A participant sample of 114 cancer survivors was collected for this study. Participants ranged in the age from 25 to 82 (M = 53.6, SD = 14.06), and the majority (76.3%) of the participants indicated that they were female. Table 1 presents additional demographic data, illustrating that the majority of the participants were married or in a domestic relationship (60.6%), had completed university or college (40.4%), and currently earned more than $80,000 per year (37.7%). In addition, approximately one-third of the participants worked full time (31.6%), approximately one-third were retired (29.8%), and the remaining one-third worked part time, were on disability, or were temporarily unemployed.
Table 2 presents cancer-related demographic information of the 114 participants. For the majority of participants (46.5%), initial cancer diagnosis occurred more than 5 years prior to survey completion, and the stage of diagnosis varied considerably. While a majority of participants identified having breast cancer (49.1%), a wide range of cancer types were represented, including a diverse group of “other” cancer types (10.5%) which included cases of bladder, tonsil, salivary, and prostate and testicular cancers. Regarding treatments, a majority of participants received surgery (78.9%), radiation therapy (56.1%), and chemotherapy (58.8%), and at time of survey completion, 73.7% of participants indicated that they had completed cancer treatments. Further, 82.5% of participants reported that they had been informed by their physician that they were cancer-free.
In addition to cancer-specific health information, Table 2 also summarizes general health-related information as reported by participants. The most frequent health conditions reported by participants included arthritis (22.8%), high blood pressure (18.4%), and high cholesterol (14.9%). As well, 52.6% of participants reported that they have never smoked, 35.1% reported that they were ex-smokers, and 2.6% are current smokers. Participants’ BMI (M = 26.8, SD = 5.56) was calculated utilizing self-reporting measure of height and weight. Based on participant’s BMI, the majority (41.2%) of the participants were considered a healthy weight, 30.7% were overweight, and 19.3% were obese.
Three different variables were computed to analyze participant physical activity levels. Godin Leisure Scores ranged from 0 to 126 (M = 41.33, SD = 26.06), outdoor physical activity minutes ranged from 0 to 900 minutes (M = 206.73, SD = 180.46), and number of minutes of moderate-to-vigorous physical activity ranged from 0 to 1260 minutes (M = 232.63, SD = 207.12).
Aside from duration of physical activity, participants also reported the type and location of physical activity, as well as the impact of weather conditions on their activity levels (see Table 3 for summary). The three most commonly reported types of physical activity included walking (53.5%), weight training (10.5%), and biking or cycling (7.9%). Generally, 83.3% of participants reported that location is central to their choice of physical activity, and 57.0% indicated that the outdoors was central to their physical activity experience. Trails, parks, and recreational areas (28.1%) and the general neighborhood (26.3%) served as the most common locations for physical activity.
Regarding environmental conditions, heat and humidity (43.9%) and rain and storms (35.1%) were reported as the most common weather conditions impacting summertime outdoor physical activity. Conversely, ice (48.2%) and cold temperatures (27.2%) were cited as most likely to change winter-time outdoor physical activity. When asked how they participate in physical activity during poor weather conditions, the majority (29.8%) of participants simply skipped physical activity, while 25.4% moved indoors and 23.7% participated in physical activity regardless of the weather conditions.
In order to examine the impact of outdoor physical activity on various outcomes, participants were categorized as outdoor active (> 150 min of outdoor physical activity per week) or outdoor inactive. Subsequently, t tests were conducted to examine between group differences, as summarized in Table 4. The only significant result found revealed that those who spent more time outdoors also indicated greater nature relatedness.
An independent sample t test revealed that participants who indicated that the outdoors was central to their physical activity experience (57.0% of participants) also reported significantly higher levels of generalized anxiety (Mdiff = 2.20, SE = .883, p = 0.014) than participants who engaged in physical activity indoors or found the outdoors to simply be incidental to their experiences. This suggests a relationship between the importance of the outdoors and generalized anxiety.
In order to explore the barriers and facilitators for outdoor physical activity in cancer survivors, independent sample t-tests were conducted to examine differences between outdoor inactive and outdoor active participants (see Table 5 for summary). Differences in general barriers and facilitators, as well as outdoor specific barriers and facilitators, were included in this analysis. Tests revealed that outdoor active participants were significantly more motivated and confident to be active, and reported more benefit and enjoyment in being physically active.
Participants were requested to report which factors would make participation in an outdoor walking program easier or more difficult (see Table 6). While most participates cited several factors that would facilitate or prevent program participation, responses were categorized based on participants primary response. The most common factors that make adherence to an outdoor walking program easier included peer support (36.8%), timing and scheduling (18.4%), and location (16.7%). Timing and scheduling included references to work-life integration as well as set program times that would facilitate commitment and accountability. While participants frequently referred to the exposure to the natural environment as an important component of location, this factor also included proximity to home and overall accessibility, especially for those with limited mobility.
Regarding barriers to participating in outdoor walking programs, the most common factors that would make program adherence difficult included weather (24.6%), timing and scheduling (20.2%), health and energy levels (14.0%), as well as the presence of other people (14.0%). While peer support was cited as an essential component in promoting program adherence, the presence of others was also identified as a potential barrier, exampled by “poor group dynamics” such as “unfriendly” people or feeling excluded from others. Examples of timing and scheduling barriers included conflicts with work demands and poorly organized programs. Examples of problematic locations included areas of excessive city traffic or areas with limited access to natural spaces.
Bivariate analysis was conducted to explore relationships between outdoor physical activity levels and anxiety, fatigue, and subjective happiness. Minutes of outdoor physical activity was significantly and positively correlated with subjective happiness (r = 0.19, p = 0.045), nature relatedness (r = 0.34, p < 0.001), and higher quality of life based on FACIT-fatigue scores (r = 0.23, p = 0.015). Additionally, a significant correlation was found between nature relatedness and subjective happiness scores (r = 0.29, p = 0.002). No significant correlations were found between minutes of outdoor physical activity and generalized anxiety.