Recreational physical activity in natural environments and implications for health: A population based cross-sectional study in England

This is the author accepted manuscript. The final version is available from the publisher via the DOI in this record.Background Building on evidence that natural environments (e.g. parks, woodlands, beaches) are key locations for physical activity, we estimated the total annual amount of adult recreational physical activity in England's natural environments, and assessed implications for population health. Methods A cross-sectional analysis of six waves (2009/10–2014/5) of the nationally representative, Monitor of Engagement with the Natural Environment survey (n = 280,790). The survey uses a weekly quota sample, and population weights, to estimate nature visit frequency across England, and provides details on a single, randomly selected visit (n = 112,422), including: a) duration; b) activity; and c) environment type. Results Approximately 8.23 million (95% CIs: 7.93, 8.54) adults (19.5% of the population) made at least one ‘active visit’ (i.e. ≥ 30 min, ≥ 3 METs) to natural environments in the previous week, resulting in 1.23 billion (1.14, 1.32) ‘active visits’ annually. An estimated 3.20 million (3.05, 3.35) of these also reported meeting recommended physical activity guidelines (i.e. ≥ 5 × 30 min a week) fully, or in part, through such visits. Active visits by this group were associated with an estimated 109,164 (101,736, 116,592) Quality Adjusted Life Years (QALYs) annually. Assuming the social value of a QALY to be £20,000, the annual value of these visits was approximately £2.18 billion (£2.03, £2.33). Results for walking were replicated using WHO's Health Economic Assessment Tool. Conclusions Natural environments provide the context for a large proportion of England's recreational physical activity and highlight the need to protect and manage such environments for health purposes.This work was supported by the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Environmental Change and Health at the London School of Hygiene and Tropical Medicine in partnership with Public Health England (PHE), and in collaboration with the University of Exeter, University College London, and the Met Office. The funders had no role in the study design, analysis, interpretation of data, or decision to submit the article for publication. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR, the Department of Health or Public Health England