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1. Positive health effects of the natural outdoor environment in typical populations of different regions in EuropeWP4: Experimental studies Brussels, December 2015 Dr Christopher Gidlow, Staffordshire University c.gidlow@staffs.ac.uk www.phenotype.eu

2. Overall Aims • Experimental approach…. • - To evaluate the psychological and physiological responses for short term, longer term and repeated exposure to the natural environment • To explore preventive and therapeutic effects of natural environments

3. Focus / contribution: • Ecological validity/relevance of exposures • type of environment (not bad urban/good natural) • duration and type of engagement in each study • Robust measures in field-based studies (cortisol, HRV) • Instorative and Restorative • Repeated exposure • Acute and longer-termresponse • With/without water (blue space)

4. Approach by city • Randomised cross-over design, where possible • Common set of core indicators • Protocol standardisation

5. UK (preventive) URBAN (non-stressful) • Healthy, unstressed adults, to explore: • Non-stressful/pleasanturban vs. green vs. blue • Instorative effects • Single and repeated exposures BLUE GREEN

6. What we found… * * Higher perceived restoration in natural (blue and green) compared to urban environments at 30 minute follow-up (end of walk). * Sig. p < .05

7. What we found… * * Improvements in cognitive functioning (BDS task) from baseline (lab) to 60 minute follow-up (lab) in natural environments (blue and green). Cognitive functioning returns to below baseline levels in the urban environment. * * * Sig. p < .05

8. Headlines so far…. 1: Preventive (UK) In healthy, unstressed adults, light intensity walk in a natural environment confers greater benefit for perceived restoration and cognitive function; but pleasant urban and natural environment walks reduced stress and improved mood for all, over and above a healthy, unstressed baseline. 2: Preventive (UK) In healthy, unstressed adults, repeated light intensity walks in a natural environment conferred similar changes each day (not differentially attenuated or increased by environment). Implications: Promote walking in nature during work day for sustained cognitive performance benefit – employee behaviour / employer support . Walk in any pleasant environment to reduce stress

9. People with poor mental health (n=26). Exposed to green, blue and urban environments Longer exposure (typical of environments) GREEN SPAIN (therapeutic) BLUE URBAN

10. Results: Associations between exposure environments and psycho-physiological indicators.

11. Headlines so far…. 3: Therapeutic (Spain) In people with poor MH, natural environment exposure (3 hours) improved mood, and decreased stress levels and sympathetic nervous system functioning in comparison to exposure to urban environments. 4: Therapeutic (Spain) Restoration, physical activity, and air pollution are possible mediators. Implications: Promote use of natural walks for those with mental health problems. Natural environments with blue space (water) can favourably affect the parasympathetic-sympathetic balance.

12. Post-MI patients (n=20) 7-days of cardiac rehabilitation walks (typical frequency and duration; applied) Exposed to green and urban environments accessible to cardiology clinic LITHUANIA (therapeutic)

13. Changes (mean (SE)) of hemodynamic parameters between Day 1 and Day 7 in urban and park groups

14. Headlines so far…. 5: Therapeutic (Lithuania) Park vs. urban environment benefits for additional benefits for BP reduction, exercise capacity, heart rate recovery, mood (affect) and reductions in cortisol Implications: To include natural environments in cardiac rehabilitation walking programmes for additional psychological and cardiovascular benefits

15. Some take home messages … Preventive: ‘If you take your lunch-time walk in non-stressful environment, you will should have improved mood and reduced stress levels. But if you choose a natural environment, you should perform better at work after returning to your desk’ Therapeutic: ‘Natural environments should be considered for inclusion in physical rehabilitation after CAD events, for additional benefits for BP reduction, exercise capacity, heart rate recovery and stress levels’ ‘Prolonged exposures in green and blue natural environments for people with poor mental health appear beneficial for mood, with beneficial stress reducing effects in green environments’.

16. Mark J Nieuwenhuijsen Margarita Triguero-Mas David Martínez Jeroen de Bont Glòria Carrasco-Turigas Tània Martínez Christopher Gidlow Marc Jones Gemma Hurst Daniel Masterson, Graham Smith Naomi Ellis WP4 Team Regina Grazuleviciene, JoneVencloviene AstaDanileviciute, RaimondasKubilius AudriusDedele Tomas Grazulevicius Jolanda Maas Magdalena van den Berg

17. Publications submitted Grazuleviciene, R., Vencloviene, Kubilius, R., Grizas, V., Dedele A., Grazulevicius, T., Ceponiene, I., Prasciene, E., Nieuwenhuijsen, M., Jones, M. and Gidlow, C. The Effect of Park and Urban Environments on Coronary Artery Disease Patients: a Randomized Trial. BioMed Research International, 2014. Article ID 403012 Gidlow, C.J., Jones, M. V., Hurst, G., Masterson, D., Clark-Carter, D., Tarvainen, M. P., Smith, G. & Nieuwenhuijsen, M. Where to put your best foot forward: Psycho-physiological responses to walking in natural and urban environments. Journal of Environmental Psychology, 2015, doi:10.1016/j.jenvp.2015.11.003 Triguero-Mas, Margarita, Chris Gidlow, David Martínez, Jeroen de Bont, Glòria Carrasco-Turigas1, TàniaMartínez, Gemma Hurst, Daniel Masterson, Marc Jones, Mark J. Nieuwenhuijsen. The effect of different types of the natural outdoor environment on people at risk of poor mental health in Catalonia (under review). Grazuleviciene, R., Vencloviene, Kubilius, R., Grizas, V., Danileviciute A., DedeleA., Vitkauskiene A., Steponaviciute, R. Nieuwenhuijsen, M. Effectiveness of a physical activity in urban natural environments on stress and cardiac function in coronary artery disease patients: a randomized trial (under review)