Why Do People Exercise in Natural Environments? Norwegian Adults' Motives for Nature-, Gym-, and Sports-Based Exercise

This is the final version of the article. Available from MDPI via the DOI in this record.Exercise in natural environments ("green exercise") confers numerous health benefits, but little is known about why people engage in green exercise. This study examined the importance of nature experiences as a motive for physical activity and the motivational profile of people who engage in green exercise compared to gym- and sports-based exercise. Physical activity motives and typical times spent in different domains of physical activity were reported by 2168 Norwegian adults in a survey. Experiencing nature was generally rated as the second-most important physical activity motive, exceeded only by convenience motives, and it was especially important for older adults and those who engage in greater amounts of instrumental physical activity. Green exercisers reported stronger motives concerning convenience and experiencing nature, whereas gym- or sports-based exercisers reported stronger motives for physical health and sociability. The motives associated with different leisure-time exercise domains may assist in understanding optimal promotion of green exercise.Giovanna Calogiuri’s participation in this research was entirely funded by Inland Norway University of Applied Sciences, and Calogiuri did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Lewis R. Elliott declares that his participation in this research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors

Neighbourhood blue space, health and wellbeing: The mediating role of different types of physical activity

This is the final version. Available on open access from Elsevier via the DOI in this recordBackground: Evidence suggests that living near blue spaces such as the coast, lakes and rivers may be good for health and wellbeing. Although greater levels of physical activity (PA) may be a potential mechanism, we know little about the types of PA that might account for this. Objectives: To explore the mediating role of: a) ‘watersports’ (e.g. sailing/canoeing); b) ‘on-land outdoor PA’ in natural/mixed settings (e.g. walking/running/cycling); and, c) ‘indoor/other PA’ (e.g. gym/squash) in the relationships between residential blue space availability and health outcomes. Methods: Using data from the Health Survey for England (n = 21,097), we constructed a path model to explore whether weekly volumes of each PA type mediate any of the relationships between residential blue space availability (coastal proximity and presence of freshwater) and self-reported general and mental health, controlling for green space density and a range of socio-economic factors at the individual- and area-level. Results: Supporting predictions, living nearer the coast was associated with better self-reported general and mental health and this was partially mediated by on-land outdoor PA (primarily walking). Watersports were more common among those living within 5kms of the coast, but did not mediate associations between coastal proximity and health. Presence of freshwater in the neighbourhood was associated with better mental health, but this effect was not mediated by PA. Conclusions: Although nearby blue spaces offer potentially easier access to watersports, relatively few individuals in England engage in them and thus they do not account for positive population health associations. Rather, the benefits to health from coastal living seem, at least in part, due to participation in land-based outdoor activities (especially walking). Further research is needed to explore the mechanisms behind the relationship between freshwater presence and mental health.Kone FoundationEuropean CommissionNational Institute for Health Research (NIHR)European Union Horizon 202

Prevalence of TTR variants detected by whole-exome sequencing in hypertrophic cardiomyopathy

BACKGROUND: A proportion of patients with hypertrophic cardiomyopathy (HCM) have a diagnosis of cardiac amyloidosis. Hereditary transthyretin amyloid cardiomyopathy (ATTRv-CM) is caused by mutations in the TTR gene. Our aim was to study the prevalence of potentially amyloidogenic TTR variants in a whole-exome sequencing (WES) study of a large HCM cohort. METHODS AND RESULTS: 770 consecutive HCM probands underwent WES and clinical characterisation. Patients with rare or known pathogenic variants in TTR underwent 99mTechnetium labelled 3,3-diphosphono-1,2-propanodicarboxylic acid (DPD) scintigraphy and were retrospectively re-assessed for clinical features of amyloidosis. Two patients had rare TTR variants of unknown significance and four had the known pathogenic V122I (p.V142I) variant (one homozygous and also heterozygous for a likely pathogenic MYL3 variant and another double heterozygous for a likely pathogenic MYBPC3 variant). Four out of 6 patients with TTR variants underwent DPD scintigraphy; the only positive study was in the patient with the homozygous V122I (p.V142I) variant. CONCLUSIONS: Pathogenic TTR variants are rare in carefully assessed HCM patients and may occur in double heterozygosity with pathogenic sarcomere variants. The lack of evidence for an amyloidosis phenotype in all but one TTR variant carrier illustrates the importance of complete clinical evaluation of HCM patients that harbour pathogenic TTR variants

Prediction of sarcomere mutations in subclinical hypertrophic cardiomyopathy.

BACKGROUND: Sarcomere protein mutations in hypertrophic cardiomyopathy induce subtle cardiac structural changes before the development of left ventricular hypertrophy (LVH). We have proposed that myocardial crypts are part of this phenotype and independently associated with the presence of sarcomere gene mutations. We tested this hypothesis in genetic hypertrophic cardiomyopathy pre-LVH (genotype positive, LVH negative [G+LVH-]). METHODS AND RESULTS: A multicenter case-control study investigated crypts and 22 other cardiovascular magnetic resonance parameters in subclinical hypertrophic cardiomyopathy to determine their strength of association with sarcomere gene mutation carriage. The G+LVH- sample (n=73) was 29 ± 13 years old and 51% were men. Crypts were related to the presence of sarcomere mutations (for ≥1 crypt, β=2.5; 95% confidence interval [CI], 0.5-4.4; P=0.014 and for ≥2 crypts, β=3.0; 95% CI, 0.8-7.9; P=0.004). In combination with 3 other parameters: anterior mitral valve leaflet elongation (β=2.1; 95% CI, 1.7-3.1; P<0.001), abnormal LV apical trabeculae (β=1.6; 95% CI, 0.8-2.5; P<0.001), and smaller LV end-systolic volumes (β=1.4; 95% CI, 0.5-2.3; P=0.001), multiple crypts indicated the presence of sarcomere gene mutations with 80% accuracy and an area under the curve of 0.85 (95% CI, 0.8-0.9). In this G+LVH- population, cardiac myosin-binding protein C mutation carriers had twice the prevalence of crypts when compared with the other combined mutations (47 versus 23%; odds ratio, 2.9; 95% CI, 1.1-7.9; P=0.045). CONCLUSIONS: The subclinical hypertrophic cardiomyopathy phenotype measured by cardiovascular magnetic resonance in a multicenter environment and consisting of crypts (particularly multiple), anterior mitral valve leaflet elongation, abnormal trabeculae, and smaller LV systolic cavity is indicative of the presence of sarcomere gene mutations and highlights the need for further study

Urban nature and physical activity: Investigating associations using self-reported and accelerometer data and the role of household income

This is the author accepted manuscript. The final version is available from the publisher via the DOI in this recordBackground Physical inactivity is a major public health concern. Natural, or semi-natural, environments may encourage physical activity, but the influences of socio-economic factors have been under-researched. Methods We explored the associations between meeting physical activity (PA) guidelines and both neighbourhood green (area coverage) and blue (freshwater coverage and coastal proximity) environments for urban adults using data from the Health Survey for England [HSE] (2008/2012). We considered different domains of self-reported PA: walking (n = 18,391), sports and other exercise (n = 18,438), non-recreational (domestic/gardening/occupational; n = 18,446) and all three domains combined (n = 18,447); as well as accelerometer-derived PA data using a subsample (n = 1,774). Relationships were stratified by equivalised household income as an indicator of socio-economic status. Results After adjusting for covariates, living 20 km, adjusted odds ratio (ORadj) = 1.26; 95% confidence interval (CI) = 1.15–1.39) but unrelated to sports and exercise. Greater neighbourhood greenspace, however, was only associated with significantly higher odds of meeting guidelines through non-recreational PA alone (e.g. 80–100% vs. <20% ORadj = 1.32; 95% CI = 1.12–1.56). Although associations were most consistent in the lowest income quintile, income-related results were mixed. Relationships were not replicated in the smaller accelerometry subsample. Conclusion Our self-report findings for the differing domains of PA as a function of neighbourhood green and blue space broadly replicated previous research, yet the reasons for the observed differences between PA domains and environments remain unclear. We did not observe any associations between environmental variables and accelerometer-measured PA; further research with larger samples is needed.European CommissionNational Institute for Health Research (NIHR

Redesigning walking brochures using behaviour change theory: implications for walking intentions in natural environments

Summary Natural environments can be used to promote health through facilitating recreational walking. However, efforts to encourage this often neglect messages identified in psychological research that are effective at influencing intentions to walk. This is despite the National Institute for Health and Care Excellence stating that promotional efforts should utilize theoretical frameworks of behaviour change and be targeted towards less active adults. As an illustrative example, this experiment compared a prototypical recreational walking brochure with an “enhanced” version including such persuasive messages on people’s intentions to walk for recreation in natural environments. The enhanced brochure heightened intentions for inexperienced recreational walkers through our hypothesized mechanisms, but appeared to dissuade already-experienced walkers. Optimal messaging strategies in recreational walking brochures require tailoring to more and less active readerships. Guidelines are provided for authors of recreational walking brochures, though the principles and techniques could easily be extended to other means of outdoor walking promotion.</jats:p

Generating evidence in support of site planning and design

This is the final version. Available on open access from Routledge via the DOI in this recordThis chapter presents the development and application of the BlueHealth Environmental Assessment Tool (BEAT). It also introduces the online tool, which is an output of the project and free to use by readers. The evidence-based approach to planning requires that various kinds of data be collected and analysed before and after any intervention is made. This provides the necessary understanding of the balance of risks and benefits associated with changes in an environment, in its usage, in the activities conducted in that space and in the health and well-being of its users and subsequently to plan in a way that maximises benefits and minimises risks. The BEAT is primarily designed to be used as an online tool, but it is also available for download, which allows for a printed version to be used on sites where assessors are not connected to the internet. There are several opportunities for using BEAT in tandem with the decision support tool

Inequalities in residential nature and nature-based recreation are not universal: A country-level analysis in Austria

This is the final version. Available from Elsevier via the DOI in this record. Evidence suggests that residential nature, e.g., greenness around the home, and nature-based recreation, e.g., visits to specific natural locations, are beneficial for health and well-being. However, several studies report that residential access is lower among socio-economically disadvantaged communities, potentially exacerbating health inequalities. We explored this issue in Austria, a relatively rural and mountainous country that also contains several cities, including the capital Vienna with around 2 million citizens. Data were drawn from a representative survey of the adult population across all nine Austrian regions (N = 2258) and explored sociodemographic predictors of residential green and blue space (using satellite data on surrounding greenness and distance to rivers and lakes), and visit frequencies to 12 different urban and rural green/blue environments. In contrast to most findings elsewhere, which usually focus on relatively specific locations (e.g., cities), we found little evidence of socio-economic inequalities in residential green/blue space at the whole country level. Further, although frequent visits to specific environments were less likely among, e.g., people with lower vs. higher education, other typically disadvantaged groups, e.g., those self-identifying as belonging vs. not belonging to an ethnic minority, reported more visits to e.g., urban parks and rivers. Findings suggest that inequalities in nature exposure may not be universal when considered at a country level.European Union’s Horizon 2020Vienna Science and Technology Fund (WWTF

A novel method for assessing design fidelity in web-based behavioral interventions.

Objective: Delivery is one of the most common ways of assessing fidelity in behavioral interventions.However, there is a lack of research reporting on how well an intervention protocol reflects its proposed theoretical principles (design fidelity). This study presents a systematic method for assessing design fidelity and applies it to the eMotion web-based intervention targeting physical activity and depression.Method: The eMotion intervention comprises of 13 web-based modules, designed according to an underlying intervention map. An independent rater with expertise in behavior change coded the presenceor absence of behavior change techniques (BCTs) in the content of eMotion. Results of coding werecompared to the intervention designers’ a priori specification for interrater reliability. Results: Afterdiscussion, the independent rater and the intervention designer had a high agreement for the presence ofBCTs relating to behavioral activation (AC1 0.91) with “demonstration of behavior” and “monitoringof emotional consequences” having the lowest agreement (AC1 0.4). There was also high agreementfor the presence of BCTs targeting physical activity (AC1 0.88) with “demonstration of behavior” and “monitoring of emotional consequences” having the lowest agreement (AC1 0.4). The eMotion description was then amended to align the interrater agreement. Conclusions: This study presents a novelmethod for assessing design fidelity. Developers of behavioral (and other multicomponent) interventions are encouraged to develop and refine this method and assess design fidelity in future interventions to ensure BCTs are operationalized as intended