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      Nature–Based Interventions for Improving Health and Wellbeing: The Purpose, the People and the Outcomes


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          Engagement with nature is an important part of many people’s lives, and the health and wellbeing benefits of nature–based activities are becoming increasingly recognised across disciplines from city planning to medicine. Despite this, urbanisation, challenges of modern life and environmental degradation are leading to a reduction in both the quantity and the quality of nature experiences. Nature–based health interventions (NBIs) can facilitate behavioural change through a somewhat structured promotion of nature–based experiences and, in doing so, promote improved physical, mental and social health and wellbeing. We conducted a Delphi expert elicitation process with 19 experts from seven countries (all named authors on this paper) to identify the different forms that such interventions take, the potential health outcomes and the target beneficiaries. In total, 27 NBIs were identified, aiming to prevent illness, promote wellbeing and treat specific physical, mental or social health and wellbeing conditions. These interventions were broadly categorized into those that change the environment in which people live, work, learn, recreate or heal (for example, the provision of gardens in hospitals or parks in cities) and those that change behaviour (for example, engaging people through organized programmes or other activities). We also noted the range of factors (such as socioeconomic variation) that will inevitably influence the extent to which these interventions succeed. We conclude with a call for research to identify the drivers influencing the effectiveness of NBIs in enhancing health and wellbeing.

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          Stress and Health: Psychological, Behavioral, and Biological Determinants

          Stressors have a major influence upon mood, our sense of well-being, behavior, and health. Acute stress responses in young, healthy individuals may be adaptive and typically do not impose a health burden. However, if the threat is unremitting, particularly in older or unhealthy individuals, the long-term effects of stressors can damage health. The relationship between psychosocial stressors and disease is affected by the nature, number, and persistence of the stressors as well as by the individual's biological vulnerability (i.e., genetics, constitutional factors), psychosocial resources, and learned patterns of coping. Psychosocial interventions have proven useful for treating stress-related disorders and may influence the course of chronic diseases.
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            Increasing walking: how important is distance to, attractiveness, and size of public open space?

            Well-designed public open space (POS) that encourages physical activity is a community asset that could potentially contribute to the health of local residents. In 1995-1996, two studies were conducted-an environmental audit of POS over 2 acres (n =516) within a 408-km2 area of metropolitan Perth, Western Australia; and personal interviews with 1803 adults (aged 18 to 59 years) (52.9% response rate). The association between access to POS and physical activity was examined using three accessibility models that progressively adjusted for distance to POS, and its attractiveness and size. In 2002, an observational study examined the influence of attractiveness on the use of POS by observing users of three pairs of high- and low-quality (based on attractiveness) POS matched for size and location. Overall, 28.8% of respondents reported using POS for physical activity. The likelihood of using POS increased with increasing levels of access, but the effect was greater in the model that adjusted for distance, attractiveness, and size. After adjustment, those with very good access to large, attractive POS were 50% more likely to achieve high levels of walking (odds ratio, 1.50; 95% confidence level, 1.06-2.13). The observational study showed that after matching POS for size and location, 70% of POS users observed visited attractive POS. Access to attractive, large POS is associated with higher levels of walking. To increase walking, thoughtful design (and redesign) of POS is required that creates large, attractive POS with facilities that encourage active use by multiple users (e.g., walkers, sports participants, picnickers).
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              Understanding environmental influences on walking; Review and research agenda.

              Understanding how environmental attributes can influence particular physical activity behaviors is a public health research priority. Walking is the most common physical activity behavior of adults; environmental innovations may be able to influence rates of participation. Review of studies on relationships of objectively assessed and perceived environmental attributes with walking. Associations with environmental attributes were examined separately for exercise and recreational walking, walking to get to and from places, and total walking. Eighteen studies were identified. Aesthetic attributes, convenience of facilities for walking (sidewalks, trails); accessibility of destinations (stores, park, beach); and perceptions about traffic and busy roads were found to be associated with walking for particular purposes. Attributes associated with walking for exercise were different from those associated with walking to get to and from places. While few studies have examined specific environment-walking relationships, early evidence is promising. Key elements of the research agenda are developing reliable and valid measures of environmental attributes and walking behaviors, determining whether environment-behavior relationships are causal, and developing theoretical models that account for environmental influences and their interactions with other determinants.

                Author and article information

                Sports (Basel)
                Sports (Basel)
                10 June 2019
                June 2019
                : 7
                : 6
                [1 ]Zealandia Centre for People and Nature, 6012 Wellington, New Zealand
                [2 ]Population Wellbeing and Environment Research Lab (PowerLab), School of Health and Society, University of Wollongong, 2522 Wollongong, Australia; thomasab@ 123456uow.edu.au
                [3 ]School of Public Health, University of Queensland, Brisbane, 4006 Queensland, Australia; e.barber@ 123456uq.edu.au
                [4 ]Discipline of Psychology, Australian College of Applied Psychology, Brisbane, 4000 Queensland, Australia; e.brymer@ 123456leedsbeckett.ac.uk
                [5 ]Environment & Sustainability Institute, University of Exeter, Cornwall TR10 9EZ, UK; D.T.C.Cox@ 123456exeter.ac.uk (D.T.C.C.); K.J.Gaston@ 123456exeter.ac.uk (K.J.G.)
                [6 ]School of Public Health, University of Queensland, Brisbane, 4006 Queensland, Australia; j.dean@ 123456sph.uq.edu.au
                [7 ]European Centre for Environment and Human Health, University of Exeter Medical School, Exeter EX1 2LU, UK; michael.depledge@ 123456pms.ac.uk
                [8 ]School of Biological Sciences, University of Queensland, Brisbane, 4072 Queensland, Australia; r.fuller@ 123456uq.edu.au
                [9 ]Institute for Housing and Urban Research, Uppsala University, 75120 Uppsala, Sweden; terry.hartig@ 123456ibf.uu.se
                [10 ]Social, Economic and Geographical Sciences, James Hutton Institute, Aberdeen AB15 8QH, UK; katherine.irvine@ 123456hutton.ac.uk
                [11 ]Norwich Medical School, University of East Anglia, Norwich, Norfolk NR15 1LT, UK; a.p.jones@ 123456uea.ac.uk
                [12 ]Centre for Biodiversity and Restoration Ecology, Victoria University of Wellington, 6012 Wellington, New Zealand; Heidy.Kikillus@ 123456vuw.ac.nz
                [13 ]European Centre for Environment and Human Health, University of Exeter Medical School, Truro TR1 3HD, UK; R.Lovell@ 123456exeter.ac.uk
                [14 ]Centre for Research on Environment, Society and Health, University of Glasgow, Glasgow G12 8QQ, UK; richard.Mitchell@ 123456glasgow.ac.uk
                [15 ]Department of Environmental Science, University of Helsinki, 00014 Helinski, Finland; jari.niemela@ 123456helsinki.fi
                [16 ]ISGlobal, Barcelona Institute for Global Health, Barcelona Biomedical Research Park (PRBB), 08003 Barcelona, Spain; mnieuwenhuijsen@ 123456creal.cat
                [17 ]Department of Biological Sciences, University of Essex, Colchester, Essex CO4 3SQ, UK; jpretty@ 123456essex.ac.uk
                [18 ]School of Health & Social Development, Deakin University, 3217 Geelong, Australia; mardie.townsend@ 123456deakin.edu.au
                [19 ]Zoology Department, University of Otago, 9016 Dunedin, New Zealand; yolanda.vanheezik@ 123456otago.ac.nz
                [20 ]Integrative Medicine, The University of Michigan, Michigan, MA 48710, USA; swarber@ 123456med.umich.edu
                Author notes
                [* ]Correspondence: danielleshanahan@ 123456gmail.com ; Tel.: +64-27-2033288
                © 2019 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).


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