Systematic review of the ‘added value’
for well-being of physical activity in
outdoor natural environments
Ruth Garside
Senior Lecturer in Evidence Synthesis
Bangor 080312
Funded by NIHR through PenCLAHRC
Ruth Garside Bangor 080312
Ruth Garside Bangor 080312
Ruth Garside Bangor 080312
Ruth Garside Bangor 080312
Is exercising outside
better for you
than exercising inside?
Vs.
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
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Is long term adherence to
outdoor exercise initiatives
superior to that of indoor exercise
initiatives?
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Searches
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Medline
Embase
PsycINFO
GreenFile
Sport DISCUS
Cochrane Library
Science Citation Index
Social Citation Index
Arts and Humanities Citation Index
Conference Proceedings Citation Index
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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
• Hand searching
Groundwork
Living Streets
MIND
National Parks
National Trust
Natural England
Open Space
Walking for Health Initiative
Ruth Garside Bangor 080312
Ruth Garside Bangor 080312
Inclusion criteria
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Population: Adults or children
Intervention: Physical activity
Comparison: Indoors vs. outdoors
Outcomes: measures of physical or mental
wellbeing
• No language restrictions were applied
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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
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Identified
studies
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Study characteristics
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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
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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.
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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
Ruth Garside Bangor 080312
Ruth Garside Bangor 080312
Results: the effects of outdoor exercise
Increases in:
revitalisation
positive engagement
energy
Decrease in:
tension
confusion
anger
depression
calmness
Ruth Garside Bangor 080312
Results: attitudes
• Compared to indoor activity, outdoor activity
results in:
Greater enjoyment
Greater satisfaction
Greater intent to repeat the activity
Ruth Garside Bangor 080312
Ruth Garside Bangor 080312
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
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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
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
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)
Ruth.Garside@pms.ac.uk
www.ecehh.org
Any questions?