Dr carly wood
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- Research shows that spending time in nature has physiological and psychological benefits such as reducing stress and improving mood and well-being. - "Green exercise", or physical activity in natural environments, has been shown to lower heart rate and blood pressure in response to stress and enhance recovery from stress. The effects of green exercise may last over 12 hours. - Ecotherapy interventions, which incorporate nature-based activities, significantly increase participants' well-being, self-esteem, social inclusion, and connection to nature over the course of a program.
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Dr carly wood
- 1. Dr Carly Wood University of Essex Nature, Health and Wellbeing What does the research show?
- 2. Outline • Theories linking nature & health – a snapshot • Green Exercise or Ecotherapy– What do the terms mean? • Green Exercise Research Grants • Ecotherapy: Ecominds Project • Implications and Conclusions
- 3. Our relationship with nature has changed....
- 4. Theory Linking Nature and Health • “an innate sensitivity to and need for other living things – as we have co-existed for thousands of generations” • Hardwired into our genetic makeup • Evolved with affiliation for nature, urban settings not part of our genetic history • Closeness to nature ↑ WB & likelihood of understanding & caring for nature • Important resource for human health Wilson (1984)
- 5. Nature Contributes to Healthy Communities Nature Reduces property crime Violent crime Levels of aggression Provides a sense of belonging Enhances social cohesion Reduces social isolation Improves social networking Encourages intergenerational links Reduces stress Perceived Objective – e.g. Cortisol Restores mental fatigue Improves mental health and wellbeing Self-esteem Mood Reduces health inequalities Facilitates activity Improves physical health Lowers BP Increases HRV Reduces obesity
- 6. Physical Activity Known to have positive effects on physical and mental health Green Exercise To what extent does physical activity in the presence of green space affect mental and physical well-being? Exposure to Nature Known to have positive effects on mental health “Green Exercise” Green Exercise
- 7. ‘Ecotherapy’ or ‘Green Care’? • Umbrella terms for a range of nature-based interventions for vulnerable groups. • Initiatives – facilitated, specific intervention, for particular participants, rather than simply ‘an experience in nature’ for general public. • ‘Green Care’ approaches – ‘therapeutic’ in nature although some (minority) of initiatives also include formal therapy as an integral part of the programme. • Recently term ‘Ecotherapy’ used more generically/ interchangeably with GC
- 8. Green Exercise Research Grants • ESRC Early Career Fellowship (2009-2012) • British Heart Foundation Studentship (2010-2014) • Series of studies exploring the links between nature and stress in terms of: - Stress recovery - Response to stress
- 9. Heart Rate Variability • Marker of cardiovascular function which is altered by stress • High HRV reflects a healthy CV system able to adapt to stimuli from the brain and receptors around the body • Reduced HRV is a risk for cardiovascular disease
- 10. Study 1 Can viewing scenes of nature prior to stress 1. ↓physiological stress response &/or 2. ↑ physiological recovery from a stressor?
- 11. On arrival • Participant reads information sheet and signs informed consent • Participant fitted with ECG, finger blood pressure cuff, and respiration strap Baseline • Participants rested in a semi-supine position for 15 minutes • Physiological measures recorded for the final 5 minutes of the rest period Viewing • Participants viewed scenes of either a nature or built environment for 10 minutes • During Visit 2 participants viewed the set of slides not viewed during Visit 1 Stressor • Five minute forward digi-span stressor • Buzzer was sounded twice irrespective of incorrect or correct answers given • Physiological measures recorded throughout Recovery • Physiological measures recorded immediately post-stressor for five minutes
- 12. Views
- 13. Results – response n = 23 Mean heart rate Mean systolic blood pressure * *
- 14. Mean (± SD) heart rate variability Results – recovery
- 15. Study 2- Can a walk in nature affect night time HRV? Randomly assigned to walking a 1.8km route around either a built or a natural environment. On the second visit they undertook the other walk. Pace was similar on both walks. Participants wore an RR interval sensor overnight (eMotion sensor, Mega Electronics Ltd) to allow HRV to be examined during sleep. Three 10 minutes segments were selected by a reviewer blinded to type of walk. These segments were 1-2 hours after the participant noted in a diary they had fallen asleep (approx phase 4 of sleep).
- 17. Summary: Green Exercise Grants • Research provides ecologically valid evidence that nature reduces physiological stress and enhances recovery from stress; • Physiological effects of Green Exercise may last for more than 12 hours • Green Exercise may therefore enhance essential recovery and restoration during night time sleep and improve overall health.
- 18. Ecotherapy: Ecominds wellbeing evaluation • First study of different types of ecotherapy in the UK • Longitudinal & acute effect study • Recognised outcome measures 3 key themes: i) wellbeing, ii) social inclusion, iii) connection to nature All projects study In-depth study Within group study Between groups study Changes after an Ecominds session Changes over the Ecominds programme Ecominds evaluation Figure 3. Overview of the University of Essex Ecominds evaluation
- 19. Results All projects study - Significant changes Bragg et al., (2013) Change in mean positivity, nature connection and health scores from beginning to the end of the Ecominds programme * * * * indicates a significant increase in mean score
- 20. Results ‘In Depth’ study Significant increase in participant wellbeing over the course of the programme Significant increase in participant self-esteem over the course of the programme
- 21. Results ‘In Depth’ study Increased social inclusion Increased connection to nature
- 22. Summary: Ecotherapy Interventions • Encourages PA which impacts on health • ↑ Self-esteem, mood, WB • ↑ Connection to nature - (giving back to nature through shaping & restoring NE’s) • ↑ Self-perceived health • ↑ Environmentally friendly behaviour • Facilitate social contact , ↓ social exclusion • Build resilience & capacity to cope with life stresses • Provide sense of place • Are multifaceted, promoting good health & WB
- 23. Implications of Research • Nature can improve public health and wellbeing • Build resilience for those at risk of developing mental ill-health • Preventative measure for the vulnerable • And for us all.... • Treatment option for those with existing mental health problems • Another tool in the tool box for mental healthcare
- 24. Implications continued. • An enjoyable option to help people feel better • Efficient – multiple outcomes simultaneously • wider than clinical outcomes • Cost-effective • Leaving the diagnosis at the gate • Helps reduce social isolation
- 25. Conclusion • NE is an important resource for human health – need to actively protect it to ensure access for all • Nature↓ public health costs by promoting healthier communities • Need to engage commissioners of health & social care services to fund & support Ecotherapy initiatives • Promote it to GP’s, call upon NICE to consider the evidence & recommend Ecotherapy interventions as treatment options for mental ill-health • Need to think of Natural Health Service to complement NHS?
- 26. “DQ has done more for me than I could have imagined, it has released my spirit and I feel completely different” Thank you for listeningcjwood@essex.ac.uk www.greenexercise.org
Editor's Notes
- Introduction!
- Start with some background information to provide context for those of you that might not be familiar with the theories underpinning the positive relationship between nature, health and WB. informing the evidence base. Share a couple of examples of projects I have been directly involved in – Mind and WF
- For most of human history, we have been closely connected to nature - We have shaped it, and it has shaped us Our desire for contact with nature is partly evolutionary. Humans were hunter-gatherers and farmers for some 350,000 generations; we have been industrialised for only 8-10. We are outdoor animals largely living inside. (0.002%) So - we feel comfortable, de-stressed, connected when we are in nature and its elements. Width of room……
- The Biophilia hypothesis suggests that ‘humans have an inherent inclination to affiliate with nature’ (Grinde and Patil, 2009, p.2232) that is genetically based (Kahn, 1997). The human tendency for nature enhanced the fitness of our ancestors and has tuned our brains and minds to unconsciously extracting, processing and evaluating information from the natural world (White and Heerwagen, 1998). The theory proposes that contact with nature stems from an evolutionary competitive advantage in having superior knowledge about the natural world. This improved knowledge contributes to improved well-being and mental development (Kellert, 1983). The theory recognises the importance of nature in our emotional, cognitive, aesthetic and spiritual development and its contribution to improved well-being (Kellert, 1983; Fawcett and Gullone, 2001). In relation to children and adolescents, this theory indicates that young people are drawn and attuned to nature and its features (Kahn and Kellert, 2002). Children choose to access natural environments and by feeling connected to them and having knowledge about them, experience benefits for well-being. However proof for this hypothesis has not been acquired, as no genetic mechanisms have been identified.
- Snapshot of the health and wellbeing benefits of nature – as highlighted in the published literature But there are GAPS in evidence base
- 6
- Green care approaches are ‘therapeutic’ in nature although some (a minority) of initiatives also include formal therapy (e.g. counselling sessions, CBT, psychotherapy etc.) as an integral part of the programme (Bragg et al., 2013). However green care is not yet considered ‘mainstream’ as a treatment option in mental healthcare. Most GPs do not consider the use of green care as a treatment intervention for common mental health issues, such as mild to moderate depression
- BP, HR, HRV, Measures MH- mood, health related QL HRV- Marker of cardiovascular function; Insight into what is happening in the ANS and Sympatho-adrenal medullary (SAM) pathway Having high HRV is a good thing, it reflects a healthy CV system able to adapt to stimuli from the brain and receptors around the body. It is altered by stress and emotion and therefore has the potential as an indicator of effects of nature and stress together. Acutely stress usually triggers our fight or flight response increasing the associated branch of the ANS the sympathetic branch. Reduced HRV. Fits into the wider context of cardiovascular health there is evidence of reduced HRV being a risk for developing cardiovascular disease and more specifically reduction in vagal activity. To link back to the allostatic load framework for physiological processes if HRV shows prolonged changes due to stress then the it may be detrimental to health. Stress increases sympathetic activity and decreases vagal activity (Hjortskov et al. 2004) Reduced HRV- greater cardiovascular risk (Tsuji et al., 1996) Increased risk for cardiovascular events if vagal activity reduced (Thayer et al., 2006) Over exaggerated or prolonged changes due to stress have health implications
- BP, HR- secondary markers HRV- Marker of cardiovascular function; Insight into what is happening in the ANS and Sympatho-adrenal medullary (SAM) pathway Having high HRV is a good thing, it reflects a healthy CV system able to adapt to stimuli from the brain and receptors around the body. It is altered by stress and emotion and therefore has the potential as an indicator of effects of nature and stress together. Stress can reduce HRV and prolonged stress result in CVD risk. Acutely stress usually triggers our fight or flight response increasing the associated branch of the ANS the sympathetic branch. Reduced HRV. Fits into the wider context of cardiovascular health there is evidence of reduced HRV being a risk for developing cardiovascular disease and more specifically reduction in vagal activity. To link back to the allostatic load framework for physiological processes if HRV shows prolonged changes due to stress then the it may be detrimental to health. Stress increases sympathetic activity and decreases vagal activity (Hjortskov et al. 2004) Reduced HRV- greater cardiovascular risk (Tsuji et al., 1996) Increased risk for cardiovascular events if vagal activity reduced (Thayer et al., 2006) Over exaggerated or prolonged changes due to stress have health implications
- Some examples of the slides viewed. Picked pictures of two extreme environments based on the panel approved images of Pretty et al 2005 Urban characteristics specifically lacking elements of nature environments. Nature characteristics, inclusion of countryside i.e. grass, trees, hedge rows minimal man-made structures 12
- Two-way RM ANOVA Describe the graphs Significant main effect of time, increasing HR and SBP. No difference between condition. The stressor worked but view did not have an effect.
- Better recovery from the stress when viewed nature scenes
- HRV measures including vagal measures were significantly enhanced following nature walk compared to built walk. Physiological effects of walking in nature may last for more than 12 hours especially during approximately stage 4 of sleep. Potentially nature walks may enhance essential recovery and restoration during night-time sleep and improve health
- Provides ecologically valid evidence that nature reduces physiological stress Physiological effects of walking in nature may last for more than 12 hours especially during approximately stage 4 of sleep. Potentially nature walks may enhance essential recovery and restoration during night-time sleep and improve health Green exercise at work is feasible for the benefit of mental well-being.
- Over 800 people took part 500 from 52 projects- meta- analysis! Pre at start involvement in ecominds and post Questionnaires end project. Between and within design as some participants completed at start and end but some were different ppl. Outcome measures- all projects WB (positivity), social inclusion(Nhood Belong, import be others), CN (perceived conn, import nature), healthy lifestyles (healthy food etc). First study of different types of ecotherapy in the UK Longitudinal & acute effect study Recognised outcome measures In depth- 300 from 9 projects. Changes programme, changes session- within design!! Questionnaires start involvement and end programme but also after individual sessions. Wb (WEMWBS, SE, MOOD), social inclsion (engagment and support, neighbourhood belonging, satisfaction, community invol), CN and healthy lifestyles. . So what did we find??
- Sig increase perceived health, connection nature and positivity.
- Wellbeing and self-esteem levels significantly improved over the course of the green care programmes and strongly correlated with each other. Increases in both of the wellbeing parameters occurred simultaneously with increases in social engagement, connection to nature and aspects of a healthy lifestyle.
- Levels of social engagement and support significantly increased from the beginning to the end of the green care programmes. Increases in the frequency of participants taking part in community activities were also found. Participant connection with nature significantly increased over the programmes and increases in nature connection occurred simultaneously with improvements in all of the other variables except pro-environmental behaviour. A significant change in pro-environmental behaviour was also found between the start and end of the programme and these increases correlated with improvements to health. An increase in self-perceived health measure scores was found after participation in the programme. Health also correlated with both wellbeing measures, connection to nature, pro-environmental behaviour and healthy eating.
- Treat depression? Engage mental healthcare services Multiple outcomes
- Gr-een care could therefore be promoted not only for use as a treatment option for people with existing mental health problems, but also as a preventative approach to future stress reduction for those that have an elevated risk of developing a mental health problem (for example older people, the unemployed and those with long term physical disabilities or chronic health conditions). The UK population has become more sedentary and disconnected from nature in the last fifty years and many people are increasingly vulnerable and socially isolated, burdening health and social care systems and increasing their costs. The natural environment in rural and urban areas is also under pressure from reduced funding for land management, from development and unsustainable practices. Could green care interventions help more people living with a mental health problem recover and to become less isolated from society?
- This research has shown that the majority of participants will leave their green care interventions with multiple health and social outcomes, including better wellbeing and self-esteem and will feel more socially included. Participants will often have gained new skills and developed healthier, more sustainable lifestyles and an increased connection to nature. Those responsible for the provision of health and social care for those suffering with mental health problems should therefore consider the multiple health, mental wellbeing and social benefits to participants in green care interventions, when commissioning and funding mental healthcare services. The significant improvements found as a result of green care have implications for not only the mental wellbeing and resilience of individuals but also for public health and the management of natural environments.
- In times of burgeoning mental health costs, economic hardship, shrinking budgets (across all sectors) and amidst worries that we are becoming a society of sedentary and obese people, increasingly disconnected from nature, can we really afford not to promote ecotherapy as one of the solutions?
- My Traffic Lights are on Green A green environment gives me pleasure A time in which to reflect to treasure To ramble and walk at my leisure And give me time-out without measure My Green Exercise is sadly over Having helped me to rediscover The real meaning of positivity A life including sensitivity Encouragement and forward thinking Lifting me up when I am sinking What have I learnt whilst attending? What message has it been sending? I need to use it to promote my advancement Setting the stage for forward enhancement I hope I have learnt some very sound lessons To see me through future lonelier sessions Nature embraces and makes me calm Brings me peace, my nerves embalm I need to remember these tentative beginnings To give me hope and inspiration for future innings