The benefits of nature exposure: The need for research that better informs implementation.

Concern about humanity's detachment from nature has spawned a global push to increase the availability of green spaces within cities. One impetus for this movement is a growing collection of studies documenting an association between improved human well-being and exposure to nature. The challenge lies in translating this research into pragmatic recommendations for cities. The usefulness of the existing research portfolio is diminished by the limitations of prevailing research designs. For example, most nature exposure studies (>80%) are observational. The rare randomized manipulative experiments tend to be indoors or virtual and rely on nature exposures on the order of ten to fifteen minutes. "Nature" and "biodiversity" are commonly invoked together as benefiting human well-being despite little evidence that biodiversity has particular importance for human psychological and emotional health. The most glaring gap in nature exposure research is the neglect of differences among cultures and ethnic groups with respect to the nature they prefer. In the few cases where researchers looked for differences among groups, they often found heterogeneous responses. Finally, few studies have compared greening interventions to other possible efforts to improve urban life. Thus, the utopian city of the future might be resplendent with urban parks on every block, but it is not clear whether those parks should offer basketball and pickleball courts, or small woodlands with a cornucopia of birds. We advocate for the next generation of nature exposure research that better informs the envisioning of our future sustainable cities with enhanced and equitable access to nature.

Does daily nature exposure enhance children's self-worth and positive feelings? An experience sampling study.

Previous studies suggest that nature exposure has positive effects on children's cognitive performance and well-being . However, inconsistent evidence was found for effects on children's self-worth and feelings. These inconsistencies may be resolved by studying children's actual exposure and experiences in detail. Therefore, in the present study, we investigated the effect of daily nature exposure on children's self-worth and feelings with an experience sampling method. Sixty-six third graders (29 girls, mean age = 9.04 years) participated two to three times per day consecutively for 9 days. The resulting 1199 observations were analyzed and showed that when exposed to nature children reported significantly higher self-worth and positive feelings than when not exposed to nature, with baseline levels controlled. Positive feelings played mediating roles in relationships between nature exposure and children's self-worth. Our study strengthens the evidence on beneficial effects of nature on children's well-being. The mechanisms involved in this effect are discussed.

A short simulated nature experience as an effective way to promote restoration from work-related stress.

Spending time in nature, and even watching images or videos of nature, has positive effects on one's mental state. However, cognitively stressful work is often performed indoors, in offices that lack easy access to nature during breaks. In this study, we investigated whether watching a 5-min audiovisual video that describes a first-person perspective walk on a forest path could help to restore one's mental state after cognitive stress. Participants were asked to perform cognitive stressor tasks, after which they were shown either a nature walk video or a control video. Subjective restoration was measured using self-reports before and after the videos, while electrodermal activity (EDA) and electroencephalography (EEG) were measured during the video-watching session. The results showed that experiencing the nature walk video enhanced subjective restoration more than watching the control video. Arousal of the autonomic nervous system, measured using EDA, decreased more during the nature walk video than during the control video. Additionally, activity in the EEG's upper theta band (6-8 Hz) and lower alpha band (8-10 Hz) increased during the nature walk video, suggesting that it induced a relaxed state of mind. Interestingly, the participants' connection with nature moderated the effects of the nature video. The subjective and physiological measures both suggest that watching a short, simulated nature walk may be beneficial in relaxing the mind and restoring one's mental state after cognitive stress.

The effects of virtual nature exposure on pro-environmental behaviour.

Exposure to (virtual) natural environments may encourage people to care about environmental protection and to engage in pro-environmental behaviour. Previous research on this effect produced inconsistent results, suggesting that it may depend on the type of nature and behaviour under study. In the present study (N = 266), we investigated nature exposure effects on effortful pro-environmental behaviour in an online experiment. After watching pictures of either intact or destroyed natural environments, participants could exert voluntary extra efforts to generate real donations to an environmental organisation. In comparison to the intact nature condition, participants exerted significantly more effort for environmental protection after being exposed to pictures of destroyed nature. No clear differences were observed between the nature exposure conditions and a no-picture control condition. These findings illustrate the complexity of nature exposure effects and suggest that different types of nature exposure may differentially affect people's pro-environmental behaviour.

A randomized controlled trial of surf and hike therapy for U.S. active duty service members with major depressive disorder.

BACKGROUND: Major depressive disorder (MDD) is the most prevalent mental health disorder worldwide, including among U.S. service members. In addition to evidence-based treatments, activity-based approaches have been shown to effectively treat depressive symptoms, particularly when they occur in the natural environment. METHODS: This study compared two activity-based interventions, Surf Therapy and Hike Therapy, on depression outcomes among 96 active duty service members with MDD. Participants were randomized to 6 weeks of Surf or Hike Therapy. Clinician-administered and self-report measures were completed at preprogram, postprogram, and 3-month follow-up. A brief depression/anxiety measure was completed before and after each activity session. RESULTS: Multilevel modeling results showed that continuous depression outcomes changed significantly over time (ps < .001). Although service members in Hike Therapy reported higher average depression scores than those in Surf Therapy, the trajectory of symptom improvement did not significantly differ between groups. Regarding MDD diagnostic status, there were no significant differences between the groups at postprogram (p = .401), but Surf Therapy participants were more likely to remit from MDD than were those in Hike Therapy at the 3-month follow-up (p = .015). LIMITATIONS: The sample consisted of service members, so results may not generalize to other populations. Most participants received concurrent psychotherapy or pharmacotherapy, and, although statistically accounted for, results should be interpreted in this context. CONCLUSIONS: Both Surf and Hike Therapies appear to be effective adjunctive interventions for service members with MDD. Research is needed to examine the effectiveness of these therapies as standalone interventions. TRIAL REGISTRATION: Clinical trials registration number NCT03302611; First registered on 05/10/2017.

The significance of green exercise for the health and wellbeing of Italian immigrants in Norway: a mixed-methods study.

BACKGROUND: Green exercise (physical activity in presence of nature) has beneficial effects for health and wellbeing. Green exercise is a popular form of recreation in the Nordic countries, but participation is lower among the immigrant population from non-Western countries. However, no attention has been given to immigrants from the European Economic Area regarding this topic. Given the cultural and structural differences that surround green exercise in Italy and Norway, the case of the Italian immigrants in Norway is of interest to enrich our understanding of green exercise and its significance for health and wellbeing among immigrants in the Nordic countries. METHODS: This convergent mixed methods study investigated the pathways that link green exercise to health and wellbeing among Italian immigrants in Norway. Quantitative data were collected through an online survey (n = 321), which was oversampled to better reflect the sociodemographic profile of the reference population. Logistic regression was used to model the association of green exercise with self-rated health (SRH) or satisfaction with life (SWL) before and after controlling for selected confounders (age, gender, educational level, language proficiency, social support, and childhood experiences with green exercise). Qualitative data were collected through semi-structured in-depth interviews (n = 14) and analysed thematically. Merging of the two strands was done using a simultaneous bidirectional approach. RESULTS: The logistic regression found a significant bivariate association of green exercise with both SRH and SWL, though the association remained significant only for SWL after controlling for confounders. From the thematic analysis, three themes were identified: Green exercise opportunities contributing to overall satisfaction, Closeness to nature, and Embracing a new lifestyle. The integrated findings indicate that green exercise supported the immigrants' wellbeing, especially by providing stress relief, though socioeconomic status and acculturation may have a major impact on general health. Familiarity, appreciation of nature benefits, social support, and acculturation were identified as facilitating factors. CONCLUSIONS: This study provides novel insights into how green exercise supports health, wellbeing, and inclusion among immigrants to the Nordic countries and emphasizes the importance of developing culturally adapted strategies to enhance this health-promoting activity among immigrant populations.

Is indoor and outdoor greenery associated with fewer depressive symptoms during COVID-19 lockdowns? A mechanistic study in Shanghai, China.

Increasing numbers of studies have observed that indoor and outdoor greenery are associated with fewer depressive symptoms during COVID-19 lockdowns. However, most of these studies examined direct associations without sufficient attention to underlying pathways. Furthermore, few studies have combined different types of indoor and outdoor greenery to examine their effects on the alleviation of depressive symptoms. The present study hypothesized that indoor and outdoor exposure to greenery increased the perceived restorativeness of home environments, which, in turn, reduced loneliness, COVID-related fears, and, ultimately, depressive symptoms. To test our hypotheses, we conducted an online survey with 386 respondents in Shanghai, China, from April to May 2022, which corresponded to strict citywide lockdowns that resulted from the outbreak of the Omicron variant. Indoor greenery measures included the number of house plants, gardening activities, and digital nature exposure as well as semantic image segmentation applied to photographs from the most viewed windows to quantify indoor exposure to outdoor trees and grass. Outdoor greenery measures included total vegetative cover (normalized difference vegetation index [NDVI]) within a 300 m radius from the home and perceived quality of the community's greenery. Associations between greenery and depressive symptoms/clinical levels of depression, as measured by the Patient Health Questionnaire-9 (PHQ-9), were examined using generalized linear and logistic regression models. Structural equation modeling (SEM) was used to test pathways between greenery exposure, restorativeness, loneliness, fear of COVID-19, and depressive symptoms. The results showed that: 1) indoor and outdoor greenery were associated with fewer depressive symptoms; 2) greenery could increase the restorativeness of the home environment, which, in turn, was associated with fewer COVID-related mental stressors (i.e., loneliness and fear of COVID-19), and ultimately depressive symptoms; and 3) gender, education, and income did not modify associations between greenery and depressive symptoms. These findings are among the first to combine objective and subjective measures of greenery within and outside of the home and document their effects on mental health during lockdowns. Comprehensive enhancements of greenery in living environments could be nature-based solutions for mitigating COVID-19 related mental stressors.

The impact of nature exposure on body image and happiness: an experience sampling study.

Exposure to nature is associated with improved psychological well-being and positive body image. Here, we examined whether everyday exposure to natural environments is associated with state body image outcomes (and, for comparative reasons, state happiness) using an experience sampling method. One-hundred-and-seven participants completed a 30-day experience sampling phase in which they reported their state body image (body weight, body shape, and physical appearance satisfaction), state happiness, and features of the surrounding environment (total = 6,025 responses) at three random time-points each day. Results indicated that being outdoors was associated with significantly higher state body image on all three indicators, but effect sizes were lower compared to effects on state happiness. Specific environment type was also important, with blue-spaces and wood- and grasslands, respectively, having stronger effects than other environments. These results provide evidence that everyday exposure to natural environments is associated with more positive state body image and greater happiness.

Indoor nature exposure and influence on physiological stress markers.

Spending time in nature is beneficial for stress reduction and recovery. Using the properties of biophilic design, this study examined the influence of a nature-based indoor environment on physiological stress systems. An experimental study was designed to assess the influence of indoor natural elements on autonomic activity (heart rate variability or HRV), self-reported environmental assessments. No differences in heart rate variability were found between participants assigned to either condition. The room with natural elements was rated more positively than the room without natural elements. Participant preference had more impact on changes in HRV for participants without exposure to natural elements. The results suggest that natural elements in indoor environments may influence the regulation of stress response via environmental preference.Abbreviations: ANCOVA: Analysis of Covariance; ANS: Autonomic Nervous System; AVNN: Average of NN; DST: Digit Span Test; EAS: Environmental Assessment Scale; ECG: Electrocardiograph; fMRI: Functional magnetic resonance imaging; HF: High Frequency; HRV: Heart Rate Variability; INE: Indoor Nature Exposure; NR: Nature-Relatedness Scale; PANAS: Positive and Negative Affect Schedule; SAM: Search and Memory Test; SLSI: Student Life Stress Inventory; SMT: Sentence Making Test.

Natural Environments Near Schools: Potential Benefits for Socio-Emotional and Behavioral Development in Early Childhood.

Features of the natural environment such as tree canopy and green space have been found to promote health and well-being; however, minimal research has investigated potential benefits of nature near schools for early childhood development. This study examined differences in teacher ratings of preschoolers' socio-emotional and behavioral functioning in relation to the presence of natural elements (e.g., trees, parks) near children's homes and schools. Students' development of emotional and behavioral regulatory skills was the greatest when there were high levels of tree canopy either at home or school. Additionally, students developed greater independence and social skills when their schools were in neighborhoods with limited impervious surface (e.g., concrete); this trend was the most pronounced for students from neighborhoods low in impervious surface. Further, results suggested that associations with tree canopy may fluctuate seasonally (i.e., stronger relationships in the spring) and that the potential impact of school nature may depend on levels of home nature exposure. Although not yielding causal evidence regarding the impact of nature exposure or the effectiveness of greening interventions, findings suggest that school administrators and city planners could collaborate to maximize potential benefits of greening efforts near schools or within their catchment zones.

How Does Nature Exposure Affect Adults With Symptoms of Mental Illness? A Meta-Analysis.

Existing research on the effects of nature exposure on the mental health of adults indicates that spending time in nature reduces depressive symptoms and stress, increases quality of life and mood and improves mental health. This meta-analysis aimed to answer the question: what are the effects of nature exposure on the social, mental and physical health of adults with symptoms of mental illness? The meta-analysis included all studies relevant to the study research questions which collected quantitative data on nature exposure using validated instruments for at least two time points on each participant and which were published between 1990 and 2020. Regarding the impact of nature exposure on adults with symptoms of mental illness, analyses showed significant, moderate effect sizes for all studies and smaller, but significant, effect sizes for studies with control groups Analyses also yielded critical information regarding the effect size of the type of nature dosage, nature setting, nature-based activity, key mental health outcomes and other factors. These findings from the present study results have important implications regarding the potential benefits of nature exposure for adults and its role in healthcare.

Harnessing the power of nature exposure to mitigate adolescents' Internet addiction: A chain mediation model.

Previous studies have focused more on the facilitating effect of nature exposure on positive behavioural consequences. However, less attention has been paid to whether nature exposure can inhibit internalized problem behaviours, such as Internet addiction. Within the framework of the stimuli-organism-response theory, the present study examined the relationship between nature exposure and Internet addiction and investigated the mediating roles of anthropomorphism of nature and awe. In China, we recruited 1469 adolescents (mean age = 13.90 years old, SD = 0.59, 53.2% girls). Mediation analyses indicated that awe partially mediated the relationship between nature exposure and adolescents' Internet addiction. The anthropomorphism of nature and awe served as sequential mediating roles in the relationship between nature exposure and adolescents' Internet addiction. This study provides a nature-based perspective on the prevention and intervention of adolescents' Internet addiction.

Associations between nature exposure and body image: A critical, narrative review of the evidence.

Researchers, practitioners, and policy-makers are having to deal with the negative impact of body image concerns in populations globally. One cost-effective way of promoting healthier body image outcomes is through exposure to natural environments. A growing body of research has shown that spending time in, interacting with, and even just looking at natural environments can promote healthier body image outcomes. In this narrative review, I consider the different forms of evidence documenting an association between nature exposure and body image (i.e., cross-sectional and mediational, experimental and quasi-experimental, comparative, prospective, experience sampling, and qualitative research). Beyond this, I shine a critical light on the available evidence, highlighting concerns with methodological (i.e., who research has focused on and what types of natural environments have been considered), psychometric (i.e., how body image and nature exposure are measured), and conceptual issues (how the association is explained). I conclude that, although there are issues affecting the way the existing body of research is to be understood, there are reasons to be hopeful that nature exposure can be leveraged to promote healthier body image outcomes in diverse populations.

Does a nature walk improve state body appreciation in children?

The available evidence suggests that exposure to natural environments promotes more positive body image, but to date this research has not considered impacts on children. To answer this question, we invited two groups of children in Poland - matched in terms of age (range = 6 to 12 years), gender identities, and racialised status - to go for a group walk in either a natural environment (n = 80) or a built environment (n = 81). Before and after the walks, participants were asked to complete an adapted, state version of the Body Appreciation Scale-2 for Children. The results of a mixed analysis of variance indicated that children who went for a walk in the natural environment reported a significant improvement to state body appreciation (d = 0.35), whereas those who went for a walk in the built environment did not (d = 0.04). The results also showed no significant impact of gender identity (girls vs. boys) or age (middle vs. late childhood) on this finding. These results show for the first time that nature exposure may help to improve body image outcomes in children, at least in the immediate term, which may prove beneficial for future interventionist work.

The relationship between nature exposure and depression among Chinese prisoners: a moderated mediation model.

Aim: This study examined the association between self-reported nature exposure and depression among Chinese prisoners, as well as the mediating and moderating effects of meaning in life and callous-unemotional (CU) traits, respectively. Background: Prisoners are more likely to experience depression than any other mental illness. Exposure to nature has been proposed as a highly cost-effective method of treating their depressive symptoms. However, the mechanism underlying the link between nature exposure and depression among prisoners needs further investigation, as the findings may provide new insights into how to address depression in incarcerated populations. Method: Data were collected through a survey conducted in four prisons in southern China from April to May 2022. The participants were 574 prisoners who anonymously completed four questionnaires about nature exposure, meaning in life, depression, and CU traits. Results: The results show that: (1) meaning in life significantly mediates the association between nature exposure and depression, and (2) CU traits moderate the connection between nature exposure and meaning in life. Conclusion: The current study uncovered that prisoners who contact more with the natural environment have a higher meaning in life and lower depression, and individuals with higher CU traits can benefit more from nature exposure.

Gender Differences in Psychological Outcomes Following Surf versus Hike Therapy among U.S. Service Members.

BACKGROUND: Surf and hike therapies have demonstrated effectiveness as adjunct interventions for service members with major depressive disorder (MDD). This study explores gender differences in intervention outcomes following a pragmatic, randomized controlled trial of Surf and Hike Therapy for service members with MDD (N = 96; men, n = 46; women, n = 50). METHODS: Clinician-administered and self-report measures (depression, anxiety, positive affect, negative affect, resilience, and pain) were completed at preprogram, postprogram, and 3-month follow-up; brief measures (depression/anxiety and positive affect) were completed before and after each session. RESULTS: Multilevel modeling results showed that anxiety decreased from pre- to postprogram and significantly differed by gender (B = -2.26, p = 0.029), with women reporting greater reductions. The remaining outcomes from pre- to postprogram demonstrated significant improvements that did not differ by gender (ps = 0.218-0.733). There were no gender differences through follow-up (ps = 0.119-0.780). However, within sessions, women reported greater improvements in depression/anxiety (B = -0.93, p = 0.005) and positive affect (B = 3.73, p = 0.001). The change in positive affect scores within sessions was greater for women in Hike Therapy compared to men (p = 0.016). CONCLUSIONS: Overall, results demonstrate that both genders benefit from adjunctive Surf and Hike Therapies, but women exhibit a better response in terms of longer-term anxiety and immediate psychological outcomes.

Effects of immersive virtual nature on nature connectedness: A systematic review and meta-analysis.

Objective: This study systematically summarizes the extant literature on the impacts of immersive virtual nature (IVN) on nature connectedness in the general population. Methods: Papers were considered eligible if peer-reviewed, in English language, comprising experimental or quasi-experimental trials, including at least one outcome relative to nature connectedness in the general population. Database search was conducted on Scopus, Web of Science, Google Scholar, Medline, and GreenFILE (22-28 November 2021). Risk of bias was established by the Cochrane RoB 2 tool. Data synthesis was conducted through meta-analysis according with the Cochrane Consumers and Communication Group guidelines. Results: Six eligible papers (9 studies; n = 730) were selected, in which IVN was compared to (i) non-immersive virtual nature, (ii) immersive virtual built environments, (iii) non-immersive virtual built environments, and (iv) actual nature. The risk of bias was predominantly "low" or of "some concerns." Meta-analyses showed a statistically significant overall effect for the first (g = 0.26; 95% CI = 0.06-0.45; I2 = 35%) and fourth group (g = -1.98; 95% CI = -3.21 to -0.75; I2 = 96%), the former in favor of IVN and the latter in favor of actual nature. Subgroup analyses were conducted for the first and second groups of studies to explore possible sources of heterogeneity. The small number of studies available limits the validity of the outcomes of the meta-analyses. Conclusion: The findings indicate that IVN may be an effective tool for the promotion of nature connectedness, although the evidence in this field is still limited and largely mixed. Recommendations for future research are discussed.

Assessing nature exposure: a study on the reliability and validity of a Portuguese version of the nature exposure scale.

Introduction: Engaging with nature has been widely acknowledged for its positive impact on well-being. Traditionally, assessments of nature exposure focus on estimating green space exposure and outdoor time. However, the Nature Exposure Scale (NES) offers a unique approach by evaluating the quality of nature experiences, encompassing both deliberate and spontaneous encounters. Methods: This study aimed to assess the validity and reliability of the NES in the context of Portugal. Exploratory Factor Analysis (PCA) and Confirmatory Factor Analysis (CFA) were employed to examine the underlying structure of the scale. Additionally, reliability assessments, along with tests of convergent and divergent validity, were conducted. Data were collected from a sample of 558 adults and 241 adolescents between 2016 and 2018. Results: The findings revealed strong internal consistency of the NES, supported by acceptable correlation values and robust factor loadings within a unidimensional model. The scale effectively predicted variations in nature exposure across diverse professional activities. Discussion: In summary, the 4-item NES emerged as a reliable tool for assessing nature exposure in various settings, effectively bridging a gap in the Portuguese context. The scale demonstrated potential for cross-cultural research and was particularly adept at predicting nature exposure in different professional contexts. The results suggest that the NES can enhance our understanding of the impact of nature on well-being in diverse cultural settings. Conclusion: The study underscores the reliability of the NES in assessing nature exposure in Portugal, paving the way for further exploration in Portuguese-speaking regions. The scale holds promise for advancing research on the relationship between nature and well-being, contributing valuable insights across different cultural contexts.

Distance to Natural Environments, Physical Activity, Sleep, and Body Composition in Women: An Exploratory Analysis.

A growing body of evidence indicates that living close to nature is associated with better health and well-being. However, the literature still lacks studies analyzing the benefits of this proximity for sleep and obesity, particularly in women. The purpose of this study was to explore how distance to natural spaces is reflected in women's physical activity, sleep, and adiposity levels. The sample consisted of 111 adult women (37.78 ± 14.70). Accessibility to green and blue spaces was assessed using a geographic-information-system-based method. Physical activity and sleep parameters were measured using ActiGraph accelerometers (wGT3X-BT), and body composition was assessed using octopolar bioimpedance (InBody 720). Nonlinear canonical correlation analysis was used to analyze the data. Our findings reveal that women living in green spaces close to their homes had lower levels of obesity and intra-abdominal adiposity. We also demonstrated that a shorter distance to green spaces seemed to correlate with better sleep onset latency. However, no relationship was found between physical activity and sleep duration. In relation to blue spaces, the distance to these environments was not related to any health indicator analyzed in this study.

Do Mental Health Changes in Nature Co-occur with Changes in Heartrate Variability and Executive Functioning? A Systematic Review.

PURPOSE OF REVIEW: Given the global burden of mental health issues, new solutions are needed to promote mental health. Nature exposure represents a promising option to promote mental health, but the mechanisms are poorly understood. Recent frameworks have argued that changes in mental health in nature are caused by activity changes in the vagus nerve, which connects the heart and the brain, and that these changes also improve executive functioning (EF) abilities. This suggests that changes in mental health symptomology in nature should be accompanied by changes in vagus nerve activity, as well as changes in executive functioning. Yet, little work has systematically examined co-variation of these outcomes in empirical studies. The present manuscript systematically examines whether changes in mental health in nature are accompanied by changes in vagus nerve activity (approximated by heartrate variability) and changes in executive functioning. RECENT FINDINGS: There is compelling evidence that spending time in nature can increase heartrate variability, improve mental health, and improve executive functioning. However, despite strong theoretical claims that these three outcomes should be linked after spending time in nature settings, few studies directly examine such co-occurrence. The study systematically examines whether studies that considered both mental health and executive functioning (n = 6) showed co-occurring effects in response to nature exposure. Similarly, the study also considers if studies examining mental health and heartrate variability (n = 6) showed similarly directional effects following nature exposure. This systematic review concludes with discussion about the limited number of studies (n =1) that include all three measures. We find mixed results of co-occurrence with these variables, suggesting that the relationship between these three constructs in nature may be more nuanced than current theory suggests. Perhaps more importantly, our results demonstrate that there is very little existing work linking changes in mental health to changes in EF and vagal tone. We conclude with justification for why it may be beneficial for researchers to include all three metrics as well as guidance on how to do so.