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8
Green Exercise, Health and Well-Being
Ana Loureiro and Susana Veloso
8.1 Physical Activity, Health
and Well-Being
The evolutionary perspective of physical activity,
fitness and health states that human anatomy and
physiology have remained relatively unchanged
over the past 40,000 years (Astrand 1994). In this
sense, the relationship between energy intake,
energy expended and physical activity required
has essentially persisted the same since the Stone
Age (Spence and Lee 2003). For prehistoric man,
who depended on hunting, fishing and exploita-
tion of wild resources to survive, physical activity
played a major role in his daily life. In fact,
we are now living our lives in totally differ-
ent ways from what we have done as humans
for more than 99 % of our existence (Biddle
and Mutrie 2008). Since the industrial revolu-
tion, people have reduced their physical activity,
reaching this huge contradiction: a human body
biologically prepared for high levels of energy
expenditure left at the mercy of modernization
A. Loureiro ()
School of Psychology and Life Sciences, Lusófona
University, Lisbon, Portugal
COPELABS, Lusófona University, Lisbon, Portugal
e-mail: ana.loureiro@ulusofona.pt
S. Veloso
Faculty of Physical Education and Sport, Lusófona
University, Lisbon, Portugal
e-mail: veloso.susana@gmail.com
with an increasingly sedentary lifestyle (Spence
and Lee 2003). Motorized transport, all kinds of
work done by machines (that was once manual
work), modern forms of entertainment such as
television, movies, videos, and computers, have
all brought humans to the point of living every
day in an almost fully sedentary way. In fact,
most people preferably perform mental and non-
physical work (Sallis and Owen 1999).
Epidemiologic studies, like the Eurobarometer
survey, report that 41 % of EU citizens exercise or
play sport at least once a week, while a significant
proportion of them (59 %) never or seldom do
so (European Commission 2014). At least once
a week, 48 % do some form of other physical
activity (such as cycling, dancing or gardening),
while 30 % never do this kind of activity at all.
Adults spend 50–60 % of their day in sedentary
pursuits. Gender differences are favorable for
men, who engage in more physical activity than
women. However, this is more evident in the
younger group (15–24 years old) where boys tend
to exercise on a regular basis (74 %) more than
girls (55 %). Physical activity tends to decrease
with age, reaching about 70 % in people over
55 years old. In general, citizens in the North-
ern part of Europe (e.g. Sweden, Denmark, and
Finland) are more active than in the Southern
member states (e.g. Bulgaria, Malta, Portugal,
and Italy) (European Commission 2014). These
decreasing trends in physical activity are reflected
in changing bodies, contributing to the growing
© Springer International Publishing Switzerland 2017
G. Fleury-Bahi et al. (eds.), Handbook of Environmental Psychology and Quality of Life Research,
International Handbooks of Quality-of-Life, DOI 10.1007/978-3-319-31416-7_8
149
150 A. Loureiro and S. Veloso
epidemic of obesity in the world. Although the
USA is the leader in obesity levels, its worldwide
prevalence nearly doubled between 1980 and
2008. According to World Health Organization
estimates for 2008, over 50 % of both men and
women in the European region were overweight,
and roughly 23 % of women and 20 % of men
were obese (http://www.euro.who.int/en/health-
topics/ noncommunicable-diseases/obesity/data-
and-statistics).
This sedentary lifestyle results in a large cost
to health, while reducing the quality and quan-
tity of life. Country-specific estimates of eco-
nomic costs attributable to physical inactivity
range from 1.2 % to 2.5 % of annual health care
expenditure. The longest sedentary time com-
pared with the shortest was associated with a
49 % increase in the risk of all-cause mortality
(Katzmarzyk 2011). In fact, the project Designed
to Move is based on the current evidence that
“today’s children are the first generation to have
a shorter life expectancy than their parents” (de-
signedtomove.org). This is an action-project that
gives urgent priority to increasing the world’s
commitment to physical activity. Solutions must
be put into practice, and the change-makers must
know “what” needs to be done and “how” to do it.
In 1985, Caspersen and colleagues defined
physical activity as any bodily movement pro-
duced by the contraction of skeletal muscles that
results in a substantial increase in caloric require-
ments over resting energy expenditure (Ameri-
can College of Sport Medicine – ACSM 2013).
Aiming to clarify the concept of physical activity
further, it is useful to distinguish other constructs
such as physical exercise and sports, which are
not synonymous. Exercise is a subgroup of phys-
ical activity, defined as planned, structured, and
repetitive bodily movements done to improve
and/or maintain one or more components of phys-
ical fitness. This leads to the concept of physical
fitness, which is defined as a set of attributes or
characteristics that individuals have or achieve
that relates to their ability to perform physical
activity. These characteristics are usually sepa-
rated into health-related (e.g. cardiorespiratory
endurance, muscular strength, flexibility, body
composition) and skill-related (e.g. agility, coor-
dination, balance, speed) components of physical
fitness (ACSM 2013). Sport is an even more
specific structured form of physical activity; com-
petitive, and characterized by achievement, luck
and strategy (Kaplan et al. 1993).
In addition to defining physical activity and
exercise, it is important to define clearly the
wide range of intensities that help distinguish
between active and sedentary individuals, as each
can cause different health outcomes. However,
measuring the physical activity required for a
healthy quality of life is a difficult and complex
task. Physical activity can take a huge variety of
forms: it can be accomplished in formal and in-
formal contexts, including the most routine tasks
of everyday life (walking, housekeeping activi-
ties, gardening); it may be practiced in intense,
moderate or light forms; for very short periods
(a few seconds or minutes) or extended periods
(hours); with a high or low frequency, regular or
irregular; and alone, in a group or accompanied
by someone (Kaplan et al. 1993).
The relationship between health and physical
activity has been the subject of research for more
than 25 years, and many national health services
(e.g. American College of Sport Medicine and
Center for Disease Control and Prevention in the
US, National Health Service in the UK, World
Health Organization) have established guidelines
to clarify for people and professionals (of public
health, health/fitness, clinical exercise, and health
care) the amount and intensity of physical activity
needed to improve health, lower susceptibility
to disease (morbidity), and decrease premature
mortality.
The global recommendations of physical ac-
tivity for health resumed by the World Health Or-
ganization (World Health Organization – WHO
2010) for adults aged 18–64 are: (1) at least
150 min of moderate-intensity aerobic physical
activity throughout the week or at least 75 min
of vigorous-intensity aerobic physical activity
throughout the week or an equivalent combina-
tion of moderate-vigorous intensity activity; (2)
aerobic activity should be performed in bouts of
at least 10 min duration; (3) for additional health
benefits, adults should increase their moderate-
intensity aerobic physical activity to 300 min per
week, or engage in 150 min of vigorous-intensity
physical activity per week, or an equivalent com-
8 Green Exercise, Health and Well-Being 151
bination of moderate-and-vigorous intensity ac-
tivity; (4) muscle-strengthening activities should
be done involving major muscle groups on 2
or more days a week. Unless specific medical
conditions indicate the contrary, these guidelines
are relevant to all healthy adults and could be ap-
plied in leisure time or transportation (e.g. walk-
ing or cycling), in occupational time (i.e. work,
gardening), in household chores, play, games,
sports or planned exercise, in the context of daily,
family and community activities (WHO 2010). In
addition, the last US physical activity guidelines
in 2008 made age-specific recommendations tar-
geted at older adults (>65 years), children and
adolescents (6–17 years), and younger children
(<6 years) (U.S. Department of Health and Hu-
man Services 2008).
These physical activity guidelines have re-
cently been complemented by a new paradigm
of sedentary behavior. Physical and sedentary
activities are not viewed as opposite behaviors,
but as different constructs with independent ef-
fects on the health and disease process (Yates
et al. 2011b). Epidemiological studies show this
independent effect, since a strong association was
found between TV viewing time and the risk of
type two diabetes and independently of physical
activity (Hu et al. 2003). Sedentary behavior,
defined as an MET of 1.5 or less (metabolic
equivalent units of energy cost of resting quietly),
corresponds to activities undertaken while lying
or sitting, such as watching TV and other forms
of screen time. Thus, any standing activity (unless
absolutely still) is classified as non-sedentary
(Yates et al. 2011a). This may be an opportunity
for new recommendations based on simply sit-
ting less and standing more, which are expected
to revolutionize health promotion (Yates et al.
2011b). In the recent ACMS guidelines (ACSM
2013), the complementary advice “long periods
of sitting should be avoided” is already included.
Physical inactivity or a sedentary lifestyle is
the greatest risk factor for the most common
causes of death (e.g., being inactive doubles the
risk of cardiovascular disease), meriting the same
level of concern as tobacco consumption, choles-
terol and obesity. In turn, participation in regular
physical activity increases life expectancy, pre-
vents diseases, and has multiple beneficial effects
on many body systems (Sallis and Owen 1999;
ACSM 2013).
There is a large body of research about the
benefits of physical activity and exercise. The
immune and nervous systems and many parts of
the body (heart, skeletal muscles, bones, blood)
can reduce risk factors for non-communicable
diseases (NCDs – often referred to as chronic
diseases) (C3 Collaborating for Health 2011).
This is important because these major NCDs
account for 68 % of the 56 million deaths an-
nually, a number that is expected to increase
from 38 million in 2012 to 52 million by 2030
(WHO 2014). Some of the risk factors are blood
pressure, cholesterol level, and body mass index
(BMI), which influence chronic diseases such as
type two diabetes, heart disease and many can-
cers. When regular physical activity is performed
in youth, the benefits are, on one hand, reduced
levels of adiposity, blood pressure and lipids,
cardiovascular risk factors, injury, and mental
health concerns like depression and, on the other
hand, increased strength, fitness and bone health
(Janssen and LeBlanc 2010).
The mental benefits of physical activity are
less well documented than the physical effects.
However, many studies and clinical trials have
shown specific benefits, including improving
mood, reducing symptoms of stress, anger and
depression, alleviating anxiety and slowing
cognitive decline (Babyak et al. 2000). A review
of the research literature on the role of physical
activity in a wide range of parameters of well-
being, such as anxiety, depression, mood and
affect, health-related quality of life, cognitive
function, and self-esteem, concluded that there
is a remarkable consistency in the evidence
for a positive association between exercise
and well-being; however, the quality of the
evidence, for the most part, is not optimal
(Ekkekasis and Backhouse 2009). Specific
studies support exercise as a first-line treatment
for mild to moderate depression, compared to
antidepressant medication, and also to improve
depressive symptoms when used as an adjunct
to medication (Carek et al. 2011). However,
for major depression disorders, of mild-to-
152 A. Loureiro and S. Veloso
moderate severity, only aerobic exercise at a dose
consistent with public health recommendations is
an effective treatment; a lower dose is comparable
to a placebo effect (Dunn et al. 2005). Although
not as extensively studied as depression, exercise
has been shown to be an effective and cost-
efficient alternative treatment for a variety of
anxiety disorders (Carek et al. 2011).
Research on exercise and well-being
frequently discusses the paradox – “If exercise
makes most people feel better, why are most
people physically inactive or inadequately
active?” Backhouse and colleagues suggest
that this might be an artifact because research
over the past three decades has established
that exercise can make people “feel better”
(e.g., during walking, during more vigorous
exercise among certain participants, and during
recovery from vigorous exercise among nearly
all participants), but has tended to discount, or
not measure, the negative effects of exercise.
These authors highlighted the importance
of examining the complex exercise–affect
relationship and considering whether diverse
affective responses could account for part of
the variability in physical activity behavior and
adherence (Backhouse et al. 2007).
The Self-Determination Theory (SDT),
founded by Deci and Ryan in 1985, has
proved useful in explaining the antecedents and
processes that underpin exercise behavior and
adherence (Deci and Ryan 1985; Ryan and Deci
2000; Hagger and Chatzisarantis 2008; Ryan et
al. 2009). The aim of Exercise Psychology is
to explain why people adopt physically active
versus inactive lifestyles. The psychological
SDT proposes that all humans possess three
basic psychological needs: autonomy, which
reflects a desire to engage in activities of one’s
choosing; competence, which implies a desire
to interact effectively with the environment; and
relatedness, which involves feeling connected
to others or feeling that one belongs in a
given social environment (Edmunds et al.
2009). When these psychological needs are
satisfied, more autonomous forms of regulation
guide behavior (e.g., intrinsic motivation and
motivations guided by values) and adaptive
exercise outcomes are expected (e.g., exercise
adherence and enjoyment). In contrast, thwarted
needs and more controlling forms of regulation
(e.g., external and introjected) are expected to
result in non-optimal outcomes (e.g., dropout
and dissatisfaction). To resume, SDT suggests
that the psychological needs and the type of
motivation guiding behavior determine what kind
of exercise-related outcome will occur (Ryan and
Deci 2000; Edmunds et al. 2009; Veloso et al.
2012).
Although SDT has recently provided greater
understanding of physical activity adherence
and how to motivate people to adopt an
active lifestyle, the research about physical
activity correlates has increased scientific
knowledge for decades. The factors associated
with children’s and adolescents’ physical
activity, reviewed by Biddle and colleagues,
could be demographic/biological, psychological,
behavioral, social or environmental (Biddle et
al. 2011). Age and gender are the demographic
factors (boys and younger children/adolescents
have greater levels of physical activity). The
positive psychological correlates of physical
activity are positive body image, good intentions,
feelings of competence and confidence, and a
motivational style centered on effort and self-
improvement, while a negative factor is the
presence of barriers to physical activity. Previous
practice and sport participation are the positive
behavioral correlates of physical activity, with
smoking and sedentary behavior the negative
ones. The social/cultural correlates of physical
activity are parental influence and social support.
Finally, supportive environments are associated
with greater physical activity, such as access to
facilities, a minor distance from home to school,
more time spent outside, and less local crime
(Biddle et al. 2011).
For adults, the social correlates with phys-
ical activity associated with more practice are
high levels of education and socioeconomic sta-
tus. Overweight and obesity are inversely cor-
related with physical activity, but a healthy diet
is directly associated. The positive psycholog-
ical correlates are enjoyment, expected bene-
fits, intention, perceived health, self-motivation,
8 Green Exercise, Health and Well-Being 153
self-efficacy, a high stage of behavior change,
and self-schemata for exercise, while the nega-
tive correlates are mood disturbance and barri-
ers (Biddle and Gorely 2012). There is strong
evidence for self-efficacy and enjoyment. It is
important to relate the evidence of enjoyment
to intrinsic motivation as SDT has demonstrated
(Ryan and Deci 2000; Edmunds et al. 2009). The
environmental correlates with physical activity
are access to facilities, an environment with en-
joyable scenery and neighborhood safety (Biddle
and Gorely 2012).
Research about correlates of physical activity
in older adults is understudied (Biddle and Gorely
2012). A review of studies, including mostly
healthy volunteers, who probably do not express
the physical activity correlates of those living
with chronic illness or disabilities, showed evi-
dence for initiation and maintenance of physical
activity (Van Stralen et al. 2009). Physical health
status, exercise habits and physical activity at the
baseline level are behavioral positive correlates;
self-efficacy, intention, action planning, motiva-
tional readiness to change, outcome expectations,
and perceived benefits are the psychological ones.
The physical environmental correlates are per-
ceived access, safety from crime, and program
format (home). The social correlates of social
support from significant others and social norms
have the least evidence (Van Stralen et al. 2009).
Given the great impact that physical
inactivity has on people’s health and national
economies, the problem could be seen as
social rather than just individual. The WHO,
in its global strategy for diet and physical
activity promotion, recognized this fact (WHO
2010). This is consistent with the ecological
approach, which demands population-based,
multi-sectorial, multi-disciplinary, and culturally
relevant strategies (Biddle and Mutrie 2008).
In fact, living in cities with more cars, greater
urbanization, and lack of play spaces contributes
to decreasing physical activity. On the other
hand, more structured activity facilities, like new
paths for walking or cycling, more pedestrian
zones in urban areas and parks for playing or
walking the dog, could all contribute to increased
physical activity. In this context, the concept
of green exercise becomes relevant, due to the
growing interest in the physical environment
and its influence on involvement in physical
activity.
The environmental context, including access
to active opportunities, the weather, perceived
safety and aesthetics of place, has the potential
to influence activity levels and this could interact
with psychosocial variables in determining physi-
cal activity adherence and promotion (Biddle and
Mutrie 2008). Research on environmental and
exercise psychology could be integrated to pro-
vide evidence for policy-making and the design
of relevant environmental changes.
8.2 Contact with Nature, Health
and Well-Being
Throughout human history, nature has always
been of great importance to the lives of indi-
viduals. Becoming innate, this bond, connection
and tendency to affiliate with and focus on the
natural environment are the main claims of the
biophilia hypothesis proposed by Wilson (1984).
Even today, when people live further away from
other living species, there is a wide recognition
of the need to be close to nature and of its
benefits, namely those related to physical and
mental health (Gullone 2000).
One of the most common reasons why indi-
viduals search for and, in many circumstances,
prefer natural environments is the resulting im-
provements in health state and well-being. Want-
ing to escape from routine and the pressure of
daily stress, or to experience calm and stimulation
are some of the psychosocial benefits that moti-
vate people to seek natural places (Home et al.
2012; Loureiro 1999). Feelings of being away,
relaxation, or reduced negative mood are also
mentioned as contributing to the choice of green
and natural settings as people’s favorite places,
and their preference for natural rather than urban
places (Hartig and Staats 2006; Korpela 2003;
Korpela et al. 2001).
It is expected that by 2050, the great ma-
jority of the world’s population or even almost
the whole population (if developed regions are
154 A. Loureiro and S. Veloso
considered) will live in urbanized areas (UN-
Habitat 2011). Our current age is characterized
by a growing urbanizing world, where humans
live mainly in urban and closed environments
and have fewer opportunities to access natural
settings. Given the significance of natural experi-
ences for people’s lives, an increase in occasions
to experience nature or natural elements could
be crucial for health status and quality of life
(Frumkin 2001; Hartig et al. 2010; Maas et al.
2006; Van den Berg et al. 2007). According to
the observed pervasiveness of the psychological
and physical benefits of contact with nature, re-
searchers promote the enhancement of human
health that can be reached by increasing access
to natural settings (Morris 2003).
Environmental psychologists, adopting differ-
ent theoretical and empirical approaches, have
focused on the outcomes for people of their
experiences of contact with nature (Hartig et al.
1991; Kaplan 1995; Kaplan and Kaplan 1989;
Ryan et al. 2010; Ulrich 1984). These studies
have demonstrated several health and well-being
outcomes from different types of experiences,
such as walking in an urban park, trekking or
camping in a national park, looking through a
window, or contemplating a coastal landscape.
Natural experiences in different contexts and at
different levels foster positive emotions, better
attention focus, vitality, and reduced signals of
physiological arousal (for reviews, see Hartig
et al. 2010,2014).
On one hand, the effects of nature experi-
ences on health and well-being promotion are
described as due to the restorative characteristics
of these environments. These theories empha-
size the restoration of some affected capabilities,
such as cognitive ability to focus attention or a
stress mood recovery (Kaplan and Kaplan 1989;
Ulrich et al. 1991).
On the other hand, other approaches present
different physical and psychological results of
nature-based experiences, which do not necessar-
ily follow a previous state of some compromised
capacities and without stressing this aspect. In-
stead, they focus on the enhancement of positive
states (Marrero and Carballeira 2010; Ryan et al.
2010).
Focusing on the restorative components of
natural environments, Kaplan and Kaplan devel-
oped the attention restoration theory, suggesting
that natural environments allow human beings to
refresh and restore their cognitive function from
fatigue derived from the need to direct attention
to environmental stimuli (Kaplan and Kaplan
1989; Kaplan 1995). According to this theory, the
psychological costs of information management
or mental fatigue stem from a limited ability
to direct and focus attention, which can be re-
covered in certain environments, such as those
that provide an opportunity to be away from the
place that causes fatigue, fascination, and com-
patibility between environmental characteristics
and motivations of individuals. Each individual
has his/her restorative environments, which may
be a playground, a trip to the countryside or
waterside, an urban square or a cultural place
(Adevi and Grahn 2011; Ashbullby et al. 2013;
Collado et al. 2013; Grahn and Stigsdotter 2010;
Korpela et al. 2010; Packer and Bond 2010).
Settings that provide contact with nature cor-
respond to very good opportunities to restore psy-
chological functioning, namely in its cognitive
aspects, due to their particular features. Taking
a few minutes to walk in a garden, listen to
the motion of the leaves, look at the clouds,
and stroll slowly along a pathway might be an
important action to recover cognitive function-
ing and psychological well-being (Kaplan 1995).
This power of nature also explains why people
generally prefer natural environments to urban
ones. It occurs when the balance between the
setting’s characteristics is perceived to provide
individuals with the ability to process information
and in which this process is effective (Kaplan and
Kaplan 1989).
Individuals rate their preference for natural
settings according to the setting’s ability to give
them the opportunity to experience more positive
emotions, less stress, and emotional regulation
(Korpela et al. 2001). The psycho-physiological
evolutionary stress recovery theory argues that
health benefits derived from contact with na-
ture occur because experiencing natural scenes
initiates the physiological and psychological re-
sponses that support recovery from stress (Ulrich
8 Green Exercise, Health and Well-Being 155
1984; Ulrich et al. 1991). Negative emotions
and physiological arousal may be decreased after
viewing, being exposed to or moving in natu-
ral contexts because these environments promote
physiological recovery and relaxation from situ-
ations that threaten well-being. Within a natural
environment, an individual’s negative affect is
replaced by a positive affect, negative thoughts
are inhibited and autonomic arousal decreases.
These theoretical approaches have been the
background for several studies that aim to demon-
strate the links between exposure to natural set-
tings and the positive outcomes related to recov-
ery from mental fatigue or from stressful events
(Berto 2014; Hartig et al. 2014). The evidence
comes from studying different types of virtual or
real environments, and the use of several mea-
sures such as self-reported measures of mood and
stress, attention tests and physiological indicators
of stress.
Laboratory experiments using exposure to vir-
tual images and environments have provided ev-
idence for the benefits of natural virtual envi-
ronments on the reported mood or performance,
attentional tasks, or physiological measures such
as salivary cortisol, skin conductance, pupillom-
etry, eye-tracking and heart rate (e.g. Alvarsson
et al. 2010; Brown et al. 2013; Depledge et al.
2011; Haluza et al. 2014; Hartig et al. 2003;
Kort et al. 2006). Data on the subject also comes
from studies investigating the benefits of expo-
sure to real natural environments, which found
a decline in blood pressure and salivary cortisol,
better performance in attentional tasks, positive
mood and emotion reports, lower self-reported
stress, a sense of well-being, or school course
ratings as significant outcomes of experiencing
window views of natural settings in residential or
clinical locations, nature near to public housing
and residential places, or walks in natural areas
(e.g. Beil and Hanes 2013; Benfield et al. 2015;
Kaplan 2001; Kuo and Sullivan 2001; Raanaas
et al. 2011; Roe et al. 2013; Taylor et al. 2001).
Following the research on restorative envi-
ronments, some studies have sought to identify
the features of natural environments, as well
the quantity of natural elements, which could
elicit the positive outcomes related to exposure
to nature. The number of trees, percentage of
grass covering the ground surface area, the pos-
sibility of seeing bushes, the setting size, the
presence of flowers and plants, and water features
predicted the likelihood of restoration identified
by individuals (Nordh et al. 2009; Nordh and
Ostby 2013). Individuals rate places that have
more natural features as more restorative (Carrus
et al. 2013) while viewing spreading trees is
associated with positive emotions and happiness
(Lohr and Pearson-Mims 2006). In a recent study,
researchers found a reverse U curve for stress
reduction related to exposure to medium-density
tree canopy (Jiang et al. 2014). However, more
research is needed to continue to identify the
specific settings and their key characteristics that
explain the benefits in relation to restoration and
well-being (Joye and Van den Berg 2011; Velarde
et al. 2007).
Previously, an association was found between
several experiences with nature and their physical
and physiological signs of short-term benefits for
individuals’ well-being. These benefits included
a better recovery after surgery, lower blood pres-
sure, lower heart rate, lower electrodermal ac-
tivity, or changes in electromyographic (EMG)
activity (e.g. Hartig et al. 2003; Laumann et al.
2003; Lohr and Pearson-Mims 2006; Parsons
et al. 1998; Ulrich 1984; Ulrich et al. 1991).
More recently, some studies have suggested
that natural spaces are vital to health and well-
being, whether it is a personal garden, the pres-
ence of trees on the street, a state forest or an ur-
ban park. This is something that people recognize
as they perceive themselves as being healthier
when they are more exposed to environments that
have more natural and green elements. In fact,
there is a correlation between the number of natu-
ral features in an individual’s living environment
and the level of general health perceived by these
individuals (Maas et al. 2006).
A direct relationship between the existence
of natural elements, such as trees, in the en-
vironment where people live and the level of
human health is receiving increased attention and
support from research evidence and epidemio-
156 A. Loureiro and S. Veloso
logical data (Donovan et al. 2013; Hartig et al.
2014; Takano et al. 2002). Despite the need for
more evidence on the effects of natural spaces on
health and well-being, namely urban green spaces
(Lee and Maheswaran 2011; Richardson et al.
2012), the idea of instorative besides restorative
effects of the natural environment is receiving
growing attention (Joye and Van den Berg 2012).
If the deviation from nature has negative health
effects, then the change in current patterns of re-
lationships with nature may contribute to greater
human vitality and health (Stilgoe 2001).
Being in a natural setting has vitalizing effects,
promoting an energized and positively toned state
(Plante et al. 2006; Ryan et al. 2010). Outdoor
green environments are more revitalizing, more
stimulating, and decrease tiredness, particularly
when people are performing some kind of ac-
tivity. On the other hand, viewing virtual nat-
ural environments may contribute to relaxation
and less tension, even when people are exercis-
ing (Plante et al. 2006). This positive impact
of natural experiences on subjective vitality was
observed in a group of studies using different
methodologies, and supports the idea that contact
with nature is a way of promoting well-being
and physical health, namely by increasing lev-
els of subjective vitality (Ryan and Deci 2008;
Ryan et al. 2010). This is evidence for the link
between natural experiences and subjective well-
being. General satisfaction with life and specific
satisfaction with sentimental life and leisure are
associated with opportunities to be in contact
with nature activities (Marrero and Carballeira
2010). Developing personal projects in natural
settings induces positive affect and also a sense
of the project’s efficacy, support and meaning,
which together contribute to personal well-being
(Roe and Aspinall 2012). Living in a greener
neighborhood is associated with more residential
satisfaction and reported happiness (Van Herzele
and De Vries 2012).
Different experiences with nature foster psy-
chological and physical well-being and these ben-
efits may come from an experiential sense of
unity and harmony with the natural environment
that individuals may develop while being in na-
ture during their lives (Bell et al. 2014;Olivos
et al. 2011). Feeling that one belongs and is
embedded in nature may partly explain the pos-
itive benefits of experiences in the natural world
(Mayer et al. 2009). In fact, individuals who are
more related and connected to nature report a
greater perception of a restorativeness capacity
from forest settings (Tang et al. 2014). People
more related to nature also tend to look for
more experiences with nature, and benefit from
the well-being outcomes from those experiences,
such as feelings of positive mood, happiness or
vitality (Nisbet et al. 2011; Zelenski and Nisbet
2014).
Contact with nature may even have an im-
pact beyond well-being and health outcomes.
For example, experiencing nature also results
in people having feelings of autonomy and in-
trinsic aspirations. Immersion in natural settings
promotes higher intrinsic aspirations, related to
prosocial value orientations, and lower extrinsic
aspirations, which can lead to more prosocial
actions such as generous decision-making (We-
instein et al. 2009). This effect of immersion
in a natural context was also found for helping
behavior (Guéguen and Stefan 2014). Thus, being
in contact with nature could be associated with
not only personal well-being but also social well-
being.
People in different phases of personal de-
velopment may benefit from frequent exposure
to natural environments. The evidence presented
by research in the domain of health and well-
being outcomes from the experiences of contact
with nature has been an important motive and
argument for taking the opportunity to provide
people with these experiences in different settings
such as schools, playgrounds, work offices, resi-
dential and urban spaces, homes for the elderly or
healthcare environments, and within the context
of different activities like education, work, treat-
ment of physical or psychological diseases, rest,
leisure, or physical activity (Bird 2007; Bloom
et al. 2014; Corazon 2012; Gladwell et al. 2013;
Godbey 2009).
8 Green Exercise, Health and Well-Being 157
8.3 Green Exercise and Outdoor
Physical Activity
The term “green exercise” was proposed by
Pretty and colleagues (Pretty et al. 2003)from
Essex University, and the first peer-review paper
was published in 2005 (Pretty et al. 2005). These
authors sought to describe the synergistic benefit
to health that occurs when exercising whilst being
directly exposed to nature (Gladwell et al. 2013;
Pretty et al. 2003). Green exercise is defined as “a
physical activity in green places that may bring
both physical and mental health benefits” (Pretty
et al. 2003, p. 7), or as the exercise or physical
activity that occurs in the presence of nature,
such as cycling in the countryside or walking in
an urban park (Barton and Pretty 2010).
As previously noted, physical activity has pos-
itive effects on physical and psychological health,
and exposure to nature is also good for mental
health and well-being. Thus, the health bene-
fits of green exercise come simultaneously from
physical activity and contact with nature. The
relationship between the natural environment and
health has received wide interest for decades,
fostering initiatives in civil and scientific commu-
nities both to promote public health and to con-
serve biodiversity (Bowler et al. 2010). In fact,
although most citizens currently live in urban
environments, disconnected daily from nature,
and there is an increase in sedentary lifestyles
in the majority of populations, people tend to
appreciate the benefits of protecting the environ-
ment (Pretty et al. 2003). Some of these initiatives
are: membership of environmental and wildlife
organizations; visits to the countryside and the
growth in national and international ecotourism;
membership of gymnasiums and of sports and
outdoor organizations (Pretty et al. 2003). The
Conservation Volunteers Green Gym, developed
by a British charitable organization, is a program
that aims to provide people with a way to enhance
their fitness and health while taking action to
improve the outdoor environment. The invitation
on the program’s website, “Want to improve your
health and well-being but not too keen on running
machines or lycra?” summarizes their assump-
tions (http://www.tcv.org.uk/greengym/).
Several associations between the natural en-
vironment and health and well-being have been
identified (Hartig et al. 2014). The natural envi-
ronment (e.g., urban parks, species diversity, and
the number of trees near home) is directly associ-
ated with air quality and stress, which in turn ben-
efit health and well-being (e.g. performance, sub-
jective well-being, physiological changes, mobil-
ity, mortality and longevity). However, the nat-
ural environment is also related to contact with
nature (e.g. frequency, duration, activity such as
viewing or walking), which in turn is associ-
ated with air quality and stress, but also with
physical activity and social contacts, variables
also related to health and well-being. In other
words, individuals or groups who consciously
engage with nature, simply for viewing or for
practicing a physical activity, could amplify the
impact of the natural environment on their health
and well-being, through promoting psychical ac-
tivity levels (walking for recreation and outdoor
play) and/or social contact (e.g. interacting with
neighbors and a sense of community). Of course,
all these relationships are subject to modifica-
tion by the characteristics of the people or the
context, and there is also a reciprocal relation-
ship between these variables (air quality, physical
activity, social contacts, and stress). This model
can support the role of green exercise in health
promotion, showing its impact at the personal,
social, community and public level. In fact, peo-
ple engage in physical activity firstly because it
helps them to feel good in the short term and
then because it will benefit their health in the
long term. Thus, people regularly seeking natural
spaces for restoration could engage in some form
of physical activity to amplify the benefits (Hartig
et al. 2014).
Empirical studies have aimed to show the
benefits of exercise in nature, arguing that being
active in green spaces may yield health benefits
over and above the positive effects of physical
activity in other environments, such as indoors
and without nature elements (Hug et al. 2009;
Pretty et al. 2005; Thompson Coon et al. 2011;
Mitchell 2013).
Natural settings, such as a park or riverside,
providing an added outdoor setting in an urban
158 A. Loureiro and S. Veloso
context, may promote public health as they offer
an additional environmental context for physical
activity besides indoor spaces. Given the benefits
presented previously related to the improvements
in health and well-being derived from contact
with nature, we may argue for the additional
and increased positive outcomes for public health
provided by the performance of physical activity
in natural environments, as it contributes to both
physical and mental health.
The research about the specific benefits of
green exercise is growing. A recent systematic
review summarizes a wide range of health and
well-being outcomes, such as higher positive and
lower negative emotions, after exercising in a
natural rather than a more synthetic environment
(e.g. non-green outdoor built environments and
indoor environments) (Bowler et al. 2010).
Physiological outcomes, such as healthy levels of
blood pressure and cortisol, are less supportive of
consistent positive evidence. There is also some
support, but again not very strong, for greater at-
tention and concentration after practicing in a nat-
ural environment (Bowler et al. 2010). Another
review summarized how the great outdoors can
promote physical activity and health in the gen-
eral population, exploring the impact of green ex-
ercise on psychological and physiological health
markers, and also the mechanisms by which
green exercise has an impact on health (Gladwell
et al. 2013). Outdoor natural environments,
beyond the benefits of simple exposure, may
facilitate adherence to physical activity, through
lower levels of perceived effort, stress and mental
fatigue, leading to improved mood (e.g. reducing
tension, anger and depression), self-esteem
and perceived health state. Green exercise also
promotes physiological functioning, including
health markers, such as heart rate, blood pressure
and autonomic control, and endocrine markers,
such as noradrenaline, adrenaline and cortisol.
Moreover, green exercise can facilitate adher-
ence to physical activity through promoting at-
tention to an external pleasant and green environ-
ment, which consequently distracts from and re-
duces awareness of physiological sensations and
negative emotions, thus minimizing the percep-
tion of effort (Gladwell et al. 2013). Studies com-
paring indoor versus outdoor physical activity
in natural environments show greater feelings of
revitalization and engagement in outdoor settings
(Thompson Coon et al. 2011). The difference
is not in the quality of the practice of indoor
and outdoor exercise, but in the wider benefits
that accrue from exposure to an outdoor envi-
ronment. For example, health clubs and similar
establishments have a cost, a closing time, and
are more likely to hassle, and this discourages
many individuals from adhering to practice (Tof-
tager et al. 2011; Parachin 2011). A person’s
access to green spaces could thus be one of
the important resources of the living environ-
ment to enhance physical activity contributions,
to reduce obesity and improve health (Lachowycz
and Jones 2011). A study of 11,649 exercise
participants (54 % outdoors, 18 % indoors and
28 % practicing in both environments) found that
outdoor practitioners dealt better with stress and
depression, and had a better knowledge of health
maintenance (Puett et al. 2014). In Denmark,
a study of a random sample of 21,832 adults
showed a relationship between a shorter dis-
tance between residences and green spaces and
a higher level of physical activity and related
lower rates of obesity (Toftager et al. 2011).
This association will probably not be equal else-
where. For example, 56.6 % of 514 residents in
Philadelphia (USA) were considered active, and
of these 64 % were indoor practitioners, 22.6 %
were outdoor practitioners and 13.4 % practiced
in both environments (Hillier et al. 2014). In Por-
tugal, a study with 282 practitioners of outdoor
and indoor physical exercise analyzed the rela-
tionship between outdoor physical exercise and
well-being and observed that participants with
outdoor activity or who combined outdoor with
indoor physical exercise (56.4 %) reported more
positive emotions and well-being associated with
exercise, and that their connectedness to nature
was a significant predictor of well-being, also
negatively predicting psychological distress. The
same association was not found for the group who
only performed physical exercise in indoor envi-
ronments (43.6 %) (Loureiro and Veloso 2014).
Positive outcomes of green exercise for
individuals’ mental health improvements are
8 Green Exercise, Health and Well-Being 159
observed even for short periods of practice. These
effects on self-esteem and mood are independent
of location, duration, intensity, gender, age, and
health status (Barton and Pretty 2010). Taking
this into account, specific recommendations for
greater efficacy of green exercise are proposed for
duration, intensity and type of green space. Only
5 min of green exercise results in self-esteem and
mood improvements, less than 60 min produces
a smaller effect, and an active whole day results
in great improvements in mood and self-esteem
(duration); self-esteem only increases with a
light green exercise activity; however, mood
increases with both light and vigorous activity
(intensity); both health markers improve in green
environments, but the presence of water generates
greater improvements for near waterside practice
(e.g. beach or river) or participation in water-
based activities (a type of green/natural space).
Green exercise brings improvements in self-
esteem for both genders; however, men show
a better mood. Younger people report more
improved self-esteem after green exercise and
the middle-aged group report a better mood.
Mentally ill people should be encouraged to
undertake green exercise because they experience
the greatest changes in self-esteem (Barton and
Pretty 2010).
The impact on different subgroups of the pop-
ulation is a subtle point that future studies should
consider. Green exercise potentially increases the
level of physical activity across the whole pop-
ulation; however, larger individual benefits seem
to occur in specific populations (Thompson Coon
et al. 2011). For example, a study found that
mortality rates of cardiovascular and respiratory
diseases decreased with increasing access to nat-
ural environmental places, but this only occurred
in males (Richardson and Mitchell 2010).
Although fewer people are regularly present in
natural settings, many seek out nature for outdoor
recreational activities and some look for chal-
lenging outdoor activities. Paradoxically, there
is a large population with insufficient physical
activity levels for the recommendations that en-
sure health (Gladwell et al. 2013). How might
the environment help to motivate and facilitate
physical activity? A green environment may fos-
ter increased physical activity through decreasing
perceptions of effort and improving motivation
(Gladwell et al. 2013). Adherence to physical
activity could be promoted by extrinsic motiva-
tion through relationships between green exercise
and health, driven by external factors such as
pressure from significant others; however, this is
not likely to affect everyone, much less over the
long term. The engagement in physical activity
by intrinsic motivation, driven by enjoyment or
excitement about the challenge, is more likely to
occur and be maintained over a long term (Ryan
and Deci 2000). Some people engage for health
benefits, whereas others adhere for social rea-
sons. However, the social and enjoyment benefits
of physical activity appear to be more successful
than the health benefits at persuading individuals
to participate in physical activity (Gladwell et al.
2013). In this sense, green exercise can help to
promote physical activity through the fun and
escape from the routine of daily life that it offers,
satisfying both social and pleasure reasons for
practice adherence.
Another advantage of green exercise is some
evidence suggesting that exercise in a natural
environment may be perceived as easier to per-
form. An experimental study comparing brief
indoor and outdoor walks found that participants
reported a greater intention to engage in future
outdoor walks, and this was accompanied by
a higher level of enjoyment and positive affect
after outdoor walks (Focht 2009). Therefore, the
combination of exercise and exposure to nature
could be a useful tool to improve physical ac-
tivity motivation and human physical and psy-
chological health. The epidemiological problem
of sedentary people, who fail to achieve the
recommended daily amounts of physical activity,
could benefit from green exercise, as a vehicle for
driving physical activity promotion. In fact, green
exercise could be a pleasant activity leading to the
fulfillment of the Healthy People 2010 Guidelines
(U.S. Department of Health and Human Services
2008) which encourage people to select an appro-
priate dose of activity that is enjoyable.
Although natural environments tend to facili-
tate physical activity adherence and health ben-
efits, some disengagement with nature has been
160 A. Loureiro and S. Veloso
observed, especially in children and adolescents,
due to a reduced relationship and connectedness
with nature. For example, in England, only 10 %
of today’s youth has regular contact with nature,
compared to 40 % of adults who did so when
they were young (Natural England 2009). The
parental fears of traffic, strangers and criminal ac-
tivity restrict young people from accessing nature
(Ward Thompson et al. 2008). Knowing that the
amount of time spent outdoors is associated with
physical activity in both children and adolescents,
access to nature could be a powerful instrument to
combat sedentary lifestyles and promote healthy
ones (Cleland et al. 2008;Frost n.d.).
The suitability and attractiveness of spaces for
certain types of physical activity may influence
levels of physical activity and rhythm of prac-
tice (Hartig et al. 2014). Access to facilities, an
enjoyable scenery and neighborhood safety are
important environmental correlates of physical
activity (Biddle and Gorely 2012). The quality
of urban spaces can also influence the level of
physical activity. A Brazilian study of 2,046 par-
ticipants (over 16 years old) practicing for at least
150 min per week showed a relationship between
the level of physical activity and the accessibility
of footpaths or spaces for physical activity (Hallal
et al. 2012). Studies in different countries, such as
Japan, Scandinavia and the Netherlands, showed
that access to green space was associated with
longevity and a decreased risk of mental illness
(Gladwell et al. 2013). Sometimes, running or
walking in certain urban streets involves expo-
sure to unpleasant, inadequate and noisy envi-
ronments, which probably reduces the benefits of
the physical activity itself. For example, outdoor
exercise in a busy urban environment may have
less effect on mental well-being and adherence
than an aesthetically appealing and supportive
indoor environment (Gladwell et al. 2013). The
quality of green space perception may be associ-
ated with physical and psychological health ben-
efits (Thompson Coon et al. 2011). The quality
of the natural environment could be a modera-
tor in the associations between access to green
space and physical activity (Jones et al. 2009).
Coastal areas seem to provide more physical
activity initiatives, encouraging and facilitating
outdoor activity (Thompson Coon et al. 2011).
A European study showed a relationship between
living in a greener environment and the level of
physical activity (three times more likely) and the
chance of being overweight or obese (40 % lower
chance) (Ellaway et al. 2005). However, more
evidence is needed about the association between
access and quality of urban green space, physical
activity and health (Hillsdon et al. 2006; Maas
et al. 2008).
Data about the cumulative effects of experi-
ences in nature strongly suggest that the contin-
ued practice of green exercise can enhance the
restorative effects of natural environments, and
thus result in very significant gains in the health
and well-being of the population (Marselle et al.
2013). Nevertheless, more research and evidence
is crucial to support the relationship between
contact with nature, physical activity and human
health and well-being (Hartig et al. 2014).
8.4 Implications of Green
Exercise for QOL and Health
Promotion
There is a wide recognition of the relevance
of physical activity in the promotion of health
and quality of life. Physical inactivity levels are
rising in many countries, particularly in the more
developed regions, and are presently identified as
the fourth leading risk factor for global mortality.
They contribute significantly to the prevalence
of non-communicable diseases (NCDs) and their
major implications for the general health of the
population worldwide (WHO 2010). This is why
WHO recommendations stress the need to in-
crease support actions to raise physical activity
levels across all age groups (WHO 2010,2014).
Physical activity is crucial for the prevention
of NCDs and the improvement of general level
of public health, helping to address public health
challenges faced by humankind. As described
in the previous sections of this chapter, nature
based physical activity may potentiate these ben-
efits. Green exercise and other forms of out-
door recreational activities foster physical and
psychological health and well-being in several
8 Green Exercise, Health and Well-Being 161
ways (Bowler et al. 2010; Pretty et al. 2005;
Thompson Coon et al. 2011). Accordingly, the
combination of physical activity and exposure to
nature in green exercise may be useful for the
prevention of NCDs and the promotion of health
levels worldwide (Gladwell et al. 2013; Haluza et
al. 2014; Pretty et al. 2011).
Declining physical activity levels, especially
in the developed world, are significantly associ-
ated with a decrease in natural experiences and
relatedness with nature. This nature disengage-
ment often begins in childhood and usually leads
to an unhealthy life pathway (Pretty et al. 2009).
The current younger generation, mostly in devel-
oped countries, is extremely deprived of contact
with nature, as they have less access to outdoor
environments or have become less willing to visit
and experience nature. Therefore, this genera-
tion’s detachment from the natural environment
and consequent less real and active contact with
nature may be associated with the increase in
NCDs in the adult population (Gladwell et al.
2013).
Improving and increasing the availability of
settings and supporting access to green exercise
in particular, and contact with nature activities
in general, would have substantial positive out-
comes on the health of the whole population,
as these contexts are important supportive envi-
ronments helping people to be more physically
active and encouraging the adoption of health-
ier lifestyles (Bedimo-Rung et al. 2005;Barton
2009; Pretty et al. 2003). People whose living
space has a more natural environment available
usually have higher levels of physical activity in
different forms besides sport, such as walking,
playing or gardening (Calogiuri and Chroni 2014;
WHO 2014).
Providing access to a natural environment was
the main objective of the design and construction
of the first urban parks, driven by the urban park
movement in England and North America. Still
today, the health benefits of nature and associated
healthy lifestyles are a central question in health
and quality of life promotion. As access to na-
ture is essential to improve mental and physical
health, it should be a main concern in land use
policy (American Public Health Association –
APHA 2013; Ward Thompson 2011). The impli-
cations for public and urban policy and design
are widely emphasized, and can be achieved by
different types of measures of urban planning and
public space design, transport policy, education
environments, and campaigns stressing contact
with nature as a motive for green exercise prac-
tice (APHA 2013; Calogiuri and Chroni 2014;
Gladwell et al. 2013). However, it is important to
differentiate health outcomes from nature-based
physical activity experiences from those related
to other activities and interventions like diet and
physical activity in itself (Lee and Maheswaran
2011).
WHO recommendations of physical activity
for health cover the whole life span and are
specific for different phases (WHO 2010). In
accordance with this, types of activity and related
environments that contribute to promoting health
and well-being, namely those that are natural and
outdoors, can be identified for people of all ages.
Moreover, APHA policy statements reinforce that
efforts should be made to incorporate nature
in urban and land policies, due to evidence of
gains in health and well-being for children, young
people, adults and the elderly who have more
contact with nature (APHA 2013). Nature in the
form of urban parks, gardens, greenways, natu-
ralized schoolyards and playgrounds, and natural
landscaping around homes and workplaces give
people of all ages the opportunity to experience
nature in different ways, such as contemplation
or engaging in outdoor physical activity.
When considering the implications for health
and well-being across a life span, all features
must be integrated into public space design. En-
vironmental factors are potential physical ac-
tivity promoters and affordances but can also
be barriers. Regarding green exercise promotion,
the integration of natural features such as trees,
plants, and greenways must be considered to-
gether with other elements such as street and path
type, access points, permeability, views, sound,
light, maintenance and surveillance (Pikora et al.
2003). Although it might be advocated that it
would be difficult and unrealistic to provide peo-
ple with access to large park systems, especially
in an urban context, contact and experience with
162 A. Loureiro and S. Veloso
nature is affordable by different means, such as
planting trees, greening alleys, cultivating gar-
dens in schools, communities, and hospitals, or
creating greenways for pedestrians and cyclists
(APHA 2013). Moreover, these interventions are
effective in giving people more proximity to en-
gage in nature-based physical activity.
In childhood, play and transportation are the
main activities that may give a child the chance
to be physically active. Public or private gar-
dens, such as school playgrounds, provide chil-
dren with very good opportunities to engage
in activities that are physically demanding, and
when the settings are rich in natural features and
elements children can gain both psychological
and physiological benefits from these activities
(Collado et al. 2013; Hodges et al. 2013; Pretty
et al. 2009). Outdoor green environments such as
neighborhood parks, promoting gardening, play
and recreation also have the potential to engage
less active children in physical activity (God-
bey 2009; Moore and Cosco 2014; Reed et al.
2013). Urban design that encourages access to
nature when walking or cycling to school on
a greenway or crossing a park is essential to
enhance children’s physical activity and nature
experiences (Moore and Cooper Marcus 2008).
For teenagers and young people, the search for
natural areas is associated with engaging in play
and adventure combined with social play and
interaction (Staempfli 2009).
Adults can gain great health and well-being
advantages from living in a natural environment,
or in an urban context with natural elements, as
these can encourage active lifestyles and higher
levels of physical activity (Hartig et al. 2014).
The potential to combine nature health benefits
with physical activity outcomes may be achieved
in different types of activities and settings. Green
exercise may be practiced on a regular daily basis,
as when individuals walk or cycle to work, or
jogging in a park at weekends, or on a non-regular
basis as when they spend their holidays trekking
in a national park. Wilderness recreation and
tourism is increasing with more people planning
their annual holiday in national parks and wilder-
ness areas looking for adventure and nature-based
experiences (Buchell and Eagles 2007). People
often look to combine green exercise with other
aims such as socializing or enjoying landscape
(Miller et al. 2014). Furthermore, setting features
are important factors in facilitating or inhibiting
levels of participation in green exercise or other
recreational activities in natural environments.
These features include safety perception, proxim-
ity, leisure time and design (Godbey 2009).
Engaging in physical activity in green spaces
such as woods and forests lowers the risk of poor
mental health more than exercising in a gym or
in the streets (Miller et al. 2014). Greenways or
urban streets with trees and plants are also es-
pecially motivating for pedestrians and green ex-
ercise practitioners (Calogiuri and Chroni 2014).
Besides offering direct food safety and supply for
an urban population, as well as better environ-
mental quality, urban agriculture is an opportu-
nity for people to be more physically active. In-
volving urban citizens in gardening and horticul-
ture projects increases physical activity levels and
fitness and thus contributes to weight manage-
ment in particular and public health in general.
City farmers participating in food growing and
gardening community projects experience social
connections and reduced stress (Schmutz et al.
2014).
For adults, the workplace is an important set-
ting for health promotion and disease prevention.
The feedback provided by pedometer interven-
tions at work, combined with other components
such as a diary, a website for records, sharing be-
haviors or communication between participants
in a work setting program, the dissemination of
health promotion information, counseling ses-
sions, or group activities motivate individuals to
increase and maintain their physical activity over
time (Freak-Poli et al. 2013). Promoting green
exercise experiences among employees, combin-
ing the benefits of being physically active with
those of exposure to nature, is a promising way
to cultivate a healthier company workforce.
More attention is being given to the imple-
mentation of outdoor running and walking group
programs as extended measures of public health
promotion as they can reach large groups of the
population at the same time. The evaluations of
these programs find that people taking part show
8 Green Exercise, Health and Well-Being 163
greater positive affect and mental well-being and
a decrease in depression, perceived stress and
negative affect (Marselle et al. 2013).
Despite the importance of physical activity for
disease prevention and maintenance of quality of
life in the elderly, there is a lack of knowledge
about levels of physical activity that are needed
in this population (Sun et al. 2013). Park-based
leisure time is associated with health indicators
and reduced perceived stress. When older people
perceive they have a good physical health state
and are accompanied during outdoor experiences,
they tend to spend more time in these settings,
such as parks, and these walkable green spaces
may be responsible for greater longevity among
this group of the population (Orsega-Smith et al.
2004). Environmental design and features can be
an important source of encouragement for walk-
ing and other physical activities among elderly
people and thus contribute to their healthy lives.
More directly related to health and quality
of life promotion in general, and prevention of
diseases such as NCDs in particular, programs
aiming to intervene in these areas have a great
potential to reduce social and economic costs
associated with illness and loss of quality of
life. The economic investment in programs to
promote physical activity among children, young
people, adults and the elderly is less than that
needed to treat and heal health problems such as
those related to obesity or cardiovascular diseases
(WHO 2010). Engaging people in programs of
exercise in outdoor and natural environments,
such as integrating outdoor running groups in
gyms, or trekking activities during ecotourism
holidays or leisure time, provide people with
natural experiences that can contribute to bet-
ter psychological states and the relief of stress
and, through this, improve their attitudes toward
physical activity. This process can be a route
to increasing and reinforcing people’s intentions
to engage in physical activities (Calogiuri and
Chroni 2014).
Combining natural experiences with physical
activity has provided good opportunities to ob-
tain positive outcomes in mental health treatment
(Barton and Pretty 2010; Maller et al. 2005).
Exercise and other types of physical activities
in natural settings can be therapeutic in contexts
such as child attention deficit and hyperactivity,
or severe and enduring adult mental illness. Land-
scape therapy, horticulture therapy, wilderness
therapy, nature or animal therapy, therapeutic
gardening or healing gardens are different types
of treatment with a nature-based approach in
common that are receiving more attention from
mental health professionals and social services
(Maller et al. 2008).
Green exercise programs, combining physical
activity, nature and social components, are ef-
fective in enhancing well-being, self-esteem and
positive mood levels in individuals with mental
illnesses (Barton et al. 2012). Nature-based men-
tal health interventions, where people are placed
in safe outdoor natural settings, separate them
from daily negative influences and give them ac-
cess to self-characteristics usually more difficult
to perceive (Hine et al. 2011). Improvements in
self-esteem and mood may induce decreases in
depression and anxiety and therefore result in
better mental health for individuals participating
in therapeutic green exercise. These direct out-
comes for mental health conditions occur simul-
taneously with increased feelings of connection
with nature and progress in individuals’ physical
state such as a better Body Mass Index (Hine et al.
2011).
The positive influence of green exercise goes
beyond the direct outcomes for individuals’ men-
tal and physical health. The connection with na-
ture resulting from the increased contact with
the natural environment can be a way to develop
more environmental values and attitudes, and
thus have an effect on behaviors and decisions
with an environmental impact for individuals and
societies (Collado et al. 2015; Hartig et al. 2007).
Contact with nature, through the practice of phys-
ical activity such as green exercise, may thus be
also considered a path to more long-term changes
in attitudes and relationships with nature and the
environment (Pretty et al. 2003). Associating the
individual’s health and well-being benefits as a
result of environmental actions, framing environ-
mental behaviors as health behaviors, or using
health and well-being motivations to promote
sustainable values and actions, is a promising
164 A. Loureiro and S. Veloso
approach to the sustainability challenges faced by
humankind (Nisbet and Gick 2008). The benefits
for present and future societies may come from
different paths toward changing values and ac-
tions that support a social, economic and environ-
mentally sustainable development.
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