THE EFFECTS OF A NATURE BASED PHYSICAL ACTIVITY SETTING
FOR CHILDREN WITH DISABILITIES
A Report of a Senior Study
by
Stephanie Ray Gleason
Major: Exercise Science
Maryville College
Fall, 2015
Date Approved _____________, by ________________________
Faculty Supervisor
Date Approved _____________, by ________________________
Division Chair
ABSTRACT
Physical activity, a renowned technique to maintain personal health can be
combined with the restorative and vitalizing abilities of nature to capitalize on the
individual advantages provided through each separate entity. Currently, the decreased
engagement in physical activity in the adult population is coalescing with the decreased
time spent in nature, and therefore an epidemic of a characteristically unhealthy
population is formed. Cascading from the negative trends within the adult population is
the feeble use of both physical activity and nature for health related benefits in children.
Increasing quantities of children’s time are being spent indoors; thus, natural physical and
mental benefits provided through outdoor activity are eradicated. Particularly concerning
are the consequences being induced on a particular subset of children – children with
disabilities. In an outdoor environment, these children require specific provisions and
accommodations which further bar their participation in nature based physical activity.
However, despite this decrease, potentially combining the benefits of physical activity
with the restorative power of nature could heighten health benefits in this population. Due
to the relationship between decreased physical activity, decreased time spent in nature,
and the gains individually provided by both mediums, this study aims to investigate a
nature based physical activity setting to maximize the potential social, physical,
cognitive, and emotional benefits in children with disabilities.
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TABLE OF CONTENTS
Page
Chapter I
Introduction
1
Chapter II
Nature’s Social and Physical Benefits
on Children with Disabilities
16
Chapter III
Nature’s Cognitive and Emotional Benefits
on Children with Disabilities
27
Chapter IV
Summary
38
References
47
iv
v
CHAPTER I
INTRODUCTION
Consistent physical activity is a method to maintaining personal health.
Currently, less than half of all adults meet the physical activity guidelines, making it
increasingly important to provide knowledge of the benefits of physical activity (Center
for Disease Control and Prevention [CDC], 2014). Some broad categories of the benefits
of regular physical activity are well documented, including physical, social,
psychological and cognitive. Besides helping with the improvement of daily activities,
evidence also exists proving physical activity can reduce the risk of dying early (CDC,
2014). As reported by university students, the benefits of physical activity were
approximately forty-three percent health promotion, eleven percent revitalization, six
percent physical appearance and self-esteem, and five percent stress management
(Dhurup, 2012). First, the calories burned during physical activity contribute to weight
management. One hundred and fifty minutes of moderate-intensity physical activity is
suggested through scientific evidence to maintain personal weight (CDC, 2014). While
increasing the amount of physical activity can help to lose weight, continuing regular
physical activity can also reduce the risk of Type 2 Diabetes and metabolic syndrome by
controlling blood glucose levels. Research also shows that physical activity lowers the
1
risk of both colon cancer and breast cancer (CDC, 2014). Joints, bones, and muscles are
all strengthened through physical activity. Additionally, physical activity has both
physiosocial and psychological benefits. Physiosocial benefits simply include increased
social contact between people. Psychological benefits improve thinking, learning, and
judgment skills.
Along with the decrease in physical activity, the beneficial use of nature and
outdoor time is often overlooked. In fact, the last four decades have brought about a fifty
percent decrease in nature based recreation. The time spent in nature is decreasing, and
the time spent both indoors and with technology is increasing. As outdoor contact
decreases, positive emotions are decreasing and negative emotions are increasing. An
epidemic of stress has formed across the United States of America, the number of mental
health disorders has increased, and people have become less active (Selhub & Logan,
2012). It is reported that less than twenty percent of people are flourishing in happiness
and general satisfaction with life. This statistic supports the notion that United States of
America category of life satisfaction is trending negatively (Selhub & Logan, 2012). Due
to the correlation between decreased physical activity, decreased time spent in nature, and
increased negativity, scientific researchers are investigating nature’s role in health. At
the core of this research lies the simple fact that being in nature benefits individuals in all
ages and stages of life (Selhub & Logan, 2012).
The benefits due to increased time in nature appear in the elderly and help to
protect against aging (Selhub & Logan, 2012). As one example, gardening improves
physical and cognitive factors within an individual. Gardening as exercise maintains
muscle strength and physical health through the aging process. Gardening additionally
2
presents cognitive challenges requiring memorization, visuospatial skills, and executive
functioning (Selhub & Logan, 2012). Using these cognitive attributes helps to place a
layer of protection against the forces of brain aging. Such gardening programs also can
help improve motivation, communication, grief processing, depressive thoughts, anxiety,
sleep, psychosocial skills, self-esteem, stress reduction, and overall psychological
wellbeing (Selhub & Logan, 2012). Another example of nature based benefits arises
through wilderness adventure interventions. These interventions aid patients with a
serious form of mental illness and have a treatment adherence above ninety-seven percent
(Selhub & Logan, 2012). This is important because these same interventions stimulate
positive emotions. Wilderness adventure interventions elevate the benefits of physical
activity (Selhub & Logan, 2012). Through the example of gardening and wilderness
adventure, the array of positive influences due to the diverse use of time spent in nature
are displayed.
The current scarcity of information on an individual’s physical activity
environment prompted a study to address the relationship of physical activity
environment (indoor, outdoor, or a combination) with tension, stress, emotional outlook,
and perceptions of health status (Puett et al., 2014). This study revealed that physical
activity was greater for those reporting outdoor physical activity compared to those
reporting indoor physical activity. Furthermore, the percentages of stress and emotional
factors were found to be linked to physical activity environment (Puett et al., 2014).
Physical activity environment was significantly associated with overall health perception,
with a greater percentage of participants reporting a positive overall health perception in
the outdoor physical activity group compared to the indoor physical activity group.
3
Participants in the outdoor group generally reported zero to moderate tension, managed
their stress fairly well or very well, had few stress symptoms, had a generally optimistic
outlook, and perceived they were in good to excellent health. The least amount of
minutes per week of physical activity occurred with the indoor group when compared to
the amount of minutes per week of physical activity with the outdoor group (Puett et al.,
2014). Simply adding a combination of outdoor physical activity into the indoor
environment groups’ workout regime suggested an increased protection against tension,
stress, poor emotional outlook, and poor overall health perception (Puett et al., 2014).
Outdoor physical activity environment also appears more beneficial with respect
to the outcomes examined for men and women who are currently participating in physical
activity (Puett et al., 2014). A study was conducted to test the psychological effects of
exercise through a comparison of indoor exercise and outdoor exercise. Participants were
divided into different groups which would be exercising indoors, outdoors, or a
combination of both indoors and outdoors (Plante, Cage, Clements, & Stover, 2006). The
psychological effects were then tested through an Activation-Deactivation Adjective
Check List and The Paces Activity Enjoyment Scale. The Activation-Deactivation
Adjective Check List is a self-reported checklist designed to measure momentary mood
states, including energy, calmness, tension, and tiredness. The Paces Activity Enjoyment
Scale includes eighteen bipolar items on which individuals rate themselves and their
perceived experience during an activity exercise. The data exemplified that an outdoor
exercise environment is more enjoyable, revitalizing, stimulating, and energizing in
comparison to indoor exercise (Plante et al., 2006). In fact, not only did findings suggest
that exercising outside was the most enjoyable experimental condition, but also support
4
the belief that adapting the exercise environment to promote greater comfort and
enjoyment may encourage greater psychological benefits (Plante et al., 2006).
Outdoor programs prove to be a valid environmental setting for physical activity;
however, merely twenty percent of people meet the aerobic and muscle-strengthening
physical activity guidelines (CDC, 2012). While most people associate the Center for
Disease Control and Prevention’s activity recommendations with adults, physical activity
is also important for the development of children. Physical activity in children can help
control weight, reduce blood pressure, raise high density lipoprotein (HDL) cholesterol,
reduce the risk of diabetes and some cancer, as well as improve psychological well-being,
gain self-confidence, and improve self-esteem. For these benefits to take effect children
aged two and older should participate in at least sixty minutes of moderate-intensity
physical activities every day. While a full sixty minutes may be too long of a period of
time, two thirty minute periods should be provided for children to engage in physical
activity (American Heart Association [AHA], 2015).
Investigations into children’s activity habits unveiled not a problem with the
current population of children but the immersion into the current school structure. This
stems from varying statistical support discovered in a review of the literature. It is
reported that those who attended preschool for half a day achieved a higher amount of
time engaged in physical activity then those who attended preschool for a full day
(O’Dwyer et al., 2014). This suggesting the current structured school environment leads
to decreased activity (O’Dwyer et al., 2014). Similarly, there is a need to improve or
modify the indoor environment to better support the activity levels of young children
(Vanderloo, Tucker, Johnson, & Holmes, 2013). To help combat the sedentary behavior
5
in schools, The Comprehensive School Physical Activity Program (CSPAP) created five
components that independently and collectively seek to increase physical activity
(McMullen, Kulinna, & Cothran, 2014). These components include physical education,
physical activity during school, physical activity before and after school, staff
involvement, and family and community engagement. Twelve teachers were asked to use
as many (greater than or equal to one) physical activity breaks to judge the features of
preferred activity break. The threats posed were chaos, space, and refocus of students.
Teachers preferred a break that included a connection to academics, ease of
implementation, and enjoyment. These breaks promoted student movement and
reinforced academic content. The movement breaks, also known as BrainBreaks,
Energizers, and Activity Bursts, provided an interruption of the prolonged sedentary
behaviors common to the school day (McMullen et al., 2014). Altering children’s
activity time, especially within the school structure, can instigate healthy physical
activity.
As previously discussed, decreased physical activity coincides with decreased
time spent in nature; thus potential positive effects received through the outdoors are lost.
Similar benefits that appear in the elderly due to increased time in nature also appear in
children. Studies dealing with subjects in childhood years have found that less contact
with nature, particularly in one’s young years, appears to remove a layer of protection
against psychosocial stress (Selhub & Logan, 2012). This means that even children are
becoming stressed and are contributing to the United States of America’s trend of
increased negativity (Selhub & Logan, 2012). Further research has been conducted about
stress, and likewise research has been conducted about the benefits of the outdoors.
6
However, it is rare to find a study about children’s stress and the effects of outdoor
activities to directly help this stress (Russell, Widmer, Lundberg, & Ward, 2015). In fact,
researchers suggest that a person’s ability to handle stress may be more important than
the actual amount of stress in their lives (Russell et al., 2015). Youth can encounter
stress in all aspects of their lives, and they must be able to handle this stress in order to
continue a healthy lifestyle (Russell et al., 2015). Developing strategies to increase
children’s immersion into nature provides potential avenues to assist children’s coping
mechanisms for stress.
Stress, its relationship to adolescents, the outcomes, general coping strategies, and
outdoor adventure was studied in a blind review. Thirty-five adolescents were asked to
identify stressors that they found in the outdoors. Panelists then conducted a test to check
the reliability and validity of the given stressors. Based on the data collected, a new
index was then created, which concluded that demographics played a part in the breakdown of the data. This allowed for the first development of a domain specific coping
measure for adolescents, which focused on therapeutic use of the outdoors and, therefore,
provided the first reliable and valid measurement of stress in the outdoor setting (Russell
et al., 2015).
In addition to added stress, the decreased time children spend in nature and the
increased screen time causes overstimulation and brain exhaustion in children (Selhub &
Logan, 2012). An additional effect manifests itself indirectly by reducing sleep quantity
and quality (Selhub & Logan, 2012). To combat increased screen time in children,
scientists have researched the notion of increased time spent in nature. When a
restriction was placed on children’s screen time, there was a result in reduction in body
7
mass index, caloric intake, and improved health (Selhub & Logan, 2012). Nature
immersion restores the brain and shields the stress of environmental overload. As used
with the adult population, one specific example of nature immersion is gardening with
children (Selhub & Logan, 2012). Gardening has been shown to aid improvement in
cognitive functions. The children who participated in gardening achieved higher scores
on standardized testing, improved problem solving, and received social benefits such as
the ability to work in groups and self-understanding (Selhub & Logan, 2012).
While the previously mentioned studies provide groundbreaking evidence that is
statistically sound, a lack of numerous and significant studies on children’s physical
activity in the outdoors still exists. Children’s outdoor physical activity recently arose as
a topic of concern and investigation, especially since statistics show not enough children
are physically active during the day. Due to the current rise in children’s sedentary
activities, decrease in physical activity, and decreased time spent in nature, many recent
studies centered on measuring and increasing children’s time outdoors in hopes to
consequently increase physical activity. These reports stem off the notion that an outdoor
setting harnesses opportunity to increase physical activity. Among countless other
projects to reinstate children’s playtime outdoors, the 10 Million Kids Outdoors Initiative
was created to immerse children back outside (Keffer, 2015). Numerous health benefits
have been linked to outdoor activity, including general wellness, reduction of ADHD
symptoms, and an increase to critical thinking skills (Keffer, 2015). This outdoor
experience for youth addresses multiple goals and objectives through the outdoor
medium which is a multi-sensory approach in exploring, investigating, and learning about
one’s natural environment (Brannan, 2003). Generalization and transfer of learning are
8
facilitated through this medium because numerous opportunities arise to acquire and
apply knowledge and skills to solve challenges when a child is outdoors (Brannan, 2003).
The 10 Million Kids Outdoors Initiative urged children’s activity outdoors to increase the
incidence of nature based health benefits.
Research demonstrating evidence of the benefits of outdoor activity have been
measured both objectively and subjectively. All children, as early as preschool aged
children, benefit from outdoor play (O’Dwyer et al., 2014). On the objective side,
accelerometers accessed the intensity of activities and found that both more vigorous
exercise and beneficial activities occurred outdoors (O’Dwyer et al., 2014). Furthermore,
not only is physical activity increased outdoors, but sedentary activity is increased
indoors (Vanderloo et al., 2013). Children themselves reported an increase in physical
activity, along with decreased stress and increased focus when prompted to go outdoors
(Edwards, Duerden, Lizzo, Campbell, & Kamper, 2014).
The previous investigations and interventions are all aimed toward the general
population of children, but children with disabilities are affected in a more specialized
way. Although the trend between children with disabilities and able-bodied children is
similar, children with disabilities are less active then developing peers (Tyler, Cook, &
Macdonald, 2014). The percentage of persons with a disability who are physically
inactive during the week is more than twice the percentage of persons without a disability
who are physically inactive (Tyler et al., 2014). Physical activity, expressed through an
optimal mode, intensity, frequency and duration of exercises, is known to provide a better
quality of life and mental health in children with disabilities through a chance for
independent movement, a chance to learn how to cooperate and socialize with others, and
9
a chance to control and understand their own body (Kornatovská, & Trajková, 2012).
Unfortunately, similar to the trend in able-bodied children, general movement
insufficiency can be observed in children with disabilities. Lack of movement generally
results in symptoms such as impulsivity, irritation, non-concentration, lack of selfcontrol, discomposure, and aggressiveness (Kornatovská, & Trajková, 2012).
One reason children with disabilities are not receiving enough physical activity
can be attributed to the lack of knowledge and opportunities for children with disabilities
to receive physical activity (Kornatovská, & Trajková, 2012). For example, in all of
South Bohemia, only seventeen sports clubs are specialized in physical activities for
people with disabilities. Another example arises in Bulgaria, where only the Bulgarian
Paralympic Association and the Bulgarian Movement of Special Olympiads exist as
organizations that deal with physical activities of people with disabilities in Bulgaria.
This investigation shows the poor organized physical activity for children with
disabilities and the importance to improve the state of availability, organization and
health-social benefits of controlled movement activities in children with disabilities
(Kornatovská, & Trajková, 2012).
This lack of physical activity opportunities for children with disabilities is not
simply recognized in limited countries but is continued around the world. The United
Nations declares that children with disabilities, like able bodied ones, should have the
freedom to play outside (Abdou, 2011). An environment should be available to provide
children with disabilities the opportunity to participate in a play area that allows
favorable conditions due to the consideration that this permits children with disabilities to
10
become more confident, grow a sense of belonging and acceptance by peers, and learn
new ways of talking, listening, and communicating (Abdou, 2011).
Due to this phenomenon, the National Center on Health, Physical Activity, and
Disability works to create inclusive environments and assist in modification of activities
for children with disabilities (Tyler et al., 2014). This inclusion begins with a Certified
Inclusive Fitness Trainer who works to create safe and adapted experiences.
Accessibility Instruments measure fitness and recreation environments with a focus on
environmental accessibility and enhancers for participation. Lastly, collaboration
between academic and clinical sector professionals is promoted to identify a disability,
program designs, and appropriate goals (Tyler et al., 2014).
A study was conducted to reveal the importance of creating Accessible Urban
Spaces in which all children would have the opportunity to participate together through
play because it leads to more understanding between the core of society (Abdou, 2011).
With this comes a formation of a cohesive society that does not refuse or limit the
participation of any of its individuals on the basis of limited abilities. This sustainable
outlook allows people to live a life of dignity in harmony with nature. Abdou’s study
called for a need to start at the basis of society’s forming generation, that is at children’s
levels, and try to integrate children with disabilities with their able-bodied peers so that
they could grow together, accepting each other with no regard to disability or its impact
on one’s performing abilities (Abdou, 2011). The strategy allowed a possibility to
overcome discrimination based on attitudes towards disability. Basically, this is
expressing a belief that society should start inclusion and removal of negative barriers
11
from able bodied individuals and persons with disabilities towards each other at an early
age (Abdou, 2011).
Although inclusive programs have been an established part of our culture since
the early 1900s, there has been a void of well-designed research using validated
instrumentation to determine the actual effects or outcomes of outdoor programs with
persons who have a disability, thus compromising the overall validity of outdoor
programs in relation to persons with a disability (Brannan, 2003). Such research is
important because of the nature based benefits originally observed in typically
developing children. This void occurs for a number of reasons and barriers. Major
barriers that have traditionally limited research in determining the benefits of outdoor
programs on children with disabilities include the lack of well designed, systematic, and
programmatic research, the non-research orientation of many professionals in outdoor
programs, the scarcity of well-conceptualized, reliable, and validated instrumentation, the
limitations related to number of subjects, types of disabilities, geographic information,
and the failure to address the generalization of acquired knowledge and skills to home
and community settings (Brannan, 2003).
One study, conducted by the National Centers for Environmental Prediction
(NCEP) studied specialized resident camps serving campers with disabilities (Brannan,
2003). The findings strongly supported the use of both professional and parent opinions
in determining the significance and impact of resident outdoor programming on persons
with disabilities (Brannan, 2003). Although often disregarded as invalid, parental
judgements, in particular, provided an important type of evidence which revealed the
12
positive impact of inclusive outdoor programs on the growth and development of
campers’ disabilities (Brannan, 2003).
While barriers can inhibit broad program research, there are also specific outdoor
experiences that have proven benefits in the population of children with disabilities.
Exploration of the different types of outdoor therapies reveal adventure therapy,
challenge education, wilderness therapy, and therapeutic recreation. Actually,
therapeutic recreation is generally a well-known fit for individuals with disabilities
because it includes an integration of occupational therapy (Ewert, McCormick, & Voight,
2001). Therapeutic recreation affects three main aspects of the individual and includes
sociological, psychological, and physiological benefits. Sociological benefits include
cooperation, team building, leadership, communication, and decision-making (Ewert et
al., 2001). Psychological benefits include self-analysis, introspection, coping, selfesteem, self-confidence, self-determination, self-efficacy, and increased awareness
(Ewert et al., 2001). Culminating outdoor therapy benefits, the physiological part of an
individual primarily affected is an increase in overall physical health, cardiovascular
improvement, a reduction in glucose levels, reduced fat in body mass, increased bone and
muscle mass, increased strength and endurance, orthopedic fitness, increased immune
function, and increased endorphin levels (Ewert et al., 2001). Outdoor therapy also
affects the physiological portion of an individual by decreasing stress, sleep disturbances,
hypertension, cholesterol levels, and incidences for disease (Ewert et al., 2001).
Combining positive effects of physical activity and nature appears to expand potential
benefits for children with disabilities.
13
Exercise is one of our most important brain tonics and improves cognitive
functioning, academic grades, weight loss, perceptual skills, disease prevention, memory
recall, and overall health, yet more than half of the population does not receive these
benefits since they do not meet the required amount of physical activity (CDC, 2014;
Selhub & Logan, 2012). As exercise is studied according to the different groups of the
population, its significance becomes increasingly important. It is not only crucial to
realize the benefits of physical activity on children but the subset of children who have
disabilities. While exercise is often correlated with the indoors, nature alone has the
ability to restore the brain from stressors, improve positive moods, and increase physical
activity (Selhub & Logan, 2012). Access to green space is a significant predictor of
moderate to vigorous physical activity and increases attention scores, balance, and
memory (Selhub & Logan, 2012). Furthermore, outdoor exercise decreases negative
thoughts, so intentions to stick with an exercise program through the increase of selfesteem and positive thoughts are consequently increased (Selhub & Logan, 2012).
Combining the benefits of exercise with the distinct mental benefits of immersion in
greenspace, which includes cognitive and mood-regulating benefits, magnifies the
benefits produced (Selhub & Logan, 2012). Regarding the subset of children with
disabilities, environmental activities would mean taking measures or provisions to adapt
specifically to the needs and abilities of children with disabilities (Abdou, 2011). In fact,
a comparison of the benefits and constraints to nature based outdoor recreation for those
with disabilities concluded that there is an association with positive health enhancements,
social benefits, achievement, self-improvement, and relaxation-related benefits
(Freudenberg & Arlinghaus, 2010). Therefore, due to the relationship between
14
decreased physical activity, decreased time spent in nature, and the gains separately
provided by both mediums, the purpose of this study is to investigate a nature based
physical activity setting to maximize the potential social, physical, cognitive, and
emotional benefits in children with disabilities.
15
CHAPTER II
NATURE’S SOCIAL AND PHYSICAL BENEFITS
ON CHILDREN WITH DISABILITIES
While the benefits of nature based physical activity are easily discussed from
childhood into adulthood, there is a subset of the world’s population which is often
overlooked. This subclass, children with disabilities, can also reap benefits from
increased physical activity and time spent in nature. However, not only are they
overlooked, there are a set of barriers hindering their experience in the outdoors
(Woolley, 2013). Divisions of academic disciplines recognize both how children’s
physical activity is beneficial in a multi-faceted way and how the lack of play affects
society, but children with disabilities are still under-represented in the use of green space
(Woolley, 2013). This lack of use of the outdoor setting indirectly encumbers society
through the direct impediment it places on children with disabilities. Removing this
obstacle through stimulation of nature based physical activity in children with disabilities
could provide numerous health benefits. Nature is a restorative environment which offers
a setting for diverse, imaginative, and creative activity that stimulates and develops social
interaction, independent social interaction, through language and communication skill
16
enhancement, and physical improvements in motor development and physical fitness
(Mustapa, Maliki, & Hamzah, 2014).
The right of the child to play is stated in Article 31 of the United Nations
Convention of the Rights of the Child; State Parties recognize the right of the child to rest
and leisure, to engage in play and recreational activities appropriate to the age of the child
and to participate freely in cultural life and the arts (United Nations, 1989). This refers to
regulating child’s play through age, not ability, thus proving that this subset of children
with disabilities should be equally engaged to reap the benefits of nature (Woolley,
2013). Article 31 is typically interpreted and adapted through ‘inclusive outdoor play’
which consists of three dimensions and specifically expresses that children with
disabilities should be able to play in the same space as their non-disabled peers (Woolley,
2013). When children with disabilities are immersed in outdoor therapy, for example,
through hippotherapy, the dynamic systems theory is applied (Granados & Agís, 2011).
Hippotherapy, therapy using a horse, combines physical therapy, occupational therapy,
and speech therapy into one outdoor setting (Granados & Agís, 2011). Within this
setting, the child is constantly interacting, adapting, and changing in response to the
dynamic outdoor environment (Granados & Agís, 2011). Additionally, within a dynamic
outdoor environment, children with special needs gain practice in auditory processing,
body awareness, coordination between sides of the body, fine motor control, motor
planning, ocular control, perception of movement, touch perception, and visual-spatial
perception (Granados & Agís, 2011). The benefits gained through outdoor therapy, such
as hippotherapy, are not entirely possible while in an indoor setting. Getting these
17
children outside provides both social and physical benefits and has the potential to
increase exercise.
The first step to acquiring these benefits from the outdoors is environment
education (Dominguez & Schilling, 2001). Participation in outdoor programs is a
traditional and popular form of education, recreation, and leisure for our nation’s citizens
(Brannan, 2003). Environmentally aware and involved citizens only become so through
education, such as formal education or opportunities in nature, which help to shape the
individual’s behavior. However, environmental awareness and outdoor recreation skills
for people with disabilities are lacking in support and promotion when compared to
environmental education for the general public (Dominguez & Schilling, 2001). Many
people with disabilities and special needs have not experienced exposure in the outdoors
even if they are capable of independent living and decisions regarding health and welfare
as a result of limited sources in both number and scope (Dominguez & Schilling, 2001).
Dominguez and Schilling (2001) conducted a program that aimed to help those with
disabilities form connections with the natural environment and obtain experience within
the outdoors. The subjects took a pre and post test, which revealed a nine percent
increase in long-term retained knowledge about the environment. Therefore, there is a
carry-over of knowledge about the environment when an education program is provided
for those with disabilities (Dominguez & Schilling, 2001).
Social benefits can be specifically received in children with disabilities through
group integration into nature (Farnham & Mutrie, 1997). Farnham and Mutrie (1997)
conducted research examining outdoor development and its potential to facilitate social
and integration skills for children with special educational needs. Beginning with
18
nineteen subjects from Firpark School in Motherwell, the subjects participated in a series
of pre and post questionnaires regarding outdoor participation. More specifically, three
questionnaires were used in the study, and all were adapted for use with children with
special needs. The Profile of Mood States, developed to identify fluctuating mood states,
was used in the study to measure individual tension and anxiety levels (Farnham &
Mutrie, 1997). The Physical Self-Perception Profile was used to measure individual selfperception and esteem. Lastly, the Group Environment Questionnaire (GEQ) was used to
measure group cohesion. The data collection was performed over a three-month period,
through an observational session at the school, resulting in an indication of a decrease in
tension and anxiety levels. Qualitative results noted an improvement in social skills such
as increased self-esteem, increased overall group cohesion, decreased loud and aggressive
behavior, increased self-motivated behavior, and feelings of achievement, relaxation, and
enjoyment immediately after the program (Farnham & Mutrie, 1997). It is important to
note that the increase in group cohesion was additionally noted at both the four week and
six week follow-up (Farnham & Mutrie, 1997). The teachers and subjects felt that they
communicated with each other more and learned to trust each other (Farnham & Mutrie,
1997). Overall, the results indicated that nature based physical activity provides positive
social improvements for children with disabilities (Farnham & Mutrie, 1997).
Chapman (2000) investigated nature education simply as activities in the
outdoors. The participants in this study had a statement of special educational needs, in
accordance with the Code of Practice, and identified them with moderate learning
difficulties (MLD). There is a strong association between the presence of MLD and
social disadvantage, leaving a substantial proportion of social skill deficits in the children
19
who participated in the study (Chapman, 2000). There was a wide range of abilities
within the group, but they all displayed poor social skills. The participants took part in a
variety of team development challenges and adventure activities which resulted in an
increase in self-esteem (Chapman, 2000). The pupils perceived having more friends after
the camp, had greater trust in other people, did not feel as sad, and felt that they were a
success. To clarify, before the camp, the pupils did not know anyone from the other
schools, therefore it was concluded that the increase in friendships can be attributed to
making new friends in challenging circumstances. Additionally, the author assessed
happiness as a good measure of self-concept because an individual usually exhibits
happiness when they achieved something, feel secure, and have friends (Chapman, 2000).
Success and achievement are some of the primary concepts contributing to social benefits
provided to children with disabilities through outdoor physical activity (Chapman, 2000).
Social skills and interactions, tested and enhanced through observation of nature
based physical activity, are not the only benefits to activity intervention for children with
disabilities. In fact, physical health improves in children with disabilities due to
increasing physical activity alone. One research study aimed to establish the level of
influence of basketball elements on motor development (speed, coordination, and
accuracy) of children with disabilities and also to adapt particular segments of basketball
by adjusting them to suit the needs of these children (Radenković, Berić, & Kocić, 2014).
Students in the experimental sub-sample followed a modified program of basketball
elements adjusted to the intellectual abilities of the children, and the students of the
control sub-sample followed the program designed for special schools (Radenković et al.,
2014). The first week focused on ball control and dribbling through different variations,
20
but the second through third weeks focused on passing and catching the ball (Radenković
et al., 2014). Results increased in every variable, and significant statistical difference
existed for the variable referring to the repetitive strength of the shoulder belt and arms
which is important for the basic motor movements that most children use in their daily
activities (Radenković et al., 2014). Elements of basketball statistically and significantly
influenced the development of speed and precision among the students of the
experimental group, and the given hypothesis had partially been confirmed. Therefore, it
was concluded that the corrected basketball program adjusted to suit children with special
needs significantly influenced the development of particular motor skills (Radenković et
al., 2014).
Similarly, another 2014 study determined changes in physical indicators in
participants of a table tennis training program (Francová, 2014). One research group
consisted of non-disabled individuals, and the other was comprised of individuals with
intellectual disabilities (Francová, 2014). In order to detect the development of motor
skills, quantitative testing was applied through pre and post standardized tests of
individual table tennis skills (Francová, 2014). A group of children with intellectual
disabilities improved in all skills after the completion of regular training process. The
average improvement of children with disabilities was a 24.2% gain through examination
of the pre and post tests (Francová, 2014). Comparatively, the results of children from
the non-disabled population showed an average improvement of 11% (Francová, 2014).
The group of children with intellectual disabilities reached 80% of the acquired skills of
the non-disabled population (Francová, 2014). Children with disabilities were able,
21
within their capabilities, to achieve greater progress, whereas individuals of the nondisabled population reached much more moderate improvement (Francová, 2014).
A more specific study examined the effect of a six-week exercise intervention on
gross motor function for non-ambulant children with cerebral palsy (Bryant, Pountney,
Williams, & Edelman, 2013). These participants were randomly allocated to a static bike
group, a treadmill group or control group. Participants in the bike and treadmill groups
received exercise training sessions three times weekly for six weeks, while the control
group received their usual care. A significant improvement was found in the standing
scores for participants in both the static bike group and the treadmill group when
compared to the control group. The walking, running, and jumping scores were higher
for both the static bike group and the treadmill group when compared to the control group
(Bryant et al., 2013). Overall, both treadmill and bike groups demonstrated significant
improvements in their exercise capability, therefore, suggesting that exercise intervention
holds potential physical and gross motor function benefits for children with disabilities
(Bryant et al., 2013).
Aquatic therapy is another example of physical activity which can provide
physical benefits to children with disabilities (Stan, 2012). Aquatic environments help
establish initial patterns of movement (Stan, 2012). Rhythmic breathing and breath
control activities in aquatic activity improve risk factors in children with disabilities by
strengthening respiratory muscles and improving breathing (Stan, 2012). Aquatic activity
can be a fun way to improve the vital capacity, mobility, muscle tone, and overall
physical training for children with disabilities without putting excessive pressure on
joints in the development of the locomotor system (Stan, 2012). Adapting physical
22
activity for children with disabilities, such as decreased pain through aquatic therapy,
altered basketball programs to successfully improve motor development, or activity
incorporated into the schedule of an otherwise sedentary child with cerebral palsy, can
significantly improve physical functioning.
To further amplify these physical gains from physical activity, studies on children
and nature have demonstrated that nature based physical activity positively affects
children’s physical health by maximizing benefits provided by both physical activity and
nature (Mustapa et al., 2014). Children experience nature through exploration, activity,
and play in a direct way. In a comparison study, physical fitness in children five to seven
years old was investigated in a natural area and conventional playground. The children
who played in the forest, a natural area, demonstrated a significant increase in motor
fitness in balance and coordination abilities when compared to children who played in
conventional playground (Mustapa et al., 2014). Compared to playing indoors, children
are likely to be more physically active when playing outdoors compared to playing
indoors due to the environmental opportunity to directly interact with nature through
physical activity (Mustapa et al., 2014).
Mobility is a major exercise issue within the population of children with
disabilities since many depend upon wheelchairs to engage in activities (Barfield &
Malone, 2013). Lack of physical movement and aerobic exercie often causes people with
disabilities to be affected in major physical health aspects. This lack of exercise is a
major risk factor among persons with disabilities for reduced lung capacity and secondary
conditions such as obesity, depression, and pain (Barfield & Malone, 2013; Stan, 2012).
Therefore, many studies have been conducted about the importance of physical exercise
23
for students with disabilities. Physical health benefits of physical activity on those with
disabilities often include increased motor capacity and functional development (Barfield
& Malone, 2013; Bryant et al., 2013; Durbacea-Bolovan, 2011; Francová, 2014;
Radenković et al., 2014; Verschuren, Darrah, Novak, Ketelaar & Wiart, 2014).
Beginning with a broad spectrum, research reveals that there is a positive evolution of
motor capacity for students with special needs that practice regularly, thus calling
importance to the integration of these students in outdoor physical activities (DurbaceaBolovan, 2011). One related experiment tested motor capacity by means of specific tests
such as speed running, standing jump, throwing a ball from a standing position, stretching
the body lying on a ventral position, and rising the body from lying on the back
(Durbacea-Bolovan, 2011). The results from all of these tests resulted in a positive score
growth and supported the hypothesis that physical exercise can increase the motor
capacity of children with disabilities (Durbacea-Bolovan, 2011).
A more specific study observed the perceived benefits from nature based physical
activity among participants who had cerebral palsy (Barfield & Malone, 2013).
Participants were recruited from a national power wheelchair soccer competition and
completed the Exercise Benefits and Barriers Scale, a scale producing three numeric
scores (total, benefits, and barriers) at a tournament (Barfield & Malone, 2013). Power
wheelchair soccer players with cerebral palsy perceived several physical outcome
benefits, including improvement of muscle tone, the relationship of overall health and life
span with exercise, and cardiovascular functioning (Barfield & Malone, 2013). Several
participants with cerebral palsy had functional improvements from exercise which caused
24
them to want to continue improving personal physical performance through sports
(Barfield & Malone, 2013).
To further understand the monumental gains made by the previous study, it is
important to recognize that children with cerebral palsy usually have poor physical fitness
(Verschuren et al., 2014). Additionally, cardiorespiratory fitness and muscle strength are
affected due to both primary impairments, such as muscle biology and strength, and
resulting secondary impairments, such as contractures and movement limitations
(Verschuren et al., 2014). Neuromuscular deficits noted in cerebral palsy include
atypical muscle tone, impaired coordination, challenges with muscle co-contraction,
balance impairments, lack in coordination, and sensory deficits (Verschuren et al., 2014).
General health of children with cerebral palsy is to be improved by aerobic fitness and
muscle strengthening intervention programs similar to Barfield and Malone’s soccer
study (2013), thus making it essential that training continues on a regular basis to ensure
fitness benefits are maintained.
While both physical activity and nature have potential to separately influence
social and physical benefits in children with disabilities, combining the two in nature
based physical activity fully exploits the maximum potential benefits. Children’s activity
can enhance social skill development (Chapman, 2000; Mustapa et al., 2014). More
specifically, natural environments for activity stimulate children, and allow for increased
happiness, self-concept, trust, increase of friends, and group cohesion; all of these are
aspects of the social benefits of outdoor exercise for children with disabilities (Chapman,
2000; Mustapa et al., 2014). In addition to the social benefits, outdoor exercise can
improve muscle tone, the relationship of overall health and life span with exercise, and
25
cardiovascular functioning in children with disabilities (Barfield & Malone, 2013).
These physical fitness enhancements are especially possible through nature based
physical activity because of nature’s restorative ability (Selhub & Logan, 2012).
26
CHAPTER III
NATURE’S COGNITIVE AND EMOTIONAL BENEFITS
ON CHILDREN WITH DISABILITIES
Although social and physical benefits are clearly evident as observable products
of nature based physical activity, a trend from outdoor activity to indoor activity
continues in a phenomenon affecting children all over the world (David, 2015). This is
made apparent as there is a decline in the use of areas designed for children’s physical
activities (David, 2015). The declining trends raise numerous concerns because play as
activity is the best communication and the most natural learning environment for children
(Acar, 2014). The American Association of Pediatrics stresses the importance of free
play for children’s overall development, and, according to the National Association for
Education of Young Children, free play develops the imagination, self-regulation,
language, and the quality of childhood interactions (David, 2015). Outdoor spaces are
stimulatory environments for children, and a decreased use in the outdoors directly
affects the development of children (Acar, 2014). Nature based physical activity for
children with disabilities provides learning opportunities to increase cognitive and
emotional development.
27
As a child with disabilities grows, the development will be slower in comparison
to a typically developing child, but the child will continue to undergo substantial brain
developments (Ploughman, 2008). Neurotrophins are proteins which have a positive
correlation with the increase of exercise (Ploughman, 2008). Basically, these special
proteins act to regulate neurons during child development (Ploughman, 2008). Since
neurotrophins are increased in response to physical activity, it can be concluded that
increased physical activity helps to form and retain memories in cognitive functioning
during the development of a child with disabilities (Ploughman, 2008). This
phenomenon, originally tested in animals, has been further examined through studies
involving children with disabilities (Ploughman, 2008). Findings support the exercisecognition phenomenon with an increase in neuroelectric responses, processing speed,
executive control and processing centers, and academic achievements (Ploughman,
2008).
Beginning in the womb, a child is sensitive to environmental changes, reacts to
the surrounding environment, and subsequently continues to interpret stimuli received
from the environment through all stages of childhood (Acar, 2014). Thus, quite simply,
environment is one of the first and foremost important pieces in normal development of
children (Acar, 2014). Past theorists believed that a newborn’s mind is tabula rosa, or a
blank slate, but it is now known that children are active learners (Bransford, 1999). As
the child grows, development is aided through the active process of learning, especially
in regard to the child’s environmental surrounding (Acar, 2014; Bransford, 1999).
Psychologist Jean Piaget described the child’s growing mind as cognitive development
through environmental stimulation (Bransford, 1999). Theories continue to branch off
28
this notion, but the one constant is that children actively learn based on their interaction
with their surrounding environment (Bransford, 1999). This development can be
categorized into the formation of personality and the mode of cognitive learning (Acar,
2014). To elaborate Acar (2014), states, “Cognitive development refers to thinking and
problem solving skills (p. 848).
Another stage of child development which is promoted by contact with nature is
the comprehension stage (Kahn & Kellert, 2002). The comprehension stage is the
systematic interpretation of information by a child (Kahn & Kellert, 2002). Nature is a
real and tangible source for children to experience and develop mental analysis (Kahn &
Kellert, 2002). As an example, rain occurs at one temperature, and snow occurs at a
colder temperature. Although this piece of information is intuitive to the general
population of adults, it is only as a result of the cognitive development during childhood
which established this comprehensive ability. Children who experience the difference
between rain and snow enter critical thinking and a series of analyses in which past
experiences and knowledge must be collated with the present stimuli. This sequence is in
correlation with the steps of cognition in childhood development (Kahn & Kellert, 2002).
One study aimed to identify the association between connectedness with nature
and cognitive styles in adolescents (Leong, Fischer, & McClure, 2014). Four
questionnaires which assessed the connectedness with nature, nature relatedness, thinking
preference, and preferred creative style were completed by 138 participants (Leong et al.,
2014). Results demonstrated that there was a significant correlation between relatedness
to nature and innovative thinking (Leong et al., 2014). The experimenters conducted a
second study to test replication of the original findings and additionally control
29
underlying variables such as demographics (Leong et al., 2014). The results of the
second study repeated the first study findings, thus providing evidence which supported
the direct correlation between nature and different cognitive styles (Leong et al., 2014).
Currently, child specialists accept that physical activity has an important role in
facilitating the learning process, often at its peak while learning through experience
(Acar, 2014). Outdoor spaces offer optimal opportunities and situations for children to
gain learning (Acar, 2014). Children’s direct interaction with nature refers to their
authentic presence in the outdoors and their activity within this nature setting (Kahn &
Kellert, 2002). This direct contact to nature links children to cognitive benefits, such as
the development of problem-solving skills and analysis (Kahn & Kellert, 2002). One
stage of cognitive development gained through nature based physical activity is the
ability to differentiate, classify, and label objects (Kahn & Kellert, 2002). For example, a
child in nature is unconsciously prompted to recognize, name, and differentiate objects in
the surrounding environment. While participating in physical activity outdoors, a child
may be playing hide-and-seek. Upon opening their eyes, the child would distinguish
between trees that are too small for other players to hide behind and trees that are big
enough for other players to hide behind. The child then counts three large trees and
searched behind these for other players. Thus, nature based physical activity acts as a
vehicle for recognition, naming, differentiation, counting, and decision making as
cognitive development in the child
A recent study, which aimed to prove the developmental gains based on outdoor
physical activity in children, examined the direct relationship between child behaviors
and the outdoor physical environment in the child’s home space (Christian et al., 2015).
30
The behaviors observed included play, physical activity, social interaction, exploration,
and stimulation of learning (Christian et al., 2015). The correlation of children’s physical
activity outdoors showed that features which accommodate outdoor activity, such as
parks and recreational facilities, are positively associated with children’s physical activity
(Christian et al., 2015). Overall, outdoor play and physical activity in the early years was
positively associated with accessible nature (Christian et al., 2015).
Since it has been established that nature increases physical activity, questions of
the implications of nature based physical activity on the cognitive effect on children with
disabilities arise. In fact, further examples of the rich cognitive benefits provided through
outdoor based physical activity are currently underway across the globe. Steven Knolls
School, located in Maryland, is a school for students with varying mental and physical
disabilities (Picciuto, 2014). One of the progressive elements of this school is the
therapeutic gardens which are located on school property (Picciuto, 2014). These
gardens were designed as healing spaces and are specifically geared to integrate children
with disabilities and increase their activity in the outdoors (Picciuto, 2014). The two
central byproducts of these sensory gardens are an increase in children’s activity or play,
and, likewise, an increase in children’s senses, an important factor in cognitive
development.
Children’s activity and play has been acknowledged as a primary stimulant of
concept development and problem solving (Zigler, Singer, & Bishop-Josef, 2005).
Activity and play methods strengthen the child’s use of organized mental structures while
sustaining interest and excitement about learning and remembering (Zigler et al., 2005).
This is especially important for the population of students with disabilities who use the
31
sensory garden at Steven Knolls School. Activity helps stimulate communication in both
verbal and nonverbal children, promoting the three basic functions of cognitive languagecommunication, expression, and reasoning (Zigler et al., 2005). For the nonverbal
children, the nature based physical activities act as a mechanism which allow the children
to turn their impulses into a specific action (Zigler et al., 2005). The children are brought
into contact with multiple stimuli that induce the development of categorization,
generalization, and conceptual acquisition skills (Zigler et al., 2005). The gardens
provide an opportunity to engage all five senses at one time, therefore delivering an
opportunity for children to participate in activity while receiving an abundance of sensory
input.
In Toronto, Blaydon Public School used nature as a setting for an integrated
classroom, and resulted in positive teacher reports of students with disabilities adapting
new ways of learning (Gordon, 2013). Contemporary perspectives on the physical
activity of play consider it a means for acquiring information and exercising cognitive
functions (Zigler et al., 2005). This certainly seems to be the case for the class of
children with autism whom were integrated to use the outdoor classroom (Gordon, 2013).
Reports from the teachers supported the notion that observations from activity outside
stimulate lessons learned when the children return indoors (Gordon, 2013). This
increased interest in learning has led to improved literacy and attention (Gordon, 2013).
Activity, such as play outdoors, is a stimulant for child development because children are
capable of integrating knowledge gained from their different senses which provides a
foundation for astonishing growth, concepts, causation, memory, and problem solving
(Gordon, 2013). The significant improvements in the children of Blaydon Public School
32
supported the notion that outdoor activity pushes children towards school readiness and
lays a foundation for basic cognitive functions needed for a child to excel in further
development (Gordon, 2013).
Further development from nature based physical activity often occurs through the
form of emotional development. Emotional development begins as ‘non-verbal
emotional literacy’ during infancy and includes instances such as mirroring or imitating
emotional states (Woolf, 2013). As childhood is entered, a child uses free play and
physical activity to demonstrate and develop emotional maturity (Woolf, 2013).
Programs such as Social and Emotional Aspects of Learning, SEAL, have been
developed with a focus on self-awareness, empathy, motivation, and managing feelings,
for school-aged children (Woolf, 2013). The implementation of these programs and the
promotion of emotional development in children with mental or physical disabilities is
especially important for the success of overall health and integration into society. Young
children use the experiences gained from physical activity as powerful avenues for
understanding and thus a channel to learn about the world and formulate emotions (Zigler
et al., 2005).
Physical activity has abundant benefits for children with disabilities. A review of
the literature was completed to gather inclusive information on the relationship between
children with Autism Spectrum Disorder and exercise (Lang et al., 2010). A total of 18
studies and 64 participants concluded physical activity benefits a child’s behavior and
self-stimulatory behavior (Lang et al., 2010). Furthermore, the positive benefits were
pinpointed to be personal mental gains (Lang et al., 2010). Children with cerebral palsy,
a neurological disorder affecting a child’s physical and mental development, have been a
33
major target for rehabilitation services (Shikako-Thomas et al., 2012). While a disability
does not always correlate with a drastically decreased quality of life, a child’s quality of
life is generally affected in varying levels (Shikako-Thomas et al., 2012). Participation in
physical activities, such as sports and other self-improvement activities, can lead to a gain
in understanding of individual abilities, an increase in skills for success, and mental
health achievements (Shikako-Thomas et al., 2012). One particular study, spanning ten
years, examined 63 patients who completed participation in activities and a quality of life
questionnaire. The scores were assessed with The Pediatric Quality of Life Inventory and
The Children’s Assessment of Participation and Enjoyment (Shikako-Thomas et al.,
2012). From these scales, it was found that the intensity of participation in physical
activity is positively associated with well-being and may foster quality of life (ShikakoThomas et al., 2012).
Quality of life may be improved through physical activity, but it can be hindered
through depression, which is often an increased risk in individuals with disabilities
(Wilson & Christensen, 2012). Although numerous studies validated the advantageous
role of nature in coping with depression, research was lacking in the exploration of
nature’s effects on depression in individuals with disabilities (Wilson & Christensen,
2012). Not only does depression affect one’s emotional health, it is also linked with
decreased physical activity rates and increased sedentary lifestyles, thus reversing the
previously improved quality of life due to exercise (Wilson & Christensen, 2012). In
2012, a study aimed to determine the relationship between outdoor recreation
participation and depression among individuals with disabilities (Wilson & Christensen,
2012). Findings supported a negative effect on depression among individuals with
34
disabilities due to the use of nature (Wilson & Christensen, 2012). Participants in the
study decreased the odds of having current depression by a factor of 1.723 compared to
participants who did not participate in outdoor activity (Wilson & Christensen, 2012).
Engaging in physical activity at a minimum of four times per week significantly
decreased depression (Wilson & Christensen, 2012). This groundbreaking study provides
a foundation for further research to discover the extent of the effects of nature on
depression, but it can be currently concluded that decreasing depression is an additional
benefit of nature, as it can increase emotional health for individuals with disabilities
(Wilson & Christensen, 2012).
Methods, such as nature based physical activity, assist and stimulate the healthy
growth and development of emotion in children with disabilities. Outdoor physical
activity is especially important for the emotional well-being of those with disabilities due
to their restricted access to the outdoors (Arslan, 2013). However, people with disabilites
often struggle to make society understand their feelings and emotions (Sadruddin &
Wahab, 2014). An important aspect to measure emotional well-being is a person’s
perceived quality of life (Arslan, 2013). One study aimed to test the psychological
benefits and quality of life in individuals with disabilities who are part of a Disabled
Family Center (Arslan, 2013). Individuals with a disability (N=266) were randomly
chosen as participants in this study and were given a survey developed by the researcher
(Arslan, 2013). The fundamental factors which reportedly benefited from outdoor
physical activity were self-esteem, personal development, and psychological relief and
satisfaction (Arslan, 2013). The self-esteem factor included an increase in self-esteem, a
decrease in stress about having a disability, acceptance of all people, and an increase in
35
the willingness to try new activities (Arslan, 2013). Similarly, the personal development
factor consisted of being happier and an increase in the perception of being successful
within one’s life (Arslan, 2013). The greatest gains were seen in the psychological relief
and satisfaction factor which included a decrease in stress, forgetting negative aspects of
one’s life, acceptance of one’s disability, feeling refreshed, and emotional relief (Arslan,
2013). Further factor analysis was completed to identify the most important benefit of
participating in activity outdoors. This revealed nature based physical activity is an
improvement in emotional quality of life (Arslan, 2013).
Specifically recommended for children with emotional disabilities, horticultural
therapy provides rehabilitation within the natural environment through the use of plants
(Schimmel, 2004). This type of therapy has been given to students simply through school
gardens and classrooms for children in need of emotional engagement, and it provides an
opportunity to receive this emotional engagement through nature based physical activity
(Schimmel, 2004). Charnock Road Elementary School, located in Los Angeles, uses
horticulture as rehabilitation for children with learning disabilities who have trouble with
reading and language. Horticultural works with these children to assist in expression of
feelings and enable learning through new experiences present in the garden (Schimmel,
2004). There is a focus on the self-exploration of the child because many students with
learning disabilities struggle with articulating feelings (Schimmel, 2004). An example of
the application of horticulture is happiness, an important emotion, being related to
mastering memory, such as memorizing the parts of a plant or counting the number of
leaves (Schimmel, 2004). For example, a child can be encouraged to walk, skip, or run
through the garden to count the leaves, thus allowing nature based physical activity to act
36
as a vehicle for emotional development of happiness when the task is correctly
completed.
Nature provides a balanced environment for children with disabilities to engage in
physical activity, and develops both cognitive and emotional benefits. Early in childhood
development, the environment is a contributing factor to development because it allows
for children to actively learn and interact forming cognitive problem solving skills (Acar,
2014). Additionally, physical activity promotes cognitive development through memory
maintenance, increased processing speed, and executive control in children with
disabilities (Ploughman, 2008). Similar to the cognitive developments fueled through
nature based physical activity, emotional benefits can also be observed in children with
disabilities. Outdoor settings, such as sensory gardens, provide environments to stimulate
physical activity and consequent emotional development (Schimmel, 2004).
Furthermore, nature based physical activity has the potential to increase quality of life
(Shikako-Thomas et al., 2012).
37
CHAPTER IV
SUMMARY
Physical activity is a method to maintain personal health, including maintaining
healthy weight, reducing risk for disease, cognitive thinking and judgement skills, and
strengthening both physical factors, such as bone strength (Center for Disease Control
and Prevention [CDC], 2014). Despite these recognized benefits in adult individuals,
physical activity engagement continues to decline (CDC, 2014). In addition to the
negative physical activity trend, a less recognized means to maintain individual health,
time immersed in nature, is also declining (Selhub & Logan, 2012). Currently as time
spent in nature decreases, positive and healthy emotions are consecutively decreasing
(Selhub & Logan, 2012). Statistics specifically calculating the satisfaction of life in
individuals living in the United States of America show a negative trend in happiness
which is matched by a positive trend in stress levels. Due to the correlation between
decreased physical activity, decreased time spent in nature, and increased negativity,
scientific researchers are investigating nature’s role in health.
Abounding research investigates the positive enhancements for individuals due to
time spent in nature. For example, in both adult and elderly populations, gardening and
wilderness adventure interventions place a layer of protection against the forces of brain
38
aging (Selhub & Logan, 2012). Nature provides cognitive challenges, communication,
increased self-esteem, and increased positivity within the adult and elderly population
(Selhub & Logan, 2012). Another important product of increased time submerged in
nature is the elevated benefits of physical activity (Selhub & Logan, 2012). As a result of
the well-known benefits of physical activity and the progressive knowledge of the
advantages of nature, yet few studies linking the two, researchers began to investigate
potential health gains of nature based physical activity. Findings suggest that exercising
outside was the most enjoyable experimental condition which promoted greater comfort
and enjoyment as well as psychological benefits (Plante, Cage, Clements, & Stover,
2006). Adding a combination of outdoor physical activity into an indoor environment
group’s workout regime suggested an increased protection against tension, stress, poor
emotional outlook, and poor overall health perception (Puett et al., 2014). Furthermore,
outdoor physical activity environment continued to be beneficial for the individuals who
were already physically active (Puett et al., 2014).
Mirroring benefits produced in adult individuals from physical activity, the
current population of children can developmentally benefit from participating in physical
activity (American Heart Association [AHA], 2015). However, children’s activity habits
are hindered by the current school structure which inhibits the amount of physical activity
necessary to maintain health (O’Dwyer et al., 2014). One program which induced within
the school system incorporated physical activity breaks throughout the school day to
combat children’s sedentary behavior (McMullen, Kulinna, & Corthran, 2014). The
activity breaks during school encouraged student movement and reinforced academic
39
content by providing an interruption to the prolonged sedentary behaviors (McMullen et
al., 2014).
Repeatedly similar to adults, benefits from nature appear in children through
therapeutic use of the outdoors as a coping measure, thus providing protection against
psychological stress (Russell, Widmer, Lundberg, & Ward, 2015). The decreased
immersion of children in nature contributes to the United States of America’s increase in
negativity and stress levels (Selhub & Logan, 2012). Nature provides a potential reversal
of these trends by increasing children’s cognitive functioning, increasing problem solving
skills, decreasing body mass, and increasing overall health (Selhub & Logan, 2012).
Due to the benefits of nature combined with the current rise in children’s
sedentary activities and decrease in physical activity, many recent studies centered on
measuring and increasing children’s time outdoors in hopes to consequently increase
physical activity. An outdoor experience for youth addresses multiple goals and
objectives through the outdoor medium, and it provides a setting for more vigorous
activity to occur (Brannan, 2003; O’Dwyer et al., 2014). Measureable accelerometer
statistics and self-reports from children support the phenomenon that increased time
outdoors is correlated with increased physical activity (Edwards, Duerden, Lisso,
Campbell, & Kamper, 2014; O’Dwyer et al., 2014).
The trend for physical activity and nature is similarly declining in both adults and
children, yet a subcategory of underrepresented children, those with disabilities, is
affected in a specialized manner. Children with disabilities are less active then
developing peers (Tyler, Cook, & Macdonald, 2014). This is increasingly important
because physical activity is known to provide a better quality of life and mental health in
40
children with disabilities, yet general movement insufficiency is often observed in
children with disabilities (Kornatovská, & Trajková, 2012). Currently, this is induced
due to a lack of physical activity opportunities which exists for children with disabilities
(Kornatovská, & Trajková, 2012).
One response to the lack of opportunities for children with disabilities to be
engaged in physical activity, declared by the United Nations, states children with
disabilities, like able bodies ones should have the freedom to play outside (United
Nations, 1989). An environment should be available to provide children with disabilities
the opportunity to participate in play areas that allow favorable conditions, considering
this provides children with disabilities become more confident, grow a sense of belonging
and acceptance by peers, and learn new ways of talking, listening, and communicating
(Abdou, 2011). Consequently, inclusive environments are on the rise to integrate
children with disabilities with their able-bodied peers (Abdou, 2011). These programs
have been established for a century, but there has been a lack in well-designed research
which investigates physical activity and the outdoors in children with disabilities
(Brannan, 2003).
Outdoor therapies reveal adventure therapy, challenge education, wilderness
therapy, and therapeutic recreation all benefit sociological, psychological, and
physiological factors (Ewert, McCormick, & Voight, 2001). Additionally, access to
green space is a significant predictor of moderate to vigorous physical activity because it
increases attention scores, balance, and memory (Selhub & Logan, 2012). Combining
positive effects of physical activity and nature appears to expand potential benefits for
children with disabilities. Therefore, to further study these gains, the purpose of this
41
study was to investigate the potential social, physical, cognitive, and emotional benefits
of a nature based physical activity setting for children with disabilities.
The term ‘inclusive outdoor play’ has three dimensions, one which expresses that
children with disabilities should be able to play in the same space as their non-disabled
peers (Wooley, 2013). One of these play mediums is the outdoors. Nature is a
restorative environment which offers a setting for diverse, imaginative, and creative
activity that stimulates and develops social interaction, communication skills, and
physical improvements in motor development (Mustapa, Maliki, & Hamzah, 2014).
Simple nature based physical activities, such as hippotherapy, combined different
therapies which allowed children to adapt to their environment, practice auditory
processing, and coordinate motor planning (Granados & Agís, 2011; Lewis, 2000;
Randall, 2006).
However, despite the compelling social and physical benefits provided though
nature based physical activity, many individuals with disabilities are denied this
opportunity and lack the inclusive support when compared to the general population.
Benefits can begin to be received through basic group integration into nature (Farnham &
Mutrie, 1997). A study examined the profits created through this integration and found
an increase in group cohesion, communication, and trust (Farnham & Mutrie, 1997).
Children with moderate learning difficulties (MLD) are typically associated with social
disadvantages and social skill deficits, yet outdoor activities increased friendships, trust,
and feelings of success (Chapman, 2000). Activity, alone, has potential to increase social
skills in children, yet integrating this form of activity within the diverse environment of
42
nature further restores and promotes psychosocial development in children with
disabilities (Bixler et al., 2002; Mustapa et al., 2014; Prezza et al., 2001).
In addition to the social skills provoked through nature based physical activity,
children with disabilities receive physical health improvements through physical activity
alone. One study integrated various physical activities for children with disabilities and
influenced motor development in specific areas such as speed, precision, mobility,
muscle tone, and greater progress achievement compared to the moderate improvement
of non-disabled peers (Francová, 2014; Radenković, Berić, & Kocić, 2014; Stan, 2012).
A gross-motor exercise intervention in children with cerebral palsy demonstrated
significant improvements in their exercise capability, therefore proving that exercise
intervention holds potential physical and gross motor function benefits for children with
disabilities (Bryant, et al., 2013).
While the previous studies all exemplified positive outcomes in children with
disabilities due to physical activity, children experiencing nature through a direct way
also demonstrated improved health benefits (Mustapa et al., 2014). In a comparison
study, children who played in a natural forest area demonstrated a significant increase in
motor fitness compared to children playing in a conventional playground (Mustapa et al.,
2014). Research revealed that there is a certain positive evolution of motor capacity for
students with special needs that practice regularly because it decreased secondary
conditions among persons with disabilities such as obesity, depression, and pain (Barfield
& Malone, 2013; Durbacea-Bolovan, 2011). Such studies demonstrated the importance
to the integration of students with disabilities into physical activity. Additionally, a study
incorporated physical activity into nature for children with disabilities and found
43
improvement of muscle tone, the relationship of overall health and life-span with
exercise, and improved cardiovascular functioning (Barfield & Malone, 2013).
Other health subdivisions in children with disabilities affected by physical activity
and nature immersion are cognitive and emotional development. Physical activity, such
as outdoor play, helps to form and retain memories in cognitive functioning during the
development of a child with disabilities (Ploughman, 2008). Activity methods strengthen
a child’s use of organized mental structures, sustain interest and excitement about
learning and remembering, and stimulate verbal and nonverbal children through
communication functions of language (Zigler et al., 2005). In nonverbal children,
activity acts as a mechanism which allows the children to turn their impulses into a
specific action (Zigler et al., 2005). Furthermore, a child’s initial interactions with the
environment, including the stimuli which produce or inhibit subsequent behaviors, begins
cognitive development (Acar, 2014). There is a direct correlation between nature and
different cognitive styles, problem-solving skills, and analysis such as differentiation,
classification, and labeling (Leong et al., 2014; Kahn & Kellert, 2002). Outdoor spaces
offer different opportunities and situations for children to gain learning through the
integration of physical activity, play experience, and nature (Acar, 2014).
This link between physical activity and nature allows for maximized cognitive
development in children with disabilities. Nature based physical activity of children with
disabilities provides learning opportunities which are often at a peak while learning
through experience (Acar, 2014). For example, gardens designed as healing spaces
integrated children with disabilities into the outdoors through physical activity (Picciuto,
44
2014). Efforts in the school system, such as integrated outdoor classrooms, increased
school readiness and improved cognitive functioning (Gordon, 2013).
Further development from nature based physical activity often occurs through the
form of emotional development. Emotional development begins during infancy and
extends through childhood with physical activity existing as the means for a child to
demonstrate their emotions (Woolf, 2013). The promotion of emotional development in
children with disabilities is especially important for the success of overall health and
integration of the individual into society (Woolf, 2013). Participation in physical activity
can lead to a gain in understanding individual abilities, an increase in skills for success,
and mental health achievements (Keiko et al., 2012). Additionally, methods such as
nature based physical activity, assisted and stimulated the healthy growth and
development of emotions in children with disabilities through an increase in self-esteem,
personal development, psychological relief, and satisfaction (Arslan, 2013).
Psychological relief and satisfaction included a decrease in stress, forgetting negative
aspects of one’s life, acceptance of one’s disability, feeling refreshed, and ultimate
emotional relief (Arslan, 2013).
Nature provides a balanced environment for children with disabilities to engage in
physical activity, thus procuring social, physical, cognitive, and emotional benefits.
Physical activity and nature have potential to separately influence multiple health aspects
in children with disabilities, but the use of both modes is consistently decreasing. The
obvious solution is to either increase physical activity or nature immersion in children
with disabilities. However, simply increasing one vehicle for development is not enough.
Combining the two mediums into nature based physical activity fully exploits and
45
maximizes potential profits which provide the paramount opportunity to increase the
social, physical, cognitive, and emotional benefits in children with disabilities.
46
REFERENCES
Abdou, S. I. (2011). Inclusion of physically disabled children through environmental
rehabilitation of urban spaces case study: AL Azhar Park, Cairo, Egypt. Procedia
Engineering, 21(2011 International Conference on Green Buildings and
Sustainable Cities), 53-58. doi:10.1016/j.proeng.2011.11.1986
Acar, H. (2014). Learning environments for children in outdoor spaces. Procedia - Social
And Behavioral Sciences, 141(4th World Conference on Learning Teaching and
Educational Leadership (WCLTA-2013), 846-853.
doi:10.1016/j.sbspro.2014.05.147
American Heart Association. (2015, March). Fitness Basics. Retrieved on 2015, May 6
http://www.heart.org/HEARTORG/GettingHealthy/PhysicalActivity/FitnessBasic
s/Fitness-Basics_UCM_462340_SubHomePage.jsp.
Arslan, S. (2013). Psychological results of recreative participation for disabled people
and its effects on perception of quality of life. International Journal of Academic
Research, 5(6), 23-26. doi:10.7813/2075-4124.2013/5-6/B.4
Barfield, J. P., & Malone, L. A. (2013). Perceived exercise benefits and barriers among
power wheelchair soccer players. Journal of Rehabilitation Research and
Development, 50(2), 231-238.
47
Brannan, S. A. (2003). Chapter one: Outdoor programs and persons with disabilities.
Including Youth With Disabilities In Outdoor Programs, 3-17.
Bransford, J. (1999). How people learn: Brain, mind, experience, and school. Chapter 4.
Washington, D.C.: National Academy Press.
Bryant, E., Pountney, T., Williams, H., & Edelman, N. (2013). Can a six-week exercise
intervention improve gross motor function for non-ambulant children with
cerebral palsy? A pilot randomized controlled trial. Clinical Rehabilitation, 27(2),
150-159.
Centers for Disease Control and Prevention. (2014, August 25). Physical Activity.
Retrieved on 2015, May 6 from http://www.cdc.gov/physicalactivity/everyone/
guidelines/index.htm.
Chapman, L. (2000). The use of outdoor education to aid the social development of
pupils with special educational needs. Horizons, (7/8), 32-37.
Christian, H., Zubrick, S. R., Foster, S., Giles-Corti, B., Bull, F., Wood, L., & ... Boruff,
B. (2015). The influence of the neighborhood physical environment on early child
health and development: A review and call for research. Health and Place, 33,2536. doi:10.1016/j.healthplace.2015.01.005
David, B. (2015). The shift from outdoor to indoor play in the French Caribbean Island of
Guadeloupe: Implications for Childhood Development. Review of Human Factor
Studies, 21(1), 73-80.
48
Dhurup, M. (2012). A dimensional analysis of the benefits derived from physical activity
participation among university students and variation in terms of gender
[Electronic Version]. African Journal for Physical, Health Education, Recreation
and Dance, 18(3), 614-627.
Dominguez, L., & Schilling, M. (2001). Environmental awareness and outdoor
recreation: A pilot program for people with special needs. World Leisure Journal,
43(3), 42-47.
Durbăcea-Bolovan, M. (2011). Research on the level of disabled students' motor
capacity. Annals of The University Dunarea De Jos Of Galati: Fascicle XV:
Physical Education and Sport Management, (1), 257-262.
Edwards, M. B., Duerden, M. D., Lizzo, R. D., Campbell, K. S., & Kamper, L. M.
(2014). Youth time outside. Journal of Leisure Research, 46(5), 635-643.
Ewert, A., McCormick, B., & Voight, A. (2001). Outdoor experiential therapies:
Implications for TR practice [Electronic Version]. Therapeutic Recreation
Journal, 35(2), 107-122.
Farnham, M., & Mutrie, N. (1997). The potential benefits of outdoor development for
children with special needs [Electronic Version]. British Journal of Special
Education, 24(1), 31-38.
Francová, L. (2014). The level of physical and social skills after completion of the
training program for children aged 9-11. Acta Universitatis Palackianae
Olomucensis. Gymnica, 44(1), 33-45.
49
Freudenberg, P., & Arlinghaus, R. (2010). Benefits and constraints of outdoor recreation
for people with physical disabilities: Inferences from recreational fishing. Leisure
Sciences, 32(1), 55-71.
Gordon, A. (2013, July 19). Kids with autism benefit from outdoor classroom. Retrieved
on 2015, October 25 from http://www.childrenandnature.org/2013/07/09/
kids_with_autism_benefit_from_outdoor_classroom/
Granados, A. & Agís, I. (2011). Why children with special needs feel better with
hippotherapy sessions: A conceptual review [Electronic Version]. Journal of
Alternative and Complementary Medicine, 17(3), 191-197.
Kahn, P., & Kellert, S. (2002). Experiencing nature: Affective, cognitive, and evaluative
development in children. In Children and nature: Psychological, sociocultural,
and evolutionary investigations. Massachusetts Institute of Technology.
Keffer, K. (2015). Kids and the outdoors: It's natural. Parks & Recreation, 50(1), 32-33.
Shikako-Thomas, K., Dahan-Oliel, N., Shevell, M., Law, M., Birnbaum, R., Rosenbaum,
P., & Majnemer, A. (2012). Play and be happy? Leisure participation and quality
of life in school-aged children with cerebral palsy. International Journal Of
Pediatrics, 2012387280. doi:10.1155/2012/387280.
Kornatovská, Z., & Trajková, A. (2012). Availability, organization and health-social
benefits of physical activities in disabled children -- A comparative study of 2
regions in bulgaria and the Czech Republic. Rozprawy Naukowe, 3, 919-30.
50
Lang, R., Koegel, L. K., Ashbaugh, K., Regester, A., Ence, W., & Smith, W. (2010).
Physical exercise and individuals with autism spectrum disorders: A systematic
review. Research in Autism Spectrum Disorders, 4,565-576.
doi:10.1016/j.rasd.2010.01.006
Leong, L. C., Fischer, R., & McClure, J. (2014). Are nature lovers more innovative? The
relationship between connectedness with nature and cognitive styles. Journal of
Environmental Psychology, 4,057-63. doi:10.1016/j.jenvp.2014.03.007
McMullen, J., Kulinna, P., & Cothran, D. (2014). Physical activity opportunities during
the school day: Classroom teachers' perceptions of using activity breaks in the
classroom. Journal of Teaching Physical Education, 33, 511-257.
Mustapa, N. D., Maliki, N. Z., & Hamzah, A. (August 2014). Repositioning children's
developmental needs in space planning: A review of connection to nature
[Electronic Version]. Procedia - Social And Behavioral Sciences, 170, 330-339.
O'Dwyer, M., Fairclough, S. J., Ridgers, N. D., Knowles, Z. R., Foweather, L., &
Stratton, G. (2014). Patterns of objectively measured moderate-to-vigorous
physical activity in preschool children. Journal of Physical Activity and Health,
11(6), 1233-1238.
Picciuto, E. (2014, October 29). Magical gardens for the blind, deaf, and disabled.
Retrieved on 2015, September 24 from http://www.childrenandnature.org/
2014/10/29/magical_gardens_for_the_blind_deaf_and_disabled/
51
Plante, T., Cage, C., Clements, S., & Stover, A. (2006). Psychological benefits of
exercise paired with virtual reality: Outdoor exercise energizes whereas indoor
virtual exercise relaxes [Electronic Version]. International Journal of Stress
Management, 13(1), 108-117.
Ploughman, M. (2008). Exercise is brain food: The effects of physical activity on
cognitive function. Developmental Neurorehabilitation, 11(3), 236-240.
doi:10.1080/17518420801997007
Puett, R., Teas, J., Espana-Romero, V., Garcia Artero, E., Lee, D., Baruth, M., . . . Blair,
S. (2014). Physical activity: Does environment make a difference for tension,
stress, emotional outlook, and perceptions of health status [Electronic Version].
Journal of Physical Activity and Health, 11, 1503-1511.
Radenković, M., Berić, D., & Kocić, M. (2014). The influence of the elements of
basketball on the development of motor skills in children with special needs Facta
Universitatis: Series Physical Education and Sport, 12(2), 123-130.
Russell, M. S., Widmer, M. A., Lundberg, N., & Ward, P. (2015). Adaptation of an
adolescent coping assessment for therapeutic recreation and outdoor adventure
settings. Therapeutic Recreation Journal, 49(1), 18-34.
Sadruddin, M. M., & Wahab, Z. (2014). Don't tag me as mentally retarded, as I am
normal: A case study to understand the emotional development, dreams and
insecurities of mentally challenged people. In J. Merrick, J. Merrick (Eds.) , Child
health and human development yearbook 2013 (pp. 285-296). Hauppauge, NY,
US: Nova Science Publishers.
52
Schimmel, B. S. (2004). Horticultural therapy in a classroom for learning disabled
children. Journal of Therapeutic Horticulture, 15, 1536-1540.
Selhub, E., & Logan, A. (2012). Your brain on nature: The science of nature's influence
on your health, happiness and vitality. Mississauga, Ont.: John Wiley & Sons
Canada.
Stan, A. E. (2012). The benefits of participation in aquatic activities for people with
disabilities. Sports Medicine Journal, 8(1), 1737-1742.
Tyler, K., Cook, N. M., & Macdonald, M. (2014). Physical activity and children with
disabilities. Palaestra, 28(4), 17-22.
United Nations. (1989, November). Convention on the rights of the child. Retrieved on
October 10, 2015 from www.ohchr.org/en/professionalinterest/pages/crc.aspx
Vanderloo, L. M., Tucker, P., Johnson, A. M., & Holmes, J. D. (2013). Physical activity
among preschoolers during indoor and outdoor childcare play periods. Applied
Physiology, Nutrition and Metabolism, 38(11), 1173-1175.
Verschuren, O., Darrah, J., Novak, l., Ketelaar, M., & Wiart, L. (2014). Health-enhancing
physical activity in children with cerebral palsy: More of the same is not enough.
Physical Therapy, 94(2), 297-305.
Wilson, J. F., & Christensen, K. M. (2012). The relationship between outdoor recreation
and depression among individuals with disabilities. Journal of Leisure Research,
44 (4), 486-506.
Woolf, A. M. (2013). Social and emotional aspects of learning: Teaching and learning or
playing and becoming? Pastoral Care in Education, 31(1), 28-42.
53
Woolley, H. (2013). Now being social: The barrier of designing outdoor play spaces for
disabled children. Children & Society, 27(6), 448-458.
Zigler, E., Singer, D. G., & Bishop-Josef, S. J. (2005). Children's play: The roots of
reading. Washington, D.C. : Zero To Three Press, c2004 (2005 printing). 54