1. Systematic review of the ‘added value’ for well-being of physical activity in outdoor natural environments Ruth Garside Senior Lecturer in Evidence Synthesis

2. Bangor 080312 Funded by NIHR through PenCLAHRC

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6. Is exercising outside better for you than exercising inside? Ruth Garside Bangor 080312

7. Vs.

8. Ruth Garside Bangor 080312 Levels of physical activity among the general population are poor 40% of men and 28% of women in England meet currently recommended levels of activity 17% of men and 13% of women between the ages of 64 and 75 meet currently recommended levels of activity Source: Health Survey for England, 2008

9. Ruth Garside Bangor 080312 Is long term adherence to outdoor exercise initiatives superior to that of indoor exercise initiatives?

10. Ruth Garside Bangor 080312 Searches Medline Embase PsycINFO GreenFile Sport DISCUS Cochrane Library Science Citation Index Social Citation Index Arts and Humanities Citation Index Conference Proceedings Citation Index

11. Ruth Garside Bangor 080312 Searches (cont.) Scrutinised bibliographies Internet site searches BTCV Collaboration for Environmental Evidence Countryside Recreation Network Environment Agency Forest Research Forestry Commission Green Exercise Green Space Groundwork Living Streets MIND National Parks National Trust Natural England Open Space Walking for Health Initiative Hand searching

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13. Inclusion criteria Population: Adults or children Intervention: Physical activity Comparison: Indoors vs. outdoors Outcomes: measures of physical or mental wellbeing No language restrictions were applied

14. Ruth Garside Bangor 080312 Review procedures Title and abstract and full text screening undertaken independently by 2 reviewers Discrepancies resolved by discussion Standardised, piloted data extraction from Data extracted by 1 reviewer and checked by 2nd No formal statistical analysis

16. Ruth Garside Bangor 080312 Identified studies

17. Ruth Garside Bangor 080312 Study characteristics Sample size ranged from 8 to 269 61% women Mean age 25.2 years (some data missing) All short term Walking (n=7); running (n=3); mixed (n=1) All reported mental wellbeing outcomes None reported effects on physical health, quality of life, long terms effects or long term adherence

19. Ruth Garside Bangor 080312 Study quality Reporting was poor in all studies Few details of – recruitment procedures – eligibility criteria – baseline characteristics. No reporting of – Randomisation procedure – Attempts to blind outcome assessment – Methods used to conceal allocation.

20. Ruth Garside Bangor 080312 Results 13 different outcome measures used to assess effect of exercise on mental wellbeing 4 different outcome measures used to assess attitude to exercise 9 of 11 studies showed some improvement in mental wellbeing on one or other measure

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22. Results: the effects of outdoor exercise Increases in:  revitalisation  positive engagement  energy Decrease in:  tension  confusion  anger  depression  calmness

23. Ruth Garside Bangor 080312 Results: attitudes Compared to indoor activity, outdoor activity results in:  Greater enjoyment  Greater satisfaction  Greater intent to repeat the activity

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25. Conclusions Some promising effects seen after outdoor exercise that were not seen after indoor exercise BUT Identified evidence is heterogeneous and of low methodological quality

26. Ruth Garside Bangor 080312 Research recommendations What’s the impact of different types of green space? Are blue spaces more beneficial? Could the magnitude of the potential benefit be greater in some people? What’s the impact of different types of activity? Easily transferrable outcome measures Longer trials that measure adherence

27. Ruth Garside Bangor 080312 This review presents independent research commissioned by the National Institute for Health Research (NIHR) through PenCLAHRC. (The Peninsula Collaboration for Leadership in Applied Health Research and Care) The views expressed are those of the authors and are not necessarily those of the NHS, the NIHR or the Department of Health

28. Ruth Garside Bangor 080312 Planned systematic reviews at the Centre: – What are the health and well being impacts of participating in activities which enhance the local environment? (SoPHR) – What are the health and well-being impacts of therapeutic gardens for those with dementia? (PenCLAHRC)

29. Ruth.Garside@pms.ac.uk www.ecehh.org Any questions?