Active by nature: exploring cancer survivors' exercise barriers, facilitators, preferences, and psychosocial benefits of engaging in outdoor physical activity.

Introduction: Large numbers of cancer survivors struggle with mental health after cancer diagnosis. Cancer survivors are encouraged to engage in physical activity in order to improve physical and mental health. Additional benefits to physical activity engagement in natural environments have been reported but this has not been explored in cancer survivors.

Methods: Study participants had to be over the age of 19, a Canadian resident, and have had a cancer diagnosis. Recruitment to complete an online survey occurred through social media and snowball sampling. The data collected included physical activity participation, preferences and location, barriers and facilitators of engagement in outdoor physical activity, nature-related questions, and measures of psychosocial health. The sample was split by the number of outdoor physical activity minutes (> 150 min per week). Correlations were computed to examine the role of outdoor physical activity minutes on measured psychosocial health outcomes.

Results: One hundred and fourteen (N = 114) cancer survivors completed the online questionnaire. More than half of the respondents indicated that an outdoor environment was central to their physical activity of choice with walking identified as the most common outdoor physical activity. Group support was the main expected facilitator of success in an outdoor walking program. Outdoor active participants were significantly more motivated and confident to be physically active and reported significantly more benefit and enjoyment in being physically active than outdoor inactive participants. Minutes of outdoor physical activity was significantly correlated with subjective happiness, nature relatedness, and higher quality of life. No significant correlations were found between minutes of outdoor physical activity and generalized anxiety.

Conclusion: While future research is needed to further explore the role of nature in cancer survivor psychosocial health, we believe that our data suggests preference and benefit for outdoor physical activity in cancer survivors.