Predicting adolescents' continuation in club sports: A prospective cohort study of the importance of personal and contextual motivational factors in five sports in Denmark.

PURPOSE: The purpose of this prospective cohort study was to investigate the influence of types of motivation, basic psychological needs satisfaction and of a coach-created motivational climate on continued participation in youth sports across types of sport, competitive levels, ages, and gender. METHODS: Participants were 7110 adolescent (age 12-20 years) members of leisure time club organized in basketball, handball, football, badminton, and gymnastics in Denmark. Motivational regulation was measured with BRSQ-6, basic psychological needs satisfaction and frustration were measured with PNSS-S, and coach-created climate was measured with the EDMCQ-C. The participants' continuation or dropout was measured at the beginning of the following season with a short electronic questionnaire. RESULTS: Intrinsic motivation, identified behavior regulation, experiences of competence, relatedness, and autonomy, as well as a coach-created empowering motivational climate, were associated with continuation both in the sport and in the club the following season across different sports, genders, age groups, and competitive levels. Introjected and external behavior regulation, frustrations with the need to experience competence, relatedness, and autonomy, as well as a disempowering coach-created climate, were associated with dropout. CONCLUSION: In Danish youth sports, autonomous motivation, satisfaction of basic psychological needs, and an empowering coach-created motivational climate have a positive impact on the continuation of the sport and the club the following season. In contrast, controlled types of motivation, needs frustration, and a disempowering coach-created climate are associated with dropout. This is the case at both elite and recreational levels, for boys and girls, adolescents, and youth.

Efficacy and mechanisms of an education outside the classroom intervention on pupils' health and education: the MOVEOUT study protocol.

BACKGROUND: Education can create better opportunities for health, and vice versa. Using a so-called 'add-in' approach, school-based physical activity (PA) promotion and prevention of sedentary behaviours can increase pupils' wellbeing and learning and, on the longer term, reduce the risk of non-communicable diseases. A PA 'add-in' approach involves integrating PA into teachers' curricular obligations without being an extra burden as opposed to an 'add-on' approach which requires additional operational resources and include activities that do not explicitly contribute towards curricular targets making them less long-term acceptable in a school-based context. Previous studies investigating education outside the classroom (EOtC) show mutual benefits for both health and education outcomes among children and adolescents. However, the evidence is of mixed quality and questionable certainty, which calls for further investigation. The aim of this study protocol is to describe and discuss the study design and methods to investigate the efficacy and mechanisms of EOtC as a vehicle for health and education. The study investigates the intervention developed and conducted in the TEACHOUT study with updated and strengthened design and measures. METHODS: The efficacy of EOtC will be investigated in a cluster randomised waitlist design. Participants will be pupils in ~54 classes, grades 4-10 (ages 10-15 years) in ~30 Danish elementary schools. Fifteen schools will be randomised to the intervention: a two-day EOtC training course targeting teachers followed by the teachers implementing EOtC >5 hours weekly over the course of one school year. Pre- and post-measures of health (PA and wellbeing) and learning (school motivation and academic achievement) will be collected. Investigation of pedagogical and motivational mechanisms will be based on observations of EOtC. DISCUSSION: The updated randomised controlled design will provide firmer evidence for the efficacy and mechanisms of EOtC and provide knowledge about how mutual benefits of health and education can be obtained. TRIAL REGISTRATION: Registered with ClinicalTrials.gov (ID NCT05237674 ) [University of Copenhagen. MOVEOUT: a Cluster RCT of the Efficacy, Mechanisms, and Mediation of an Education Outside the Classroom Intervention on Adolescents' Physical Activity, 2023], February 14, 2022. Most recently updated on November 23, 2022 (Version 2).

Factorial validity, predictive validity and measurement invariance of the Danish version of the coach-created Empowering Disempowering Motivational Climate Questionnaire (EDMCQ-C).

PURPOSE: The purpose of this study was to translate and validate a Danish version of the coach-created Empowering and Disempowering Motivational Climate Questionnaire (EDMCQ-C), retest the factor structure and provide further investigation into the psychometric properties in terms of measurement invariance across gender, age and competitive level, reliability and predictive validity. METHODS: The participants were 1719 male and 551 female Danish football players 12-20 years of age (M = 14.81) playing at recreational, medium and elite levels. Participants filled in EDMCQ-C as well as questionnaires measuring psychological needs (BPNESS) and behaviour regulation (BRSQ). Factor structure of the EDMCQ-C was tested using Exploratory Structural Equation Modelling. To test whether the factor structure differed across gender, age group and competitive level, an invariance analysis comparing configurational, metric and scalar models was conducted. RESULTS: EDMCQ-C showed good psychometric properties and measurement invariance across age, gender and competitive level. Both dimensions of EDMCQ-C were associated to needs satisfaction and behaviour regulation in expected directions and had high internal consistency. CONCLUSION: This study provides evidence for the reliability of the two dimensions of EDMCQ-C, their predictive validity and for measurement invariance across age, gender and competitive level and provides a Danish version of the EDMCQ with sound psychometric properties.

Synthesising physical literacy research for 'blank spots': A Systematic review of reviews.

The holistic concept of physical literacy (PL) has gained considerable attention worldwide and integrates different determinants (e.g., physical, affective, and cognitive) of physical activity. The purpose of this systematic review (PROSPERO registration: CRD42022312764) was to broadly synthesise PL research and determine "blank spots". We performed standardized searches for PL reviews in 23 databases. Inclusion criteria were English language, any review with a systematized search, publication by June 2023 and PL relevance in an article's main body. The content and insights of the identified reviews were assigned to six literature-driven "problem fields": (i) theory/concept, (ii) measurement/levels/trends, (iii) determinants, (iv) outcomes, (v) interventions, and (vi) policy. We employed nine items for assessing the methodological quality of the reviews (including six items from AMSTAR-2). The screening resulted in an inclusion of 41 PL reviews of different methodology. Existing reviews most frequently analysed aspects of measurement (n = 20) as well as theory/definition (n = 19), followed by interventions (n = 17). In contrast, determinants (n = 6), outcomes (n = 5) and policy aspects (n = 4) were discussed less often. Accordingly, the major "blank spots" are: empirical studies on determinants and outcomes; PL levels and trends; pivotal moderators of interventions; and policy aspects. We recommend the scientific community to address these to move the field forward.

Physical literacy in Europe: The current state of implementation in research, practice, and policy.

Background/objective: The holistic concept of physical literacy (PL) embraces different person-centered qualities (physical, cognitive, affective/psychological) necessary to lead physically active lifestyles. PL has recently gained increasing attention globally and Europe is no exception. However, scientific endeavors summarizing the current state of PL in Europe are lacking. Therefore, the goal of this study was to comprehensively assess and compare the implementation of PL in research, policy, and practice across the continent. Methods: We assembled a panel of experts representing 25 European countries. Employing a complementary mixed-methods design, the experts first prepared reviews about the current state of PL in their countries (categories: research, practice/policy). The reviews underwent comparative document analysis, ensuring a transnational four-eyes principle. For re-validation purposes, the representatives completed a quantitative survey with questions reflecting the inductive themes from the document analysis. Results: The document analysis resulted in ten disjunct themes (related to "concept", "research", "practice/policy", "future/prospect") and yielded a heterogenous PL situation in Europe. The implementation state was strongly linked to conceptual discussions (e.g., existence of competing approaches), linguistic issues (e.g., translations), and country-specific traditions. Despite growing scholarly attention, PL hesitantly permeates practice and policy in most countries. Nevertheless, the experts largely anticipate increasing popularity of PL for the future. Conclusion: Despite the heterogeneous situation across Europe, the analysis has uncovered similarities among the countries, such as the presence of established yet not identical concepts. Research should intensify academic activities (conceptual-linguistic elaborations, empirical work) before PL may gain further access into practical and political spheres in the long term.

Play, Learn, and Teach Outdoors-Network (PLaTO-Net): terminology, taxonomy, and ontology.

BACKGROUND: A recent dialogue in the field of play, learn, and teach outdoors (referred to as "PLaTO" hereafter) demonstrated the need for developing harmonized and consensus-based terminology, taxonomy, and ontology for PLaTO. This is important as the field evolves and diversifies in its approaches, contents, and contexts over time and in different countries, cultures, and settings. Within this paper, we report the systematic and iterative processes undertaken to achieve this objective, which has built on the creation of the global PLaTO-Network (PLaTO-Net). METHODS: This project comprised of four major methodological phases. First, a systematic scoping review was conducted to identify common terms and definitions used pertaining to PLaTO. Second, based on the results of the scoping review, a draft set of key terms, taxonomy, and ontology were developed, and shared with PLaTO members, who provided feedback via four rounds of consultation. Third, PLaTO terminology, taxonomy, and ontology were then finalized based on the feedback received from 50 international PLaTO member participants who responded to ≥ 3 rounds of the consultation survey and dialogue. Finally, efforts to share and disseminate project outcomes were made through different online platforms. RESULTS: This paper presents the final definitions and taxonomy of 31 PLaTO terms along with the PLaTO-Net ontology model. The model incorporates other relevant concepts in recognition that all the aspects of the model are interrelated and interconnected. The final terminology, taxonomy, and ontology are intended to be applicable to, and relevant for, all people encompassing various identities (e.g., age, gender, culture, ethnicity, ability). CONCLUSIONS: This project contributes to advancing PLaTO-based research and facilitating intersectoral and interdisciplinary collaboration, with the long-term goal of fostering and strengthening PLaTO's synergistic linkages with healthy living, environmental stewardship, climate action, and planetary health agendas. Notably, PLaTO terminology, taxonomy and ontology will continue to evolve, and PLaTO-Net is committed to advancing and periodically updating harmonized knowledge and understanding in the vast and interrelated areas of PLaTO.

Is vegetation cover in key behaviour settings important for early childhood socioemotional function? A preregistered, cross-sectional study.

The environmental influences on early childhood development are understudied. The association between vegetation cover (i.e., trees, shrubs, grassed areas) in four key behaviour settings and socioemotional functioning was investigated in 1196 young children (2-5 years). Emotional difficulties were inversely associated with vegetation cover in the home yard (OR: 0.81 [0.69-0.96]) and neighbourhood (OR: 0.79 [0.67-0.94]), but not in early childhood education and care (ECEC) centre outdoor areas or the ECEC neighbourhood. The higher odds of emotional difficulties associated with lower levels of maternal education was reduced with higher percentages of home yard vegetation cover. There was no evidence of mediation of the relationship between emotional difficulties and vegetation cover by time spent playing outside the home, day or nighttime sleep duration, or physical activity. We found no associations between vegetation cover and conduct, hyperactivity and inattention, peer difficulties, or prosocial behaviours. A video abstract of this article can be viewed at https://www.youtube.com/watch?v=J3HeEiIjVZc.

Education outside the classroom as upstream school health promotion: 'adding-in' physical activity into children's everyday life and settings.

INTRODUCTION: It is central for public health to answer questions related to how to change health and wellbeing in populations through interdisciplinarity and health in all policies and sectors. For a school physical activity promotion initiative to be acceptable and thus feasible, the buy-in of teachers is fundamental. Therefore, school physical activity promotion should be integrated into and support teaching activities. AIMS: We discuss the use of education outside the classroom as a feasible pedagogical approach that integrates and promotes physical activity for school children. METHODS: We present and discuss theoretical arguments and empirical evidence to argue and illustrate that education outside the classroom is a promising approach for promoting physical activity. RESULTS: Education outside the classroom is characterised by regular curriculum-based experiential teaching activities outside the classroom with the inclusion of physical activity as a means to pedagogical ends. School subjects are taught outside the classroom drawing on problem-based learning and experiential education. Here, physical activity is integrated without compromising curriculum goals which increases teacher buy-in and thereby intervention acceptability and feasibility. Empirical evidence suggests that education outside the classroom increases boys' moderate to vigorous physical activity and girls' light intensity physical activity. We contend that the mechanisms are a mix of place, pedagogy and pupil motivations. CONCLUSIONS: Education outside the classroom is a feasible and acceptable approach to public health and physical activity promotion because it is integrated into children's everyday settings through curriculum time and applied broadly to child populations at a low cost. The practice of education outside the classroom is context-dependent and culturally bound, and practices therefore need to be adapted to the individual sociocultural context.

Associations between children's physical literacy and well-being: is physical activity a mediator?

BACKGROUND: Physical literacy (PL) is a multi-dimensional concept that provides a holistic understanding of movement and physical activity. PL contains an affective, a physical, and a cognitive domain, which together lay the foundation for the individual's capacity and the tendency for participating in physical activities currently and throughout life. PL is increasingly regarded as a 'cause of the causes' to health promotion. Cross-sectional studies have shown associations between children's PL, physical activity behaviours, and well-being. This study aims to examine the associations between Danish children's PL and their physical and psychosocial well-being and whether the associations are mediated by moderate- to vigorous intensity physical activity (MVPA). METHODS: Cross-sectional data from Danish schoolchildren aged 7-13 years were collected in Jan-Dec 2020 in the Danish Assessment of Physical Literacy (DAPL) project. PL was assessed with the DAPL which measures the affective, cognitive, and physical domains of PL. MVPA (min/day) was measured with accelerometers (Axivity), psychosocial well-being was measured with The Strengths and Difficulties Questionnaire, and physical well-being was measured with the KIDSCREEN questionnaire. Structural equation models were constructed with PL and MVPA as predictors of physical well-being and four aspects of psychosocial well-being. RESULTS: A positive moderate association between PL and physical well-being, partly mediated by MVPA was observed. PL was positively associated with the positive aspects of psychosocial well-being and negatively associated with the negative aspects (behaviour problems). None of the associations between PL and aspects of psychosocial well-being were mediated by MVPA. CONCLUSIONS: The study contributes to evidence on the link between PL, physical activity, and health outcomes. The study found beneficial relations between PL and physical and psychosocial well-being. MVPA mediated part of the relationship between PL and physical well-being but not psychosocial well-being.

Activating the 'peerness' of youth leaders in a community sports programme through techne and phronesis.

Peer-to-peer approaches engage groups of people considered to share one or more characteristics that identify them as peers and draw on rationales of credibility, identification and role modelling in peer-to-peer interactions. Despite the popularity of the approach, the ways in which the peer leadership component specifically contributes to health promotion is not thoroughly understood. We suggest that a first step for making use of peer leader characteristics is to make explicit what the peer leadership component is expected to bring to a programme. To approach such an understanding, we investigated how peer leaders can be supported in activating their 'peerness' in health promotion programmes, using as a case the peer leader education of a youth-led, peer-to-peer community sports programme, implemented by the non-profit street sports organization, GAME. We analysed the peer leader training programme's learning objectives and field notes from observations of the training programme. The empirical material was analysed using an abductive approach by drawing upon contemporary interpretations of two forms of knowledge originally proposed by Aristotle. In so doing, this article explores how the development of techne (practical knowledge) and phronesis (practical wisdom) was supported in a peer leader training programme for young people. Findings suggest that supporting the development of both these types of knowledge can strengthen programme planners' attention to the contribution of peers. Concurrently, an emphasis on promoting phronesis in peer leader training can support and encourage peer leaders in activating their 'peerness' in peer-to-peer health promotion programmes.

Peer-to-peer approaches are commonly used in the health promotion. Peer-led programmes engage groups of people considered to share one or more characteristics that identify them as peers. Peer leaders are suggested to be credible sources of information and provide identification and role modelling to their peers. However, despite the popularity of the approach, the ways in which peer leaders specifically contribute to health promotion are not thoroughly understood. It is thus unclear how the 'peerness' of peer leaders is activated in health promotion programmes. In this study, we investigated how peer leaders can be supported in activating their 'peerness' during peer-led activities. To do so, we observed and analysed the peer leader training programme of a youth-led community sport programme, implemented by the non-profit organization, GAME. As a theoretical framework, we employed two forms of knowledge originally proposed by Aristotle; namely, techne (practical knowledge) and phronesis (practical wisdom). Our results suggest that supporting the development of both these types of knowledge can strengthen programme planners' attention to the contribution of peers. Concurrently, an emphasis on promoting phronesis in peer leader training can support and encourage peer leaders in activating their 'peerness' in peer-to-peer health promotion programmes.

Translation and validation of the Canadian assessment of physical literacy-2 in a Danish sample.

BACKGROUND: The aim of this study was to translate the Canadian Assessment of Physical Literacy, second edition (CAPL-2) into Danish language, adapt it to Danish context and to test the measurement properties on a sample of Danish school children. METHODS: The CAPL-2 measurement tool was translated into Danish language and adapted for the Danish context. This Danish version of the CAPL-2 was then tested on 891 Danish school children from 50 classes in 12 different schools. RESULTS: Confirmatory factor analysis using the four-factor model, as suggested by the CAPL-2 original developers, showed an acceptable model fit for the Danish version (CFI = .973; TLI = .957; RMSEA = 0.040 (90% CI 0.033-0.054); SRMR = 0.040). Positive significant correlations between the domains were found. The domains as well as the total CAPL-2 score were found to be positively associated with physical education teachers' assessment of their pupil's in four central aspects of PL (i.e. enjoyment, confidence, motor skills, and diversity) indicating predictive validity. High internal consistency of the instrument used to measure motivation and confidence domain were found. CONCLUSION: The translated and context-adapted Danish version of CAPL-2 is a valid and reliable measurement tool ready to use in Danish research studies.

Exploring the importance of diversified physical activities in early childhood for later motor competence and physical activity level: a seven-year longitudinal study.

BACKGROUND: Research indicates that childhood motor competence (MC) can predict physical activity (PA) levels later in life and it has been argued that frequently engaging in a wide diversity of physical activities will eventually improve children's MC. However, no longitudinal or experimental studies have confirmed this theoretical rationale. The aims of this study are to explore the longitudinal associations between diversified physical activities at age six and later MC and PA (time spent in moderate-to-vigorous PA) (age nine and 13). Furthermore, we explore to what extent the longitudinal association between diversified physical activity and PA is mediated by MC. METHODS: Longitudinal data from the Copenhagen School Intervention Study were used for this analysis, where 704 participated (69% response rate). Diversified physical activity (self-reported), MC (The Körperkoordinationstest für Kinder battery of postural stability and locomotor skills) and PA (accelerometer) were assessed in the children at age six, age nine and age 13. A total of 654 participated in at least two of the measures and, therefore, were included in the analysis. Two structural equation models were constructed, with diversified physical activity at age six and MC and PA at age nine as predictors of PA and MC at age 13. RESULTS: The data from both models demonstrated good model fit. Diversified physical activity at 6 years of age was significantly associated with physical activity and MC at age 13, when adjusting for sex, age, intervention, weight, height, and previous levels of PA and MC. Diversified physical activity at age six was also positively associated with PA and MC at age nine, which were, in turn, positively related to PA at age 13 but to a lesser degree than diversified PA at age six. The association between diversified physical activity at age six and PA at age 13 was not mediated by MC at age nine. CONCLUSIONS: The results of this study indicate that diversified physical activity at age six is important for the development of MC and PA in adolescence. Increasing the diversity of children's daily physical activities, not only the amount and intensity, seems important for future PA behavior and thereby health promotion in a life course perspective.

Associations between previous sport and exercise experience and physical literacy elements among physically inactive Danes.

BACKGROUND: Physical inactivity is recognized as a leading global public health threat. Physical Literacy, a concept describing an individual's prerequisites to participate in and adhere to physical activities, has been suggested to be a key concept in understanding physical activity in various populations. The aim of this study was to describe the prerequisites for physical activity among inactive adults in terms of their physical literacy and previous experience with sport and exercise and how these are interrelated. METHODS: Sample: 1033 physical inactive Danes. MEASURES: BREQ-3, ESES, the Levels of knowledge questionnaire and the physical self-confidence scale. RESULTS: Inactive Danish adult's physical literacy scores are generally low compared to samples in other studies. Inactive adults with no or little previous experience with sport and exercise had lower levels of competences, self-efficacy and autonomous motivation for exercise and sport than the inactive with more experience. Previous sport and exercise experience was positively associated to the physical and affective domain of PL. CONCLUSION: Previous experience with sport and exercise is very important to consider when developing sport and exercise activities for currently inactive adults as individuals with low previous experience have lower competences and autonomous motivation and therefore need lower challenges and other important attention to the motivational climate in order to ensure that the activities are motivating enough to secure continued engagement.

Danish 'add-in' school-based health promotion: integrating health in curriculum time.

Schools provide an important setting for health promotion and health education. In countries where health education is not a specific subject, it is typically undertaken by teachers in health-integrating subjects such as biology, home economics or physical education. More ambitious and holistic frameworks and whole school approaches such as health promoting schools have been considered best practice for the past three decades. Recently, more attention has been given to policy initiatives integrating health activities into school curriculum time. This paper discusses potentials and challenges of school-based health promotion applying an 'add-in' approach, that integrates health activities into teachers' curricular obligations without taking time away from them, based on a presentation of three Danish cases. This may serve as a supplement to health promotion activities that have been initiated over and above the day-to-day teaching (add-on). We contend that an 'add-in' approach to school health promotion provides a potential win-win situation where both health and core education stand to gain; makes it possible to reach a wider range of schools; mobilizes additional resources for health promotion; and leads to more sustainable activities. However, potential limitations including not addressing structural aspects of health promotion and reliance on a relatively limited evidence base should also be considered.

Sports-based recreation as a means to address social inequity in health: why, when, where, who, what, and how.

The rising global burden of noncommunicable diseases (NCDs) among people with low socioeconomic status (SES) has heightened awareness of the need for primary prevention programs in low-SES neighborhoods. Social inequity in health is apparent in mental, social and physical aspects of health among people living in low-SES neighborhoods. Viewing this problem from a life course perspective and adopting a vulnerable population approach points to the importance of inducing sustainable health behavior changes in children and young people living in low-SES neighborhoods. One important factor in lowering the risk of many NCDs while improving mental health is the promotion of physical activity (PA). In this paper, we argue that lowering the risk of many NCDs and improving mental health is best achieved through setting-based programs that facilitate long-term PA behavior changes in children and adolescents living in marginalized neighborhoods. Empirical evidence indicates that extrinsic motives for participating in physical activities, such as improving health, are insufficient when long-term participation is the goal. Therefore, we argue that interventions with the aim of affecting long-term PA in low-SES neighborhoods and thereby reducing social inequities in health should include activities that aim to create more intrinsic and autonomous motivations by building on more broad and positive understandings of health and participation. Here, we advocate that sports-based recreation (SR) holds several advantages. If implemented well, SR has the potential to be a health-promoting activity that is meaningful and motivating in itself and that involves physiological health-promoting aspects (e.g., PA), a social aspect (e.g., positive relations with others), and a psychological aspect (e.g., positive experiences of oneself). Further, we suggest four practicalities that should be considered when conducting interventions: the cost of participating, the location, the facilities required, and the suitability of the SR activities.

Health in All local Policies: Lessons learned on intersectoral collaboration in a community-based health promotion network in Denmark.

Health promotion increasingly involves collaboration with civil society organisations and the private sector rather than being implemented exclusively by public sector stakeholders. Health in All Policies (HiAP) is an approach that promotes health in policy-making across public sectors. This study explored intersectoral integration and collaboration for health promotion at a local community level through a qualitative single case study of a local community network in Denmark: the Husum Health Network. The paper describes and discusses strengths, weaknesses, and challenges of HiAP-inspired local efforts to build alliances and supportive environments for health within an inter-organisational community-based network. The data were generated from participant observations made at 11 meetings and events organised by the network partners and nine qualitative, semi-structured interviews with Husum Health Network partners conducted from August 2014 to February 2015. The data were analysed using a theoretical framework introduced by Axelsson and Axelsson (2006) to characterise aspects of integration and differentiation between organisations. With high levels of structural and functional differentiation between the partners, the network provided an opportunity to exercise inter-organisational integration at the local level. Integration was fostered by knowledge sharing, face-to-face interaction, and communal events. However, the loose structure of the network was a challenge to its sustainability and achievement. We argue that Health in All local Policies is a meaningful concept in the context of local community development only when referring to the polices and strategies of all stakeholder organisations involved in decision-making and agenda setting, and not just local government institutions.

[What is the scientific evidence with regard to the effects of forests, trees on human health and well-being?] / De quelles preuves scientifiques disposons-nous concernant les effets des forêts et des arbres sur la santé et le bien-être humains ?

In today's modern society, lifestyle-related diseases play an increasingly important role as the cause of bad health. Staying in and access to environments that contain natural elements such as forests, parks and gardens has been featured because of its potential to stimulating people's health and well-being. An independent research area has developed, which addresses issues that try to explain and document the health effects of access to and activities in nature. To bring together European researchers working with different aspects of the relation between nature and health, COST Action E39 "Forests, Trees, and Human Health and Wellbeing" was established in 2004 and terminated in November 2009. The main results of COST E39 was presented in the book "Forests, Trees and Human Health" published in 2011. This article focuses on three central research questions regarding the relationship between nature and health: (1) Nature's restorative and salutogenic effects on human beings, (2) Health effects of outdoor physical activities, and (3) Therapeutic interventions such as therapy gardens and forest bathing. Based on a systematic review of research carried out in the aftermath of the COST Action the following conclusions are made: (1) There is a remarkable amount of research publications showing a statistical correlation between access to nature and green areas and human physical activity and health. However, there are few studies that really prove a causal relationship, i.e. that access to green areas leads to increased physical activity and better health. (2) The existing research on outdoor activities in natural environments describes a number of positive associations and effects on health, and the evidence for some of these are convincing, albeit there must be reservations for the immediate applicability of the conclusions. (3) A lot of studies also show that nature-based therapeutic interventions work and provide clear positive effects, but there is serious criticism about the quality of the studies. Finally, the authors suggest more emphasis on research regarding the economic benefits of nature's health effects, more research on the effects of nature-based therapeutic interventions, and of broadening the theoretical basis. Furthermore, we foresee a better integration with health policies and practical implementation within urban planning and forest management.

Attention Restoration Theory II: a systematic review to clarify attention processes affected by exposure to natural environments.

Attention Restoration Theory (ART) predicts exposure to natural environments may lead to improved cognitive performance through restoration of a limited cognitive resource, directed attention. A recent review by Ohly and colleagues (2016) uncovered substantial ambiguity surrounding details of directed attention and how cognitive restoration was tested. Therefore, an updated systematic review was conducted to identify relevant cognitive domains from which to describe elements of directed attention sensitive to the restoration effect. Forty-two articles that tested natural environments or stimuli against a suitable control, and included an objective measure of cognitive performance, had been published since July 2013. Articles were subjected to screening procedures and quality appraisal. Random effects meta-analyses were performed to calculate pooled effect sizes across 8 cognitive domains using data from 49 individual outcome measures. Results showed that working memory, cognitive flexibility, and to a less-reliable degree, attentional control, are improved after exposure to natural environments, with low to moderate effect sizes. Moderator analyses revealed that actual exposures to real environments may enhance the restoration effect within these three domains, relative to virtual exposures; however, this may also be due to differences in the typical lengths of exposure. The effect of a participants' restoration potential, based upon diagnosis or fatigue-induction, was less clear. A new framework is presented to qualify the involvement of directed attention-related processes, using examples of tasks from the three cognitive domains found to be sensitive to the restoration effect. The review clarifies the description of cognitive processes sensitive to natural environments, using current evidence, while exploring aspects of protocol that appear influential to the strength of the restoration effect.

Children's physical activity during a segmented school week: results from a quasi-experimental education outside the classroom intervention.

BACKGROUND: Movement integration (MI) into traditional classroom teaching is a promising opportunity for children to increase physical activity (PA). Education outside the classroom (EOtC) can be regarded as MI, and has increased children's PA in case studies. The aim of this study is to investigate the effects of EOtC on children's PA by segmenting weekly activity-related behavior into a range of day types and domains. METHODS: In a quasi-experimental design, 33 classes were recruited and participants' PA was objectively measured using accelerometers taped to the lower back. In total, 361 (10.89 ± 1.03 years) participants with 7 days of 24 h wear time per day were included in a day type PA analysis, and 194 of these participants (10.46 ± 0.99 years) provided information on time spent in specific domains (e.g. EOtC or recess) and were included in a domain-specific PA analysis. Differences in proportion of time spent in PA intensities were tested using mixed-effects regression models. RESULTS: More moderate-to-vigorous physical activity (MVPA) occurred on days with physical education (PE) than days with EOtC (girls 0.79%, p = .001, CI = .26% to 1.31%; boys 1.35%, p = .003, CI = .32% to 2.38%), while no difference was found between EOtC days and school days without EOtC and PE. Light physical activity (LPA) was higher on EOtC days than school days without EOtC and PE (girls 2.43% p < .001, CI = 1.21% to 3.65%; boys 2.08%, p < .001, CI = .69% to 3.47%) and PE days (girls 2.18%, p < .001, CI = .80% to 3.56%; boys 2.40%, p < .001, CI = .83% to 3.96%). Comparing EOtC and classroom domains, boys proportionally spent 7.95% (p < .001, CI = 3.00% to 12.90%) more time in MVPA while no difference (p = 1.000) was measured for LPA, and girls had no difference (p = .176) in MVPA, but spent 9.76% (p < .001, CI = 7.12% to 12.41%) more time in LPA. CONCLUSIONS: EOtC was implemented without the provision of additional resources and with positive effects on PA. Findings suggest EOtC as a way to provide children with an additional opportunity to accumulate PA within the existing school setting.