Got the Blues, then Find some Greenspace: The Mental Health Benefits of Green Exercise

Mind report 1.0, Feb 2007
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Got the Blues, then find some Greenspace
The Mental Health Benefits of Green Exercise Activities and Green Care
Mind week report, February 2007
Jo Peacock, Rachel Hine and Jules Pretty
Centre for Environment and Society, Department of Biological Sciences, University of Essex
Wivenhoe Park, Colchester CO4 3SQ
Photographs courtesy of Cyrillia Francis and Steph Berns of Mind

Background
Mind commissioned Professor Jules Pretty, Jo Peacock and Rachel Hine, lead researchers of
the green exercise programme at the University of Essex, to investigate the mental health
benefits Mind members derive from participating in a range of green exercise activities. One
hundred and eight Mind members took part in our research looking at the effects of existing
green exercise activities which they are already engaging in locally. In addition, a further 20
members participated in a smaller study which compared the mental health benefits
experienced from participating in a green walk outdoors, with an equivalent walk indoors. Both
the statistical findings from this process together with the qualitative narrative are included in the
report.
Mind and the University of Essex would like to thank all Mind members for their assistance with
the research published in this report. We are very grateful to all the people who completed the
questionnaires and those who took part in the walking study and agreed to share details about
their experiences.
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Contents
1. Key findings 4
2. Introduction 8
3. Review of existing literature 10
3.1 The value of greenspaces and contact with nature 10
3.2 The value of exercise 11
3.3 The emergence of green exercise 12
3.4 What do we know so far? 14
3.5 What are we yet to fully understand? 16
3.5.1 Application of green exercise in the mental health population
3.5.2 Green exercise as a treatment for mild to moderate depression
3.5.3 Green care for marginalised populations
3.5.4 Limitations of research to date
4. Assessment of existing Mind green exercise activities 23
4.1 Findings - green exercise activities 23
4.2 Findings - people involved in the activities 24
5. A Mind study to compare a green outdoor walk and an indoor walk 32
5.1 Backgound and methodology 32
5.2 Results 35
6. Conclusions and recommendations 41
6.1 Issues affecting progress of research 41
6.1.1 Ethical issues
6.1.2 Evaluation issues
6.2 Key issues for policy 42
6.2.1 Amount of greenspace
6.2.2 Accessibility issues
6.2.3 Barriers to participation
6.2.4 Acceptance from service providers
6.2.5 Working in partnership
6.2.6 The need for further research
7. References 47

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1. Key findings
 The current health status of the UK population is becoming problematic due to our
increasingly sedentary lifestyles, our poor diets and the prevalence of mental illness. Mental
ill health severely compromises quality of life and sadly, sufferers of anxiety and depression
are all too commonplace today.
 The total costs of mental illness in England have been reported to be has high as £77.4
billion. This includes the human costs of mental illness due to reduced quality of life,
suffering, pain, disability and distress; and the costs of output losses in the economy due to
peoples’ inability to work and costs of health and social care.
 Therefore, mental illness is a burgeoning concern and public spending on mental health
services is continually rising. Perhaps it is about time we started to question the cost-effectiveness
of existing treatment options, such as therapy and drug prescriptions? Should
we be thinking about preventative treatments and if so, what should we be prescribing? Is it
inconceivable to think that we might already have a solution on our doorstep, which is
available to everyone at minimal cost? The simple answer might exist in encouraging people
to interact with nature and greenspace and to get active outdoors?
 A myriad of persuasive evidence demonstrates the positive relationship between exposure
to nature and an individual’s health and well-being. Nature and greenspaces are often
perceived as places to relax, escape and unwind from the daily stresses of modern life. This
opportunity for relaxation and recreation has a positive influence on our emotional and
physical well-being. Equally, participating in physical activity is known to result in positive
physical and mental health outcomes.
 Therefore, engaging in physical activities whilst simultaneously being directly exposed to
nature (“green exercise”) could offer an alternative preventative and curative option to
address the worrying problem of mental illness. There is an emerging and compelling
argument for green exercise therapy to be advocated as preventative medicine or the
primary treatment option for some mental illnesses, as exercise has less negative side
effects than many traditional drug therapies and it can positively treat patients experiencing
a combination of physical and mental health problems.
 However, at present, there is limited evidence concerning the application of green exercise
in the mental health population. With incidences of mental illness and especially depression
on the increase how much do we know about green exercise as a potential treatment?
There has been little research conducted which compares green exercise with more
traditional treatment options, such as antidepressants or cognitive behavioural therapy but
from initial findings we can confidently anticipate that green exercise is likely to be equally as
effective.
 Some may argue that the option of green exercise therapy or green care may prove to be an
even more effective treatment response than exercise alone as it encourages people to re-connect
with nature and experience the additional positive health benefits that are
associated with this. Contact with nature and greenspace is often uplifting and restorative,
helps to reduce stress and improve mood and combining this with physical activity will offer
a very efficacious treatment option. Green exercise also promotes social inclusion and
enables people to make healthier choices and adopt a sustainable healthier lifestyle.

However, the robust scientific evidence to support this hypothesis is still lacking. For the
idea to gain credibility and influence government policy and the health sector, more detailed
research needs to be undertaken. Some of these research limitations were addressed in this
study.
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 108 Mind members took part in our research and completed a specifically designed
questionnaire, which assessed the positive physical and mental health benefits people
derived from engaging in a range of green exercise activities. It was found that the
combination of exercising outside in the presence of nature (i.e. green exercise) was the
most influential factor, with 89.6% of respondents stating that this was very important or
important in determining how they felt. This supports the idea that it is the synergistic
amalgamation of the exercise in a green environment that produces added health benefits,
rather than either one alone.
 Many key themes emerged when assessing how taking part in these activities made
participants feel. They enjoyed becoming part of a group and socialising with likeminded
people. They took pleasure in the conversation and company and the activities left them
feeling refreshed. They felt less stressed, more alert and alive, happier and more relaxed.
Many people stated that they felt mentally healthier and a lot more motivated and positive.
They felt that the activities helped to lift their depression levels and instil a feeling of calm
and peacefulness. Their overall mood improved as did their confidence levels and self-esteem.
Many spoke of the benefits to their fitness levels and how they felt stronger, less
lethargic and more energetic. Others commented on the changes to their body profile
through losing weight, easing stiffness in their joints and becoming more agile, so there
were a range of physical health benefits reported.
 The findings from this assessment clearly showed that participating in a range of green
exercise activities provided substantial social, health and well-being benefits. The contact
with nature and greenspace is a necessity in enriching the experience and creates a
restorative environment which people can seek pleasure in escaping to. A lot of enjoyment
was derived from getting out into the fresh air, admiring the scenery and taking pleasure in
the wildlife, plants and trees.
 Participating in these activities was often perceived as therapeutic and engendered feelings
of relaxation and peacefulness. The whole process was very calming; it reduced stress
levels and encouraged people to feel good about themselves by improving their self-worth,
confidence and self-esteem. It inspired people to embrace their problems and start to deal
with them and learn how to cope. There was a great sense of achievement when an activity
was completed, as participants felt they had achieved something worthwhile and therefore
felt useful.
 In addition, 20 local Mind group members
participated in a separate small study which
addressed the research question: “Will
exercising outdoors in a green environment
significantly improve participant’s mental
health and well-being (using standardised
and well-recognised mood and self-esteem
measures) compared to the equivalent
exercise indoors?” They took part in two
Figure 1: The change in self-esteem following participation in the
walks
Indoor walk
Green outdoor walk
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19
20
21
22
Type of walk
Index of self-esteem

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separate walks, a green outdoor walk and an indoor walk at a local shopping centre. Figure
1 clearly shows the significant improvement in self-esteem following the green outdoor walk
and the detrimental effect after the indoor walk.
 Participating in a green outdoor walk also
significantly reduced feelings of anger
(Figure 2), depression (Figure 3) and
tension (Figure 4) in comparison to the
indoor walk. In fact, after the indoor walk
participants were left feeling tenser than
when they had started. Feelings of fatigue
also reduced even though they had been
walking for an hour. Participants also felt
more active and energetic, so it offers an
ideal way of getting rid of those blues.
 The findings undoubtedly showed that
exercising outdoors in a green
environment is a lot more effective in
enhancing your mood and improving your
self-esteem compared to the equivalent
amount of exercise indoors.
 Participating in the green outdoor walk
was a lot more effective in reducing
feelings of anger, depression, tension and
confusion, in comparison to the indoor
walk. It also increased feelings of vigour
and left participants feeling more active
and energetic.
 The enjoyment of engaging in green
exercise activities in groups was a
valuable part of the experience, as well as
the opportunity to breathe in fresh air,
admire the scenery and enjoy the wildlife.
 The findings add significant value to the
ever expanding green exercise research
programme as it focuses on individuals
experiencing mental health issues and
separates the elements that constitute the
green exercise experience.
Figure 2: The change in feelings of anger following participation
in the walks
Indoor walk
Green outdoor walk
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42
41
40
39
38
Type of walk
Index of anger
Figure 3: The change in feelings of depression following
participation in the walks
Indoor walk
Green outdoor walk
42
41
40
39
38
Type of walk
Index of depression
Figure 4: The change in feelings of tension following participation
in the walks
Indoor walk
39
38
37
36
35
34
33 Type of walk
Green outdoor walk
Index of tension
 In today’s world, where sufferers of mental ill health are more commonplace, nature can act
as a vital health resource. With significant costs incurred due to lost outputs, increased
expenditure in the provision of care and the inestimable cost to the individual, the
importance of access to nature and greenspaces is paramount.

 Green exercise and green care therefore have implications for many sectors, suggesting the
need for cross-disciplinary and sectoral strategies and action. Increasing support for and
access to, a wide range of green exercise activities for all sectors of society should produce
substantial economic and public health benefits. Such support could include the provision
and promotion of healthy walks projects, green exercise on prescription, healthy school
environments, green views in hospitals, care farms, city farms and community gardens,
urban green space, and outdoor leisure activities in the countryside.
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2. Introduction
The current health status of the UK population is becoming problematic due to our increasingly
sedentary lifestyles, our poor diets and the prevalence of mental illness. It is believed that at
least one in six individuals' suffer from a “significant” mental health problem at any one time and
some reports quote this figure as high as one in four.
Mental ill health can severely compromise an individual’s quality of life and it is a leading cause
of disability. Sufferers of anxiety and depression are commonplace and by 2020 it is predicted
that depression will be the second most common cause of disability in the developed world.
Mental ill health is therefore a major issue and sadly problems surrounding social exclusion,
vilification and discrimination of the mentally ill are still real challenges to overcome.
Mental illness is not solely a challenge for the health sector to address as it inflicts additional
economic and social costs. It is estimated that the total costs of mental illness in England in
2002-03 were approximately £77.4 billion (The Sainsbury Centre for Mental Health, 2003). To
put this in perspective, the cost of crime for our society in the same period was substantially
less, so mental illness is costing us more than crime. The costs of mental illness can be
segregated into three key areas, impacting upon human costs, health and social care and
output losses (Box 1).
Box 1: The burden of mental illness in the UK
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 At least 1 in 6 individuals are affected at any one time
 10% of children aged 5-15 yrs suffer from a mental disorder
 Instances of depression and mixed anxiety rose from 7.8% in 1993 to 9.2% in 2000
 £41.8 billion represents the human cost of mental illness due to reduced quality of life, suffering, pain,
disability and distress
 £23.1 billion is the cost of output losses in the economy due to peoples inability to work
 £12.5 billion is the cost of health and social care provided by the NHS and Local Authorities and informal
care given by family and friends
 £4.9 billion is spent on NHS hospital and community health services
 £1.4 billion is spent on Local Authority social services
 £898 million is spent on GP consultations
 £754 million is spent on drug prescriptions
 £3.1 billion per year represents the net saving across the government as a whole if better mental health
care is introduced (Wanless, 2002). This conservative estimate does not include the additional savings
gained from promoting mental health and preventing problems in the first instance.
It is evident that mental illness is a burgeoning concern and public spending on mental health
services is continually rising. It is estimated that £7.9 billion was spent in England in 2002-03 on
mental health services including £754 million on drug prescriptions. The cost of antidepressants
has risen dramatically. In 1992, the number of antidepressant prescriptions dispensed was 9.9

million but by 2003 this figure had increased to 27.7 million. This represents a cost of £395.2
million and implies an increase in cost of 2,083% in only 11 years.
The government is also currently spending more money on training therapists to co-ordinate
cognitive behavioural therapy (CBT) sessions, so mental ill health is emerging as a costly
predicament. Perhaps it is about time we started to explore alternative preventative and curative
therapies which, while comparable in their success rates, are cheaper to employ. The
importance of the health of the individual and affected family members involved in care
provision supersedes any financial cost, but if there is a potential solution which addresses both
issues, this could significantly reduce public spending and human costs.
Is it inconceivable to think that we might already have a solution on our doorstep, which is
available to everyone at minimal cost? The simple answer might exist in encouraging people to
interact with nature and greenspace and get active outdoors? The positive relationship between
exposure to nature and greenspace and an individual’s health is continually being evidenced.
The quality and quantity of nature and greenspace in the surrounding environment transforms a
person’s mental health, both at home, at work and at the places they visit. This concept is not
revolutionary but it has yet to significantly influence the planning of urban and rural
environments or public health and social care priorities. However, nature and greenspaces are
often perceived as places to relax, escape and unwind from the daily stresses of modern life.
This opportunity for relaxation and recreation has a positive influence on our emotional and
physical well-being. Therefore, in today’s world, where sufferers of mental ill health are more
commonplace, nature can act as a vital health resource. With significant costs incurred due to
lost outputs, increased expenditure in the provision of care and the inestimable cost to the
individual, the importance of access to nature and greenspaces is paramount.
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3. Review of existing literature
3.1 The value of greenspaces and contact with nature
There is a myriad of persuasive evidence which connects regular contact with the natural
environment and greenspace to enhanced physical health and mental well-being. This
incorporates a variety of outdoor settings, from the open countryside, fields and forests, remote
wildlands, parks and open spaces, to street trees, allotments and gardens. The key message
emerging is that contact with these greenspaces improves psychological health by reducing
stress levels, enhancing mood and offering a restorative environment which enables you to
relax, unwind and recharge your batteries. Greenspaces also provide an ideal opportunity and
incentive for exercise and can be especially valuable in urban areas for facilitating social contact
and helping to bring people together.
A significant relationship between the proximity of urban open green spaces, visiting frequency,
duration of stay and the level of self-reported stress experienced has been reported (Grahn and
Stigsdotter, 2003). The quantity of available greenspace has also been correlated with longevity
and a reduced risk of mental ill health (Takano et al., 2002; De Vries et al., 2003). Open space
is also vitally important for children and studies have shown that children with Attention Deficit
Disorder worked better and their concentration improved after participating in activities in green
surroundings (Taylor et al., 2001).
So, if research strongly indicates that exposure to nature and greenspace positively affects our
physical health and mental well-being, do we fully understand why? What are peoples
motivations for engaging with nature? With a multitude of choices available, why do so many
people still seek out green places (both rural and urban) on a regular basis? As hominids were
hunter-gatherers for over 300,000 generations, having daily contact with nature and the land,
are the reasons co-evolutionary? In comparison, the increasingly urbanised and industrialised
environment we currently live in has only emerged in the past six to ten generations.
Many of us already recognise and appreciate the health benefits we derive from spending time
engaging with nature. In the UK we make 1.2 billion day visits to the countryside each year, with
a further 5 billion visits to urban parks. 5 million people are regular anglers, and some 15 million
garden regularly; 6 of every 10 households have a pet; and many millions of others are bird
watchers, wild-fowlers, pigeon-racers, dog-walkers, ramblers, runners, horse-riders, cyclists and
game shooters. Why do we do all these things? What motivates us to take the trouble to be in
the presence of green nature and living things, when we can now easily stay at home and watch
it on the television? Why do we say that we feel great after green activities? And if we feel so
good doing it, why do we not spend more time visiting greenspaces and put time aside to enjoy
it?
Equally, we may question what consitutes a green experience? Do artificial plastic trees and
plants have the same effect as rainforest trees or hay meadows in the spring? In what way does
nature affect us emotionally as opposed to intellectually – is the experience different if you are
aware the nature is simulated? What difference does spending five minutes a day in contact
with nature make to two weeks in the wild? Does an individuals personal history affect their
experience? Is there a contrast between urban and rural dwellers, or someone visiting their own
local environment compared to someone coming from another culture? Does the culture of
origin affect the experience, or is the desire to connect with nature the same irrespective of

cultural context? These thought-provoking questions need to be explored so that we can begin
to shape our reasons for engaging with nature and greenspace.
3.2 The value of exercise
Participating in regular physical activity is generally accepted as a highly effective method for
preventing illness and offers a therapeutic intervention for tacking existing illness. Physical
activity has been evidenced to be an important determinant of both physical health and
psychological well-being. Moderate regular exercise reduces morbidity rates by 30-50% and has
a particularly protective effect against maturity onset Type II diabetes, coronary heart disease,
musculo-skeletal diseases and cancer. It lowers blood pressure, improves blood lipid and
glucose profiles and boosts the immune system. It also enhances mental health by improving
mood and self-esteem, reducing stress, enriching an individual’s quality of life and diminishing
the chance of depression. We are now gaining a better understanding of the intimate inter-relationship
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between mental and physical health, as the status of one considerably affects the
other. Therefore, exercise can be used as a successful tool to ensure preferable health states
are experienced.
Throughout the last fifty years, the UK has witnessed a dramatic fall in the levels of daily
physical activities, despite the robust evidence for staying active. On average, adults expend
500 kcal less energy per day in comparison to their ancestors fifty years ago. This is
comparable to undertaking a marathon a week on top of current activity levels, just to restore
this reduction in energy expenditure. This is primarily because people have become increasingly
sedentary in all aspects of daily life, including during leisure time, in travelling to and from work
and during work itself. Home life has also become more sedentary and although gym and
fitness club membership has risen (although many have a low adherence rate) in the past
twenty years, there are indications that people are becoming less likely to engage in organised
sports and leisure activities.
The level of weekly physical activity required to achieve general health benefits has led to the
development of a universal recommendation. It advises that individuals should participate in “at
least 30 minutes a day of at least a moderate intensity on 5 or more days of the week”
(Department of Health, 2004). However, it is estimated that only 35% of men and 24% of
women actually meet this recommendation. The major problem is the misconception that
current physical activity levels are sufficient to avoid ill-health. 80% of individuals are aware that
regular exercise is beneficial for their health, but most inaccurately believe that they participate
in enough exercise to reap these rewards. For these targets to be met a dramatic modification is
necessary and perceptions need to be revolutionised.
Due to this activity transition, populations have suffered very significant public health
consequences. The annual costs of physical inactivity in England are reported to be
approximately £8.2 billion (Department of Health, 2004). This figure excludes individuals who
are obese due to inactivity, which contributes an extra £2.5 billion annual cost to the economy.
These figures incorporate both costs to the NHS and costs associated to the economy (e.g.
work absenteeism). This rise in inactivity levels and the associated problems with obesity are a
priority on the government’s agenda and although there is a general acknowledgement that
greenspaces rich in biodiversity encourage physical activity, the relationship needs further
investigation to develop a deeper understanding. Undertaking physical activities in outdoor
green environments seems to be a more sustainable option in maintaining long-term activity
levels, as it is the interaction with the environment and the social contact that are the main

incentives. In this situation, the health benefits derived from the exercise are not the sole focus
and become a secondary outcome. With the current inactivity predicament, exploring the use of
rural and urban greenspaces as ideal locations to encourage physical activity could prove to be
a benefit for all.
3.3 Emergence of green exercise
There is a growing body of empirical evidence which proclaims that exposure to nature induces
substantial mental health benefits. Equally, participating in physical activity is known to result in
positive physical and mental health outcomes. Therefore, at the University of Essex we have
combined these ideas into a programme of research which investigates the synergistic benefits
of engaging in physical activities whilst simultaneously being directly exposed to nature. We
refer to this as “green exercise” (Figure 5). This programme addresses current concerns about
the adverse health effects of modern diets and sedentary lifestyles, along with growing evidence
that stress and mental ill-health have become substantial health problems for many people in
industrialised societies.
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Figure 5: The concept of green exercise and the health benefits it engenders
Engaging in
physical activity
Exposure to nature
and greenspaces
Green Exercise
1. Improves
psychological well-being
2. Generates
physical health
benefits
3. Facilitates social
networking and
connectivity
Healthier communities and avoided
public health costs
From a wide variety of University of Essex research involving more than three thousand people,
we have discerned three key outcomes from participating in green exercise activities: 1)
improvement of psychological well-being (by enhancing mood and self-esteem, whilst reducing
feelings of anger, confusion, depression and tension); 2) generation of physical health benefits
(by reducing blood pressure and burning calories) and 3) facilitation of social networking and

connectivity (by enhancing social capital). Box 2 shows a selection of qualitative comments that
have been collected during the research which supports this idea.
Box 2: A selection of comments collated during our research programme supporting the key
health outcomes identified
1: Improves psychological well-being
“It is relaxing mentally where I can get away from responsibilities of a managerial job and being a parent. I find it
refreshes me for everyday life and its problems. A great day”
“I feel it helps my well being and I feel more healthy”
“In good spirits and very relaxed”
“Good to be out and meet people. Boosts your ego and makes you feel good”
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2: Generates physical health benefits
“Exercise, being outdoors, enjoying the environment”
“Relaxing, exercises the body, clears the head”
“Fun to do, great exercise and in a beautiful location which helps keep me fit and happier”
“To try to keep fit and lose weight, good company”
3: Facilitates social networking and connectivity
“Enjoyment especially the social interaction and meeting and talking to people we wouldn’t ordinarily meet!”
“Feel refreshed – better for taking part, enjoy social aspect”
“I feel much more alive and my spirits have lifted by the walk and the company of other walkers”
“As a retired person it is valuable for me to meet other people for recreation and conversation”
Our research has also enabled us to gain an insight into some of the underlying reasons for
engaging in green exercise activities. Table 1 illustrates these ideas by identifying four key
principles and separating these into ten sub categories, which describe some of the pleasures
we commonly refer to.
Green exercise seems to be effective in generating a variety of health benefits which lead to
healthier communities and avoided public health costs. With the understanding of the close
inter-relationship between mental and physical health gaining acknowledgement, engaging in
green exercise activities presents an ideal way of advancing collective health states.
Three of the government’s six key priorities in their recent Public Health White Paper were to
“reduce obesity”, “increase exercise” and “improve mental health”. Therefore, encouraging more
people to adopt green exercise behaviour may contribute to the compliance of these objectives
whilst also enhancing the health of the nation.

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Table 1: Four key principles describing why people enjoy engaging in green exercise activities
Principles Sub-categories
Descriptors
1. Natural
and social
connections
a. Social Being with friends and family, companionship and social interaction,
creation of collective identity, making new friends, conviviality
b. Animals
and wildlife
Direct bonding with companion animals (e.g. dogs, horses) and wild
animals (both observing and hunting), feeding birds, recognising, counting
and collecting (greater value of rarities)
c. Memories
and
knowledge
Visiting special places where memories and stories are provoked and
recalled (childhood associations), story-telling, personal identity, links to
myths, stimulation of imagination, ecological literacy
d. Spiritual Large scale and longevity of nature in contrast to humans, transformative
capacity of green nature, oneness with nature and animals
2. Sensory
stimulation
a. Colours
and sounds
Diverse colours of nature and landscapes, views of landscape, beauty of
scenery, bird-song and sounds of other animals, light (especially sunrise /
sunset), visual and aesthetic appreciation of landscapes
b. Fresh air
Smell and other senses, being outdoors, exposed to all types of weather,
changing of seasons, a contrast to indoor and city life, escape from urban
pollution
c.
Excitement
Adrenalin rush, exhilaration, fun, arising from a physical activity or
experience of risk (e.g. rock climbing, mountain biking), sense of adventure
3. Activity
a. Manual
tasks
Learning a skill and completing a manual task (e.g. conservation activity),
challenging, fulfilling and rewarding, sense of achievement, leading to a
sense of worth and value
b. Physical
activity
Enjoyment of the activity itself and the physical and mental health benefits
associated with it, makes people feel good, more energetic, less lethargic
4. Escape
a. Escape
from
modern life
Getting away from modern life, relaxing (as a contrast), time alone or with
family, a time to think and clear the head, peace and quiet, tranquillity and
freedom, privacy, escape from pressure, stress and “rat-race”, recharging
batteries
3.4 What do we know so far?
Even just viewing nature through a window or in a painting can positively influence people’s
well-being. Research has shown this in hospitals, prisons, the workplace and whilst travelling to
work1. Green views from the window help to buffer stresses, reduce frustration and enhance
concentration. Viewing green landscape paintings aids recovery from illness, improves mood,
reduces stress and improves mental well-being. At the University of Essex we have
demonstrated that engaging in physical activities whilst viewing a series of green rural or urban
pictures reduces blood pressure and enhances mood and self-esteem (Pretty et al., 2005).
Incidental exposure to nearby nature whilst engaging in some other activity also assists in
reducing stress, enhancing mood status and promoting relaxation. This nearby nature
incorporates countryside and neighbourhood greenspaces, parks, grounds of hospitals and care
homes, along with healing gardens2. Healing gardens are designed to aid recovery from stress
and are often present in hospitals and care homes, whereby stressful experiences are
encountered by patients, visitors and staff. Therefore, outdoor natural settings are often
1 (Verderber and Reuman, 1987; Tennessen and Cimprich, 1995; Leather et al., 1998; Parsons et al., 1998; Kaplan, 2001;
Laumann et al., 2003)
2 (Cooper-Marcus and Barnes, 1995, 1999; Wells, 2000; Whitehouse et al., 2001; Ulrich, 2002; Wells and Evans, 2003)

perceived as therapeutic “healing places” and a wide range of research has demonstrated this
effect (Pretty, 2007).
Direct participation in some green exercise activity, such as gardening, walking, running, cycling
or fishing also yields a series of unequivocal physical and psychological health benefits. Studies
have looked at the benefits of wilderness experiences, adventure therapy, forest schools, social
and therapeutic horticulture (which is based on the value of gardening for mental and physical
health), care farming and private and community gardens.
The University of Essex has undertaken research involving 263 participants which measured
the effects of ten green exercise activities (including walking, cycling, horse riding, fishing, canal
boating and conservation activities) in four countries of the UK (Pretty et al., 2006; Pretty et al.,
2007). We found that participants felt significantly less angry, depressed, confused and tense
after engaging in the activities and their self-esteem levels all significantly improved. These
improvements were not affected by the type, intensity, or duration of the green exercise activity,
indicating the potential for a wider health and well-being dividend from green exercise.
It is often argued that the underlying reasons for nature’s ability to help people recover from
stress and mental fatigue is due to its restorative powers. Terry Hartig has pioneered the notion
that nature can restore deficits in attention arising from overwork or over-concentration, making
people both feel and think better. He has found that sitting in a room with tree views promotes
more rapid blood pressure decline than sitting in a windowless room, and also that walking in a
nature reserve reduces blood pressure more than a walk along an urban and non-green street.
In both contexts, the green room and green walk, people recover more rapidly from attention-demanding
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tasks and the long-term effects may be important. Another five-year study of older
people found that access to green space in which they could walk was an accurate predictor for
longevity, as those who walked in green places lived longer (Takano et al., 2002).
It has been suggested that spending time in ecologically restored areas and having a
heightened knowledge of nature can encourage more frequent visits outdoors for longer periods
of time. Young people are currently becoming more and more disconnected with nature and,
therefore, are currently making fewer visits to the countryside than ever before, and engaging
children with nature from a young age can encourage them to participate in more outdoor
exercise and make more frequent countryside visits throughout adulthood leading to the
associated health benefits.
It is apparent that there is an emerging body of evidence supporting green exercise and green
care and it is becoming increasingly recognised as an idea which can be linked to current
government health and social care policies. The research holds implications for human health,
environmental protection and national policies alike. Engaging in green exercise activities
conveys substantial mental, physical and social health benefits, even from relatively short
exposures. These health benefits will lead to avoided public health costs, which will ultimately
save the NHS money. Although there are many opportunities already available, they are
accessed predominantly by reasonably healthy individuals. The cohorts of people studied to
date are those already choosing to engage in green exercise activities and therefore can be
considered healthy. We are yet to engage and research the harder to reach sedentary
population or those experiencing mental ill-health. If we can develop a methodology for
engaging these populations, the potential financial savings are immeasurable.

16
3.5 What are we yet to fully understand?
3.5.1 Application of green exercise in the mental health population
There is limited evidence concerning the application of green exercise in the mental health
population. Initial steps are being taken to try and engage individuals experiencing mental
illness in green exercise activities. For example, greater participation by the public in green
exercise has led to the introduction of new initiatives, such as the “Green Gym’s” set up by the
British Trust of Conservation Volunteers (BTCV). These outdoor gyms encourage participation
in local nature conservation activities to improve health and well-being and establish social
networks. The projects vary, including creating community gardens, managing local woodlands,
tree-planting and maintenance of public footpaths. These Green Gym groups often attract
individuals experiencing mental illness and initial evaluation findings have reported significant
increases in mental health state scores, a reduction in depression and a trend towards weight
loss (Reynolds 1999, 2002). A further national evaluation of the health benefits of participating
in Green Gyms was conducted by the School of Health and Social Care at Oxford Brookes
University during 2006 and is expected to be published shortly.
Another example of a green exercise initiative for people suffering from mental health problems
is the Stepping Out project. This is funded by Natural England (formerly the Countryside
Agency) and supports and enables both informal carers of people suffering from mental ill
health, and those that they care for, to explore and discover green spaces and the countryside
in and around Coventry. The project is managed by Warwickshire Wildlife Trust in close
partnership with Coventry Carers and the Asian Mental Health Action Project and through a
series of confidence building and awareness activities forming a ‘stepping stones’ journey,
Stepping Out supports and encourages participants to access the local environment3.
Findings of research suggest that therapeutic applications of green exercise could therefore be
effective and this is termed “green care”. There is a growing movement towards green care in
many contexts, ranging from green exercise activities, social and therapeutic horticulture,
animal assisted therapy, eco-therapy and care farming. Green care in agriculture or “care
farming” is defined as the use of farms and agricultural landscapes as a base for promoting
mental and physical health (Hassink, 2003; Braastad, 2005). Farming is used to provide mental
and physical health benefits for a wide range of people. These may include those with defined
medical or social needs (e.g. psychiatric patients, those suffering from mild to moderate
depression, people with learning disabilities, people with a drug history, disaffected youth or
elderly people) as well as those suffering from the effects of work-related stress or ill-health
arising from obesity. Care farming is a partnership between farmers, health care providers and
participants, and so combines the care of people with the care of the land. Care farming is part
of a growing recognition that the land is multifunctional, providing a range of environmental and
social goods and services. Green care on farms is thus part of a movement to reconnect people
to the land, and to the food produced by domestic farming.
There are now several hundred green care farms in Norway, the Netherlands, Italy, Germany,
Austria, Belgium and Slovenia4. Such green care farms are formally tied to local social services
and hospitals, and provide a new component of care in the community. Farmers are paid for
providing a kind of “health service” whilst continuing with agriculture. This can help to maintain
3 http://www.warwickshire-wildlife-trust.org.uk/SteppingOut/index.htm
4 See Farming for Health (Europe) www.farmingforhealth.org

the economic viability of farms, farmers benefit from the extra labour and they can still sell their
produce.
There are many different terms for green care in agriculture across Europe including Farming
for Health, Care Farming and Social Farming but all essentially refer to the same concept. Much
of the research into Green Care had until recently been largely qualitative and anecdotal, but
research initiatives are currently underway examining the physical, mental and social health
benefits of green care for various populations and groups. Research which is particularly
relevant for people with mental health issues includes a Dutch study for example. Researchers
at Wageningen University in the Netherlands are looking at the effect of green care farms on
quality of life of demented elderly and for people with a psychiatric and/ or drug addiction
background5. Studies in Norway (Norwegian University of Life Sciences) are looking at the
health benefits of animal assisted therapy on farms for people with mental health disorders and
similar studies with animals assisted interventions are being conducted in the Netherlands
(Wageningen)6.
While the term “care farming” is well-recognised in Europe, here in the UK, the concept is
relatively new. There is an increasing amount of interest from many sectors including farmers,
health care professionals and social care providers, the prison and probation services and there
are a number of care farms already operating throughout the UK. However the numbers of care
farms are thought to be small and the movement is very embryonic at present, with no national
framework. The National Care Farming Initiative (UK)7 aims to promote and support the
expansion of care farming throughout the UK and is currently undertaking research to establish
the scale of care farming in the UK.
Like the UK, Denmark, Finland, Italy, Austria and Germany have also initiated research into the
health benefits of care farming and this is expected to combine with the research underway in
the Netherlands and Norway to produce evidence to support the use of care farming for health
benefits. The European Farming for Health Community of Practice(CoP) 8 , a network of those
involved with care farming in Europe and beyond recognised the need for a sound body of
evidence to support the health and “therapeutic” benefits of care farming in order to influence
health and social care professionals and policy-makers alike (Hassink and van Dijk, 2006). The
Farming for Health CoP has been instrumental in developing a COST Action on green Care in
Agriculture9 which is an EU funded action to increase the scientific knowledge on the best
practices for implementing green care in agriculture with the aim of improving human mental
and physical health and the quality of life. In particular one of the areas of priority for the action
is to coordinate research in this field by the comparison and discussion of ongoing projects
related to health effects on people and the establishment of a set of good research
methodologies.
There has been most research into another form of green care, social and therapeutic
horticulture (STH). Social and therapeutic horticulture has been used as a therapy or as an add-on
to therapy for many years and in the UK there has been a steady rise since the 1980s in the
17
numbers of garden projects that offer horticultural therapy to many different groups of people.
The associated health benefits to those who participate in STH are well documented and also
5 Simone de Bruin, Marjolein Elings, Nicole van Erp, Jan Hassink, Eric Baars
6 Bjarne Braastad and Bente Berget (Norway) and Reina Ferwerda and Jorine Rommers (Netherlands)
7 See National Care farming Initiative (UK) website www.ncfi.org.uk
8 see www.farmingforhealth.org for more information
9 www.umb.nor/greencare

include studies which focus on those who are suffering from mental health problems in
particular.
A recent collaboration between the Centre for Child and Family Research at Loughborough
University and Thrive called “Growing Together” has concluded a major piece of research
examining the physical, mental and social health benefits of STH (Sempik et al., 2003, 2005). In
this study Sempik et al., (2003) carried out a comprehensive survey of literature of STH and
discovered a wealth of descriptive literature on horticulture, health and well-being. STH projects
are widely used for patients suffering from Alzheimer’s disease and a study of over 2000 older
people living in the Gironde area of France conducted by Fabrigoule et al., (1995) found that it is
also possible that regular participation in gardening may offer some protection against the
development of dementia. In a prospective study showed that those who took part in gardening
(or who travelled, carried out odd jobs or knit) were significantly less likely to develop dementia
than those who did not. Later studies have shown that the exercise provided by gardening
activities may also be significant in delaying the onset of dementia and Alzheimer’s disease
(Rovio et al., 2005 and Larson et al., 2006).
However, as is the case with green care and Green exercise projects in general although there
is much descriptive and qualitative data available there is a relative scarcity of quantitative
research. Sempik et al., (2003, 2005) concluded that there was also a need for more “hard”
evidence to support the findings.
Green care, care farming, SHT, green gyms and other green exercise projects are worthy
examples of how engaging in green exercise and care activities can help people with mental
health problems. Therefore, the initial successes of green care in Europe combined with
innovative green exercise initiatives poses the question – should people experiencing mental
illness be prescribed “green care” such as green exercise therapy, social and therapeutic
horticulture or time at a care farm instead of, or in addition to, traditional medicine?
3.5.2 Green exercise as a treatment option for mild to moderate depression
With incidences of mental illness and especially depression on the increase how much do we
know about green exercise as a potential treatment? It is estimated that 25% of women and
10% of men in the UK will experience a period of depression requiring treatment, at some point
in their lives (Halliwell, 2005). Often, visiting their GP is the first step they take in addressing the
situation and it is usually the GP who is primarily responsible for organising their treatment.
A recent report conducted by the Mental Health Foundation reported that in cases of mild to
moderate depression, 55% of GP’s prescribe antidepressants as their first choice of treatment
response (Halliwell, 2005). However, only 35% actually believe that antidepressant medication
is the most effective intervention in these situations. It was reported that although GP’s deemed
alternative treatments to be more suitable, 78% of them had still prescribed antidepressants as
the treatment option in the last three years. In comparison, only a minority of patients
experiencing mild or moderate depression are offered the choice of exercise therapy as a
primary treatment response. A mere 5% of GP’s offer exercise therapy as one of their three
most common treatment responses, in comparison to 92% of GP’s who commonly prescribe
antidepressants as a treatment response.
Yet, research has demonstrated that a supervised programme of exercise can be equally as
effective as antidepressants in treating mild to moderate depression (Halliwell, 2005;
18

Richardson et al., 2005). In a report by the Chief Medical Officer it was stated that “physical
activity is effective in the treatment of clinical depression and can be as successful as
psychotherapy or medication, particularly in the longer term” (Department of Health, 2004).
Therefore, a compelling argument for exercise therapy to be advocated as the primary
treatment option can be formulated. Exercise has less negative side effects and can positively
treat patients experiencing a combination of physical and mental health problems. A common
concern is that people experiencing a period of depression will not have the desire or motivation
to exercise, but compliance rates are often much better than for medication, especially if they
are receiving adequate support and encouragement.
The option of green exercise therapy or green care may prove to be an even more effective
treatment response than exercise alone as it encourages people to re-connect with nature and
experience the additional positive health benefits that are associated with this. Contact with
nature and greenspace is often uplifting and restorative, helps to reduce stress and improve
mood and combining this with physical activity will offer a very efficacious treatment option.
Green exercise is very cost effective and participation is often free or at a minimal cost. Unlike
fitness centres and gymnasiums it does not require an initial joining fee or a monthly
subscription, as you can walk around your local park or woodlands at no cost. Exercising in
traditional gyms often incurs an extremely low adherence rate due in part to lycraphobia (a fear
of undertaking physical activity in a commercial fitness industry setting). Outdoor exercise
provides the opportunity to escape this setting and the additional confinements of indoor
activities. Green exercise also promotes social inclusion and enables people to make healthier
choices and adopt a sustainable healthier lifestyle.
However, to date, there has been little research conducted which compares green exercise with
more traditional treatment options, such as antidepressants or cognitive behaviour therapy. We
anticipate that green exercise will be equally as effective, but the robust scientific evidence to
support this hypothesis is still lacking. For the idea to gain credibility and influence government
policy and the health sector, more detailed research needs to be undertaken. Therefore, at the
University of Essex we have collaborated with South Essex Partnership NHS Foundation Trust
to design a feasibility study which compares a green exercise programme with a series of CBT
sessions as treatment options for patients suffering from mild to moderate depression. A total of
sixteen participants will be recruited to the study and eight will be randomly allocated to the
green exercise group and the remaining eight to the CBT group. Each group programme will
consist of a two hour session, once a week for a period of six weeks and we will evaluate and
compare the effectiveness of the two different programmes. The green exercise programme will
involve one hour of moderate walking in the local countryside and woodlands. This will be a led
walk and a certain level of social interaction will be encouraged but monitored. The CBT
programme will follow the traditional pattern and involve small group discussions and a mini-lecture.
19
A series of standardised psychological instruments will be used to measure levels of
depression, mood, self-esteem, social adaptation and general mental health. These will be
administered at regular intervals over the six week period to monitor any changes. The initial
findings from the feasibility study will be used to obtain further funding to conduct the study on a
larger scale and generate a wider interest.
Colleagues in Australia have also initiated some research into the participation in forest and
woodland management as a treatment for depression (Townsend, 2006). Their pilot project
engages people experiencing depression in nature-based activities in a woodland environment.
The project is on-going but initial findings suggest encouraging improvements to physical and
mental health, along with a reduction in social isolation.

3.5.3 Green care for marginalised populations
There is also limited evidence concerning the use of green exercise therapy for populations
most marginalised in mental health, for example, those residing in hospitals, prisons and
institutions whereby mental ill health is problematic. Two classic studies from the 1980’s (Moore,
1981; Ulrich, 1984) initiated research into the health benefits for both prisoners and hospital
patients of windows overlooking greenspace compared to those facing brick walls. The first
found that prisoners in Michigan whose cells overlooked farmland and trees reported 24% less
sick cell visits compared to those in cells facing the prison yard. The second was a ten year
comparative study of post-operative patients in Pennsylvania whose rooms either overlooked
trees or a brick wall. The hospital stay for those patients with tree views was significantly less,
they also required fewer painkillers and used less strong or moderate medication and nursing
staff reported fewer negative evaluation comments in the medical records.
An initial study in a Swedish psychiatric hospital reported the amount of damage to paintings on
walls over a 15 year period. Damage was only ever inflicted on abstract paintings and there
were no recorded attacks on paintings depicting nature and landscapes. In a more recent study
of hospital patients, (Diette et al., 2003) demonstrated the clear value of a landscape picture
accompanied by the sounds of nature. Prior to their operation, a group of bronchoscopy patients
overlooked a large landscape picture present at their bedside whilst listening to sounds of
birdsong and a babbling brook. This group’s level of good or excellent pain control was 50%
higher in comparison to those without access to the picture or sounds. This simple intervention
has financial implications if it suggests that less money can be spent on pain killing drugs for
patients. These studies imply that greenspaces and nearby nature should be seen as a
fundamental health resource.
One of the nine major reasons that cause ex-offenders to re-offend has been identified as poor
mental and physical health (SEU, 2002) and a significant number of prisoners in the UK suffer
from a variety of mental health issues. “Offender and Nature” (O&N) schemes can address
several of the underlying factors contributing to re-offending and are another example of an
initiative to improve mental and physical health and well-being by using green exercise
activities. O&N initiatives involve partnerships between offender-management organisations10
and natural-environment organisations11.
Offenders and Nature schemes involve offenders working as volunteers on nature conservation
and woodland sites, carrying out tasks such as creating and maintaining footpaths, opening up
dense vegetation to create more diverse habitats, establishing ponds and building boardwalks.
O&N schemes are seen as reparative work that benefits the public, while providing experience
of teamwork, life and skills training to offenders and also boosting their confidence and self-esteem
(Carter and Hanna, 2007). Many offenders and supervisors have observed a ‘calming’
and ‘focusing’ effect in volunteers. Some O&N schemes explicitly apply ‘ecotherapy’, which
uses working in natural environments to support people with mental health issues and addiction
problems, specifically drawing on the capacity of nature to calm, heal and inspire (Hall, 2004;
Burls, 2005; Burls and Caan, 2005). As is the situation for many other green exercise and green
care initiatives, although there is much qualitative and anecdotal evidence supporting these
projects, there is a lack of “hard” or quantitative data and there is a need for further evaluation of
these schemes.
20
10 Such as National Offender Management Service, Her Majesty’s Prison Service and National Probation Service
11 For example Natural England, Forestry Commission, BTCV and National Trust

Traditionally hospitals have been renowned for their surrounding beautiful gardens and array of
plants (Nightingale, 1860, 1996). Similarly, monasteries often designed intricate gardens to offer
a pleasant relaxing environment for the ill to visit for a respite (Gerlach-Spriggs et al., 1998).
Sadly, over time, hospital funding has become more concerned with reducing the risk of
infection and focusing on efficiency and this has been reflected in design and lack of greenery.
Consequently, they have evolved into stressful establishments which do not fulfil the emotional
needs of patients, their families and staff (Lindheim and Syme, 1983; Ulrich et al., 1991;
Horsburgh, 1995). This problematic transformation needs to be addressed as research implies
that gardens and nature in hospitals enhance mood, reduce stress and improve the overall
appreciation of the health care provider and quality of care.
Healing gardens are designed to aid recovery from stress and are often present in hospitals and
care homes, where stressful experiences are often encountered by patients, visitors and staff.
Sempik et al. (2002) comprehensively reviews studies that analyse positive effects of these
types of gardens. In addition, Cooper Marcus and Barnes (1999) extensively review research
into the positive impact of healing gardens on the patient’s health and well-being. Whitehouse et
al. (2001) found that a healing garden in a children’s hospital in California had numerous
positive effects on users. 54% stated that they felt more relaxed and less stressed, 24%
refreshed and rejuvenated, 18% more positive and able to cope and only 10% had experienced
no difference in mood. Nearly half of all observed visitors spent less than 5 minutes per visit in
the garden, so even vary short visits were beneficial. Visitors to the garden want to “escape the
stresses of the hospital and enjoy the relaxing and restorative elements of nature”.
A lot more research needs to be conducted within the area of marginalised populations,
especially targeting those with mental health problems in addition to those populations in
hospitals and prisons in general. However, the findings do suggest that perhaps those involved
in hospital design and planning should consider the value to patients and visitors of pleasant
views from windows, of landscape artwork in wards and of hospital gardens. The majority of the
research has been conducted in the USA and Scandinavia, so we need to learn from this and
initiate our own research here in the UK.
3.5.4 Limitations of research to date
i) Type of evidence
In the fields of Social and Therapeutic Horticulture, Green care, Care Farming and Green
Exercise there are several similarities to the limitations of research to date. Although there is
much valuable qualitative evidence describing the physical, mental and social health benefits of
exposure to exercise and nature there remains a shortage of scientifically robust, quantitative
evidence. This “hard” data is necessary to convince healthcare professionals, social care
providers and sceptics of the merit of green exercise and green care.
ii) Exposure time to green exercise
The research has also not yet fully addressed the issues of exposure time and sustainability.
Research has demonstrated that short or occasional exposures to nature and physical activity
are potentially highly beneficial in improving mental health and physical well-being. However, we
are yet to establish whether cumulative short exposures, such as viewing nature out of a
window or taking a short walk equate to longer, less frequent exposures to nature, such as a
weekend trekking in the hills (Hartig et al., 2003). We do not know if short exposures alone will
lead to long-term improvements, but there is some evidence to suggest that behavioural and
lifestyle changes can be provoked by such activities, leading to continuing re-exposure which
21

would result in a healthier population. Secondly, the findings do not explore enhanced or
different effects of exposure to specific places for certain people because they hold memories
and stories which are associated with them. It could be hypothesised that some environments
may me green and beneficial, but anonymous, whereas others may evoke pleasant memories
which affect the experience (Tuan, 1977; Gallagher, 1994).
An important unanswered question for those concerned for sustainability is to what extent do
the benefits of such green experiences continue off-site? How long do the physical and
psychological benefits last once you return to your urbanised more stressful environment? Do
the benefits last for the day, the next day or for the next week? Does contact with nature
provoke long-term changes in thinking, which could lead to deep social and political
transformations?
iii) Economic considerations
The full economic benefits of promoting nature and greenspaces as a health resource are not
yet fully understood. We still lack the health economic data to accurately estimate the total
savings that a public mental health strategy could yield. A recent report written by Willis and
Liesl (2005) highlighted four major gaps in the current evidence base which prevents a full
economic assessment of the health benefits of greenspace being evaluated. These include: 1)
quantifying the value of the psychological benefits from greenspace; 2) improved evaluation of
green exercise activity programmes; 3) the time profile of risks when exercise is continued or
discontinued for different age groups and 4) assessing benefits from increased physical activity
between the sedentary populations and those participating in intermediate or frequent activity.
Therefore, large scale surveys are required which relate greenspace accessibility and use to
improved health outcome measures, to enable a full economic costing to be undertaken.
The Department of Health (2004) has estimated that a 10% increase in adult physical activity
would benefit the UK by £500 million per year, saving 6000 lives. The potential economic impact
of emotional benefits and improved mental well-being has not yet been quantified but would be
additional to these physical health benefits, and might indeed outweigh them. If these activities
are achieved through “green activities” that might also provoke long-term changes in attitudes to
nature and the environment in both rural and urban contexts, then wider support for pro-sustainability
22
policies is more likely to arise.
Can green exercise and green care, therefore, be considered a good buy for pubic health,
providing physical, social and mental health benefits? Can green exercise and green care be
used in a preventative way before we become ill to safeguard our mental well-being? Can care
farming provide another option for treating mental ill-health? Could some of the annual £10
billion of costs of obesity, coronary heart disease and physical inactivity be avoided? Could the
£77 billion annual cost incurred in 2002-03 for mental illness be significantly reduced in the
future?
One of the central needs now is to ensure that the assessment of the value of greenspace and
the countryside includes the potential mental and physical health benefits to those both working
and visiting those areas. The NHS budget is several hundred times more than current spending
on conservation and access to greenspaces, yet spending on these will help to prevent illness
and to save the UK money.

4. Assessment of existing Mind green exercise activities
There are a wide range of very successful green exercise activities and projects already in
existence amongst Local Mind Associations (LMA’s). These activities include walking,
gardening activities (especially on allotments), social and therapeutic horticulture, garden
design, conservation activities, bush craft (exploring local woodlands and building fires etc) and
dog walking.
A lot of the gardening activities encourage clients to grow and learn about the plants and flowers
on local allotments in the community. Many conservation groups assist garden teams working at
local formal gardens, woodlands and the open countryside. They always employ a socially
inclusive approach, so the activities are open to staff, service users and volunteers alike.
Many of the walks take place regularly in the open countryside, at local parks or woodlands,
along the beach or canalside, in all weathers. Whilst participants are walking they are often
encouraged to engage in other activities such as bird watching, photography, admiring the
wildlife and enjoying the scenery.
Therefore with this in mind, we designed a universal tool which could be used to evaluate this
wide range of green exercise activities to illustrate what positive effects they were having on
participants’ physical and mental health.
A specifically designed questionnaire was sent out to all Mind members who were engaging in a
selection of green exercise activities and 108 completed questionnaires were returned from 19
different Mind groups (see Box 3).
Box 3: Mind groups included in the assessment of green exercise activities
23
 Birmingham  Mid-Staffordshire
 Brighton  Mid-Warwickshire
 Dartford, Gravesham and Swanley  Redcar and Cleveland
 East Berkshire  St Helens
 Great Yarmouth  Tameside and Glossop
 Havering  Taunton
 Hull and East Yorkshire  Thurrock
 Kensington and Chelsea  Wallingford
 Lewes District and Wealden  West Cornwall
 Maidstone
4.1 Findings - green exercise activities
The green exercise activities were predominantly made up of gardening projects, conservation
activities and walking groups. 52% of the respondents were engaging in gardening activities on
allotments or specific projects. These activities included weeding, digging, planting, grass
mowing, watering, pruning and composting. A further 7% of participants were involved in
specific conservation activities including scrub clearances and laurel thinning. 37% of
respondents were participating in regular walks around local gardens, along the river bank or
“cross country”. The remaining 3% were running in greenspaces regularly and 1% had been
cycling.

The duration of a typical activity session varied considerably, ranging from a minimum of 15
minutes to a maximum of 6 hours. The average length of a session was 2 ¾ hours (163.2 ± 89.4
minutes) and the most common session duration was 2 hours. 29% of the activities lasted over
4 hours.
Respondents attended
sessions fairly frequently, with
the majority of people engaging
in these activities on a weekly
basis (55%). A total of 26% of
participants attended sessions
at least twice a week or more
frequently, whereas only 6%
engaged in the activities
occasionally (Figure 6).
Respondents were asked how
long they had been attending
the green exercise activity
sessions. Responses varied
from a minimum of one month
to a maximum of 16 years. The
average time was just over 2
years (25.5 ± 35.7 months);
with the most common answer
also being reported as 2 years.
Figure 7 categorises the
answers into specific groups
which highlight the percentages
calculated for each time period.
24
4.2 Findings - people
involved in the activities
Out of the 108 completed
questionnaires returned, 72% of
respondents were male and
28% were female. Figure 8
reports the percentage of
individuals within each age
band. It is clear that the most
common age group was the 31-
50 years, closely followed by
the 51-70 year age group.
Together this made up 82% of
the sample population, with a
further 15% aged between 19-
30 years.
Figure 6: How often respondents attend the sessions
60
50
40
30
20
10
0
Daily Three times
a week
Twice a
week
Weekly Fortnightly Monthly Occasionally
Frequency
(%)
Figure 7: How long respondents have been attending the green
exercise sessions
35
30
25
20
15
10
5
0
6 months or less 6 months - 1 year 1-2 years 2-5 years Over 5 years
Length of time
(%)
Figure 8: Age categories of the respondents
1%
15%
47%
35%
2%
11-18 yrs
19-30 yrs
31-50 yrs
51-70 yrs
71+ yrs

Respondents were asked to
reflect on the qualities they
hoped to get out of
participating in the activities
before they started engaging
in them and compare these
to the qualities they actually
get, now they have been
participating in the activities
on a regular basis (Figure 9).
The most popular answer
overall was to “get out in the
fresh air” (83%), followed by
“meeting new people” (76%)
and “getting fitter” (69%). The
percentage of respondents
deriving pleasure out of the 4 aspects listed increased once they were engaging in the activities
regularly in comparison to their initial expectations.
17% of respondents stated “other” hopes that they anticipated getting out of the activities,
before they started participating in them. These included improving their concentration,
enhancing their self-esteem, keeping them occupied, keeping them sane, building their
confidence, keeping them motivated, building friendships and losing weight.
16% of respondents listed “other” qualities that they actually got out of participating in the
activities, since engaging in them on a more regular basis. These included improving their
confidence, helping with their depression, a sense of achievement, contributing to organic
growing and biodiversity, immense enjoyment and fun, socialising, friendship and keeping them
occupied.
Participants were also asked the question “how does taking part in these activities normally
make you feel?” 103 respondents provided comments to address this question and their
answers were grouped into 9 key themes:
25
Figure 9: Key qualities that respondents gain out of participating
in the activity
90
80
70
60
50
40
30
20
10
0
Meet new people Learn new skills Get out in the
fresh air
Qualities
(%)
Key theme Examples of comments from respondents
1.
Becoming part of a
group – enjoyment
of socialising with
likeminded people,
having company and
conversation and
feeling refreshed.
What they hoped to get before
starting the activity (%)
What they actually get now they
are doing the activity (%)
Get fitter Other
“Socialising and talking about your problems helps me a great deal”
“It gives me company which I don’t have where I live”
“Being part of a team, getting out on a nice bright day, feeling refreshed.
Often don't feel confident to be out alone. Don't have my own garden so
would otherwise stay indoors”
“Refreshed and feeling more like facing things. Having been with likeminded
people and had company and conversation”
“Like being part of the workforce in the community, feeling good”

26
2.
Sense of
achievement –
completing a task
and achieving
something
worthwhile, feeling
useful
“Pleased and a sense of achievement that I have done a task that I have
been asked to do and finished it”
“Better about myself, feeling a sense of achievement”
“Feel good about doing an activity that has definite results”
“That I have achieved something worthwhile”
“It makes me feel I am doing something useful”
3.
Feeling relaxed and
less stressed
“Before attending Mind I only went out if I had to, I now find it less stressful”
“Relaxed, peace of mind”
“Relaxed, more focus of mind and greater co-ordination, greater self esteem”
4.
Feeling able to deal
with problems and
begin to cope
“Improves my depression, helps me be more motivated and gives me
satisfaction in doing things. Since starting the project I have been able to
improve on my quality of life. Coming here has helped me overcome most of
my problems”
“Happier and able to cope again”
“Less depressed, revitalised and more able to cope with my issues”
“It takes me out of my depression for a while and gives me something to look
forward to”
“It takes my mind off my worries”
5.
Feeling healthier and
fitter – both
physically and
psychologically
“It improves my fitness and is very beneficial for my mental and physical
health”
“Healthier, more active, fitter”
“Positive and healthy”
“Healthier psychologically and physically”
“Much fitter and I feel especially good immediately after a session. I feel able
to chat to other runners easily and feel generally less anxious”

27
6.
Feeling good about
myself – improving
self-worth,
confidence, self-esteem
“It makes me feel good about myself and it improves my confidence”
“A lot happier in myself, also there is a great sense of peacefulness here and
the nature is wonderful”
“More positive about myself, better for being with people and out in fresh air”
“After being out in the fresh air and doing gardening I feel better in my self -
eat well and sleep well”
“It gives a feeling of self worth because you have made a difference /
improvement no matter how small! Slowly builds confidence which in turn
has a knock on effect and improves all aspects of life”
7.
Feeling great – more
alive and confident.
The word “great”
was used very
frequently
“Great - life's worth living, clears the mind”
“Alive and confident”
“More focused, feeling confident, much happier”
“Makes me feel good, it is good, makes you get out of the house, look
forward to all the activities”
8.
Feeling “happy” –
this word was also
used very frequently
“It makes me feel good and happy and lifts my mood”
“I enjoy the fresh air and conversation, it makes me happy”
“It makes me happy”
9.
A sense of escape –
getting out of the
house and having
something to do
“Its nice to get out and go for a walk, to get out of the house”
“I love to get away from the hustle and noise of the town and out into the
Chase wilderness, I feel great out there”
“It gives me something to do during the week which makes me happy to be
out socialising. I don’t tend to go out much so it gives me something to do”
“Sleeping better at night, gets me out of the house, socialising better, gaining
new skills, coming to the project has given me new confidence and a belief in
myself”
“I enjoy being in the countryside away from the stresses of the town, traffic,
crowds, noise etc and the people are nice and friendly and good company”
Other comments included feeling a sense of satisfaction, feeling refreshed, at peace with
nature, having a new lease of life and being set free and that it was a preferred option to sitting
staring at the walls. It is clear that engaging in a range of green exercise activities generates a
myriad of positive healthy feelings.

Respondents were then asked how important being outside with nature was in determining how
they felt and 88.1% stated that this was very important or important. Similarly, 88.8% felt that
participating in some form of exercise was very important or important in influencing how they
felt. However, the combination of exercising outside in the presence of nature (i.e. green
exercise) was even more influential, with 89.6% of respondents stating that this was very
important or important in determining how they felt. This supports the idea that it is the
synergistic amalgamation of the exercise in a green environment that produces added health
benefits, rather than either one alone.
The next question in the questionnaire asked respondents to identify the differences that
participating in these green activities made to how they felt and they were asked to distinguish
between the mental and physical aspects. 102 comments were received concerning the mental
health benefits and once again familiar messages emerged. Many respondents talked about the
positive effect on their minds and how it helped them to think more clearly, provided a focus for
concentration and offered overall peace of mind. They felt less stressed, more alert and alive,
happier and more relaxed.
Many people stated that they felt mentally healthier and a lot more motivated and positive. They
felt that the activities helped to lift their depression levels and instil a feeling of calm and
peacefulness. Their overall mood improved as did their confidence levels and self-esteem and
some of the key comments are listed in Box 4.
Box 4: Participants comments concerning what differences the activities made to how they felt
mentally
97 comments were received concerning the physical health benefits of engaging in green
exercise activities. Overall, respondents felt a lot healthier, more alive and refreshed. Many
spoke of the benefits to their fitness levels and how they felt stronger, less lethargic and more
energetic. Others commented on the changes to their body profile through losing weight, easing
stiffness in their joints and becoming more agile (see Box 5 for examples of typical comments).
28
“More stable, able to think for myself more”
“Less worried, co-ordination of body and mind, better sense of well being”
“It stimulates the mind and gives me something to concentrate my mind on”
“Memory has improved and I think clearer and more positively”
“I am more alert, less stressed”
“Helps me to relax and stop worrying”
“More relaxed and able to sleep at night”
“I always feel better - more relaxed, less tense after a good session of exercise, more able to talk to
people”
“Lifts depression gives me a good feeling”
“They help me focus on positive things rather than negative”
“Makes you want to get out of bed and I’m not as low as I have been”
“It feels calm and satisfying on my allotment, I look forward to going”
“Improves my mood, more self-esteem and makes me feel good about myself”
“Feel more confident (alive) not looking at four walls”

29
Box 5: Participants comments concerning what differences the activities made to how they felt
physically
“ I feel a lot stronger and fitter”
“My fitness has improved, I feel refreshed and alive”
“I feel fitter for getting out more often”
“Feel lifted and less lethargic”
“More energetic and less lifeless”
“I feel as though I can do things without being tired. I am more active, less lethargic, I want to join in
things and my body is looser and more agile”
“More stamina and less physically restless”
“I use my hands so it helps my hands to move better as they are painful and stiff due to arthritis”
“Stops the stiffness in the joints, that I get when I just sit around doing nothing”
“Lost weight, more agile, helps to keep my body moving”
“Becoming involved in outdoor activities, also good therapy for body and soul”
“Helped me to get more active”
“Makes me feel good to get my heart pumping”
Finally, participants were asked to comment on what they felt was special about the activity and
102 responses were received. It was clear from the collated narratives that there were 5 main
aspects which were special about the green activities. These were the: 1) Social benefits; 2)
Benefits from contact with nature; 3) Benefits from the activity itself; 4) Psychological benefits
and 5) Physical benefits. These findings clearly support the green exercise model and the
following tables illustrate some of the key comments supporting each feature.
Key feature Examples of comments from respondents
1.
Social benefits –
meeting and
socialising with
people out in the
fresh air, team work,
companionship,
camaraderie, being
part of a group
“Excellent teamwork, meeting new people to make friends, we are a family
and look out for each other”
“I think it is because I take part with people I know well, who enjoy doing the
same things and nobody judges you or criticises you”
“Everyone is friendly and I feel part of something collectively positive”
“I have made new friends and am able to communicate better, staff members
are very helpful and listen to my problems, everybody is very friendly towards
me”
“It gives me the opportunity to be active and social, team work, being outside
with others, making friends, enjoying their company”
“The chance to meet people, plus a chance to exchange news and views”
N.B: 44% of respondents made comments concerning social benefits

30
2.
Benefits of contact
with nature – fresh
air, wildlife, trees,
plants, scenery
“Being with nature, out in the fresh air and the peace and quiet”
“Because I was out in the open air and was also interested in the birds and
wildlife”
“Being outside hearing and seeing wildlife watching your own plants grow. It
gives me a good feeling”
“Freedom, space, no one to judge you, view the scenes, keep fit, breathe in
the fresh air. I love being in nature's garden, that's how I see it”
“You see lots of wildlife, get a feeling of space and tranquillity and see places
I wouldn't normally see if travelling by car”
“A closeness to nature is the most special feeling and it gives you
acceptance of yourself”
N.B: 21% of respondents made com ments concerning social benefits
3.
Benefits of the
activity itself -
growing vegetables,
learning new skills,
new experiences
“The activity is good to look back at when completed. We have all worked
very hard on our allotment, the results have been very rewarding
“It gets people out into a different environment other than what they would
usually do”
“Learning new skills, growing vegetables from seed that you can eat”
“Gardening is very therapeutic because it is stress free, outdoors, physical
and you can see what you love achieved at the end”
“Its fun, it costs nothing, no special equipment and the views are stunning”
4.
Psychological
benefits –
therapeutic, calming,
sense of
achievement
“Open air activity is good for my mental health. My confidence has improved.
Also meeting others who have similar mental health problems helps”
“Takes my mind of the depression”
“Its therapeutic and calms me”
“It is special because it gives you a sense of achievement in all the jobs you
do on the farm”
N.B: 10% of respondents made com ments concerning social benefits
5.
Physical benefits
“Keeps you active and mobile”
“Being close to nature and doing physical activities”
“Its easy physically but all counts helping towards my fitness for the future”
“The exercise with nature”

The findings from this assessment clearly show that participating in a range of green exercise
activities provides substantial social, health and well-being benefits. The contact with nature and
greenspace is a necessity in enriching the experience and creates a restorative environment
which people can seek pleasure in escaping to. A lot of enjoyment is derived from getting out
into the fresh air, admiring the scenery and taking pleasure in the wildlife, plants and trees (Box
6).
Participating in these activities is often perceived as therapeutic and engenders feelings of
relaxation and peacefulness. The whole process is very calming; it reduces stress levels and
encourages people to feel good about themselves by improving their self-worth, confidence and
self-esteem. It inspires people to embrace their problems and start to deal with them and learn
how to cope. Participants feel healthier and fitter, more alive, refreshed and a lot happier. There
is a great sense of achievement when an activity is completed, as participants feel they have
achieved something worthwhile and therefore feel useful.
Engaging in green activities in groups also inspires new friendships to develop and enhances
social capital, which supplements the range of health benefits experienced. Participants enjoy
becoming part of a group, socialising with likeminded people and having companionship,
camaraderie and conversation. Therefore, meeting and socialising with people out in the fresh
air is a key ingredient in the activities success.
Box 6: Comments from a participant engaging in gardening activities at a local allotment
A woman aged between 51 and 70 years has been working on a local allotment regularly for the
past 11 years. She attends the sessions most weeks and typically spends around 6 hours on the
allotment per session. Before she started helping out at the allotment she hoped that this would
provide her with an opportunity to learn some new skills and get out in the fresh air. Since she has
been attending regular sessions, she finds that not only does she learn new skills and get out in the
fresh air, but she’s also enhanced her fitness, met new people and contributed to organic growing
and biodiversity.
“I enjoy gardening, seeing things grow and then picking, cooking and eating them and I feel
a sense of achievement. I'm interested in learning about gardening and about nature
conservation and I love watching wildlife, birds etc. If I arrive at the allotments feeling low or
preoccupied I feel my mood lift and I find a sense of well-being”
“I have been interested in "green" activities all my life - gardening, walking, conservation,
being close to nature, but the "extra" benefit of this is the sense of sharing and co-operating
with other people. Also our allotment site is very beautiful and peaceful so I feel in harmony
with the world there”
“I enjoy the physical movement and effort and I appreciate the experience of all my senses -
sight, sound, smell, taste and touch and I like working with the earth”
“It's very creative - especially so since our allotment leader is not only a great gardener but
also an artist so as well as producing great fresh food through working physically in the
open air we're also involved in making a beautiful place. Some would say a place of healing
too, and everyone is kind and supportive of one another”
31

32
5. A study to compare a green outdoor walk and an indoor walk
5.1 Backgound and methodology
Another major gap in the evidence base is the comparison of indoor exercise to equivalent
outdoor green exercise activities. This would enable us to identify what extra health benefits are
derived from the contribution of the green elements. When comparing innovative outdoor
voluntary activities, such as the green gyms to indoor sports, the adherence rates are a lot more
successful in the long term. Nearly half of the participants of indoor sports drop out within the
first six months, whereas walking outside seems to be the most preferred form of exercise to
maintain adherence (Hilldsdon and Thorogood, 1996). Research analysing joggers also
reported that running in a stimulating green environment detracted the mind from the physical
discomfort of exertion and fatigue. This enabled participants to continue jogging for longer
periods of time (Pennebaker and Lightner, 1980). However, there is a shortage of compelling
evidence in this area, especially in the UK.
To date the University of Essex has been involved in a series of studies and research
programmes that have analysed the physical and mental health benefits of participating in green
exercise activities. However, a key question which is yet to be addressed is: how does green
exercise compare to exercising indoors? If the type, intensity and duration of the exercise
remains the same, but it is conducted in two very distinct environments (indoors, with no green
natural elements and outdoors in a natural green space), we would be able to establish what
additional benefits the “green” engenders. Therefore Mind approached the University of Essex
for advice and guidance to enable them to undertake some innovative research. This research
involved local Mind group members engaging in a green outdoor walk and a comparable indoor
walk and results were analysed by the University of Essex. This short study addressed the
research question: “Will exercising outdoors in a green environment significantly improve
participant’s mental health and well-being (using standardised and well-recognised mood and
self-esteem measures) compared to the equivalent exercise indoors?”
The locations for the indoor and outdoor walks were initially identified and then the walks took
place in early January 2007. They occurred one week apart, at a similar time of day and both
lasted for an hour. Mini-buses were used to transport participants to the locations. The outdoor
green exercise walk involved walking around Belhus Woods Country Park, which has a diverse
landscape of woodlands, grasslands and lakes12. In contrast the indoor walk involved walking
around Lakeside shopping centre. In both conditions continuous walking was preferred,
although participants were allowed to stop briefly to admire the scenery or shop windows and a
certain level of social interaction was also encouraged.
Both of the group walks were led by the same Mind organiser and they were equivalent in
duration and intensity. The same leader was present at both walks to ensure consistency of
personality. The study was a repeated measures design, as the same group of subjects
participated in both walks to eliminate their diverse health states as confounding variables. 20
members of various local LMA groups volunteered to take part in the research and they all
attended both of the organised trips.
12 Belhus Woods Country Park -
http://www.essexcc.gov.uk/vip8/ecc/ECCWebsite/dis/guc.jsp?channelOid=14413&guideOid=16906&guideContentOid=14412

A mixed method design incorporating both quantitative data and qualitative narrative was
utilised to collect data using a composite questionnaire. The questionnaires were administered
immediately before and immediately after both of the walks to allow direct comparisons to be
made and to identify any changes in health parameters as a direct result of exposure to the
environment. The questionnaires included standardised tools which measured participants’
levels of self-esteem and mood and other qualitative questions were asked to allow us to
capture some detailed narrative. Participants were asked to complete the questionnaires
individually and not to compare or discuss their answers. Questions were answered according
to how the participant felt at that particular moment in time.
The standardised tools incorporated in order to determine any changes in psychological states
derived from the walks, measured self-esteem and mood. Self-esteem was measured before
and after the walks using the one-page Rosenberg Self–Esteem Scale (RSE) (Rosenberg,
1989), which is a widely used measure of self-esteem in health psychology. Mood change was
measured before and after the walks using the (McNair et al., 1984) Profile of Mood State
questionnaire (POMS). This is a short form one-page version of the POMS test which has a
background of successful use for mood change post-exercise. The POMS subscales measured
were anger, confusion, depression, fatigue, tension and vigour. In addition, a Total Mood
Disturbance (TMD) score was calculated to denote an overall assessment of emotional state.
This method is regularly used as it provides an indicator of overall mood. It involved summing
the POMS subscale T-scores of anger, confusion, depression, fatigue and tension and then
subtracting the T-score for vigour (McNair et al. 1992, p.6).
Photographs from the green outdoor walk at Belhus Woods Country Park
33

34
Photographs from the indoor walk at Lakeside shopping centre

35
5.2 Results
A total of 20 participants took part in both walks, of which 7 (35%) were male and 13 (65%)
were female. 47% of the participants were aged between 31-50 years and the remaining 53%
were aged between 51-70 years.
Initially, a paired samples t-test was conducted to identify if there were any significant
differences in the participants’ preliminary mood and self-esteem scores between the two walks.
This did not reveal any significant findings, indicating that prior to both the walks participants’
levels of self-esteem and mood were comparable.
Secondly, paired samples t-tests were conducted to identify any significant changes in starting
self-esteem and mood levels and those reported after each walk. Each walk was initially
analysed separately to distinguish any differences between the two walks.
i) Outdoor Walk
Figure 10: The change in self-esteem following participation in the
Figure 10 highlights the
green outdoor walk
statistically significant
19
improvement in self-esteem
from 21.3 to 19.0 (p<0.01)
(Note - the lower the value, the
20
higher the self-esteem). Scores
ranged from a high of 12 to a
low of 37 prior to the walk. After
the green outdoor walk, they
21
ranged from the highest
possible self-esteem score of
10 to a low of 35.
22
The change in the six subscale
Before After
mood factors were also
analysed following participation
in the green outdoor walk.
Figure 11 illustrates the
significant reductions in feelings
of anger (from 42.6 to 39.2,
p<0.05); confusion (from 39.5
to 36.5, p<0.01); depression
(from 42.1 to 39.4, p< 0.01);
fatigue (from 43.4 to 37.1, p<
0.0005) and tension (from 39.5
to 34.4, p<0.01), so participants
were feeling less angry,
confused, depressed and tense
after the outdoor walk. Feelings
of vigour increased from 40.7 to
42.1, so even though they had
been walking for an hour, participants felt less fatigued and more active and energetic.
Represents a significant
increase in self-esteem of
2.31 (p< 0.01)
Figure 11: The change in the subscale mood measurements
following participation in the green outdoor walk
44
43
42
41
40
39
38
37
36
35
34
Anger * Confusion ** Depression ** Fatigue *** Tension ** Vigour
Mood factor
Index of mood
Before
Significance tested with 1- After
tailed t test (* p<0.05; **
p<0.01; *** p<0.0005)

36
Therefore, Figure 12 shows that
the total mood disturbance (TMD)
significantly improved after
participating in the outdoors green
walk from 166.4 to 144.4 (p<0.01)
(Note – the lower the score, the
better the overall mood).
ii) Indoor walk
Figure 13 highlights the non
significant decrease in self-esteem
from 21.0 to 21.8 (Note -
the lower the value, the higher the
self-esteem). Scores ranged from
the highest possible self-esteem
score of 10 to the lowest possible
score of 40, both before and after
the indoor walk.
The change in the six subscale
mood factors were also analysed
following participation in the
indoor walk. Figure 14 illustrates
the only mood factor to be
significantly reduced, which was
fatigue (from 42.3 to 39.0,
p<0.05). Feelings of anger
reduced slightly (from 41.6 to
41.1) and depression levels also
reduced slightly (from 41.3 to
40.8, p<0.01). However, in
contrast to the green outdoor
walk, feelings of tension slightly
increased (from 37.2 to 37.7) and
confusion levels also slightly
increased (from 39.2 to 39.5).
Feelings of vigour decreased from
41.7 to 38.7, so after this walk,
participants were feeling less
active and energetic and more
tense and confused.
Therefore, Figure 15 shows that
the total mood disturbance (TMD)
hardly changed after participating
in the indoor walk from 159.9 to
159.4 (p<0.01) (Note – the lower
the score, the better the overall
mood).
Figure 12: The change in total mood disturbance (TMD) following
participation in the green outdoor walk
140
145
150
155
160
165
170
Before After
Index of TMD
Represents a significant
improvement in total mood
disturbance of 21.9 (p<
0.01)
Figure 13: The change in self-esteem following participation in
the indoor walk
20
21
22
Before After
Figure 14: The change in the subscale mood measurements following
participation in the indoor walk
43
42
41
40
39
38
37
36
35
34
Anger Confusion Depression Fatigue * Tension Vigour
Mood factor
Index of mood
Before
After
Significance tested with
1-tailed t test (* p<0.05;
** p<0.01; *** p<0.0005)

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