title: Recreational physical activity in natural environments and implications for health: A population based cross-sectional study in England.
abstract: 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.
  
  
  
  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.
  
  
  
  Approximately 8.23 million (95% CIs: 7.93, 8.54) adults (19.5% of the population) made at least one 'active visit' (i.e. ≥30min, ≥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. ≥5×30min 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.
  
  
  
  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.
authors.affiliation: European Centre for Environment & Human Health, University of Exeter Medical School, Knowledge, Spa, Royal Cornwall Hospital Treliske, Cornwall, TR1 3HD, United Kingdom. Electronic address: mathew.white@exeter.ac.uk.
authors.forename: M P
authors.initials: MP
authors.lastname: White
authors.affiliation: European Centre for Environment & Human Health, University of Exeter Medical School, Knowledge, Spa, Royal Cornwall Hospital Treliske, Cornwall, TR1 3HD, United Kingdom. Electronic address: l.r.elliott@exeter.ac.uk.
authors.forename: L R
authors.initials: LR
authors.lastname: Elliott
authors.affiliation: European Centre for Environment & Human Health, University of Exeter Medical School, Knowledge, Spa, Royal Cornwall Hospital Treliske, Cornwall, TR1 3HD, United Kingdom. Electronic address: t.j.taylor@exeter.ac.uk.
authors.forename: T
authors.initials: T
authors.lastname: Taylor
authors.affiliation: European Centre for Environment & Human Health, University of Exeter Medical School, Knowledge, Spa, Royal Cornwall Hospital Treliske, Cornwall, TR1 3HD, United Kingdom. Electronic address: b.w.wheeler@exeter.ac.uk.
authors.forename: B W
authors.initials: BW
authors.lastname: Wheeler
authors.affiliation: Health Economics Group, University of Exeter Medical School, South Cloisters, St Luke's Campus, Exeter EX1 2LU, United Kingdom. Electronic address: a.e.spencer@exeter.ac.uk.
authors.forename: A
authors.initials: A
authors.lastname: Spencer
authors.affiliation: Public Health England, Environmental Change Department, 133-135 Waterloo Road, London SE1 8UG, United Kingdom. Electronic address: angie.bone@phe.gov.uk.
authors.forename: A
authors.initials: A
authors.lastname: Bone
authors.affiliation: European Centre for Environment & Human Health, University of Exeter Medical School, Knowledge, Spa, Royal Cornwall Hospital Treliske, Cornwall, TR1 3HD, United Kingdom. Electronic address: m.depledge@exeter.ac.uk.
authors.forename: M H
authors.initials: MH
authors.lastname: Depledge
authors.affiliation: European Centre for Environment & Human Health, University of Exeter Medical School, Knowledge, Spa, Royal Cornwall Hospital Treliske, Cornwall, TR1 3HD, United Kingdom. Electronic address: l.e.fleming@exeter.ac.uk.
authors.forename: L E
authors.initials: LE
authors.lastname: Fleming
mesh_terms: D003430:Cross-Sectional Studies; D004739:England; D004777:Environment; D015444:Exercise; D015438:Health Behavior; D006801:Humans; D000068316:Parks, Recreational / Q000706:statistics & numerical data*; D019057:Quality-Adjusted Life Years; D011998:Recreation / Q000502:physiology*; D011795:Surveys and Questionnaires
keywords: England; Natural environments; Physical activity; Quality adjusted life years