Table 3.

Added Health Benefits of Exposure to Nature-Based Components and Physical Activity

	Direction of Change	Selected Scientific Articles
Physiological (cardiovascular and metabolic parameters)
Blood pressure	↓	(Park et al., 2010)1; (Twohig-Bennett & Jones, 2018)2; (Li et al., 2011)1; (Yang, Markevych, Bloom, et al., 2019)4
Diastolic blood pressure	↓	(Twohig-Bennett & Jones, 2018)2
Heart rate	↓	(Park et al., 2010)1; (Twohig-Bennett & Jones, 2018)2
Heart rate variability	↑	(Blum et al., 2019)1; (de Brito et al., 2020)1
Low frequency	↓	(Twohig-Bennett & Jones, 2018)2; (Park et al., 2017)3
High frequency	↑	(Twohig-Bennett & Jones, 2018)2
Nighttime	↑	(Gladwell et al., 2016)1
Body mass index (BMI)	↓	(Veitch et al., 2016)4; (Tilt et al., 2007)4; (Astell-Burt, Feng, et al., 2014a)4; (Li & Ghosh, 2018)4; (O’Callaghan-Gordo et al., 2020)4
Sleep/circadian rhythms
Align internal rhythms with natural sunrise and sunset.	↑	(Wright et al., 2013)1
Sleep duration	↑	(Shin et al., 2020)2; (Johnson et al., 2018)4; (Astell-Burt & Feng, 2020a)4; (Wright et al., 2013)1
Sleep quality	↑	(Shin et al., 2020)2; (Pasanen et al., 2014)4 (Xie et al., 2020)4
HDL cholesterol	↓	(Twohig-Bennett & Jones, 2018)2; (Fan et al., 2020)4
Markers of oxidative stress	↓	(Mao, Lan, et al., 2012)1; (Mao, Cao, et al., 2012)1
Alpha-amylase	↓	(Egorov et al., 2017)4; (Hunter et al., 2019)3
Cortisol	↓	(Park et al., 2010)1; (Egorov et al., 2017)4; (Hunter et al., 2019)3; (Honold et al., 2016)4; (Gidlow et al., 2016)3; (Twohig-Bennett & Jones, 2018)2
Adiponectin	↑	(Li et al., 2011)1; (Li et al., 2016)1
Dehydroepiandrosterone sulfate	↑	(Li et al., 2011)1
Pro-inflammatory cytokines (e.g., IL-6; TNF-α)	↓	(Mao, Lan, et al., 2012)1; (Mao, Cao, et al., 2012)1; (Oh et al., 2017)2
Anti-inflammatory cytokines (e.g., IL-8)	↑	(Egorov et al., 2017)4
Natural Killer Cells	↑	(Li et al., 2007)1; (Li et al., 2009)1; (Tsao et al., 2018)1
Allostatic Load	↓	(Egorov et al., 2017)4; (Ribeiro et al., 2019) 4
Parasympathetic nerve activity
Heart rate variability	↑	(Farrow & Washburn, 2019)2; (Park et al., 2010)1; (Park et al., 2017)1; (Lee et al., 2014)3; (Song et al., 2019) 1
Sympathetic nerve activity
Heart rate variability	↓	(Farrow & Washburn, 2019)2; (Park et al., 2010)1; (Park et al., 2017)1; (Lee et al., 2014)3; (Song et al., 2019)1
Urine adrenaline/noradrenaline/dopamine	↓	(Li et al., 2008)1; (Li, 2010)1; (Li et al., 2011)1; (Li et al., 2016)1
Neurotransmitters
Noradrenaline/adrenalin	↓	(Li et al., 2011)1; (Egorov et al., 2017)4
Dopamine	↓	(Li et al., 2011)1; (Li et al., 2016)1; (Egorov et al., 2017)4
Disease Prevalence/Risk
Asthma	↓	(Twohig-Bennett & Jones, 2018)2; (Lovasi et al., 2008)4
Hypertension	↓	(Twohig-Bennett & Jones, 2018)2
Dyslipidemia	↓	(Twohig-Bennett & Jones, 2018)2
Obesity/metabolic syndrome	↓	(Nielsen & Hansen, 2007)4; (Lachowycz & Jones, 2011)2; (Ulmer et al., 2016)4; (Egorov et al., 2017)4; (Schalkwijk et al., 2018)4; Browning and Rigolon 20184; (O’Callaghan-Gordo et al., 2020)4; (Huang et al., 2020)4; (Yang et al., 2020)4; (de Keijzer et al., 2019)4
Stroke	↓	(Twohig-Bennett & Jones, 2018)2; (Orioli et al., 2019)4
Coronary heart disease	↓	(Twohig-Bennett & Jones, 2018)2; (Wang et al., 2019)4
Diabetes type II/gestational	↓	(Twohig-Bennett & Jones, 2018)2; (Bodicoat et al., 2014)4; (Ulmer et al., 2016)4; (Egorov et al., 2017)4; (Yang, Markevych, Heinrich, et al., 2019)4; (Astell-Burt, Feng, et al., 2014b)4; (Qu et al., 2020)4
Pre-term birth/small size for gestational age	↓	(Twohig-Bennett & Jones, 2018)2
Cardiovascular mortality	↓	(Twohig-Bennett & Jones, 2018)2; (Yitshak-Sade et al., 2019)4
All-cause mortality	↓	(Villeneuve et al., 2012)4; (James et al., 2016)4; (Twohig-Bennett & Jones, 2018)2; (Rojas-Rueda et al., 2019)2; (Crouse et al., 2019)4
Psychological/Emotional Parameters
Well-being	↑	(Korpela et al., 2017)4; (Pasanen et al., 2018)4; (Pasanen et al., 2014)4; (MacKerron & Mourato, 2013)4; (Marselle et al., 2013)4; (White et al., 2019)4; (Triguero-Mas et al., 2015)4; (Thompson Coon et al., 2011)2
Positive engagement
Revitalization
Tension
Confusion		(Thompson Coon et al., 2011)2
Anger		(Thompson Coon et al., 2011)2
Risk of Poor Mental Health	↓	(Mitchell et al., 2013)34
Emotional Experience
Relaxation	↑	(Aspinall et al., 2015)3
Frustration	↓
Self-esteem	↑	(Barton et al., 2012)3; (Barton & Pretty, 2010)2; (Swami et al., 2016)4
Body image/appreciation	↑	(Swami et al., 2019)4
Stress	↓
In children	↓	(Razani et al., 2019)1
In adults	↓	(Kondo et al., 2018)4; (Marselle et al., 2013)4; (Nielsen & Hansen, 2007)4; (Largo-Wight et al., 2011)4; (Wooller et al., 2018)1; (Corazon et al., 2018) 4; (Grahn & Stigsdotter, 2003)4
Stress related illnesses	↓
Risk of Psychological Distress	↓	(Francis et al., 2012)4; (Astell-Burt & Feng, 2019)4
Anxiety	↓	(Niedermeier et al., 2017)1; (Bratman et al., 2015)1; (Mackay & Neill, 2010)3
Depression	↓	(Thompson Coon et al., 2011)2; (Egorov et al., 2017)4; (Irandoust & Taheri, 2017)1
Rumination	↓	(Bratman et al., 2015)3
Child resilience	↑	(Razani et al., 2019)1
Affective Response	↑	(Niedermeier et al., 2017)1
Affective valence	↑	(Bratman et al., 2015)1
Activation	↑	(Niedermeier et al., 2017)1
Elation	↑	(Niedermeier et al., 2017)1
Calmness	↑↓	(Niedermeier et al., 2017)1
Negative affect	↓	(Bowler et al., 2010)2; (Thompson Coon et al., 2011)2 (Marselle et al., 2013)4; (Bratman et al., 2015)1
Mood	↑	(Barton et al., 2012)3; (Gidlow et al., 2016)3; (Barton & Pretty, 2010)2; (Wooller et al., 2018)1
Energy	↑ ↔	(Legrand et al., 2018)1; (Thompson Coon et al., 2011)2; (Kjellgren & Buhrkall, 2010)1
Vitality	↑	(Bowler et al., 2010)2; (Thompson Coon et al., 2011)2; (Kjellgren & Buhrkall, 2010)1
Fatigue	↓	(Ryan et al., 2010)1,3; (Niedermeier et al., 2017)1
Self-reported good health	↑	(Pasanen et al., 2014)4; (White et al., 2019)4; (Sugiyama & Ward Thompson, 2007)4; (Triguero-Mas et al., 2015)4; (Kyttä et al., 2012)4; (Twohig-Bennett & Jones, 2018)2
Health-related Quality of Life	↑
Poor Health	↓	(Stigsdotter et al., 2010)4; (Kim et al., 2016)4 (Astell-Burt & Feng, 2019)4; (Stigsdotter et al., 2010)4
Cognitive Function Cognition & Experience Parameters
Memory	↑	(Gidlow et al., 2016)3; (Flouri et al., 2019)4; (Astell-Burt & Feng, 2020b)4
Direct Attention	↑	(Bowler et al., 2010)2; (Rogerson et al., 2016)3
Social Interaction Time	↑	(Rogerson et al., 2016)3; (Aram et al., 2019)4; (Rasidi et al., 2012)4
Restoration Experience	↑	(Gidlow et al., 2016)3; (Pasanen et al., 2018)4; (Bailey et al., 2018)3
Healthy Child Development	↑	(Gill, 2014)2
Intelligence/Academic Performance	↑	(Browning & Rigolon, 2019b)2; (Bijnens et al., 2020)4; (Li et al., 2019)4; (Kuo et al., 2018)4
Perception of Required Effort for Exercise	↑↓ ↓	(Gladwell et al., 2013)2 (Lahart et al., 2019)2
Nature Engagement	↑	(Han & Wang, 2018)3
Frequency of Exercise	↑	(Hug et al., 2009)4
Engagement in and Duration of Moderate-to-Vigorous Physical Activity	↑	(Beyer et al., 2018)4; (Wood et al., 2014)3; (Byrka & Ryczko, 2018)4; (Cleland et al., 2008)4
Play Styles (Children)	↑	(Gill, 2014)2; (Sandseter et al., 2020)4
Social Parameters
Socialization Opportunities and Activities	↑	(Fan et al., 2011)4
Social Support	↑	(Fan et al., 2011)4
Social Capital	↑	(Holtan et al., 2015)4; (Maas et al., 2009)4
Social Cohesion	↑	(Ruijsbroek et al., 2017)4; (de Vries et al., 2013)4; (Sugiyama & Ward Thompson, 2007)4; (Liu et al., 2020)4
Social Mobility	↑	(Browning & Rigolon, 2019a)4
Health Care Spending	↓	(Becker et al., 2019)4

¹Experimental study design

²Literature review or meta-analysis

³Quasi experimental study design

⁴Non-experimental/observational study design

↑ Increased

↓ Decreased

↑↓ Conflicting results

↔ No change