD 150 (7.1) 205 (6.4) 448 (7.1)
Leg/Joint Problems (>1) * 1092 (51.8) 1666 (51.7) 3051(48.3)
Medication Use for Stress*
Frequently 175(8.3) 290(9.0) 630(10.0)
Occasionally 271(12.9) 445(13.8) 838(13.3)
Seldom 308(14.6) 515(16.0) 842(13.3)
Almost Never 1353(64.2) 1971(61.2) 4011(63.5)
* Chi square test for differences pvalue<0.05
Physical Activity: Does Environment Make a Difference for Tension, Stress, Emotional Outlook, and Perceptions of Health Status?” by Puett R et al.
Journal of Physical Activity & Health
© 2014 Human Kinetics, Inc.
Table 2 Stress and emotional factors according to type of physical activity and gender
Indoor Indoor and Outdoor Males Females Low PA
High PA
Outdoor
(n=2107) (n=3221) (n=6321) (n=10296) (n=3744) (n=3408)
(n=8231)
Tension and Anxiety
No to moderate tension 1615 (76.7) 2487 (77.2) 4863 (76.9) 6643 (76.7) 2322 (77.2) 2560 (74.9)
6405 (77.8)
High and very tense 492 (23.4) 734 (22.8) 1458 (23.1) 2014 (23.3) 670 (22.4) 858 (25.1)
1826 (22.2)
P-value* 0.890 0.329
<0.001
Stress Management
Very well most of the time and 1967 (93.4) 3027 (94.0) 5936 (93.9) 8167 (94.3) 2763 (92.4) 3179 (93.0)
7751 (94.2)
fairly well most of the time
Not well most of the time 140 (6.6) 194 (6.0) 385 (6.1) 490 (5.7) 229 (7.7) 239 (7.0)
480 (5.8)
P-value* 0.604 <0.001
0.018
Symptoms of Stress and/or Tension
One or no symptoms of 1346 (63.9) 2017 (62.6) 4084 (64.6) 5840 (67.5) 1607 (53.7) 1997 (58.4)
5450 (66.2)
stress and/or tension
Two or more symptoms of stress 761 (36.1) 1204 (37.4) 2237 (35.4) 2817 (32.5) 1385 (46.3) 1421 (41.6)
2781 (33.8)
and/or tension
P-value* 0.160 <0.001
<0.001
Physical Activity: Does Environment Make a Difference for Tension, Stress, Emotional Outlook, and Perceptions of Health Status?” by Puett R et al.
Journal of Physical Activity & Health
© 2014 Human Kinetics, Inc.
General Emotional Outlook
Generally happy and usually very 1823 (86.5) 2832 (87.9) 5517 (87.3) 7618 (88.0) 2554 (85.4) 2927 (85.6)
7245 (88.0)
happy and optimistic
Often very depressed, generally, 284 (13.5) 389 (12.7) 804 (12.7) 1039 (12.0) 438 (14.6) 491 (14.4)
986 (12.0)
sad and happy and sad equal amounts
P-value* 0.320 <0.001
<0.001
Overall Health
Good and Excellent 1819 (86.3) 2895 (89.9) 5518 (87.3) 7577 (87.5) 2655 (88.7) 2780 (81.3)
7452 (90.5)
Fair and Poor 288 (13.7) 326 (10.1) 803 (12.7) 1080 (12.5) 337 (11.3) 638 (18.7)
779 (9.5)
P-value* <0.001 0.080
<0.001
*Chi-square p-value for differences between groups
Physical Activity: Does Environment Make a Difference for Tension, Stress, Emotional Outlook, and Perceptions of Health Status?” by Puett R et al.
Journal of Physical Activity & Health
© 2014 Human Kinetics, Inc.
Table 3 Odds ratios and 95% CI for stress and emotional factors stratified by gender*
Males Females
Tension and Anxiety
Indoor and Outdoor 0.97 (0.83, 1.14) 0.85 (0.65, 1.11)
Outdoor 0.99 (0.86, 1.13) 0.89 (0.70, 1.14)
Indoor 1.00 (Referent) 1.00 (Referent)
Stress Management
Indoor and Outdoor 0.89 (0.67, 1.18) 0.77 (0.52, 1.16)
Outdoor 0.96 (0.75, 1.23) 0.80 (0.55, 1.16)
Indoor 1.00 (Referent) 1.00 (Referent)
Symptoms of Stress and/or Tension
Indoor and Outdoor 1.05 (0.91, 1.21) 0.78 (0.58, 1.04)
Outdoor 1.05 (0.92, 1.20) 0.94 (0.72, 1.23)
Indoor 1.00 (Referent) 1.00 (Referent)
General Emotional Outlook
Indoor and Outdoor 0.93 (0.76, 1.13) 0.72 (0.52, 0.98)**
Outdoor 0.89 (0.75, 1.06) 0.93 (0.70, 1.23)
Indoor 1.00 (Referent) 1.00 (Referent)
Overall Health
Indoor and Outdoor 0.75 (0.61, 0.92)** 0.63 (0.44, 0.91)**
Outdoor 1.13 (0.95, 1.35) 0.95 (0.69, 1.30)
Indoor 1.00 (Referent) 1.00 (Referent)
*All models adjusted for age, body mass index, cardiovascular disease, asthma, chronic obstructive pulmonary disease, leg/joint problems,
medication use to relieve stress and emotional factors and baseline examination year.
** p value<0.05
Physical Activity: Does Environment Make a Difference for Tension, Stress, Emotional Outlook, and Perceptions of Health Status?” by Puett R et al.
Journal of Physical Activity & Health
© 2014 Human Kinetics, Inc.
Table 4 Odds ratios and 95% CI for stress and emotional factors stratified by gender and by low and high total physical activity (PA)*
Males Females
Low total PA High total PA Low total PA High total PA
Tension and Anxiety
Indoor and Outdoor 0.93 (0.65, 1.34) 0.92 (0.76, 1.11) 0.74 (0.42, 1.31) 0.91 (0.64,
1.28)
Outdoor 1.27 (1.02, 1.59)** 0.84 (0.70, 1.01) 1.02 (0.71, 1.45) 0.84 (0.59,
1.18) Indoor 1.00 (Referent) 1.00 (Referent) 1.00 (Referent) 1.00 (Referent)
Stress Management
Indoor and Outdoor 0.81 (0.42, 1.57) 0.85 (0.60, 1.19) 1.27 (0.50, 3.19) 0.51 (0.32,
0.82)**
Outdoor 1.18 (0.80, 1.73) 0.83 (0.60, 1.15) 1.73 (0.93, 3.20) 0.44 (0.27,
0.71)** Indoor 1.00 (Referent) 1.00 (Referent) 1.00 (Referent) 1.00 (Referent)
Symptoms of Stress and/or Tension
Indoor and Outdoor 0.91 (0.65, 1.29) 1.16 (0.97, 1.38) 0.59 (0.33, 1.07) 0.86 (0.60,
1.25) Outdoor 1.14 (0.92, 1.42) 1.05 (0.89, 1.24) 0.94 (0.62, 1.43) 0.96 (0.67,
1.37) Indoor 1.00 (Referent) 1.00 (Referent) 1.00 (Referent) 1.00 (Referent)
General Emotional Outlook
Indoor and Outdoor 1.07 (0.69, 1.64) 0.93 (0.73, 1.19) 0.58 (0.28, 1.22) 0.68 (0.46,
1.01)
Outdoor 1.04 (0.79, 1.36) 0.83 (0.65, 1.05) 1.03 (0.67, 1.57) 0.83 (0.57,
1.22) Indoor 1.00 (Referent) 1.00 (Referent) 1.00 (Referent) 1.00 (Referent)
Overall Health
Indoor and Outdoor 1.05 (0.69, 1.59) 0.74 (0.57, 0.96)** 0.64 (0.31, 1.30) 0.63 (0.39,
1.03) Outdoor 1.60 (1.23, 2.08)** 0.86 (0.67, 1.11) 1.24 (0.80, 1.91) 0.69 (0.43,
1.12) Indoor 1.00 (Referent) 1.00 (Referent) 1.00 (Referent) 1.00 (Referent)
Physical Activity: Does Environment Make a Difference for Tension, Stress, Emotional Outlook, and Perceptions of Health Status?” by Puett R et al.
Journal of Physical Activity & Health
© 2014 Human Kinetics, Inc.
*All models adjusted for age, body mass index, cardiovascular disease, asthma, chronic obstructive pulmonary disease, leg/joint problems,
medication use to relieve stress and emotional factors and baseline examination year.
** p value<0.05
... Considering the interaction of these components, participating in outdoor sports can play an important role in human health. Actually, outdoor sports have been shown to successfully break sedentary behaviors, promoting physical quality of life, healthy lifestyle [8], and better stress management and health perceptions [9], with additional positive effects that, by contrast, are not observed when participating in similar physical activity indoors [10]. Being active in nature positively influences cognition [11], educational performance, and motivation [12,13]. ...
... In general terms, several previous studies had provided evidence about the positive relationship between the practice of outdoor sports and health benefits [1][2][3]8]. Our study, although it is based in a school program and participants' perception, has taken a step forward and has given exact figures on the effects on the overall health, showing that more than 40% affirmed to have experienced benefits from it and a better quality of life, coinciding with the findings in previous works [9,24]. ...
... Furthermore, several benefits were found in relation to mental health and well-being, as already stated in numerous preceding studies [15,16,25]. Concretely, for example, this has been highlighted in terms of stress management [9], cognition and concentration [11], or good spirits and motivation [13]. Participants highlighted an increase in their sensation of calmness and tranquility, which contrasts with the results of other studies that state that such feelings are decreased following outdoor exercise [10]. ...
Article
Full-text available
Participating in outdoor sports in blue spaces is recognized to produce a range of significant social benefits. This case study empirically analyzes the social benefits associated with the School Nautical Activities project carried out in Viana do Castelo (Portugal) in school-age children and adolescents. It consisted of a 4 year program in which scholars took part in nautical activities (surfing, rowing, sailing, and canoeing) in blue spaces once a week during a semester as a part of their physical education course. The methods used for data collection were as follows: (1) a survey answered by 595 participants in the program and (2) five focus groups (FG): two FGs with participants (seven on each FG), two FGs with their parents (eight participants each), and one FG with the physical education teachers (five participants). Interviews were transcribed and qualitative analysis with NVivo software was developed. Results revealed clear evidence on the social benefits for school-age children and adolescents associated with participation in outdoor activities in blue spaces both in the overall health and in all the following analyzed categories: mental health and well-being, education, active citizenship, social behavior, and environmental awareness. More than 40% state that their overall health is much better now (13.4%) or somewhat better now (29.9%) due to their participation in the program. Thus, this article provides support for the anecdotal recognition of the benefits for school-age children and adolescents from participating in sports in the outdoors and especially in blue spaces.
... However, research on the health effects of recreational physical activity is less conclusive. The reason may be that exercises for leisure depend on the proximity to and attractiveness of activity sites in the living space while exercises in specific geographic contexts are to a varying degree related to health outcomes (Maas et al., 2008;Puett et al., 2014). For instance, outdoor recreational exercises in a green environment should have been good for health, but ambient air pollutants would increase people's exposure to environmental hazards and might counteract the health benefit of green exposure (Giallouros et al., 2020). ...
... Specifically, frequent outdoor exercises are strongly correlated with better self-rated health, both in physical and mental dimensions. This accords with the western evidence that a physically active lifestyle in the outdoor context not only reduces the risks of heart attack, obesity and, some NCDs, but also improves health-related quality of life and psychological status (Koohsari et al., 2013;Puett et al., 2014;Ambrey, 2016). However, we do not observe similar health benefits of exercises indoors as outdoors. ...
Article
With great concern over the health-promoting environment worldwide, there is a growing body of research into the neighborhood effects on health beyond the sole focus on individual socioeconomic disadvantages and lifestyle risks. Our study contributes to neighborhood health research by investigating the combined effects of multi-dimensional neighborhood environmental characteristics and recreational physical activity under different geographic contexts on residents' self-rated health. Drawing upon a health survey conducted in suburban Shanghai in 2017, we employ a series of multilevel models to examine how the multi-scale environmental and behavioral factors are related to residents' self-rated physical and mental health, respectively. The results show that the greening rate of the community, rather than accessibility to large-scale urban parks, is a significant indicator of self-rated health for suburban residents. Subjective evaluations on neighborhood safety and air pollution exposure are significantly associated with residents' physical and mental health, while neighborhood attachment matters more for mental health. Outdoor recreational exercises, especially in the environment of neighborhood green space, are conducive to better physical health, while indoor physical activity shows weaker and insignificant health benefits. These findings offer a promising way for public health policymakers and urban planners to implement place-based health interventions and develop health-supportive neighborhoods.
... Their research found that the remarkable advantage of outdoor activities is that they are affordable and varied. The positive impact of a green environment both in urban and rural areas on mental health was emphasized in Dzhambov et al. [109], Audrey et al. [110], Dean et al. [111], Pretty et al. [112], and Morris [113]; this latter study was complemented by Puett et al. [114] and Thompson et al. [115] saying that the green environment can help individuals to restore their mental strength more easily and quickly, and reduce stress levels in their life; it improves their mood [116], enhances their self-esteem [117], and leads to feeling committed in a positive sense [115]. ...
... Urban population is also characterized by an increasing demand for green spaces and natural environment [105] Besides the health benefits associated with open-air exercise [82][83][84][85][86][87][88], research also found social benefits closely related with one's psychological [109][110][111][112][113][114][115][116][117], physiological, and general well-being [106][107][108]. In terms of motivation to exercise in natural environments, nature experiences were usually the second most important motivation, which was only preceded by comfort motives [118]. ...
Article
Full-text available
The present study is a synthesizing analysis of international literature on correlations between sustainability, sport, and physical activity. The study of sustainability is considered essential in modern research; its multidisciplinary approach relies on sports science and sports economics as well. There are several aspects of sustainability that are closely associated with health and health preservation; the beneficial effect of exercise on health is also widely known. For the analysis of this complex matter, our current study relied on secondary sources, and besides exploring specialist literature, it also illustrates and analyzes related statistical data. Our results highlight the correlations between living environment and physical activity, the importance of increasing individual commitment towards sustainability and using green spaces for exercising, as well as questions on social and environmental development in relation to physical activity. The study revealed the existence of highly complex links between physical environment, physical activities, and sustainability. The results section of our study provides a brief summary on the possible ways of making people physically active. Increasing physical activity is of paramount importance for achieving the objectives formulated in relation to sustainability.
... Increasingly larger studies have explored the relationship between physical exercise and individuals' mental health, and some have found that physical exercise does improve mental health [11][12][13][14][15][16][17][18][19][20]. For example, Netz et al. [17] determined that physical exercise has important beneficial effects on individuals' physical and mental health. ...
... Another study showed that physical exercise affects the processing of negative emotional information and promotes individuals' mental health [19]. Puett et al. [20] examined questionnaire data and clinical evaluations of men and women over the age of 20 and found that those who did not exercise had a significantly higher risk of poor mood and stress than those who engaged in regular physical exercise. ...
Article
Full-text available
Walking has a positive impact on people’s emotional health. However, in the case of serious air pollution, it is controversial whether walking exercise can still improve individuals’ emotional health. Using data from the 2014 wave of the China Labor-Force Dynamics Survey, this study explored the relationship between walking and emotional health with different levels of environmental pollution. The results indicated that respondents who took regular walks had better emotional health than those who did not walk regularly. For those whose main mode of physical exercise was walking, the average number of walks per week was significantly and positively correlated with their emotional health; however, the average duration of the walk had no significant impact on their emotional health. Moreover, for those whose main mode of physical exercise was walking and who lived in neighborhoods with a polluted environment, regular walking still had a positive impact on their emotional health. This suggests that even if environmental pollution is serious, walking still plays an important role in regulating individuals’ mental health. We propose that in order to promote the emotional health of residents, it is necessary to create more public spaces for outdoor activities and simultaneously increase efforts to control environmental pollution.
... Similarly, a review of experimental studies in adults suggested that additional mental health benefits are typically observed when physical activities are undertaken in an outdoor natural environment relative to indoors (Thompson Coon et al., 2011). Puett et al. (2014) found that adults reporting more outdoor exercise had a lower odds of reporting a poor emotional outlook (Puett et al., 2014). ...
... Similarly, a review of experimental studies in adults suggested that additional mental health benefits are typically observed when physical activities are undertaken in an outdoor natural environment relative to indoors (Thompson Coon et al., 2011). Puett et al. (2014) found that adults reporting more outdoor exercise had a lower odds of reporting a poor emotional outlook (Puett et al., 2014). ...
Article
Full-text available
Both spending time outdoors and participating in physical activity improve mental health. Given that the outdoor environment provides an ideal location for physical activity, better understanding of the relationships among time spent outdoors, physical activity and positive mental health is needed to help guide interventions. The aim was to examine if physical activity moderates or mediates the relationship between outdoor time and positive mental health. Two-hundred-forty-two participants (15 ± 1 years old, 59% girls) from New Brunswick, Canada were included in the current analysis. Youth self-reported time spent outdoors and moderate-to-vigorous physical activity (MVPA) three times between October 2016 and June 2017. Data on their mental health were collected in October 2017. Values of outdoor time and MVPA were averaged across the three time points to represent the exposure and mediator variables, respectively. Mental health, dichotomized as flourishing/not flourishing, was the outcome in the mediation analysis. An interaction term tested if the mediation effect depended on outdoor time. Analyses were undertaken in 2019 using the mediation package in R. In univariate analyses, both MVPA (p < 0.001) and outdoor time (p = 0.05) were positive predictors of flourishing mental health. In mediation analyses, a small indirect mediation (OR: 1.02, 95% CI: 1.01-1.04) and no direct (1.00, 0.98-1.05) effect were noted, suggesting that MVPA mediates the effect of outdoor time on positive mental health. This effect did not vary as a function of outdoor time (interaction: 1.00, 0.99-1.01). Physical activity mediates the relationship between outdoor time and positive mental health. Outdoor time could promote positive mental health among youth through increases in physical activity.
... Further, behaviour and attitudes towards natural environments has been found to differ between genders. Puett et al. (2014) found that men more likely to engage in physical activity outdoors, whereas Zelezny et al. (2000) report that women are more likely to engage in pro-environmental behaviours and may have greater sense of being connected to the natural environment (Hughes et al., 2019). As connection with nature is a possible pathway between nature and health (Cervinka et al., 2012), this finding might indicate that women may experience greater psychological benefits from green exercise than men. ...
Article
Full-text available
The impact of environmental context on the psychological benefits derived from physical activity has attracted research attention in recent years. Previous reviews have compared effects of indoor versus outdoor exercise. This review compares the effects of physical activity undertaken in outdoor green natural environments versus outdoor urban environments on psychological health outcomes in adult general populations. An electronic literature search identified 24 experimental studies meeting the inclusion criteria. Results were analysed via narrative synthesis (n = 24) and meta‐analysis (n = 9) of effect on six outcomes. Narrative synthesis found in favour of the natural environment for anxiety, anger/hostility, energy, affect and positive engagement. Post‐intervention effect sizes suggested duration and social context as potential moderators. The meta‐analyses revealed large or moderate effects in favour of the natural environment for anxiety, fatigue, positive affect and vigour, and a small effect for depression. Results were subject to high risk of bias and heterogeneity. Physical activity undertaken outdoors in natural environments is more beneficial for a range of psychological outcomes compared with urban environments. The various effect sizes evident in the meta‐analyses may be explained by differing mechanisms through which psychological gains are experienced during physical activity in nature.
... 42,43 Hence, collectively, East Village has a multitude of activity-permissive features, which could plausibly increase physical activity levels by encouraging time spent outdoors. 84,85 Differences in the built environment of East Village were evident by the substantial changes in objective GIS measures of the built environment (including increased walkability, access to public transport and parks) and the sizeable improvements in neighbourhood perceptions observed among residents, especially those from the social housing sector. This raises the question of why larger improvements in physical activity were not observed. ...
Article
Background Low physical activity is widespread and poses a serious public health challenge both globally and in the UK. The need to increase population levels of physical activity is recognised in current health policy recommendations. There is considerable interest in whether or not the built environment influences health behaviours, particularly physical activity levels, but longitudinal evidence is limited. Objectives The effect of moving into East Village (the former London 2012 Olympic and Paralympic Games Athletes’ Village, repurposed on active design principles) on the levels of physical activity and adiposity, as well as other health-related and well-being outcomes among adults, was examined. Design The Examining Neighbourhood Activities in Built Environments in London (ENABLE London) study was a longitudinal cohort study based on a natural experiment. Setting East Village, London, UK. Participants A cohort of 1278 adults (aged ≥ 16 years) and 219 children seeking to move into social, intermediate and market-rent East Village accommodation were recruited in 2013–15 and followed up after 2 years. Intervention The East Village neighbourhood, the former London 2012 Olympic and Paralympic Games Athletes’ Village, is a purpose-built, mixed-use residential development specifically designed to encourage healthy active living by improving walkability and access to public transport. Main outcome measure Change in objectively measured daily steps from baseline to follow-up. Methods Change in environmental exposures associated with physical activity was assessed using Geographic Information System-derived measures. Individual objective measures of physical activity using accelerometry, body mass index and bioelectrical impedance (per cent of fat mass) were obtained, as were perceptions of change in crime and quality of the built environment. We examined changes in levels of physical activity and adiposity using multilevel models adjusting for sex, age group, ethnic group, housing sector (fixed effects) and baseline household (random effect), comparing the change in those who moved to East Village (intervention group) with the change in those who did not move to East Village (control group). Effects of housing sector (i.e. social, intermediate/affordable, market-rent) as an effect modifier were also examined. Qualitative work was carried out to provide contextual information about the perceived effects of moving to East Village. Results A total of 877 adults (69%) were followed up after 2 years (mean 24 months, range 19–34 months, postponed from 1 year owing to the delayed opening of East Village), of whom 50% had moved to East Village; insufficient numbers of children moved to East Village to be considered further. In adults, moving to East Village was associated with only a small, non-significant, increase in mean daily steps (154 steps, 95% confidence interval –231 to 539 steps), more so in the intermediate sector (433 steps, 95% confidence interval –175 to 1042 steps) than in the social and market-rent sectors (although differences between housing sectors were not statistically significant), despite sizeable improvements in walkability, access to public transport and neighbourhood perceptions of crime and quality of the built environment. There were no appreciable effects on time spent in moderate to vigorous physical activity or sedentary time, body mass index or percentage fat mass, either overall or by housing sector. Qualitative findings indicated that, although participants enjoyed their new homes, certain design features might actually serve to reduce levels of activity. Conclusions Despite strong evidence of large positive changes in neighbourhood perceptions and walkability, there was only weak evidence that moving to East Village was associated with increased physical activity. There was no evidence of an effect on markers of adiposity. Hence, improving the physical activity environment on its own may not be sufficient to increase population physical activity or other health behaviours. Funding This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research ; Vol. 8, No. 12. See the NIHR Journals Library website for further project information. This research was also supported by project grants from the Medical Research Council National Prevention Research Initiative (MR/J000345/1).
... The present finding was partly in line with previous work trends suggesting that virtual exercise can reduce the level of stress perceived by users [64,65]. Furthermore, the stress reduction theory argues that environment can make a difference to stress levels [66]. Specifically, in the current study, the VN group obtained more benefits in terms of reduced stress than the VAP group when cycling in the virtual reality system. ...
Article
Full-text available
Virtual exercise therapy is considered a useful method by which to encourage patients with generalized anxiety disorder (GAD) to engage in aerobic exercise in order to reduce stress. This study was intended to explore the psychological and physiological responses of patients with GAD after cycling in a virtual environment containing natural images. Seventy-seven participants with GAD were recruited in the present study and randomly assigned to a virtual nature (VN) or a virtual abstract painting (VAP) group. Their electroencephalogram alpha activity, perceived stress, and levels of restorative quality and satisfaction were assessed at baseline and after an acute bout of 20 minutes of moderate-intensity aerobic exercise. The results showed that both the VN and VAP groups showed significantly higher alpha activity post-exercise as compared to pre-exercise. The VN group relative to the VAP group exhibited higher levels of stress-relief, restorative quality, and personal satisfaction. These findings imply that a virtual exercise environment is an effective way to induce a relaxing effect in patients with GAD. However, they exhibited more positive psychological responses when exercising in such an environment with natural landscapes.
Article
Currently, the world has a population nearing eight billion people, with projections for nearly 10 billion by 2050. Many questions and concerns persist regarding how we will manage limited resources and take care of humanity, all while not further degrading the natural environment. In 2015, world leaders came together at the United Nations General Assembly and reached agreement on 17 Sustainable Development Goals (SDGs) for moving forward on tackling the complex challenges facing the world. Each of the lofty goals has a focus on improving the health and wellbeing of citizens around the world, while pursuing a more equitable distribution of resources to include: ending poverty in all forms; eliminating hunger and food insecurity through sustainable agricultural practices; reducing social inequities (education, gender, racial, occupational, etc.); and addressing environmental concerns (land, water, consumption/production) associated with climate change, among others. Each of these 17 SDGs have direct impacts with western North Carolina and the Appalachia region as a whole and provide direction moving forward. In this paper, I examine what the terms ‘sustainable’ and ‘health’ mean for the 21st century, the numerous connections between sustainability and human health, and the short-term and long-term challenges facing western North Carolina and the Appalachia region, which are intricately connected to sustainability and health. Lastly, I present principles and approaches from the fields of sustainable development, community development, and public health, which are grounded in the SDGs, that communities should seek to utilize in moving forward in the 21st century.
Article
Full-text available
This study involved four parks in Iran—two modern ones located in Tehran and two historical, traditional examples, one in Kashan and one in Esfahan—in order to ask what are the key factors contributing to the satisfaction of visitors to the two types of park and also to compare user’s perceptions and values of the different types. An extensive questionnaire survey was conducted in each park, with a target of 300 responses, using a random sampling technique. Respondents were asked to rate the importance of a number of factors, while thinking about the park they were visiting, using a 5-point Likert scale. Descriptive and inferential statistical analysis was undertaken. The results of the scores revealed differences between the two types of park. A factor analysis of the pooled results revealed that the key aspects contributing to a visit were named as ‘having fun and enjoying oneself’, in a place with ‘no barriers to using the park’ and ‘leaving one’s cares behind’ followed by ‘relaxing in the presence of natural beauty’. A further Nonmetric Multidimensional Scaling analysis was undertaken to determine the main factors affecting the differences in preference for each type of park in relation to the key demographic variables. This revealed that the modern parks were preferred over the traditional ones for three significant sets of factors—recreation, accessibility and culture—and that there was a tendency for the historical parks to been favoured by more educated people. The conclusions are that the modern parks support the main preferred activities to support the quality of life of the population—not through their design per se but because they offer many more recreational opportunities. There is potential to include traditional elements such as water features more into parks. Park planners can take the findings and use them to help improve the quality of the parks over time.
Article
Full-text available
Background Exercise has been shown to decrease breast cancer risk and slow the progression of breast cancer. Physician recommendations and clinical research data most often are for gym-based exercise programs. However, the importance of exercise location on mood and stress hormones that may influence adherence to exercise has not been addressed. Methods Women first walked for an hour outdoors along a university path and then a week later, for an hour indoors on a treadmill in a typical gym environment. Pre and post outdoor and indoor exercise moods (happy, pleased, sad, frustrated, worried, angry, delighted, and joy) were assessed by a 6 point Likert questionnaire, and saliva samples were collected for analysis of cortisol, and alpha amylase (a surrogate for serum norepinephrine). Results Nineteen healthy, non-smoking, postmenopausal women (average age 58 ± 4) participated. Compared with scores after walking outdoors, walking indoors was associated with higher scores of worry (p = 0.02; mean difference 0.9; 95% CI (0.17, 1.6) and frustration (p = 0.03; mean difference 0.9; 95% CI (0.12, 1.6), and lower scores for feelings of being pleased (p = 0.03; mean difference -0.8; 95% CI: -1.7, 0.1) and delighted (p = 0.05; mean difference -0.9; 95% CI: -1.75, -0.02). Changes in salivary hormone levels did not vary significantly between the two environments. Conclusion Walking outdoors was associated with improved mood, but walking indoors was not. Improved mood may reduce breast cancer risk indirectly by promoting regular exercise. Physician recommendations for exercise should include gym and non-gym based exercise options.
Article
Full-text available
Stress can facilitate disease processes and causes strain on the health care budgets. It is responsible or involved in many human ailments of our time, such as cardiovascular illnesses, particularly related to the psychosocial stressors of daily life, including work. Besides pharmacological or clinical medical treatment options, behavioral stress reduction is much-needed. These latter approaches rely on an endogenous healing potential via life-style modification. Hence, research has suggested different ways and approaches to self-treat stress or buffer against stressors and their impacts. These self-care-centred approaches are sometimes referred to as mind-body medicine or multi-factorial stress management strategies. They consist of various cognitive behavioral techniques, as well as relaxation exercises and nutritional counselling. However, a critical and consistent element of modern effective stress reduction strategies are exercise practices. With regard to underlying neurobiological mechanisms of stress relief, reward and motivation circuitries that are imbedded in the limbic regions of the brain are responsible for the autoregulatory and endogenous processing of stress. Exercise techniques clearly have an impact upon these systems. Thereby, physical activities have a potential to increase mood, i.e., decrease psychological distress by pleasure induction. For doing so, neurobiological signalling molecules such as endogenous morphine and coupled nitric oxide pathways get activated and finely tuned. Evolutionarily, the various activities and autoregulatory pathways are linked together, which can also be demonstrated by the fact that dopamine is endogenously converted into morphine which itself leads to enhanced nitric oxide release by activation of constitutive nitric oxide synthase enzymes. These molecules and mechanisms are clearly stress-reducing.
Article
Full-text available
This article examines four domains of variables to assess their relative merit in explaining environmental preference. Within each of the domains, between three and seven specific attributes were measured, for a total of 20 predictor variables. The study site includes small forested areas, agricultural land, and fields, with little topographic variation. Preference ratings of 59 scenes representing the area serve as the dependent variable. Taken together, the 20 attributes accounted for 83 percent of the preference variance. Taken separately, the Physical Attributes lacked predictive power. Of the Informational variables, Mystery was the only significant contributor. The Land Cover types proved effective, with Weedy Fields, Scrubland, and Agriculture all significant negative predictors. Finally, the Perception-based variables were most powerful, with Openness and Smoothness particularly useful predictors. The results point to the importance of using different predictor domains, rather than relying exclusively on any one, since their role in different environmental contexts is likely to vary.
Article
Full-text available
Depending on what is in the view, looking out the window may provide numerous opportunities for restoration. Unlike other restorative opportunities, however, window viewing is more frequent and for brief moments at a time. The setting is also experienced from afar rather than while being in it. A study conducted at six low-rise apartment communities, using a survey with both verbal and visual material, provides considerable support for the premise that having natural elements or settings in the view from the window contributes substantially to residents’ satisfaction with their neighborhood and with diverse aspects of their sense of well-being. Views of built elements, by contrast, affected satisfaction but not well-being. Views of the sky and weather did not have a substantial effect on either outcome. The potential of nature content in the view from home to contribute so significantly to satisfaction and well-being suggests clear action mandates.
Article
Interventions that reduce the magnitude of psychobiological responses are justified, at least in part, by the notion that exaggerated responses to stress can have detrimental effects on health. The biological processes underlying the association between stress and coronary heart disease (CHD) are thought to involve haemodynamic, neuroendocrine, inflammatory and haemostatic pathways. One of the many recognised benefits of exercise is in buffering physiological responses to psychosocial stressors, which is thought to be partly mediated by sympatho-inhibitory mechanisms, although other potentially important psychobiological processes such as inflammatory, neuroendocrine and haemostatic pathways have gained little attention. Thus, the present review focuses on the role of exercise in buffering psychobiological processes, particularly in relation to pathways that are directly relevant for reducing CHD risk. There are inconsistencies in the literature regarding the effects of exercise on cardiovascular responses to stressors, which may in part be accounted for by differences in experimental design, characteristics of participants, inadequate assessment of physical fitness, and the confounding effects of acute exercise. However, new emerging evidence suggests that exercise promotes an anti-inflammatory environment and increases tissue sensitivity to glucocorticoids, which may have implications for the effects of exercise on stress-induced inflammatory pathways. Future work should focus on the efficacy of exercise for promoting anti-inflammatory pathways in relation to psychosocial stress.
Article
We measured physical fitness, assessed by maximal treadmill testing in 4,820 men and 1,219 women aged 20 to 65 years. Participants had no history of cardiovascular disease and were normotensive at baseline. We followed up these persons for one to 12 years (median, four years) for the development of hypertension. Multiple logistic risk analysis was used to estimate the independent contribution of physical fitness to risk of becoming hypertensive. After adjustment for sex, age, follow-up interval, baseline blood pressure, and baseline body-mass index, persons with low levels of physical fitness (72% of the group) had a relative risk of 1.52 for the development of hypertension when compared with highly fit persons. Risk of hypertension developing also increased substantially with increased baseline blood pressure. (JAMA 1984;252:487-490)
Article
Physical activity may play an important role in the management of mild-to-moderate mental health diseases, especially depression and anxiety. Although people with depression tend to be less physically active than non-depressed individuals, increased aerobic exercise or strength training has been shown to reduce depressive symptoms significantly. However, habitual physical activity has not been shown to prevent the onset of depression. Anxiety symptoms and panic disorder also improve with regular exercise, and beneficial effects appear to equal meditation or relaxation. In general, acute anxiety responds better to exercise than chronic anxiety. Studies of older adults and adolescents with depression or anxiety have been limited, but physical activity appears beneficial to these populations as well. Excessive physical activity may lead to overtraining and generate psychological symptoms that mimic depression. Several differing psychological and physiological mechanisms have been proposed to explain the effect of physical activity on mental health disorders. Well controlled studies are needed to clarify the mental health benefits of exercise among various populations and to address directly processes underlying the benefits of exercise on mental health.
Article
This paper traces evidence of the influence of the landscape on people's health, from ancient times to the present day, noting how access to nature and attractive green spaces has been a recurring theme in descriptions of therapeutic environments and associated healthy lifestyles. It describes how the theme of health in the picturesque debates of eighteenth century England (including such concepts as ‘active curiosity’) was taken up and developed in arguments for the nineteenth century urban park movement in England and North America. Recent theories on the mechanisms behind health benefits of nature and access to landscape are compared with claims made in the nineteenth century and earlier. The importance of access to the landscape appears to be as relevant as ever in the context of modern urban lifestyles but the need for better evidence and understanding remains.
Article
A meta-analysis was conducted on 40 studies (76 effects) in order to examine exercise training as a method of stress-management treatment for adults. It offered evidence of a low-to-moderate positive effect in anxiety reduction. Exercise training studies that examined change from pre to post-treatment and studies that examined both change over time and between group differences were examined separately. The unbiased weighted average effect sizes were .45 and .36, respectively. Thus, exercise training improved anxiety levels an average of .36 standard deviations over alternative or control conditions. Adults who were more likely to have a stressful lifestyle benefited more from the exercise training than those who did not. Recommendations are made for both practice and research.