Time spent outdoors, activity levels, and chronic disease among American adults
Chronic diseases—including cancer, cardiovascular diseases, and metabolic conditions such as diabetes and obesity—account for over 60% of overall global mortality. Sedentary time increases the risk for chronic disease incidence and mortality, while moderate to vigorous physical activity is known to decrease risk. Most Americans spend at least half of their time sedentary, with a trend toward increasingly sedentary lifestyles, and few Americans achieve recommended levels of physical activity. Time spent outdoors has been associated with reduced sedentary time and increased physical activity among children/youth and the elderly, but few population-based studies have examined this relationship among working age adults who may face greater constraints on active, outdoor time. This study examines the relationship between time spent outdoors, activity levels, and several chronic health conditions among a population-based sample of working age American adults in the National Health and Nutrition Examination Survey (NHANES) for 2009–2012. Findings provide evidence that time spent outdoors, on both work days and non-work days, is associated with less time spent sedentary and more time spent in moderate to vigorous physical activity. Further, findings indicate that time spent outdoors is associated with lower chronic disease risk; while these associations are partially explained by activity levels, controlling for activity levels does not fully attenuate the relationship between time outdoors and chronic disease risk. While cross-sectional, study findings support the notion that increasing time spent outdoors could result in more active lifestyles and lower chronic disease risk. Future work should examine this relationship longitudinally to determine a causal direction. Additional work is also needed to identify mechanisms beyond physical activity, such as psychosocial stress, that could contribute to explaining the relationship between time spent outdoors and chronic disease risk.
KeywordsTime outdoors Activity levels Chronic disease Epidemiology Health promotion
The analyses were exempted by the Institutional Review Board at the Medical College of Wisconsin due to the use of public access data. This work is supported in part by the Advancing a Healthier Wisconsin Endowment and in part by the Clinical & Translational Science Institute of Southeast Wisconsin: NIH UL1RR031973.
Compliance with ethical standards
Conflict of interest
Dr. Kirsten M. M. Beyer, Dr. Aniko Szabo, Ms. Kelly Hoormann and Dr. Melinda Stolley declares that they have no conflict of interest.
Human and animal rights and Informed consent
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors. Informed consent was obtained from all patients for being included in the study.
- Beyer, K. M. M., Kaltenbach, A., Szabo, A., Bogar, S., Nieto, F. J., & Malecki, K. M. (2014). Exposure to neighborhood green space and mental health: Evidence from the survey of the health of Wisconsin. International Journal of Environmental Research and Public Health, 11, 3453–3472. https://doi.org/10.3390/ijerph110303453 CrossRefPubMedPubMedCentralGoogle Scholar
- Blaney, J. M., Lowe-Strong, A., Rankin-Watt, J., Campbell, A., & Gracey, J. H. (2013). Cancer survivors’ exercise barriers, facilitators and preferences in the context of fatigue, quality of life and physical activity participation: A questionnaire–survey. Psycho-Oncology, 22, 186–194.CrossRefPubMedGoogle Scholar
- Centers for Disease Control and Prevention. (2011). Strategies to prevent obesity and other chronic diseases: The CDC guide to strategies to increase physical activity in the community. Atlanta, GA: U.S. Department of Health and Human Services.Google Scholar
- Elizabeth Nisbet, M. L. (2015). Prescribing a dose of nature: Modern medicine is rediscovering the simple healing power of being outdoors. Alternatives Journal Canada’s Environment Voice. http://www.alternativesjournal.ca/sustainable-living/prescribing-dose-nature
- Gray, C., Gibbons, R., Larouche, R., et al. (2015). What is the relationship between outdoor time and physical activity, sedentary behaviour, and physical fitness in children? A systematic review. International Journal of Environmental Research and Public Health, 12, 6455–6474.CrossRefPubMedPubMedCentralGoogle Scholar
- Jacobs, J. M., Cohen, A., Hammerman-Rozenberg, R., Azoulay, D., Maaravi, Y., & Stessman, J. (2008). Going outdoors daily predicts long-term functional and health benefits among ambulatory older people. Journal of Aging and Health, 20, 259–272. https://doi.org/10.1177/0898264308315427 CrossRefPubMedGoogle Scholar
- Kerr, J., Sallis, J. F., Saelens, B. E., et al. (2012b). Outdoor physical activity and self rated health in older adults living in two regions of the U.S. International Journal of Behavioral Nutrition and Physical Activity, 9, 89. https://doi.org/10.1186/1479-5868-9-89 CrossRefPubMedPubMedCentralGoogle Scholar
- Kono, A., Kai, I., Sakato, C., & Rubenstein, L. Z. (2004). Frequency of going outdoors: A predictor of functional and psychosocial change among ambulatory frail elders living at home. Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 59, 275–280. https://doi.org/10.1093/GERONA/59.3.M275 CrossRefGoogle Scholar
- Thompson Coon, J., Boddy, K., Stein, K., Whear, R., Barton, J., & Depledge, M. H. (2011). Does participating in physical activity in outdoor natural environments have a greater effect on physical and mental wellbeing than physical activity indoors? A systematic review. Environmental Science & Technology, 45, 1761–1772. https://doi.org/10.1021/es102947t CrossRefGoogle Scholar
- Tsai, L.-T., Rantakokko, M., Rantanen, T., Viljanen, A., Kauppinen, M., & Portegijs, E. (2016). Objectively measured physical activity and changes in life-space mobility among older people. Journals of Gerontology. Series A, Biological Sciences and Medical Sciences. https://doi.org/10.1093/gerona/glw042 Google Scholar
- Wang, H., Naghavi, M., Allen, C., et al. (2016). Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: A systematic analysis for the Global Burden of Disease Study 2015. Lancet, 388, 1459–1544. https://doi.org/10.1016/S0140-6736(16)31012-1 CrossRefGoogle Scholar
- Ward, B. W., Clarke, T. C., Nugent, C. N., & Schiller, J. S. (2016). Early release of selected estimates based on data from the 2015 National Health Interview Survey. National Center for Health Statistics. http://www.cdc.gov/nchs/nhis.htm.
- WHO. (2014). Global status report on noncommunicable diseases 2014 (p. 176). World Health. ISBN:9789241564854.Google Scholar
- Williams, E. D., Magliano, D. J., Tapp, R. J., Oldenburg, B. F., & Shaw, J. E. (2013). Psychosocial stress predicts abnormal glucose metabolism: The Australian diabetes, obesity and lifestyle (ausdiab) study. Annals of Behavioral Medicine, 46, 62–72. https://doi.org/10.1007/s12160-013-9473-y CrossRefPubMedGoogle Scholar
- Zalli, A., Carvalho, L. A., Lin, J., et al. (2014). Shorter telomeres with high telomerase activity are associated with raised allostatic load and impoverished psychosocial resources. Proceedings of the National Academy of Sciences, 111, 4519–4524. https://doi.org/10.1073/pnas.1322145111 CrossRefGoogle Scholar