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Being in nature and doing nature-based activities has been shown to reduce stress-related illnesses such as trauma and post-traumatic stress disorders. In 2016, the crisis shelter Danner in Denmark...

Here, we developed and examined a new way of disseminating mindfulness in nature to people without meditation experience, based on the finding that mindfulness conducted in natural settings may have added benefits. We evaluated a 5-day residential programme aiming to reduce stress and improve mental health outcomes. We compared an indoor and an outdoor version of the programme to a control group in a pilot randomised controlled trial (RCT). Sixty Danish university students experiencing moderate to high levels of stress were randomised into a residential mindfulness programme indoors (n = 20), in nature (n = 22), or a control group (n = 18). Participants completed the Perceived Stress Scale and the Self-Compassion Scale (primary outcomes) along with additional secondary outcome measures at the start and end of the program and 3 months after. Stress was decreased with small to medium effect sizes post-intervention, although not statistically significant. Self-compassion increased post-intervention, but effect sizes were small and not significant. At follow-up, changes in stress were not significant, however self-compassion increased for both interventions with medium-sized effects. For the intervention groups, medium- to large-sized positive effects on trait mindfulness after a behavioural task were found post-intervention, and small- to medium-sized effects in self-reported mindfulness were seen at follow-up. Connectedness to Nature was the only outcome measure with an incremental effect in nature, exceeding the control with a medium-sized effect at follow-up. All participants in the nature arm completed the intervention, and so did 97% of the participants in all three arms. Overall, the results encourage the conduct of a larger-scale RCT, but only after adjusting some elements of the programme to better fit and take advantage of the potential benefits of the natural environment.

There is growing evidence of the health benefits of visiting green spaces. However, research indicates that individuals with mobility disabilities visit green spaces less frequently than the able-bodied population. The aim of this study was to examine the experiences and related constraints of individuals with mobility disabilities visiting green spaces. The study’s qualitative research design employed group and individual interviews, which were analysed using interpretative phenomenological analysis and social geographical theory. The results indicate that, generally speaking, the interviewees valued green spaces highly. The serenity of and possibility for close physical contact with a green space were preferred and promoted experiences of insideness and identification with the space. Conversely, lack of accessibility led to feelings of exclusion and outsideness. To increase both the accessibility and positive experience of any green space, it is advisable to include the user group in the study design process.

The work of landscape architects can contribute to the United Nation’s Sustainable Development Goals and the associated ‘Leave no one behind’ agenda by creating accessible and health-promoting green spaces (especially goals 3, 10 and 11). To ensure that the design of green space delivers accessibility and intended health outcomes, an evidence-based design process is recommended. This is a challenge, since many landscape architects are not trained in evidence-based design, and leading scholars have called for methods that can help landscape architects work in an evidence-based manner. This paper examines the implementation of a process model for evidence-based health design in landscape architecture. The model comprises four steps: ‘evidence collection’, ‘programming’, ‘designing’, and ‘evaluation’. The paper aims to demonstrate how the programming step can be implemented in the design of a health-promoting nature trail that is to offer people with mobility disabilities improved mental, physical and social health. We demonstrate how the programming step systematizes evidence into design criteria (evidence-based goals) and design solutions (how the design criteria are to be solved in the design). The results of the study are presented as a design ‘Program’, which we hope can serve as an example for landscape architects of how evidence can be translated into design.

Given the drastic changes in our lifestyles and ecosystems worldwide, the potential health effects of natural environments have grown into a highly pervasive topic. Recent scientific findings suggest beneficial effects from nature exposure on human immune responses. This review aims at providing a comprehensive overview of literature published on immunomodulatory effects of nature exposure by inhalation of natural substances. A systematic database search was performed in SCOPUS and PubMed. The quality and potential bias of included studies (n = 33) were assessed by applying the EPHPP (Effective Public Health Practice Project) tool for human studies and the ARRIVE (Animal Research: Reporting of In Vivo Experiments) and SYRCLE (Systematic Review Centre for Laboratory Animal Experimentation) tools for animal studies. The synthesis of reviewed studies points to positive effects of nature exposure on immunological health parameters; such as anti-inflammatory, anti-allergic, anti-asthmatic effects or increased NK (natural killer) cell activity. Decreased expression of pro-inflammatory molecules, infiltration of leukocytes and release of cytotoxic mediators are outcomes that may serve as a baseline for further studies. However, partially weak study designs evoked uncertainties about outcome reproducibility and key questions remain open concerning effect sizes, duration of exposure and contributions of specific vegetation or ecosystem types.

BACKGROUND: There is increasing awareness of the importance and health benefits of living near green spaces. Research usually focuses on the general population's use of green spaces and there has been little focus on the use of green spaces by specific groups, such as people with mobility disabilities. This represents a significant knowledge gap with regard to facilitating access to healthy green environments by all population groups. This study aims to provide knowledge of the use of green spaces by people with mobility disabilities.METHODS: The study was based on data from the Danish Health and Morbidity Survey in 2005. The study participants consisted of 11,238 adult Danes, 383 of whom reported mobility disabilities, meaning that they were dependent on assistive devices for walking or moving around. Multiple logistic regression analysis was used to investigate the association between mobility disability and use of green spaces.RESULTS: The results show that respondents who reported mobility disabilities visited green spaces less often than respondents without mobility disabilities. The severity of the mobility disability was associated with the frequency of visits. Frequency of visits was also related to the respondents' health-related quality of life status.CONCLUSIONS: These results highlight the need for further research into the constraints faced by people with mobility disabilities with regard to visiting green spaces.

At present, research within health promoting environments is dominated by a focus on the difference between the urban and the natural environment. However, little knowledge exists regarding which qualities within the natural environment promote restoration. The aim of the paper is to identify which qualities and perceived sensory dimensions (PSD) of a forest environment are psychologically restorative. The research consists of 26 participants' ratings and experiences of psychological restoration in a forest environment called the Health Forest Octovia®, which consists of eight different rooms designed according to previous research on PSDs, where each room represents one of the PSDs. The participants rated the restorativeness of the rooms on a scale and they were interviewed about their experiences. The interviews were analyzed by an interpretative phenomenological analysis (IPA). The results from the rating exercise show that the rooms where the PSDs serene, rich in species, refuge and nature are dominant are rated highest with regards to restoration, which supports the previous research on the subject. Further, the findings from the IPA indicate that the spatial aspects are important for the experience of restoration. An environment which includes diverse vegetation and balances enclosed dense growth with more open views is regarded as being optimal for restoration. The dense growth should have the appearance of a den and offer experiences of privacy. The results validate the potential for using the PSDs as guidelines for designing health-promoting natural environments.

Research has proven that both mindfulness training and exposure to nature have positive health effects. The purpose of this study was to systematically review quantitative studies of mindfulness interventions conducted in nature (nature-based mindfulness), and to analyze the effects through meta-analyses. Electronic searches revealed a total of 25 studies to be included, examining 2990 participants. Three analyses were conducted: Nature-based mindfulness interventions evaluated as open trials (k = 13), nature-based mindfulness compared with groups in non-active control conditions (k = 5), and nature-based mindfulness compared with similar interventions but without contact with nature (k = 7). The overall combined psychological, physiological, and interpersonal effects from pre- to post-intervention were statistically significant and of medium size (g = 0.54, p &lt, 0.001). Moderation analyses showed that natural environments characterized as forests/wild nature obtained larger numerical effects than environments characterized as gardens/parks, as did informal mindfulness compared with formal mindfulness. The small number of studies included, as well as the heterogeneity and generally low quality of the studies, must be taken into consideration when the results are interpreted. PROSPERO registration number: CRD42017065639.

Objective: This study concerned optimization of an evidence-based crisis shelter garden as a setting for everyday activities and nature-based therapy. The study hereby tested the design guidelines that the garden is based on. Background: Design guidelines for gardens intended to support health are becoming increasingly specialized, targeting different user groups. This study contributes to the knowledge concerning health-supporting garden design at crisis shelters for women and children who are exposed to domestic violence. Method: The study included a post-occupancy evaluation (POE) consisting of landscape analyses, observation of physical traces, and interviews as well as a subsequent participatory design process. Results: The landscape analyses and the observation of physical traces indicated a minimal level of maintenance and recurrent use being limited to a few areas of the garden. The interviews added nuance and new issues to these results, resulting in the following themes: maintenance, accessibility, safety, therapeutic setting and free space, many ways to play, and social and private spheres. The participatory design process led to an optimization of the garden, including changes to its physical design related to making the garden safer, positively distractive, and more versatile in terms of activities. Improvements were also made regarding policy for use, maintenance, and informing users. Conclusion: The design guidelines were tested, and the evidence was strengthened, adding nuance and new issues to consider during further development of the guidelines. Both the POE and the participatory design process were confirmed as crucial aspects of evidence-based health design.

BackgroundStress-related illnesses are a major threat to public health, and there is increasing demand for validated treatments.AimsTo test the efficacy of nature-based therapy (NBT) for patients with stress-related illnesses.MethodRandomised controlled trial (ClinicalTrials.gov ID NCT01849718) comparing Nacadia® NBT (NNBT) with the cognitive–behavioural therapy known as Specialised Treatment for Severe Bodily Distress Syndromes (STreSS). In total, 84 participants were randomly allocated to one of the two treatments. The primary outcome measure was the mean aggregate score on the Psychological General Well-Being Index (PGWBI).ResultsBoth treatments resulted in a significant increase in the PGWBI (primary outcome) and a decrease in burnout (the Shirom–Melamed Burnout Questionnaire, secondary outcome), which were both sustained 12 months later. No significant difference in efficacy was found between NNBT and STreSS for primary outcome and secondary outcomes.ConclusionsThe study showed no statistical evidence of a difference between NNBT and STreSS for treating patients with stress-related illnesses.Declaration of interestNone.

Original Research Environmental strategies of affect regulation refer to the use of natural and urban socio-physical settings in the service of regulation. We investigated the perceived use and efficacy of environmental strategies for regulation of general affect and sadness, considering them in relation to other affect regulation strategies and to subjective well-being. Participants from Australia, Finland, Germany, Great Britain, Italy, India, the Netherlands, Portugal, and Sweden (N = 507) evaluated the frequency of use and perceived efficacy of affect regulation strategies using a modified version of the Measure of Affect Regulation Styles (MARS). The internet survey also included the Satisfaction with Life Scale (SWLS), emotional well-being items from the RAND 36-Item Health Survey, and a single-item measure of perceived general health. Environmental regulation formed a separate factor of affect regulation in the exploratory structural equation models (ESEM). Although no relations of environmental strategies with emotional well-being were found, both the perceived frequency of use and efficacy of environmental strategies were positively related to perceived health. Moreover, the perceived efficacy of environmental strategies was positively related to life satisfaction in regulating sadness. The results encourage more explicit treatment of environmental strategies in research on affect regulation info:eu-repo/semantics/publishedVersion

Stress-related illnesses are a growing health problem in the Western world; which also has economic significance for society. As a consequence; there is a growing demand for effective treatments. The study investigates the long-term efficacy of the Nacadia® nature-based therapy (NNBT) by comparing it to the efficacy of a validated cognitive behavioral therapy, called STreSS. The study is designed as a randomized controlled trial in which 84 participants are randomly allocated between the treatments. Long-term efficacy is investigated through data extracts from the national database of Statistics Denmark on the sick leave and the health-care consumption. The results show that both the NNBT and the STreSS lead to a significant decrease in number of contacts with a general practitioner in the period from twelve months prior to treatment to twelve months after treatment; and, a significant decrease in long-term sick leave from the month prior to treatment to twelve months after treatment. The positive long-term effects provide validation for the NNBT as an efficient treatment of stress-related illnesses.

Serving in the military leads to mental diseases, such as post-traumatic stress disorder (PTSD), for a percentage of soldiers globally. The number of veterans with PTSD is increasing and, although medication and psychological treatments are offered, treatment results could be improved. Historically, different forms of nature-based therapy have been used for this target group. However, in spite of anecdotally good results, studies measuring the effect of this form of therapy are still lacking. The aim of this study is to explore how veterans with PTSD manage their everyday lives during and after a ten-week nature-based intervention in a therapy garden. Methods: Eight veterans participated in qualitative interviews, which were conducted during a one-year period and were analyzed using interpretative phenomenological analysis (IPA). Results: Five themes emerged from the IPA analysis: Bodily symptoms, relationships, building new identities, the future, and lessons learned. All the participating veterans gained a greater insight into and mastering of their condition, achieved better control of their lives, and developed tools to handle life situations more appropriately and to build a new identity. This improved their ability to participate in social activities and employment. Conclusion: The results should be considered in the future treatment of veterans with PTSD.

No abstract available.

Nature-assisted therapy (NAT) has become more common and recognized in both practice and research. The literature often describes how NAT gradually emerged in the UK and the US offering rehabilitation of soldiers suffering from traumatic experiences after active service in WW I and WW II. The main question of this review is to investigate what happened to this patient group? Consequently the aim is to systematically review: The literature; the evidence level; the health outcomes; and the transmissibility of the therapy programmes and results for practitioners. The review describes the development and status of practice and research concerning NAT for veterans with post-traumatic stress disorder (PTSD). The systematic review included a seven-step literature search. Relevant data sources were scrutinized in order to retrieve literature meeting the predefined inclusion criteria. Due to the limited amount of peer-reviewed literature, non-peer-reviewed literature was also included in the review. The final selection yielded eleven peer reviewed and nine non-peer-reviewed publications. Three can be characterized as RCT studies, while the remainder is qualitative case studies. Eight themes emerged from the systematic analysis of the qualitative case studies. This review found that a large amount of projects offering NAT to veterans suffering from PTSD exist in many parts of the world and they present no adverse negative results. Recommendations for future practice and research are posed.

Available evidence shows that an increasing number of soldiers are seeking help for post-traumatic stress disorder. The post-traumatic stress disorder condition has big emotional and psychological consequences for the individual, his/her family and the society. Little research has been done to explore the impact of nature-based therapy for veterans with post-traumatic stress disorder although there is a growing amount of evidence pointing towards positive outcome. This qualitative study aims to achieve a deeper understanding of this relationship from the veteran’s perspective. Eight Danish veterans participated in a 10-week nature-based therapy. Qualitative interviews were conducted and analysed using the interpretative phenomenological method. The results indicated that the veterans have achieved tools to use in stressful situations and experienced an improvement in their post-traumatic stress disorder symptoms.

Today, urbanization presents a challenge to urban planning with regard to creating healthy living environments. The aim of this research is to gain further knowledge of the restorativeness of a best case urban and natural environment: that is a historic down town urban environment and forest environment located in an arboretum. The study has a cross-over design where 51 (N) female university students are exposed to the two environments through both seated viewing and walking. A mixed method approach is used with both physiological measurements of blood pressure (BP) and heart rate variability (HRV) and psychological measurements of mood change and perceived restorativeness. The HRV results show no significant differences between the two environments, and both environments are found to be more physiologically restorative than being at the office or on the minibus. The results of the psychological measures indicate that the forest walk has a positive effect on mood, while the walk in the urban environment has no effect. The forest environment is also rated more highly with regard to perceived restorativeness than the urban environment. The results support the current research that shows natural environments as more restorative than urban environments. The study also adds to the ongoing debate on healthy urban planning by indicating that architectural and historical qualities may be associated with the physiological well-being of citizens.

The design of the Nacadia® therapy garden is based on a model for evidence-based health design in landscape architecture (EBHDL). One element of the model is a diagnostic post-occupancy evaluation (DPOE), which has not previously been fully developed. The present study develops a generic DPOE for therapy gardens, with a focus on studying the effects of the design on patients’health outcomes. This is done in order to identify successes and failures in the design. By means of a triangulation approach, the DPOE employs a mixture of methods, and data is interpreted corroborating. The aim of the present study is to apply the DPOE to the Nacadia® therapy garden. The results of the DPOE suggest that the design of the Nacadia® therapy garden fulfills its stated aims and objectives. The overall environment of the Nacadia® therapy garden was experienced as protective and safe, and successfully incorporated the various elements of the nature-based therapy programme. The participants encountered meaningful spaces and activities which suited their current physical and mental capabilities, and the health outcome measured by EQ-VAS (self-estimated general health) indicated a significant increase. Some design failures were identified, of which visual exposure was the most noteworthy. The DPOE model presented appears to be efficient but would nonetheless profit from being validated by other cases.

This study systematically evaluated the scientific evidence for health benefits of natural environments for people with mobility impairments. Literature searches based on five categories of terms—target group, nature type, health-related impacts, nature-related activities and accessibility issues—were conducted in four databases (Web of Science, Scopus, CAB ABSTRACT and Medline). Twenty-seven articles from 4196 hits were included in the systematic reviews. We concluded that people with mobility disabilities could gain different health benefits, including physical health benefits, mental health benefits and social health benefits from nature in different kinds of nature contacts ranging from passive contact, active involvement to rehabilitative interventions. Several issues related to the accessibility and use of nature for people with mobility impairments need attention from professionals such as landscape architects, rehabilitative therapists, caregivers and policy makers. The overall quality of methodology of the included studies is not high based on assessment of the Mixed Methods Appraisal Tool (MMAT). Moreover, more randomized controlled trials and longitudinal studies that focus specifically on evidence-based health design of nature for people with mobility impairments in the future are needed.

Urban green spaces have been shown to promote health and well-being and recent research indicates that the two primary potentially health promoting uses of pocket parks are ‘rest and restitution’ and ‘socialising’. The aim of this study is to identify features in pocket parks that may support these uses. The relationship between the two types of use and the shape, size, noise level, greenness, as well as ‘elements’ (paved and unpaved trails, café, historical feature, table, other seating than benches, flowerbeds, view outside park, playground) in nine pocket parks in Copenhagen were analysed. The results show that ‘green features’ do not seem to be of crucial importance for ‘socialising’ whereas, as expected, features promoting gathering should be prioritised. For ‘rest and restitution’, the main results show that ‘green ground cover’ and ‘enclosed green niches’ are important, while ‘disturbing features’ (playground, view outside park) should be avoided. The results add knowledge about the features which support the health promoting use of pocket parks to the existing body of research.

Background: In modern, urban daily life, natural environments are increasingly recognized as an important resource for stress recovery and general well-being. Aim: the present review aims to provide an overview and synthesis of the past eight years’ research into the psycho-physiological effects of outdoor nature-based interventions, related to stress recovery. Method: a structured search was performed in seven databases, returning 5618 articles. Removal of duplicates and initial screening gave a total of 95 studies. After full text reading, 36 studies were included in the assessment. Results: most of the psychological outcomes were related to different emotional measures. The synthesis of the results points towards outdoor, nature-based exposure having a positive effect on different emotional parameters, related to stress relief. The studies into physiological measures showed more equivocal results. Conclusion: the research, conducted over the past eight years, into outdoor, nature-based exposure has now attained a sound evidence base for psychological and especially emotional effects, but the evidence base for physiological effects within this timeframe shows a great degree of heterogeneity. Limitations: interpretation of the results is limited by the review only covering the past eight years’ research on the subject.

Binge eating disorder (BED), characterized by recurrent episodes of binge eating with a subjective experience of lack of control, is the world&rsquo, s most common eating disorder. The aim of the present pilot study was to examine the feasibility of implementing nature-based therapy (NBT) in the treatment of BED. The NBT intervention was compared to Support Group Meetings (SGMs), which are the only publicly available form of support for people diagnosed with BED in Denmark. Twenty participants with a BED diagnosis were included in the study, which had a mixed-methods design including Eating Disorder Examination interviews, semi-structured interviews, and questionnaires measuring well-being (The Psychological General Well-Being Index) and self-esteem (Rosenberg&rsquo, s Self-Esteem Scale). Both the NBT and the SGMs showed positive results on all outcome measures (decreases in binge eating episodes and increases in general psychological well-being and self-esteem). The interviews indicated that the NBT context made the psychotherapeutic content more accessible to the participants and further helped them transfer the therapeutic gains to daily life after completing treatment. However, these results should be interpreted with caution due to the small sample size&mdash, ideally, they would need to be tested on a larger, randomized sample.

Office workers’ job satisfaction and ability to work are two important factors for the viability and competitiveness of most companies, and existing studies in contexts other than workplaces show relationships between a view of natural elements and, for example, student performance and neighbourhood satisfaction. This study investigates whether relationships between window view, and work ability and job satisfaction also exist in the context of the workplace by focusing on office workers’ view satisfaction. The results showed that a view of natural elements was related to high view satisfaction, and that high view satisfaction was related to high work ability and high job satisfaction. Furthermore, the results indicated that job satisfaction mediated the effect of view satisfaction on work ability. These findings show that a view of a green outdoor environment at the workplace can be an important asset in workforce work ability and job satisfaction.

This paper develops, explores and evaluates an evidence-based approach to playground design, with a public park playground (playlab Cph) in Copenhagen as a case study. In the increasingly urbanised world, park playgrounds are valuable places that support healthy child development by providing opportunities for play, nature exploration and sensory stimulation. As it is increasingly expected that designers base their decisions on research evidence, there is a need to develop approaches to facilitate this, which also applies to playground design. The design of PlayLab Cph was based on relevant evidence, best practice, and the theories of Affordances and Behaviour Settings. A post-occupancy evaluation was carried out through a questionnaire survey and observation studies, which revealed that a majority of the potential evidence-based affordances were actualised, and that the application of the theories resulted in a more informed design. Although preliminary, this evidence-based approach seems valuable for practitioners and students within the field of playground design .

Urban green space in dense city areas is a limited resource. However, previous research indicates that such areas have a positive influence on mental restoration. As stress is a common problem in cities, we test to see whether park characteristics are associated with the perceived restorativeness of nine small public urban green spaces (SPUGS) in the dense city of Copenhagen. Furthermore, we investigate whether there is a difference in preferences for park characteristics amongst average users and the most stressed users of SPUGS. We conducted an on-site questionnaire survey where respondents answered the perceived restorativeness scale (PRS). All SPUGS were analysed using the eight perceived sensory dimensions (PSDs) which describe different park characteristics. The analyses were conducted to see whether the PSDs were present or not and to determine how strong or weak they were. For the first time the PRS and the PSDs have been combined to see whether significant associations can be found between park characteristics and the users’ perceived restorativeness. First, seven of the eight PSDs could be used in the study. Second, the PSDs ‘social’ and ‘serene’ were significantly associated with average users’ perceived restorativeness. And third, a difference between the users is that the PSD ‘nature’ becomes important for the most stressed individuals. The results indicate that the PSDs can be useful for the future analysis and design processes of SPUGS with the potential for mental restoration. However, the PSDs need to be developed further to make them useful to practitioners.

Dealing with stress and stress-related diseases is an increasing problem in both developed and developing countries and has an enormous cost for individuals, companies, and societies. A positive relationship between access to a green outdoor environment at work, and decreased stress has been found in previous studies, and this relationship is in line with a vast body of research in other contexts. The aim of this study is to investigate whether access to a green outdoor environment at work is related to employees’ perceived level of stress and attitude toward the workplace. The study is based on data from a questionnaire answered by 439 randomly selected individuals in Sweden. The questionnaire addressed the respondents’ level of stress and workplace attitude, and the characteristics and accessibility of the outdoor environment at the respondents’ workplace. The results showed significant relationships between physical and visual access to workplace greenery, and a positive workplace attitude and decreased level of stress for male respondents. For female respondents, a significant relationship between physical and visual access to workplace greenery and a positive workplace attitude was found, but not between access to workplace greenery and level of stress. Furthermore, a positive workplace attitude was related to decreased levels of stress for female respondents, but not for male respondents. These findings support existing research which suggests that the workplace outdoor environment is an asset for employees’ wellbeing and level of stress, and they indicate that gender plays a central role in realizing the benefits of such environments.

The availability of urban green space (UGS) is one of the environmental factors that is frequently linked to increased levels of physical activity (PA). Positive associations with increased levels of PA are reported for the amount of UGS close to home, the distance to the nearest UGS, the size of the nearest UGS, and the presence of certain features. However, the evidence to date is somewhat inconclusive, and dominated by studies from North America and Australia. There is a large variation in city structures, and recommendations for North American or Australian cities are not automatically valid for European cities. Using a sample of 1305 Danish adults and detailed descriptions of UGS, we examined the association between UGS and outdoor PA in general, as well as PA in the nearest UGS. No association between outdoor PA in general, size of, distance to, and number of features in the nearest UGS was found. The amount and number of UGS within 1 km revealed no association either. For PA in the nearest UGS positive associations with size, walking/cycling routes, wooded areas, water features, lights, pleasant views, bike rack, and parking lot were found. This indicates that PA in a UGS might be stimulated by providing these features there. However, interventions or longitudinal studies are needed to explore potential causal relationship.

Nature-based therapy can be considered an umbrella term for a diverse range of psychotherapeutic and allied practices which integrate experiences and activities in nature as therapeutic means. The objective of this article is to describe the theoretical framework for nature-based therapy in a university-founded healing forest garden near Copenhagen, Denmark. The garden will offer a 10-week treatment for people who are on sick leave with stress-related illness. This article focuses on clarifying the integration between the psychotherapeutic and gardening aspects of the nature-based therapy. The psychotherapeutic aspects are based on mindfulness and an acceptance therapy, while the gardening aspects are highly inspired by permacultural principles and methods.

Today, office work in western societies is more sedentary and more mentally demanding than ever before. This way of working plays a role in the increase in lifestyle diseases related to sedentary routines and stress. Green outdoor environments have been found to motivate physical activity and reduce stress levels. In this study, we therefore considered these environments to have a positive affect on work force health and wellbeing. However, research on the workplace outdoor environment is still limited. To investigate how and why the workplace outdoor environment is used by office workers and the impact of these environments on office workers’ health and wellbeing, five research questions were formulated. The questions addressed the use of the outdoor environments; the outdoor activities; encouragement and impediments for going outdoors; characteristics of the outdoor environment, and the impact of workplace outdoor environments on employees’ health, job satisfaction and work performance. In order to answer these research questions, we conducted a web-based questionnaire, completed by (N) 402 office workers from six Danish companies. The results show that 37.8% of the respondents spent time outdoors during their working day, and that the proportion of men spending time outdoors was higher than the proportion of women. Eight outdoor activities were identified, and significant relationships between the outdoor activities and perceived sensory dimensions (PSD) of the outdoor environment were found, indicating that the presence of the dimension ‘serene’ increased the odds for respondents going outdoors and that five of the eight activities would be performed. Only few significant relationships between outdoor environment use and employee health, job satisfaction and work performance were identified.

Children's independent access to the outdoors is often restricted by parents, making young children dependent on adult motivation for visits. Since access to play in nature can be beneficial to children's development and health, this study examines the accompanying adults’ motivational factors for bringing their children to playgrounds in urban green spaces. The study used on-site questionnaires to collect data in six public park playgrounds in the U.S. and Denmark, to reveal cultural similarities and differences. The results show that the respondents have different motivations for going to a park playground. The Danish respondents find it most important to be together with their children, while the American respondents find it most important that their children are physically active whilst being there. Other results show that different factors can influence both frequency of visits and length of stays. For Danish respondents, location is very important. Pleasing green surroundings and a nearby location tends to result in more frequent visits. All respondents stay longer and visit more often if they like the social atmosphere of the playground. However, male respondents, who are more active with their children than female respondents, have shorter stays if they dislike the variety of play equipment. Based on the results of this paper, suggestions are made as to how designers, planners and park managers can implement the results into practice, with the aim of increasing adults’ motivation for taking their children to park playgrounds.

This paper theoretically examines the interplay between cognition and bodily involvement in relation to nature-based therapy and proposes implications for practice. With support from theory within embodied cognition and neuroscientific studies, it is argued that explicit learning is actively supported by bodily involvement with the environment. This argument is placed in the context of ‘nature-based therapy’, which can be perceived as a generic term for treatments with therapeutic use of activities and experiences in natural environments. The paper proposes that the use of metaphors to conceptualize desired therapeutic understanding in connection with the performance of activities in nature-based therapy can support the learning and change process by semantically relating cognition and bodily involvement.

Everyday modern life offers fewer opportunities for outdoor activities and mental restoration. Outdoor activities in urban green spaces might be a promising means to lower levels of stress. Our hypothesis is that individuals’ Level of Stress (LS) is related to the interaction between preferences for certain perceived sensory dimensions (PSDs) of the outdoor environment and certain types of outdoor activities. A total of 953 randomly selected informants, representative of the Swedish population, answered a postal questionnaire with pre-coded items. The questionnaire consisted of three parts: personal data, preferences for PSDs and for outdoor activities, and self-estimations of health. The study focuses on ill health in relation to Level of Stress (LS). The data was analysed using factor and regression analysis. The results show that individuals reporting high LS are more likely to: be younger adults, women, be on sick-leave, have small children, be dissatisfied with their home environment, experience poorer access to green spaces and, foremost, want to use public green spaces more often. Seventeen different outdoor activity types are identified. The most preferred activity type among the most stressed informants was ‘rest activities’ followed by ‘animal activities’ and ‘walking activities’. All pairs of these three activity types and PSDs showing a significant association were transformed into ‘activity-sensory dimension types’. A regression analysis shows that the most preferred activity-sensory dimension types for informants reporting high LS are ‘animal activities’ in the PSD ‘rich in species’, ‘animal activities’ in the PSD ‘refuge’, and ‘rest activities’ in the PSD ‘nature’. These results may be interpreted as providing information regarding how to plan urban green spaces with certain characteristics that could promote outdoor activities which are preferred by stressed individuals.

The aim of this study is to acquire knowledge about what activities people reportedly engage in to relax when feeling stressed. A special focus is on physical activity to reduce stress and the association with socioeconomic status, general health, and leisure time activities. The data are derived from a Danish national health survey, and the variables are studied by statistical correspondence analyses. Results show that physical activity when relaxing from stress is related to an active leisure time, good health, and socioeconomic factors such as high education, employment, and good housing conditions. These findings support earlier research indicating that social inequality plays an important role in the choice of activities for stress reduction.

Udgivelsesdato: 2010-Jun AIMS: To investigate the associations between green space and health, health-related quality of life and stress, respectively. METHODS: Data were derived from the 2005 Danish Health Interview Survey and are based on a region-stratified random sample of 21,832 adults. Data were collected via face-to-face interviews followed by a self-administered questionnaire, including the SF-36, which measures eight dimensions of health and the Perceived Stress Scale, which measures self-reported stress. A total of 11,238 respondents completed the interview and returned the questionnaire. Multiple logistic regression analyses were performed to investigate the association between distance to green space and self-perceived stress. RESULTS: Danes living more than 1 km away from the nearest green space report poorer health and health-related quality of life, i.e. lower mean scores on all eight SF-36 dimensions of health than respondents living closer. Respondents living more than 1 km away from a green space have 1.42 higher odds of experiencing stress than do respondents living less than 300 m from a green space. Respondents not reporting stress are more likely to visit a green space than are respondents reporting stress. Reasons for visiting green spaces differ significantly depending on whether or not respondents experience stress. Respondents reporting stress are likely to use green spaces to reduce stress. CONCLUSIONS: An association between distance to a green space and health and health-related quality of life was found. Further, the results indicate awareness among Danes that green spaces may be of importance in managing stress and that green spaces may play an important role as health-promoting environments.

Research indicates a relationship between sensory perception of natural environments and human health. Our hypothesis is that people perceive green spaces in terms of certain dimensions, where some dimensions are more important and preferred than others with respect to restoring people from stress. The aims are to: identify and describe the perceived dimensions in nature; identify which dimensions people in general prefer; identify the dimensions people reporting stress prefer; and identify a combination of the dimensions people reporting stress prefer. A total of 953 randomly selected informants from nine Swedish cities (representative of the Swedish population) answered a postal questionnaire with pre-coded questions. The questionnaire consisted of three parts: personal data, preferences for natural qualities and self-estimations of health status. The data were analyzed using factor analysis and regression analyses. The results identify and describe eight perceived sensory dimensions. People in general prefer the dimension Serene, followed by Space, Nature, Rich in Species, Refuge, Culture, Prospect and Social. The dimensions Refuge and Nature are most strongly correlated with stress, indicating a need to find the most restorative environments. A combination of Refuge, Nature and Rich in Species, and a low or no presence of Social, could be interpreted as the most restorative environment for stressed individuals. From a city planning perspective, the results indicate how urban green spaces can be viewed as elements of importance to public mental health. However, before the dimensions can be used by practitioners as tools to promote health through city planning, more research is needed.

Increasing the use of urban green space has appeared on the political agenda, primarily because increased use is expected to improve the health and well-being of the urban population. Green space is contributing to restoring mental fatigue, serving as a resource for physical activity, reducing mortality and reducing the level of stress. However, knowledge and experience on how to implement this agenda are scarce. In this paper, we use a socio-ecological model as framework when studying influences on the use of respondents’ nearest urban green space in the Danish city of Odense. Data were obtained from a survey sent to 2500 randomly selected adult residents within the central part of the city. We tested the relative importance of different factors on the frequency of use of the nearest urban green space by using a multivariate logistic regression model. The results show that almost half of the respondents did not use their nearest green space the most. Whether or not respondent used their nearest green space most depends primarily on area size, distance to the area and factors that are likely to express a reduced mobility; old age, young children and poor health. If the nearest urban green space also is the most used green space, having a dog is the only factor that significantly increases the frequency of use. Further research is needed to determine what it is that makes people use an area more, if the basic conditions of a reasonable size (>5 ha) within a reasonable distance (

The aim of this study was to identify implications for the design of outdoor environments at crisis shelters for women and children survivors of domestic violence. To address this aim, landscape analyses and interviews with staff were conducted at three Danish cases. The findings are presented in descriptions of the three cases in terms of the number of residents, context, building type and the characteristics of outdoor environments. Furthermore, a thematic content analysis of the interviews resulted in five categories that offer a nuanced insight into how the different types of outdoor environments support crisis shelter functions. The categories are: Protection against perpetrators of violence and helping residents to feel safe; Accessibility in the design, straightforward activities and staff guidance; Being outside and the positive distractions of nature; Space for all; Room to play and relieve children’s feelings. Finally, the findings were summarized to give an overview of implications for design.

During recent years, the use of urban green space (UGS) has received increased attention within several research fields, as well as politically, especially in relation to the benefits it provides for human health. Much research on larger green areas has shown that they are beneficial to people's health, physically, socially and mentally. However, because of densification tendencies in cities in Western countries, large green areas are a limited resource and many people live in city areas where the distance to larger green areas reduces the possibility for frequent use. Small Public Urban Green Spaces (SPUGS) in dense city areas might contribute to satisfy the need for everyday experiences of outdoor areas, but research on SPUGS is limited. In this paper, we describe how nine SPUGS in Copenhagen are used by the citizens based on data from 686 respondents who completed on-site questionnaires during their visit. The results show that SPUGS are primarily used for ‘socialising’ and ‘rest and restitution’. Furthermore, they are mainly used by well-educated people between the ages of 30 and 49. For ‘socialising’, SPUGS are primarily used on the way home. For ‘rest and restitution’, SPUGS are primarily used ‘en route’ or on the way home. More than half of the respondents reported living more than 1000 m from the SPUGS, and more than half of the respondents reported that they travel more than 500 m to get to the SPUGS. People aged 50–65 are more likely to visit the SPUGS for ‘rest and restitution’ than the younger age groups. Furthermore the older people are, the less likely they are to visit SPUGS to socialise. These results show that SPUGS are an important asset in citizen's everyday lives, and the results may provide inspiration for landscape architects, city planners and policy makers for the future planning of dense city areas.

Background and Aims: Major Malaysian cities such as Kuala Lumpur (Peninsular Malaysia) and Kuching (Sarawak) have been experiencing rapid development. The importance of green spaces as a contributo...

Background:This study examines the relationship between distance to green space and the level of physical activity among the population of Denmark. In addition, the relationship between distance to green space and obesity is investigated.Methods:Data derived from the Danish National Health Interview Survey 2005, a cross-sectional survey based on a region-stratified random nationally representative sample of 21,832 Danish adults. All data are self-reported.Results:Respondents living more than 1 km from green space had lower odds of using green space to exercise and keep in shape compared with persons living closer than 300 m to green space (OR: 0.71; 95% CI: 0.60−0.83). A relationship between moderate/vigorous physical activity during leisure time and distance to green space can also be found. Persons living more than 1 km from green space had higher odds of being obese (BMI ≥ 30) than those living less than 300 m from green space (OR: 1.36; 95% CI: 1.08−1.71).Conclusions:Self-reported distance to green space is related to self-reported physical activity and obesity. To exercise and keep in shape is an important reason for visiting green space, and distance to green space is associated with moderate/vigorous physical activity in leisure time.

The point of departure of this chapter is to view nature-based settings as an important asset for improvement and promotion of health. During the last decades the concepts of healthy nature-based settings and accompanying treatment programs have been referred to by many names, making the subject difficult to interpret. Here the development of the theoretical framework and the research area are described. The second part of the chapter focuses on the structure of a therapy program and the health design of the nature-based setting. From the theories and experiences, including both research as well as best practice presented, the chapter ends with recommendations for future aims of research projects within this area.

Policy makers in Denmark are increasingly recognising the potential health benefits associated with green space, in particular with the use of green space. Knowledge on how green space is used, why it is used, and which factors influence its use, is becoming interesting for researchers, city planners and managers of green space. The present study is based on data from a nationwide study of 11 238 randomly selected adult Danes. Respondents were asked about the distance to four different types of green space, their frequency of use of each of these types of green space, and the main reasons for visiting green space. Multiple logistic regression analysis was used to investigate the association between potential predictor factors and visits to green space at least a few times per week. Results show that 66.9% of the respondents live within 300 m of green space, 43.0% visit green space every day and 91.5% visit green space at least once a week. Only 0.9% never visit green space. To enjoy the weather and get fresh air is the most important reason for visiting green space for 87.2% of the respondents. Distance to green space is not a limiting factor for the majority of the Danish population and for that reason we recommend a thorough analysis of a neighbourhood or city, its population, and the available green spaces, before deciding on a viable strategy to increase the use of green space.