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Exposure Africa Safari is one of the best safari tour operators based in Arusha, Tanzania. After a long time of experience, Samwel Nguro decided to Start the company and share his wildlife passion with the current and future Traveller to Africa. With great experience in this field and his team make more than 25 years of combined experience. We are so excited about the progress of tourism in Tanzania hence the company’s rise as Exposure Africa Safari.

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Reviews 5 – About Nature Exposure Safari

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Our private 8 day Safari was a fantastic experience, we will always remember our Honeymoon!

My wife and I found Exposure Safari on Facebook, we asked in a Safari group for offers for a private 8 Day Safari with a german speaking Guide. We got around 150 offers but we choose Exposure Safari, because we had the best communication...

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Wildlife Photo Safaris

Where dreams meet nature.

We specialize in wildlife photo safaris of Namibia, one of the most beautiful and travel-friendly countries in Africa. We take amateur and professional photographers to one of the world’s premier wilderness destinations, Etosha National Park, as well as other breathtaking locations.

Etosha is known for its abundant number of game and wide-open spaces. It is home to numerous predators and also the majestic black rhino. The Etosha Pan stretches as far as the eyes can see and offers a magical backdrop to your amazing photos.

Expert Tours

Rest at ease with a knowledgeable guide, scenic vistas, breathtaking natural landscapes and scenery, privileged views, of some of the world’s most majestic wild animals, unrivaled beauty, “conserving nature must become the very essence of who we are”, wildlife photography tours of namibia.

Namibia has 26 parks and reserves, making it’s abundant wildlife one of its greatest tourist assets. The most famous of these parks is the Etosha National Park which harbours 114 mammal species. There are 8 mammal species endemic to Namibia, including the black faced impala, several mice, gerbils and bats. The black faced impala is similar to the common impala except for the distinctive black stripe down its face. Etosha is also known for it’s healthy black rhino population. Namibia is also home to a wide variety of beautiful bird species. Namibia is one of few countries in the world to specifically address conservation and protection of natural resources in its constitution.

Erindi Private Reserve

Our Mission

We invite both amateurs and professional photographers to take their skills to the next level and have fun doing it. With our tailor-made 10 day itinerary, it gives you ample wildlife exposure. Every safari is personally guided by Dr. Rian van Schalkwyk, an avid and experienced nature and wildlife photographer. With his expert guidance, he will make sure you go back with not only fond memories that last, but also with that image you have always wanted framed. Rian has extensive knowledge of Namibian parks and wildlife behavior and loves to share it with you.

We will also visit upmarket game reserves and lodges with your comfort in mind. While you sit back and concentrate on getting that winning shot, we will entertain you in style. We offer you different forms of wildlife photography, including hide and night-time photography. Namibia has so much to offer, from breathtaking landscape vistas, to awe-inspiring wildlife shows.

We have a custom-designed 4×4 Safari vehicle, especially for wildlife photography in mind. With wi-fi, air-con, a fridge full of treats, pop-up roof and sliding windows, you have all you need for a comfortable photographic journey. We take only up to 4 photographers on our safaris, to make it as personal as we can.

For us, it is about the little things and personal touches and that is what makes our wildlife photo safaris stand out from the rest.

Come join us on this magical, once-in-a-lifetime wildlife extravaganza.

Rian van Schalkwyk

Rian has been a medical doctor for the last 24 years. He always had a passion for nature and wildlife and had spent all his free time in the African bush. He started with wildlife photography about 7 years ago when he was living on the banks of the Okavango River in the north of Namibia. He traveled extensively around Namibia and visited numerous parks in Namibia and the rest of Africa. Recently, he returned from a life-altering safari trip around Africa. Rian and his 4 year old daughter, Nina traveled for 10 months across 8 countries and visited 27 parks and reserves. On this trip he decided to change his career and started this photo safari business.

Check out Rian’s Photography

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The Best Camera Settings for African Safaris

Being able to walk out your tent in the morning with your camera ready for action is key when you’re on a safari in Africa .  There is simply so much to photograph that you don’t want to miss a moment!

For this article, I explain my exact settings I have dialed into my camera for each type of photographic opportunity throughout each day while on safari.

Before starting each day

Early morning starts are commonplace in Africa, as great wildlife sightings tend to happen early. While the day unfolds and before the sun gets too high, wildlife tend to be quite active.  As a result, having these go-to settings dialed into my camera before I go to bed each evening helps me think less during these half-groggy morning departures.

Aperture: f/5.6

Shutter Speed: 1/200

These settings are quite general and lend themselves to either landscape photos, like a beautiful sunrise, or quiet wildlife sightings right away.  While a 1/200 shutter speed isn’t fast enough for rapidly moving animals, you must also be cognizant of the relatively low light in the morning.  While a 1/500 shutter speed might be better for freezing motion, that would require an ISO of 4000 or even 5000, which usually is unacceptable in terms of resulting photo quality.

The aperture I have here is a good “general” aperture to snap low-light landscape photos (you don’t really need an f/8 or f/11 for sunrise shots), but is also a good wildlife portrait setting.  Depending on exact light conditions, I might even take this down to f/4 to bring a tad more light (remember, going from f/5.6 to f/4 doubles the amount of light that comes in).

When wildlife sightings start to pick up

This could of course happen without warning, hence the previous settings designed to be multi-purpose for starting the day.  However, once you really begin seeing animals, you may want to do a quick reset and prioritize wildlife photos first and foremost (perhaps once the sun has risen).

Aperture: f/4 (or even smaller f/number)

Shutter Speed: 1/500

ISO: 800-1600

The key difference here is that I’ve dropped my f/number down to prioritize wildlife portraiture…you know, that beautiful look where the animal is in great focus but the fore- and background is nicely blurred.

Because animals may be moving around at this point, I’m ramping my shutter speed up a bit so that I don’t get any motion blur if something is trotting around on the savanna.  At this point, I am very ready to increase my shutter speed if needed.  For instance, if there is rapid movement, I may want to double this and get to 1/1000 to freeze rapid movements.

My ISO is very dependent on lighting conditions.  While I’d love to not need 1600, I also want to make sure I’m able to shoot at a fast shutter speed even in low light.  However, as the day unfolds, I’m very aware of whether I need ISO 1600 any longer, or whether I can drop this down to, say, ISO 800 or lower.  Similarly, if I move to this new faster shutter speed while the light is still dim, I may need to increase the ISO to make sure I can get 1/500 of a second a f/4 or f/5.6 (generally I’m at my smallest possible f/number, which can vary from lens to lens).

Once light is near full and I’m ready for anything

This may be when the sun has fully risen, or it could be when I’m going out for our afternoon wildlife drive.  But either way, this setting is for when light is no longer a problem and we’re ready for some lower ISOs and maybe even bigger f/numbers (perhaps for wildlife in landscape photos).

Aperture: f/8

ISO: 200-400

As you may know from my other articles, one of my favorite styles of safari photos (or any wildlife for that matter) is a wildlife in landscape photo.  This is where it’s a classic landscape photo with all the things you’d think—beautiful scene, bit depth of field, engaging environment—but also features one or some of the area’s iconic wildlife.  This is converse to a wildlife portrait, where the majority of the frame features the animal.  In these wildlife in landscape photos, the landscape is indeed the front and center feature, but the wildlife in the photo really sends it over the top as an alluring capture.

Thus, to get these types of photos, you need light.  Afternoon-turning-into-evening is a great time for this, as you do get ample light, but it’s steadily getting lower, which improves the quality of the light as the day continues.

As night approaches

The time of day when the sun goes down, yet light still lingers in the sky, is one of the most intimate and enjoyable times of day for me personally while on safari in Africa . The air cools and the sounds increase from wildlife all around you. Although this is a rather challenging time of day to photograph (and some prefer to just put the camera away and soak it all the beauty) I’d be remiss if I didn’t offer some photographic guidance here.

Aperture: f/4 (or f/2.8 if possible)

Shutter: 1/50

ISO: 3200-6400

You are rapidly losing light and only a glimmer is left at this point. I recommend dialing your exposure compensation down so that you forcibly darken the photo to match the actual environment. You want the largest aperture possible, which often is f/4, but for some this may be f/2.8…you are likely photographing silhouettes, so depth of field is negotiable.

Although a 1/50 shutter is slow, many lenses and cameras today offer stabilization, such that you can eliminate hand shake at this level.  You need all the light you can get, so experiment with faster or slower than 1/50, but that’s a good starting point.

An ISO this high will create noise/grain in your photo, but there isn’t much else you can do.  Either you get a somewhat noisy shot that you will need to edit, or no shot at all.  I’d rather have the shot and do whatever I can to rescue it in post.

As you can see, there is more than one way to photograph the splendors of Africa…both with camera settings and at rather dramatically different times of day!  I hope you are headed to Africa soon, as it will no doubt be a pinnacle of your photographic career.  If you are, I hope even more that this advice proves useful and you come home with sensational (and memorable!) photographs.

• #camera settings
• #shutter speed

What’s in My Camera Bag – Iceland

Different styles of polar bear photography.

Court Whelan, Ph.D.

Court is an avid nature and wildlife photographer and naturalist Expedition Leader for Natural Habitat Adventures. His background in wildlife and conservation biology led him to pursue a joint Ph.D. in ecotourism and entomology. As Editor in Chief of The Natural Photographer, he is eager to share his photography knowledge and creative guidance with readers through comprehensive tutorials and blog posts. You may view more of his photography at www.courtwhelan.com

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• Arusha - Tanzania

Custom designed African Photographic safaris

An African photographic safaris is one of the best ways to preserve your safari memories, improve your art and impress your friends back home. Wildlife photography and traditional safaris don't often mix. As a photographer, it's always frustrating when your guide, or the people on your safari vehicle, are uninterested in subjects that you would like to photograph. Wilderness photography requires patience, preparation, dedication and a guide that understands how to get you into the right position for that perfect capture. You also need lots of space and equipment to move in your vehicle. In short - you need to go on a dedicated African photographic safaris.

• 9 Days / 8 Night
• Min People: 2
• Arusha - Lake Manyara - Ngorongoro - Serengeti

Learn how best to work with movement and light as you frame dazzling herds of zebra, lolling lions, and a colorful spectrum of birds.

Spend time with the Maasai in their village and enjoy a rare chance to shoot portraits and photograph the traditional way of life of these iconic pastoralists.

Head out on safaris, walks, and other activities designed to maximize photographic opportunities. Go on a photo shoot at a coffee plantation, and fill your lens with scenes of lush fields, bright coffee beans, and local culture.

DAY 1: ARUSHA TOWN, TANZANIA

Arrive at Kilimanjaro International Airport (JRO) this evening and transfer to our hotel.

Accommodations: Rivertrees Country Inn

DAY 2: ARUSHA TOWN / LAKE MANYARA NATIONAL PARK

Drive to Lake Manyara National Park, famous for its elephants, hippos, giraffes, flamingos, and tree-climbing lions. Get your equipment ready for our first safari this afternoon, and train your lens on giraffes or Cape buffalo against the stunning mountains of the Rift Valley.

Meals Included: Breakfast, Lunch, Dinner Accommodations: Plantation Lodge

DAY 3: LAKE MANYARA NATIONAL PARK

Rise early for a morning game drive, heading to the shores of Lake Manyara to photograph the numerous bird species and other wildlife that congregate here. Visit a coffee plantation this afternoon, and document the coffee production process and the culture of the local people.

DAY 4: NGORONGORO CRATER

Travel into the Ngorongoro Highlands after breakfast for a very special opportunity to visit with a Maasai community off the beaten path. With your camera in hand, witness an initiation ritual, and learn about this fascinating culture from the village chief and his wives. Capture the spirit of traditional song and dance, and enjoy time to work on portraiture and photographing daily life with these proud people. After lunch, descend 2,000 feet to the base of the Ngorongoro Crater, where volcanic slopes shelter almost 25,000 animals. Document the interactions of predator and prey; zoom in on birdlife from marabou storks to rainbow-hued lovebirds; and test your wildlife photography skills on elephants, rhinos, cheetahs, and more.

Meals Included: Breakfast, Lunch, Dinner Accommodations: Ngorongoro Sopa Lodge

DAY 5: NGORONGORO CRATER

Return to the crater floor at sunrise for breakfast and a morning photo safari. Take the afternoon to relax and look over your images. Listen to a talk by our National Geographic photographer, and ready your camera to catch the sun set over the crater this evening.

DAY 6: OLDUVAI GORGE / SERENGETI NATIONAL PARK

Drive to the Olduvai Gorge where, on a National Geographic-sponsored expedition in 1960, Louis and Mary Leakey discovered Homo Habilis, one of the earliest members of the human genus. Take a private tour of the site and learn about recent finds before continuing west to Serengeti National Park. This afternoon, drive to our lodge in the central Serengeti, looking for lions, cheetahs, and leopards along the way.

Meals Included: Breakfast, Lunch, Dinner Accommodations: Serengeti Sopa Lodge

DAYS 7 – 8: SERENGETI NATIONAL PARK

Rise early for a morning game drive before flying to the northern Serengeti, and with luck, witness the dramatic river crossings of the wildebeest migration. Great herds of wildebeests and zebras eye predators warily as crocodile snouts break the surface of the Mara River. Stay at luxury tented camp and on morning and afternoon game drives, take in the region’s spectacular array of wildlife. On our last evening, gather for a candlelit farewell dinner in the bush.

Meals Included: Breakfast, Lunch, Dinner Daily Accommodations: Sayari Camp

DAY 9: SERENGETI NATIONAL PARK/ARUSHA TOWN

After a final early morning safari, fly back to Arusha. Relax at our hotel before transferring to Kilimanjaro International Airport (JRO) to connect with your flight home.

Meals Included: Breakfast, Lunch Accommodations: Rivertrees Country Inn

This safari holiday is rated as light; travelers should be in good health and comfortable sitting for extended periods of time. Excursions include safari drives in open vehicles on dusty, bumpy roads; nature walks on uneven terrain; and sometimes climbing stairs without handrails.

Accommodations

Our accommodations are selected for their exceptional quality, location, and character.

Transportation

We have arranged all of your transportation needs during your stay in Tanzania as specified in your trip itinerary. When spending time on your own, you may choose to visit a site that requires transportation. If this is the case, your safari expert will happily recommend convenient transportation options.

• All accommodations per itinerary
• All meals per itinerary 
• Beverages and alcohol
• All tours and entrance fees per itinerary (unless listed as excluded)
• All transportation and transfers per itinerary
• Professional English-speaking naturalist driver/guide
• Transportation in a custom safari 4×4 with viewing roof and guaranteed window seating
• Safari vehicles have an inverter for charging batteries, communications radio, electric cooler, and filtered water
• National Park gate fees, Park commission, and Government taxes (based on current rates)
• International and domestic flights
• Meals not listed
• Tips for guides, drivers, hotel staff
• Optional tours
• Single room supplement
• Personal expenses (visas, airport taxes, Internet, etc.)
• Bottled water and drinks
• Optional tours (Olduvai Gorge and Maasai Village visit)
• Holiday supplement December 20 – January 5
• Ndutu supplement December-March
• Discount for kids under 15 years old

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from $12,476 / per person

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At silence of nature africa, we understand that every traveler is unique. whether you prefer high end luxury lodges or luxury tented camping experiences, we customize safaris to cater to your desires. we offer a variety of itineraries, from classic safaris to unforgettable cultural excursions, ensuring your journey is truly yours., why visit tanzania, tanzania is home to some of the world's most treasured national parks and game reserves including the selous game reserve, which is the world's largest game reserve and home to more than 120,000 elephants, 160,000 buffalos and 2000 rhinos. selous is also home to large concentrations of hippos, crocodiles and wild dogs, wildlife safaris.

Wildlife Safaris, we offer customised safari tours that cater to your preferences and interests, allowing you to witness the beauty of this incredible park up-close and personal

The Serengeti

The vast plains of the Serengeti comprise 1.5 million ha of savannah. The annual migration to permanent water holes of vast herds of herbivores (wildebeest, gazelles and zebras), followed by their predators, is one of the most impressive natural events in the world.

Zanzibar Island

The Zanzibar Archipelago, located in the Indian Ocean 15 miles off the coast of Tanzania, is a breathtaking spot to escape from the world. You’ll enjoy clear, turquoise-blue water; shallow sandbars perfect for wading; and many small, nearly deserted islands virtually unvisited by tourists.

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This world-famous safari destination offers its visitors superb game viewing in an unbelievably unique setting. Nothing can fully prepare you for the moment you first gaze down into the Ngorongoro Crater.

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Our passionate guides are not just experts in wildlife tracking; they are also storytellers, sharing their knowledge of tanzania's rich history, cultures, and traditions. silence of nature africa has a lineup of expert guides who speak english, french, japanese, and italian, in addition to swahili. let's help you plan your african safari., get a unique experience.

We create unique Tanzania Safari Itineraries according to your specifications, time, budget, taste and preference.

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The tanzania lodge safaris and luxury tented camps offer super cool best african safari experience, assuring comfort and stress-free while enjoying the remarkable african wildlife. please talk to our safari expert if you’re interested in one of our affordable tanzania lodging safari packages.

Silence Of Nature Africa Reviews

We love hearing from our travelers. and here’s a collection of five star reviews our guests have been kind enough to share online let us help you make your dream tour come true. we can provide you the best adventures in africa towards remarkable experiences., private safaris.

Design a Custom, Private Safari. We’ve created especially enjoyable private Custom Safaris for everyone.

Experience true lifetime Magic of Balloon Safari

Silence of nature africa represents a once-in-a-lifetime true magic and experienced balloon safari for those who wish to see africa's stunning and amazing wildlife in its natural habitat. so whether discovering the beauty of tanzania's wilderness by vehicle, foot, or air, sonaafrica will help you to explore many activities on offer to create a unique balloon safari itinerary that is distinctly memorable in ur lifetime., experience the true lifetime magic of balloon safari, 日本人はタンザニアとケニアを訪問できますか？.

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What Client Says

Beyond Expectation.

This was our second trip to Kenya and Tanzania, and we really had a good time during the safari tour. The team of guide and driver (Rama and Simba) did an excellent job. They speak English, French, Italian, Swahili, and Japanese. I think they can also communicate with wild animals because they were able to spot big five so easily. We also very much enjoyed their knowledgeable talk about the nature and animals. Hotels and food were also outstanding. I highly recommend the Silence of Nature Africa. by @Ko W

Este ha sido nuestro 2º safari y sin duda ha sido mucho mejor que el anterior. Nuestro chófer nos ha enseñado lugares y paisajes que ni habíamos imaginado que pudiéramos contemplar, además de conocer cuándo y dónde ver a los animales más fascinantes de la Sabana de Tanzania. Además el vehículo, en el que se pasa bastante tiempo si visitas varios lugares, como ha sido nuestro caso, estaba impecable, era nuevo y todo estaba muy limpio. Cuando hicimos el anterior safari pensamos que había sido el mejor viaje de nuestra vida, pero después de este último, nos equivocamos. Recomiendo a todo el mundo que si puede no dude en participar de esta experiencia, en el corazón de Tanzania, y aunque hay muchas empresas que se dedican a organizar safaris, no me cabe duda de que no hay ninguna mejor que ésta, por su conocimiento, amabilidad, paciencia y ganas de compartir su vida con nosotros. by@Daniperico

Great experience.

We just did a week-long Safari through Tanzania with them and the experience has been incredible. They have been very attentive before and during the Safari. Razak is a very experienced person, it is clear that he controls the situation at all times. Throughout the trip he explained interesting things to us about animal behavior and always with a smile. Thank you very much for everything, when we return we will definitely repeat with this safari company. by@Ferran Duran

最高のケニアとタンザニアのサファリツアー

夫婦二人での12日間のケニアとタンザニアの個人サファリツアーでしたが、素晴らしい経験でした。ガイドのラマは日本語も堪能で、自然に対する豊富な知識をを持ち、ドライバーのシンバは動物を見つけるのはとても上手で、念願のビッグ５を見ることが出来ました。このチームのおかげで、本当に素敵なプライベートのツアーを楽しむことが出来ました。ケニアとタンザニアは2回目ですが、サイレンス　オブ　ネイチャーはとても行き届いた会社です。 による@misako

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Associations between Nature Exposure and Health: A Review of the Evidence

Marcia p. jimenez.

1 Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA 02215, USA

2 Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, MA 02215, USA; ude.dravrah.hpsh@semajp

Nicole V. DeVille

3 Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA 02215, USA; ude.dravrah.hpsh@ttoillee (E.G.E.); ude.dravrah.gninnahc@hcjer (J.E.H.)

Elise G. Elliott

4 Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA 02215, USA; ude.dravrah.hpsh@ffihcsj (J.E.S.); ude.dravrah.g@tliwg (G.E.W.)

Jessica E. Schiff

Grete e. wilt, jaime e. hart, peter james.

There is extensive empirical literature on the association between exposure to nature and health. In this narrative review, we discuss the strength of evidence from recent (i.e., the last decade) experimental and observational studies on nature exposure and health, highlighting research on children and youth where possible. We found evidence for associations between nature exposure and improved cognitive function, brain activity, blood pressure, mental health, physical activity, and sleep. Results from experimental studies provide evidence of protective effects of exposure to natural environments on mental health outcomes and cognitive function. Cross-sectional observational studies provide evidence of positive associations between nature exposure and increased levels of physical activity and decreased risk of cardiovascular disease, and longitudinal observational studies are beginning to assess long-term effects of nature exposure on depression, anxiety, cognitive function, and chronic disease. Limitations of current knowledge include inconsistent measures of exposure to nature, the impacts of the type and quality of green space, and health effects of duration and frequency of exposure. Future directions include incorporation of more rigorous study designs, investigation of the underlying mechanisms of the association between green space and health, advancement of exposure assessment, and evaluation of sensitive periods in the early life-course.

1. Introduction

The “biophilia hypothesis” posits that humans have evolved with nature to have an affinity for nature [ 1 ]. Building on this concept, two major theories—Attention Restoration Theory and Stress Reduction Theory—have provided insight into the mechanisms through which spending time in nature might affect human health. Attention Restoration Theory (ART) posits that the mental fatigue associated with modern life is associated with a depleted capacity to direct attention [ 2 ]. According to this theory, spending time in natural environments enables people to overcome this mental fatigue and to restore the capacity to direct attention [ 3 ]. The Stress Reduction Theory (SRT) describes how spending time in nature might influence feelings or emotions by activating the parasympathetic nervous system to reduce stress and autonomic arousal because of people’s innate connection to the natural world [ 4 , 5 ]. Further, proponents of the biophilia hypothesis postulate that green spaces provide children with opportunities such as discovery, creativity, risk taking, mastery, and control, which positively influence different aspects of brain development [ 6 ]. Beyond the biophilia hypothesis, there are a number of other pathways through which nature may affect health, including but not limited to increasing opportunities for social engagement and space for physical activity, while mitigating harmful environmental exposures (e.g., air pollution, noise, heat) [ 7 , 8 , 9 , 10 ]. Though evidence is inconsistent, physical activity may serve as an important mechanistic pathway to beneficial health outcomes by providing increased opportunities for outdoor exercise (e.g., walking) and play [ 7 , 8 , 9 ]. Facilitation of social contact is a promising mechanism emerging from recent literature, where natural environments and green space provide an avenue for increased contact with others and a greater sense of community [ 9 , 10 ]. The mechanism’s underlying associations between nature exposure and health outcomes are many, not completely understood, and could act in isolation or synergistically [ 11 ].

While the study of exposure to nature and health outcomes has expanded substantially over recent years, there remain many understudied relationships, mechanisms, and populations. For instance, there is a much more expansive evidence base for associations between nature and health, particularly with experimental studies, in adults than in children. This narrative review synthesizes recent scientific literature on associations between nature and health, highlighting studies conducted among children and youth where possible, published throughout August 2020 and based on: (1) randomized experimental studies of short-term exposure to nature and acute responses; and (2) observational studies of exposure to nature.

A narrative review synthesizes the results of quantitative studies that employ diverse methodologies and/or theoretical frameworks without a focus on the statistical significance of the studies’ results [ 12 , 13 ]. We conducted a keyword search-based review using PubMed Advanced Search on 31 August 2020 for studies published in the last ten years with titles or abstracts containing “greenness”, “green space” or “NDVI” (i.e., normalized difference vegetation index) as the exposure, and “health, “children’s health” or “youth health” as the outcome (National Library of Medicine, Bethesda, MD, USA). Using World Health Organization definitions, we categorized a child as a person younger than 10 years and youth from 10 to 24 years inclusive [ 14 ]. We limited this narrative review to research on human subjects only and included English-language-based, international peer-reviewed articles (e.g., primary research, reviews), online reports, electronic books, and press releases. We included both experimental and observational studies and applied snowballing search methodology using the references cited in the articles identified in the literature search. Each identified item was assessed for relevance by a member of the study team. This review is not comprehensive but is intended to summarize recent literature on nature exposure and health.

In retrieving literature on associations of nature and health, we reviewed a range of research from multiple health-related disciplines, geographic regions, and study populations. Evidence from the experimental and observational studies presented below represents more recent literature (e.g., the last decade) on nature exposure and health, primarily from Western countries.

3.1. Experimental Studies

We found a substantial body of research on natural environment interventions to evaluate the effects of nature on health from an experimental approach. The interventions consisted of active engagement in the natural environment (e.g., walking, running, or other activities), passive engagement (e.g., resting outside or living with a view), or virtual exposure (e.g., watching videos or viewing images of nature) [ 15 , 16 ]. The majority of experimental studies assessed mental health and neurologic outcomes. Results from experimental studies suggested a protective effect of exposure to natural environments on mental health outcomes and cognitive function.

3.1.1. Stress

Several experimental studies have examined perceived stress and other subjective measures of stress, such as sleep quality. A recent systematic review of more than 40 experimental studies indicates that measures of heart rate, blood pressure, and perceived stress provide the most convincing evidence that exposure to nature or outdoor environments may reduce the negative effects of stress [ 17 ]. The results from perceived or reported stress after exposure to natural environments were more consistent than findings from studies using physiological stress measurements (e.g., cortisol levels) among adults. A recent meta-analysis found evidence suggesting that exposure to natural environments may reduce cortisol levels, one of the most frequently studied biological markers of stress. Song et al. [ 18 ] reviewed 52 articles from Japan that examined the physiological effects of nature therapy. There was overwhelming evidence that cortisol levels decreased when participants were exposed to a natural environment. In numerous studies, salivary cortisol levels decreased after mild to moderate exercise in a natural environment compared with an urban environment [ 18 ].

Although many studies have observed significant decreases in measured salivary cortisol levels after exposure to natural environments, others have not observed any significant differences in salivary cortisol levels before and after exposure to natural environments [ 17 , 19 ]. However, a key limitation of using cortisol as a biomarker of stress in experimental studies is the fluctuation of cortisol over a 24-h period. Diurnal cortisol levels need to be taken into account in order to make a fair comparison, and most of the literature on exposure to nature and stress have only studied cortisol levels before and after exposure [ 17 ].

Experimental studies focusing on children or youth are sparse [ 20 , 21 ]. One quasi-experimental study conducted in 10–12 year-olds in a school setting examined the influence of natural environments on stress response [ 22 ]. The researchers observed higher tonic vagal tone, a measure of heart rate variability, in natural environments but found no associations with event or phasic vagal tone.

3.1.2. Affective State

Exposure to natural environments has also been studied in relation to the self-reported affective state, or the underlying experience of feeling, emotion or mood. Although study measures vary, studies among adults have generally observed relationships between exposure to natural environments and affective state, with positive associations with positive emotions and negative associations with negative emotions [ 16 , 22 , 23 ]. A study randomly assigned sixty adults to a 50-min walk in either a natural or an urban environment in Palo Alto, California, and found that compared to urban experience, nature experience led to affective benefits (decreased anxiety, rumination, and negative affect, and preservation of positive affect) as well as cognitive benefits (increased working memory performance) [ 23 ]. In a study investigating forest bathing, or shinrin-yoku, researchers found that time spent in forests was associated with a reduction in reported feelings of hostility, depression, and anxiety among adults with acute and chronic stress [ 24 ]. Another study examining walking in different environments observed the largest and most consistent improvements in psychological states associated with forest walks [ 25 ]. Forest bathing may play an important role in health promotion and disease prevention. However, the lack of studies focused on children or youth limits the generalizability of these findings across a wide age range [ 26 ].

3.1.3. Anxiety and Depressive Mood

Exposure to natural environments has been linked with decreases in anxiety and rumination, which are associated with negative mental health outcomes, such as depression and anxiety [ 23 , 27 ]. Nature-based health interventions (NBI) are interventions that aim to engage people in nature-based experiences with the goal of improving health and wellness outcomes [ 28 ]. One study evaluated a wetland NBI in Gloucestershire, UK, that was designed to facilitate engagement with nature as a treatment for individuals diagnosed with anxiety and/or depression. The study found that the wetland site provided a sense of escape from participants’ everyday environments, facilitating relaxation and reductions in stress [ 27 ]. A recent systematic review and meta-analysis found a reduction in depressive mood following short-term exposure to natural environments [ 21 ]. However, the authors noted that the reviewed studies were generally of low quality due to a lack of blinding of study participants and a lack of information on randomization quality among randomized trials.

3.1.4. Cognitive Function

Experimental studies have examined the impact of brief nature experiences and cognition among adults, investigating cognitive function related to exposure to natural environments, and are consistent with the results from studies among school-aged children. A growing number of studies have found that exposure to natural environments compared with urban environments is associated with improved attention, executive function, and perceived restorativeness [ 16 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 ]. These studies have found statistically significant associations with positive cognitive outcomes, even after short periods of time spent in natural environments. Additionally, an emerging area of research is virtual reality (VR), using eye-tracking and wearable biomonitoring sensors to measure short-term physiological and cognitive responses to different biophilic indoor environments. These studies have found consistent physiological and cognitive benefits in indoor environments with diverse biophilic design features [ 38 , 39 ].

3.1.5. Brain Activity

Exposure to nature has been associated with alterations in brain activity in the prefrontal cortex, an area of the brain that plays an important role in emotional regulation [ 18 , 19 ]. One experimental study among female university students in Japan investigated physiological and psychological responses to looking at real plants compared with images of the same plants [ 40 ]. Although participants reported feelings of comfort and relaxation after seeing either real plants or images of the same plants, a physiological response was observed only after seeing real plants. Seeing real plants was associated with increased oxy-hemoglobin concentrations in the prefrontal cortex, suggesting that real plants may have physiological benefits for brain activity not replicated by images of plants.

3.1.6. Blood Pressure

Two meta-analyses [ 18 , 41 ] found evidence suggesting that exposure to a natural environment reduced blood pressure. Song et al. [ 18 ] reviewed the research in Japan from 52 studies on the physiological effects of nature therapy and found overwhelming evidence that blood pressure levels decreased when participants were exposed to a natural environment. Decreases in both systolic and diastolic blood pressure levels were observed across young healthy populations, as well as populations with hypertension. This suggests that forest walking may lead to a state of physiological relaxation [ 18 ]. Ideno et al. [ 41 ] conducted another systematic review and meta-analysis to synthesize the effects of forest bathing on blood pressure, including 20 trials involving 732 participants including high-school and college-aged youth. The authors found that both systolic and diastolic blood pressure taken in the forest environment were significantly lower than in non-forest environments [ 41 ].

3.1.7. Immune Function

In Japan, forest bathing has been positively associated with human immune function [ 42 ]. A study was conducted in which subjects experienced a 3-day/2-night bathing trip to forest areas, and blood and urine were sampled on days 2 and 3 of the trip. On days 7 and 30 after the trip, it was found that the mean values of natural killer (NK) cells (which play a major role in the immune system) and NK activity were higher on forest bathing days compared with control days [ 43 ]. This effect persisted for 30 days after the trip. A potential pathway for improved immune function is exposure to phytoncides (a substance emitted by plants and trees to protect themselves from harmful insects and germs), which could decrease stress hormones in the human body and increase NK cell activity. Additionally, the findings indicated that a day trip to a forest park also increased the levels of intracellular anti-cancer proteins [ 43 ].

3.1.8. Postoperative Recovery

While there is limited research on the effect of nature on postoperative recovery, a seminal study by Ulrich [ 4 ] investigated recovery after a cholecystectomy on patients with and without a room with a window view of a natural setting. Patients with a view of a natural setting had shorter hospital stays, received fewer negative evaluative comments in the nurse’s notes section of their charts, and took fewer potent analgesics (e.g., opiates) than those patients whose windows faced a brick building wall [ 4 ]. More recent research has successfully replicated the concept that plants and foliage in the hospital environment may have beneficial impacts on surgical recovery in randomized trials [ 44 , 45 ].

3.2. Observational Studies

Cross-sectional observational studies have shown evidence of positive associations between exposure to nature, higher levels of physical activity, and lower levels of cardiovascular disease. Increasingly, longitudinal observational studies have started to examine the long-term effects of exposure to nature on depression, anxiety, cognitive function, and chronic disease. Below, we summarize the key findings on mental health, physical activity, obesity, sleep, cardiovascular disease, diabetes, cancer, mortality, birth outcomes, asthma and allergies, and immune function.

3.2.1. Mental Health

A recent systematic review found limited evidence suggesting a beneficial association with mental well-being in children and depressive symptoms in adolescents and young adults [ 21 ]. However, access to green space has been linked with improved mental well-being, overall health, cognitive development in children [ 46 ], and lower psychological distress in teens [ 47 ]. A study that examined the restorative benefits associated with frequency of use of different types of green space among US-based students found that students who engaged with green spaces in active ways ≥15 min four or more times per week reported a higher quality of life, better overall mood, and lower perceived stress [ 48 ]. Research in the U.S.-based Growing Up Today Study (GUTS) found that increased exposure to greenness measured around the home was associated with a lower risk of high depressive symptoms cross-sectionally (as measured with the McKnight Risk Factor Survey) and a lower incidence of depression longitudinally [ 49 ]. The investigators observed stronger associations in more densely populated areas and among younger adolescents [ 49 ]. Similarly, a study in four European cities (Barcelona, Spain; Doetinchem, The Netherlands; Kaunas, Lithuania; and Stoke-on-Trent, UK) that evaluated childhood nature exposure and mental health in adulthood showed that adults with low levels of childhood nature exposure had, when compared with adults with high levels of childhood nature exposure, significantly worse mental health, assessed through self-reports of nervousness or depression [ 50 ]. Another study of approximately one million Danes over 28 years of follow-up found that high levels of continuous green space presence during childhood were associated with lower risk of a wide spectrum of psychiatric disorders later in life [ 51 ]. A study based in the UK tracked individuals’ residential trajectories for five consecutive years and showed that individuals who moved to greener areas had better mental health than before moving [ 52 ]. Collectively, these studies suggest that implementation of environmental policies to increase urban green space may have sustainable public health benefits.

Novel research has examined green outdoor settings as potential treatment for mental and behavioral disorders, such as attention-deficit/hyperactivity disorder (ADHD). One study demonstrated associations between green space exposure and improvement in behaviors and symptoms of ADHD and higher standardized test scores [ 46 ]. A recent systematic review found significant evidence for an inverse relationship between green space exposure and emotional and behavioral problems in children and adolescents [ 21 ]. Research has also shown that more and better quality residential green spaces are favorable for children’s well-being [ 53 ] and health-related quality of life [ 54 ]. Furthermore, the quality of green space appears to be more important as children age, as associations between green space quality and well-being are stronger in 12–13 year-olds compared with 4–5 year-olds [ 53 ]. In addition, natural features near schools, including forests, grasslands, and tree canopies, are associated with early childhood development, preschoolers’ improvement in socio-emotional competencies [ 55 ], and a decrease in autism prevalence [ 56 ].

Exposure to nature during adulthood also appears to be important for mental health. A study of 94,879 UK adults indicated a consistent protective effect of greenness on depression risk that was more pronounced among women, participants younger than 60 years, and participants residing in areas with low neighborhood socioeconomic status or high urbanicity [ 57 ]. Other innovative studies are starting to examine quantifiable time of exposure to evaluate the duration of time spent in nature that is associated with mental health benefits. For example, using a nationally representative sample of American adults, Beyer et al. [ 58 ] found that individuals who spent 5–6 or 6–8 h outdoors during weekends had lower odds of being at least mildly depressed, compared with individuals who spent less than 30 min outdoors on weekends. Another study from the UK suggested that lower levels of depression were associated with spending five hours or more weekly in a private garden [ 59 ]. Other studies are focused on uncovering which characteristics of green space are the determinants of mental health benefits. A UK study examined neighborhood bird abundance during the day and found inverse associations with prevalence of depression, anxiety, and stress [ 60 ].

The collective results from these studies suggest that nearby nature is associated with quantifiable mental health benefits, with the potential for lowering the physical and financial costs related to poor mental health. Most of these studies are cross-sectional, and reverse causation is possible. However, researchers are employing novel designs to examine the relationship between green space and mental health. For example, in a study of twins enrolled in the University of Washington Twin Registry, increased greenness was associated with decreased risk of self-reported depression, stress, or anxiety; however, only the results for depression were robust in within-twin pair analyses, suggesting the effect of green space on depression cannot be explained by genetics alone [ 61 ]. Finally, it is important to note that technological advancements have yielded improvements in assessments of exposure to nature and mental health. For instance, one study among adults 18–75 years of age used smartphones equipped with ecological momentary assessment applications to track location, physical activity, and mood for consecutive days, and found positive associations with feeling happy and restored or relaxed within 10 min of exposure to natural outdoor environments [ 62 ]. More novel studies such as these will bolster the evidence behind exposure to nature and mental health among children and/or youth.

3.2.2. Physical Activity

An extensive body of literature documents the impacts of access to green spaces or surrounding greenness on physical activity in children and adults. Proximity to green spaces may promote physical activity by providing a space for walking, running, cycling, and other activities. Although the bulk of the literature is cross-sectional, most studies (in both children and adults) have observed higher levels of physical activity in areas with more access to green space. For example, a study in Bristol, UK, evaluated associations between accessibility to green space and the odds of respondents achieving a recommended 30 min or more of moderate activity five times a week; respondents who lived closest to the type of green space classified as a formal park were more likely to achieve the physical activity recommendation [ 63 ]. Another study of adults in the UK found that people living in greenest compared with least-green areas were more likely to meet recommended daily physical activity guidelines [ 64 ]. However, another UK-based study did not find associations between road distance to nearest green space, number of green spaces, area of green space within a 2-km radius of residence, or green space quality and physical activity [ 65 ].

Almanza et al. [ 66 ] used GPS and accelerometry data among 208 children in California and found that greenness was associated with higher odds of moderate to vigorous physical activity, when comparing those in the 90th and 10th percentiles of greenness. Additionally, they found that children with >20 min daily green space exposure had nearly 5 times the daily rate of moderate to vigorous physical activity compared with those with nearly zero daily exposure [ 66 ]. Another study of Australian children illustrated that time spent outdoors at baseline positively predicted the amount of physical activity three years later [ 67 ]. In a review of youth health outcomes related to exercising in nature (i.e., “green exercise”), the results of fourteen studies (5 in the UK, 5 in the U.S., 2 in Australia, and 1 in Japan) indicated little evidence that green exercise is more beneficial than physical activity conducted in other locations, although any physical activity was beneficial across settings [ 68 ].

More recent studies have employed more sophisticated study designs to determine whether exposure to greenness increases physical activity. In studies that objectively assessed physical activity via accelerometers, individuals exposed to more greenness tended to be more physically active. For example, in a study of 15-year-olds in Germany, increases in greenness around the home address were associated with increased moderate-to-vigorous physical activity among youth in rural, but not urban, areas [ 69 ]. Another study of children in the UK evaluated momentary green space exposure based on GPS-derived location and contemporaneous physical activity measured by an accelerometer and found higher odds of physical activity in green space (versus outdoor non-green space) for boys but not girls [ 70 ].

3.2.3. Obesity

Green space may influence overweight or obesity through a physical activity pathway [ 71 ]. Some studies have shown that exposure to green space is associated with lower rates of obesity in children [ 67 ] and adults [ 72 ]; however, the results are conflicting. As with physical activity, many early studies were cross-sectional, and findings were more mixed for children than for adults. Some studies reported U-shaped associations with obesity [ 73 ], while other studies reported no association after adjustment for respondent characteristics [ 63 ] or neighborhood socioeconomic status [ 74 ]. Some studies demonstrate effect modification by gender [ 72 ]. Further, one cross-sectional UK-based study found that living in the greenest areas was associated with an increase in risk of being overweight and obese [ 75 ].

In one study of U.S. children, increasing greenness was associated with lower BMI z-scores and lower odds of increasing BMI z-scores between two follow-up times [ 76 ]. Another study of schoolchildren in Spain found that greenness and forest proximity were associated with lower prevalence of being overweight or obese [ 77 ]. One study found that street tree density was associated with lower obesity prevalence in New York City (U.S.) children; however, no association was found with park areas [ 78 ]. In an Australian study, the prevalence of being overweight was 27–41% lower in girls and boys who spent more time outdoors at the study baseline than those who spent less time outdoors [ 67 ]. Another study found that greenness was associated with decreased risk of being overweight but only among those in areas with a greater population density [ 79 ].

3.2.4. Sleep

Exposure to green space may influence sleep duration and quality. For instance, surrounding greenness may serve as a buffer for noise, which would disturb sleep. To date, only a handful of studies have examined these associations, and to our knowledge, even fewer have explored this association in children. A recent systematic review provided evidence of an association between green space exposure and improved sleep quality among adults [ 80 ]. A study of Australian adults who lived in areas with greater than 80% green space demonstrated lower risk of short sleep duration, even after adjustment for other predictors of sleep [ 81 ]. Among U.S. adults participating in the Behavioral Risk Factor Surveillance System survey, natural amenities (e.g., green space, lakes, and oceans) were associated with lower reporting of insufficient sleep, and greenness was especially protective among men and individuals over 65 years of age [ 82 ]. In the Survey of Health in Wisconsin Study, increased tree canopy at the Census block group level was associated with lower odds of short sleep duration on weekdays and suggestive of an association with lower odds of short sleep duration on weekends, although there was no association between tree canopy and self-reported sleep quality [ 83 ]. A nationally representative study of Australian and German children and adolescents found no evidence of significant associations between residential green space and insufficient sleep or poor sleep quality [ 84 ].

3.2.5. Cardiovascular Disease

Exposure to green space may affect levels of physical activity, stress, and high blood pressure that drive cardiovascular disease risk. Recent reviews have found consistent evidence that exposure to residential green space is associated with decreased cardiovascular disease incidence [ 85 , 86 ]. Participants living in areas with lower greenness have higher levels of mortality following a stroke [ 87 ], higher cardiovascular disease mortality [ 88 , 89 ], and higher coronary heart disease [ 90 ]. A study from the UK found that associations between exposure to nature and cardiovascular outcomes differed by gender, where male cardiovascular disease and respiratory disease mortality rates decreased with increasing green space, and no associations were found for women [ 88 ]. Furthermore, the relationships between exposure to greenspace and cardiovascular outcomes may be modified by urbanicity. A recent Australian study showed significantly lower odds of high blood pressure among adults in an urban population when reported green space visits were an average of 30 min or more [ 91 ].

3.2.6. Diabetes

Although limited, evidence regarding the association between green space and type 2 diabetes highlights green space as a possible route for diabetes prevention. There are a few cross-sectional studies that have reported that green space is inversely related to type 2 diabetes among adults [ 92 , 93 ]. Few studies have examined the relationship between green space and diabetes in children. Cross-sectional studies of children found inverse associations between time spent in green spaces and fasting blood glucose levels [ 77 ] and insulin resistance [ 94 ]. A recent longitudinal study conducted on US children found no associations between residential exposure to green space and insulin resistance [ 95 ].

3.2.7. Cancer

Research on the link between green space and cancer is limited and may vary depending on the type of cancer. A recent case-control study examined whether residential green space exposure was related to prostate cancer incidence and found that higher residential greenness was associated with lower risk of prostate cancer [ 96 ], and a separate study of U.S. men demonstrated inverse associations between neighborhood greenness and lethal prostate cancer [ 97 ]. Another study examined the association between green space and several cancer types and found that green space was protective for mouth, throat, and non-melanoma skin cancers but was not associated with colorectal cancer [ 98 ]. A U.S.-based nationwide study of nurses found that residential greenness was inversely associated with breast cancer mortality [ 99 ]. Conversely, another systematic review that evaluated evidence on the association between residential green spaces and lung cancer mortality found no benefits of residential greenness [ 85 ].

3.2.8. Mortality

Many early mortality studies relied on cross-sectional data and could not estimate nature exposure over time [ 100 ], whereas others could not account for important potential confounding by race/ethnicity, individual-level smoking, and area-level socioeconomic factors, such as median home value [ 101 , 102 ]. A UK-wide ecological study found that all-cause mortality was higher in greener cities [ 89 ]. An analysis of greenness and mortality in male and female stroke survivors living in Boston (U.S.) found that greater exposure to greenness was associated with higher survival rates [ 87 ]. Another U.S.-based nationwide study of nurses found a consistent protective relationship between residential greenness and non-accidental mortality [ 103 ]. The greenness–mortality relationship was explained primarily by a mental health pathway, and the relationship was strongest among those who had high levels of physical activity [ 103 ]. A study of 4.2 million adults in the Swiss National Cohort assessed the relationship between residential greenness and mortality, while mutually considering socioeconomic status, air pollution, and transportation noise exposure, and found that higher exposure to green space was associated with lower rates of death from natural causes, respiratory disease, and cardiovascular disease [ 104 ]. Protective effects were stronger in younger individuals and in women and, for most outcomes, in urban (versus rural) and in the highest (versus lowest) socioeconomic quartile. Effect estimates did not change after adjustment for air pollution and transportation noise, suggesting that the protective effect of exposure to nature persists in the absence of pollution sources. Finally, a systematic review and meta-analysis of cohort studies on green space and mortality assessed findings from nine studies, comprising 8.3 million individuals from seven countries across the globe [ 105 ]. Seven of the nine studies demonstrated an inverse relationship between green space exposure and mortality, and the authors recommended wide-scale interventions to increase and manage green spaces in order to improve public health outcomes.

3.2.9. Birth Outcomes

The relationship between exposure to nature and birth outcomes has been studied extensively in analyses across multiple countries. Findings of positive associations between greenness and birth weight and decreased risk of low birth weight are consistent, with stronger associations observed among those of a lower socioeconomic status [ 106 ]. Banay et al. [ 107 ] reviewed studies that examined the association between greenness and maternal or infant health. While the majority of studies were cross-sectional, many studies found evidence for positive associations between greenness and birth weight. Fewer studies demonstrated consistent evidence for an association between greenness and gestational age, preeclampsia, or gestational diabetes. These studies also found that effects were stronger among those of a lower socioeconomic status. A more recent review highlighted the evolving literature showing that higher levels of residential greenness were associated with lower risk of preterm birth, low birth weight, and small gestational-age babies [ 108 ]. Akaraci et al. [ 109 ] conducted a systematic review and meta-analysis of 37 studies on residential green and blue spaces and pregnancy outcomes. Increases in residential greenness were associated with higher birthweight and lower odds of being small for gestational age; however, no significant associations between residential blue spaces and birth outcomes were found.

3.2.10. Asthma/Allergies

Several studies have examined the relationship between greenspace and atopic outcomes, including asthma and allergies. Mechanistically, trees and plants are a source of allergens and respiratory irritants [ 110 ]. However, the biodiversity created by green space could be protective against inflammatory conditions [ 111 , 112 ]. The literature reflects these contrasting hypotheses with mixed findings. Some studies have shown no association between the normalized difference vegetation index (NDVI) or tree canopy cover and asthma [ 113 ], while other studies have shown that living close to forests and parks was positively associated with allergic rhinoconjunctivitis and asthma [ 77 ]. Another study of greenspace and allergies in Germany demonstrated positive associations in urban areas and negative associations in rural areas [ 114 ]. The same investigators examined data from seven birth cohorts across Sweden, Australia, the Netherlands, Canada, and Germany and found that the relationship between residential NDVI and allergic disease was positive in some countries and negative in others [ 115 ]. A study in Spain found proximity to residential greenness to be protective of bronchitis in the Mediterranean region of Spain and protective of wheezing for children in the Euro-Siberian region of Spain [ 116 ]. One study conducted in China examined the relationship between exposure to greenness and parks and asthma and allergies among middle-school-aged children [ 117 ]. The researchers observed no associations between residential greenness exposure and self-reported doctor-diagnosed asthma, pneumonia, rhinitis, and eczema; however, living farther away from a park was associated with decreased odds of currently or ever having asthma. In sum, the relationship between exposure to nature and asthma and allergies is inconsistent, with associations varying in magnitude and direction by geography. One review of fourteen studies suggested an association between early life exposure to urban greenness and allergic respiratory diseases (e.g., asthma, bronchitis, allergic symptoms) in childhood; however, there were inconsistencies among study results, likely due to variability in study design, exposure assessment, outcome ascertainment, and geographic region [ 118 ].

3.3. Natural Experiments/Randomized Controlled Trials of Chronic Outcomes

Beyond smaller experimental studies of short-term outcomes and observational epidemiologic studies of chronic outcomes, there are a few natural experiments and randomized controlled trials that add substantial evidence to the relationship between exposure to nature and health. These quasi-experimental and randomized trials have lower potential for confounding bias to explain observed associations between nature and health. One important study capitalized on a natural experiment when an invasive tree pest, the emerald ash borer, killed over 100 million ash trees in the Midwestern United States [ 119 ]. The investigators found that living in a county infested with the emerald ash borer was associated with a 41% increased risk of cardiovascular disease, and these results were only consistent when looking in metropolitan areas where they could adjust for socioeconomic status. Another innovative study examined the greening of vacant lots in Philadelphia [ 120 ]. This citywide study used a three-arm randomized trial approach to randomize 110 vacant lots to either no intervention, cleaning but no greening, or cleaning and greening. The study found that those living around lots that were greened had substantial decreases in reports of depression, poor mental health, and feelings of worthlessness compared with lots that had no intervention. Those living around lots that were cleaned but not greened showed no difference compared with no intervention. Another ongoing longitudinal study in Sydney, Australia, is evaluating the effects of large-scale investment in green space (e.g., public access points, advertising billboards, walking and cycle tracks, BBQ stations, and children’s playgrounds) on physical activity, mental health, and cardiometabolic outcomes [ 121 ]. This natural experiment utilizes proximity to different areas of the Western Sydney Parklands to define treatment and control groups.

Looking to the future, there are a few randomized trials in progress that will provide fundamental evidence to understand whether adding green pace to cities benefits health. The Green Heart Project in Louisville, Kentucky, will assess risk of diabetes and heart disease, stress levels, and the strength of social ties in 700 participants [ 122 ]. The team will take baseline measurements of air pollution levels and will plant as many as 8000 trees, plants, and shrubs throughout Louisville neighborhoods to create an urban ecosystem that promotes physical activity while simultaneously decreasing noise, stress, and air pollution. During five years of follow-up, participants will receive annual check-ups to evaluate how the increasing greenery has affected their physical and mental health and social ties. A second randomized trial is the ‘Productive Green Infrastructure for Post-industrial Urban Regeneration’ or ProGIreg, a multi-city study examining the potential effects of green infrastructure [ 123 ]. This project is based in Dortmund (Germany), Turin (Italy), Zagreb (Croatia) and Ningbo (China) where Living Labs are hosted and nature-based solutions are developed, tested, and implemented. Although health is not the main focus of this study, researchers are hoping to incorporate health metrics into the study design to examine pre- and post-intervention outcome data. Collectively, these randomized trials, natural experiments, and pre-post study designs will establish crucial data on whether interventions to incorporate nature into cities can measurably improve health.

3.4. Effect Modification/Susceptible Populations

Inequitable distribution of green spaces could exacerbate health inequalities if people who are already at greater health risks (e.g., people with lower socioeconomic status) have limited access. Many studies have indicated that disadvantaged populations have decreased access to nature and greenspace [ 124 , 125 , 126 , 127 , 128 , 129 , 130 , 131 , 132 ]. At the same time, evidence suggests that exposure to nature disproportionately benefits disadvantaged populations, a phenomenon known as the equigenic effect of green space, which upends the expected association between lower socioeconomic status and greater risk of poor health outcomes [ 133 ]. Based on the theory of equigenic environments, one study showed that populations exposed to the greenest environments also had the lowest levels of health inequality related to income deprivation, suggesting that green space might be an important factor in reducing socioeconomic health disparities [ 89 ]. A review of 90 studies on green space and health outcomes demonstrated that individuals of lower socioeconomic status showed more beneficial effects than those of higher socioeconomic status; the authors found no significant differences in the protective effects of green space on health outcomes among different racial/ethnic groups [ 134 ]. The evidence is inconsistent, and more work is needed to elucidate potential mechanisms.

Conversely, improvements in access to green space may lead to “green gentrification,” an increase in property values that displaces low-income residents from their neighborhoods [ 129 , 135 , 136 , 137 ]. This process needs to be studied and understood so that its adverse effects can be prevented. Other cultural and contextual factors may affect nature preferences and experience of nature. For instance, there is evidence that the legacy of forced labor, lynching, and other violence may evoke deeply disturbing associations with trees, fields, and forests among some African Americans [ 138 , 139 ]. Similarly, some people may prefer open fields for sports, while others prefer picnic facilities for socializing.

4. Discussion

The purpose of this narrative review was to summarize recent experimental and observational literature on associations between nature exposure and health in adults and children/youth. While some associations between nature and health outcomes are well-studied, our review highlights the lack of studies, particularly experimental, among child/youth and other susceptible populations. We found evidence for associations between exposure to nature and improved cognitive function, brain activity, blood pressure, mental health, physical activity, and sleep. Results from experimental studies indicated protective effects of nature exposure on mental health and cognitive function. Cross-sectional observational studies provide evidence of positive associations between nature exposure, higher levels of physical activity and lower levels of cardiovascular disease. Observational studies, natural experiments, and randomized controlled trials are starting to assess the longitudinal effects of exposure to nature on depression, anxiety, cognitive function, chronic disease, and other health outcomes. Our review synthesizes recent literature, primarily from Western countries; thus, a limitation of this review is that we may not have captured all relevant literature from outside our publication range or across all geographic regions.

4.1. Data Gaps and Limitations

There are several limitations in the literature on exposure to nature and health. First, definitions of nature are inconsistent across studies. Further, the impacts of the quality of green space, duration of exposure to nature, frequency of exposure, or type of nature exposure on health outcomes are not well understood. Second, methods for measuring exposure to nature (e.g., percentage of residential greenness versus distance to the closest park) or defining the relevant geographic area of exposure (e.g., 500 m away from our home versus 1 km or 10 km) are inconsistent [ 140 , 141 ]. We must also develop methods to elucidate thresholds for dose and duration of nature exposure to achieve a given health effect. Although some studies have determined potential estimates of relevant doses [ 142 ], this area of research is nascent. In addition, standard approaches towards nature exposure assessment do not capture the variations in how people experience nature differentially (e.g., smell, touch, etc.) and have low reproducibility across studies (e.g., inconsistent land-use measures). Third, critical time windows of exposure during the life course that might have the greatest impact on health are also understudied (e.g., early life exposure, childhood exposure). Fourth, mechanistic pathways are understudied. Further, the dynamic relationship between green space, air pollution, noise, temperature, and neighborhood walkability also warrant further exploration, as these factors could be both mediators or moderators of the nature–health relationship [ 143 , 144 ]. We also know little about the potential harms of exposure to nature, most commonly observed in studies of asthma and allergies.

4.2. Future Directions

There are ample promising future directions for nature and health research. First, future research should employ rigorous study designs (e.g., longitudinal studies, randomized controlled trials) and investigate the underlying mechanisms of observed associations between exposure to nature and health outcomes. Although cross-sectional studies dominate the literature, there is increasing evidence emerging from prospective studies, which are essential to investigating causal relationships [ 108 ]. Novel designs, such as quasi-experimental studies and randomized trials, will provide further detail on how nature influences health [ 119 ]. Furthermore, studies should thoroughly evaluate potential biases, such as confounding by socioeconomic status, that may threaten the validity of studies on nature and health. Researchers should rigorously examine factors that may modify the effects of exposure to nature (e.g., socioeconomic status, gender, or race) to determine the subpopulations that might benefit most from exposure to nature. A life-course approach to examining associations between green space and health is also essential. We need to better understand vulnerable time windows in the early life-course where access or exposure to nature may have stronger impacts on health than in other time periods. Similarly, additional research assessing dose-response relationships (e.g., duration of time in nature or quantity of vegetation) is crucial to determine the minimum amount of exposure to green space needed to yield health benefits or if the relevant dosage varies across the life-course or across different countries/settings [ 142 ].

Second, future studies should make use of novel datasets and computational approaches that may provide rapid advances in exposure assessment. Emergence of advanced satellite and aerial photos combined with machine learning to develop tree canopy measures and other more specific metrics of nature provide information on specific species on the ground. Google Street View and other ubiquitous geocoded imagery, when combined with machine learning, also provide scalable approaches to estimate specific natural features from the on the ground perspective as human beings experience them [ 145 ]. Combined with geocoded residential addresses or GPS data and health or behavioral data, these approaches may unveil novel insights on how nature exposure affects health. Leveraging smartphones with GPS and accelerometry enable fine-scale information on exposure and physical activity. Ecological momentary assessment (EMA) or micro-surveys administered through smartphones can be used to ask about processes for how and why people interact with nature [ 62 ]. EMA can also be applied to estimate mental health outcomes in real time, and these responses can be geo-tagged and linked to spatial measures of natural environments. In addition, consumer wearable devices (e.g., FitBit) provide objective information on physical activity patterns, heart rate, sleep, and other biometrics down to the second level [ 146 ]. These data will prove crucial to better understand the behavioral mechanisms through which nature exposure impacts health. We should also capitalize on geo-located social media data (Flickr, Twitter, Facebook) and other data sources to understand exposure to nature [ 147 ]. Innovative metrics of mental health, such as skin conductivity, cortisol (stress), heart rate variability, brain activity through EEG, and functional MRI, can also provide information on stress processes when individuals encounter natural environments [ 148 ]. Such measures of nature exposure and time spent in nature should be incorporated into large federal data collection efforts, such as the Behavioral Risk Factor Surveillance System (BRFSS), National Health Interview Survey (NHIS), and National Health and Nutrition Examination Survey (NHANES) in the United States or the Health Survey for England (HSE) in the United Kingdom. These recommendations cannot be accomplished without also considering the impacts climate change is currently having and will have on exposures to nature, and how climate change may alter the relationship individuals have with nature.

Third, future studies on nature and mental health should focus more on positive health—happiness, purpose, flourishing—instead of just the absence of negative mental health outcomes. Further, more research is required on natural water features, or blue space [ 149 ], as well as other natural environments.

Fourth, the overwhelming majority of research on nature and health is on urban study populations in North America, Europe, and Australia. Researchers should also focus on different geographic areas, low-income and middle-income settings, and vulnerable or historically marginalized populations where nature benefits might be greatest. Researchers should also work together with communities as they conduct their research to ensure their work addresses the needs of community members.

Finally, we must also recognize the potential unintended consequences of adding green infrastructure in cities. Adding green amenities to cities may entice high-income populations, and the resulting increased property values shape a new conundrum, embodied in the exclusion and displacement associated with so-called green gentrification [ 135 ]. Results from this type of research should also be considered for policies, urban planning, and designing cities.

5. Conclusions

The purpose of this review was to examine recent literature on exposure to nature and health, highlighting studies on children and youth where possible. We assessed the strength of evidence from experimental and observational studies and found evidence for associations between exposure to nature and improved cognitive function, brain activity, blood pressure, mental health, physical activity, and sleep. Evidence from experimental studies suggested protective effects of exposure to natural environments on mental health outcomes and cognitive function. Cross-sectional observational studies provide evidence of positive associations between exposure to nature, higher levels of physical activity and lower levels of cardiovascular disease. Longitudinal observational studies are starting to assess the long-term effects of exposure to nature on depression, anxiety, cognitive function, and chronic disease. Limitations and gaps in studies of nature exposure and health include inconsistent measures of exposure to nature, knowledge of the impacts of the type and quality of green space, and the health effects of the duration and frequency of exposure among different populations (e.g., adults, children, historically marginalized). Future research should incorporate more rigorous study designs, investigate the underlying mechanisms of the association between green space and health, advance exposure assessment, and evaluate sensitive periods throughout the life-course.

Author Contributions

Conceptualization, M.P.J., N.V.D., J.E.H. and P.J.; methodology, M.P.J., N.V.D., J.E.H. and P.J.; writing—original draft preparation, M.P.J., N.V.D., E.G.E., J.E.S., G.E.W., J.E.H. and P.J.; writing—review and editing, M.P.J., N.V.D., E.G.E., J.E.S., G.E.W., J.E.H. and P.J.; supervision, J.E.H. and P.J.; project administration, N.V.D.; funding acquisition, P.J. All authors have read and agreed to the published version of the manuscript.

This research was funded by The National Geographic Society, and NIH grants R00 CA201542, R01 HL150119, T32 {"type":"entrez-nucleotide","attrs":{"text":"ES007069","term_id":"164015192","term_text":"ES007069"}} ES007069 , K99 AG066949, R01 ES028712 and P30 ES000002.

Institutional Review Board Statement

Not applicable.

Informed Consent Statement

Conflicts of interest.

The authors declare no conflict of interest.

Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations.

• Nature Tours & African Safaris Okavango Delta, Botswana

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From exploring the wilds of southern Africa on our Botswana safaris to snorkeling adventures Palau and kayaking through mangroves in  Costa Rica , Boundless Journeys’ active nature tours and wildlife safaris immerse you in the natural world. Our unique and unforgettable itineraries are based upon our own travels and with the advice of our expert naturalist guides, who are among the most experienced in the world.

In fact, many of our guides come to us after years working with large outfitters, when they find themselves wanting more inspired itineraries and smaller groups. (Our safaris and nature trips never take more than 16 guests in a group, and often the number is capped at 8 or 12, not 20-40 as some companies do.)

Plus, to truly immerse you in nature, Boundless Journeys has selected luxurious wilderness camps, authentic safari lodges, and deluxe yachts that place you in the midst of the world’s great wild places in comfort and style. Excellent locations, remarkable service, and indulgent touches even in the most remote places are hallmarks of the accommodations we choose. And if you prefer an adventure for just you and your friends and family, our Custom Tours offer private alternatives for nature tours and African safaris.

So come take a walk on the wild side with Boundless Journeys!

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Each trip has been unique and wonderful with its own charms. The area I have been repeatedly impressed with is the guides. Every guide has been exceptional! Very different personalities, but all knowledgeable, friendly, adaptive, good leaders, patient, and all amazing representatives of their countries.

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Nature Explored

• Wildlife Crime - Blog
• Amboseli Mammals I (January)
• Amboseli Mammals II (January)
• Amboseli Birds I (January)
• Amboseli Birds II (January)
• Selenkay Mammals I (January)
• Selenkay Birds I (January)
• Mara Mammals I (January)
• Mara Mammals II (January)
• Mara Mammals III (January)
• Mara Birds I (January)
• Meru Mammals I (June)
• Meru Mammals II (October)
• Meru Mammals III (October)
• Meru Birds I (June)
• Meru Birds II (October)
• Meru Birds III (October)
• Meru Scenery and Sunsets I (June)
• Meru Scenery and Sunsets II (October)
• Meru Reptiles and Rivers (October)
• Naivasha and Hell's Gate (June)
• Naivasha Birds (June)
• Lake Nakuru (June)
• Lake Nakuru Mammals I (January)
• Lake Nakuru Birds and Scenery I (January)
• Ngorongoro Crater and Highlands (February)
• Ruaha Mammals I (September)
• Ruaha Mammals II (June)
• Ruaha Mammals III (June)
• Ruaha Birds and Reptiles I (September)
• Ruaha Birds and Reptiles II (June)
• Ruaha Scenery and Sunsets I (September)
• Ruaha Scenery II (June)
• Nyerere Mammals I (September)
• Nyerere Mammals II (July)
• Nyerere Mammals III (July)
• Nyerere Birds I (September)
• Nyerere Birds and Reptiles II (July)
• Nyerere Birds and Reptiles III (July)
• Nyerere Reptiles Scenery and Sunsets I (September)
• Nyerere Scenery II (July)
• NCA Mammals (February)
• NCA Birds Reptiles and Scenery (February)
• Tarangire Mammals (February)
• Tarangire Birds Reptiles and Scenery (February)
• Just Elephants
• Night Safaris
• Moremi Mammals I (August)
• Moremi Mammals II (August)
• Moremi Birds I (August)
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• Moremi Scenery (August)
• Okavango Wildlife (August)
• Okavango Scenery and Sunsets (August)
• Savuti Mammals I (September)
• Savuti Mammals II (September)
• Savuti Birds (September)
• Dry mopane bush (August)
• Savuti Scenery (September)
• South Africa (August)
• Cornish Coastline
• Amboseli (January)
• Lake Nakuru
• Mara Conservancies (January)
• Meru (June)
• Meru (October)
• Moremi (August)
• Moremi/Okavango Delta (August)
• Ngorongoro (February)
• Ruaha (September)
• Ruaha (June)
• Nyerere ex. Selous (September)
• Nyerere ex. Selous (July)
• Selenkay (January)
• NCA/SE Serengeti (February)
• Tarangire (February)
• Jackalberry Trees
• Sausage Trees
• Safari Planning
• Safari Tips
• Safari Ethics
• Photo Basics
• Composition
• White Balance
• Histograms and Tonal Range
• Wildlife Photography Considerations
• Trophy Hunting
• Amboseli January
• Meru October I
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• Moremi August
• Moremi/Okavango August
• Ngorongoro February
• Ruaha September
• Ruaha June I
• Ruaha June II
• Savuti September
• Nyerere (ex. Selous) September
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• Selenkay January
• Serengeti February
• Tarangire February
• Rhino poaching
• War on Transnational Organized Crime
• Catastrophe
• Elephant Poaching and status in 2021
• Selling rhino horn in South Africa 2018
• Poaching and related events in Eastern and Southern Africa 2017
• Great Elephant Census 2016 Results
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• Multi species poaching in Africa 2016
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• Selous 2014
• EIA Report 2014
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Welcome to Nature Explored

These photographic galleries portray some of the Magic of Nature and Wildlife from diverse environments both in the UK and Africa . I am slowly adding to the galleries as time and money permit.

There are also pages of Information for many of the National Parks and Game Reserves in Kenya, Tanzania and Botswana that I have visited, giving details of the Wildlife that is to be encountered, the climate and vegetation, and the likelyhood of being able to get away from other tourists.

There are pages of Photographic hints and techniques which may give you a starting point from which to develop your skills.

If you enjoy these photos then remember that all of nature's beautiful places need protecting right now, or else most of them, and the animals and plants that make them so special, will soon be gone. Between 2007 and 2014 144000 savannah elephants and an unknown number of forest elephants were lost to poaching . Since then the numbers are hard to quantify; they are thought to have stabilised in East Africa but are on the rise in Southern African states.

If we don't act now then elephants and many other animals could be extinct in the wild within our children's lifetimes.

Please consider helping in any way you can; even if it just means a Christmas donation to a worthwhile cause, or perhaps adding your name to an Avaaz petition calling for action to preserve a threatened species or an endangered habitat. There are some useful sites on my Links page.

Click on the thumbnails in the galleries and on most of the other pages to see the full size pictures. As well as revealing a drop down list by rolling over it, clicking on each heading on the top menu bar, or any of the drop down list submenus will show more information.

If you are considering going to any wild places then I'd go soon, as you can see from the counter below that we are rapidly expanding and our requirements for land and resources are ever increasing.

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Safari Exposure Tour Ltd

Safari Exposure Tours limited is a fully licensed Kenyan tour operator that is fast building a reputation in offering reliable and personalized services. We specialize in beach holidays, booking of Balloon safaris, conferences, culture and historic tours, honeymoons, wildlife safaris and scenic tours. We can take you to your dream African safari and what’s more we can customize any of our trips to suit your needs

Why Safari exposure? At Safari exposure tours Limited, we believe in conservation and sustainability in our conduct and activities. We are proud of you, our esteemed guests who, after the tour will appreciate our concern to protect our environment and culture. Our plea is to ask for your help and understanding in this matter purely intended to preserve nature for generations to come, yours and ours, so as they can enjoy this great heritage.

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Safari Exposure has been in the Industry for a while now. It has helped many tourists realize their adventure dreams with ease . Join these happy tourists by booking with Us!

THE 5 BEST Moscow Safaris

Safaris in moscow.

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10 cuter-than-cute animals from Primorsky Safari Park

What’s that you’ve brought me? A raccoon at Primorsky Safari Park in the village of Shkotovo.

For many years now, the most popular place for a family holiday in the Primorsky Territory has been the safari park near the village of Shkotovo (4,000 miles east of Moscow, 55 miles from Vladivostok). The famous nature reserve celebrated its tenth anniversary on Feb. 7.

Primorsky Safari Park is an enclosure inside the Ussuri taiga forest. Visitors can observe the wild inhabitants without fences or screens in conditions as natural as can be. Injured animals are nursed back to health by staff. The park has a high turnover rate: once fully recuperated, animals are released back into the wild, and their place is taken by others.

The park became famous for two local “residents”: Amur the tiger and Timur the goat. The story of their unusual friendship began in November 2015, when the cloven-hoofed one had a “dinner date” with the predator. However, Timur didn’t take kindly to being on the menu and managed to keep Amur at hoof’s length, after which they began spending time together. In late January 2016 the friends had a slight altercation, resulting in Timur being mauled for his shameless behavior. After rehabilitation, Timur was resettled. In March 2016 he received a mail-order bride all the way from Moscow — a nanny goat by the name of Merkel (no relation of the German chancellor, we presume). On January 25 Timur became the happy father of a kid, quite literally.

The young tigress Ussuri, born June 3, 2014, at the Moscow Zoo nursery, was brought to Primorsky Safari Park on October 17, 2015, as a partner for Amur. On September 18, 2016, she gave birth to a cub called Shere Khan.

The park is home to 15 species of birds of prey: hawks, owls, black kites, tawny owls, eagle owls, to name a few. A guided tour with a professional ornithologist gets you closer to the action. Some birds will even perch on your arm.

The safari park also houses foxes, badgers, minks, wolves and Amur leopards. The different species get along well.

The ungulates have an enclosed forest area of around five hectares all to themselves. Three parks in total: one winter, two summer. The animals move from park to park to give the plants time to grow. Five species of wild ungulates from the Primorsky Territory are free to roam this area, along with waterfowl and tame rabbits.

The park for ungulates now contains Manchurian wapiti, sika deer, roe deer and wild boars. The tame animals are quite happy to approach people. It’s even possible to hand-feed and stroke them, and have your picture taken together.

Dholes, or red wolves, are the rarest of animals. Once native to the Primorsky Territory, now they have all but disappeared. The last sighting of this rare species in the Primorsky Territory was back in 1973. In his Mowgli stories, Kipling described the dholes as an all-destroying, fearsome avalanche attacking the jungle. Dholes do indeed live in packs, but not as large as the fictional ones. Primorsky Safari Park currently counts three dholes in residence.

Along the perimeter of the leopard enclosure runs a six-meter high bridge offering views of leopards in their natural habitat — with no wire fencing in front of the eyes. It is currently home to one leopard, who will soon be joined by a female of the species.

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Moscow parks – leisure, nature and historical

Moscow is the most green megapolis in the world. There are over a hundred parks and green spaces like gardens, squares and boulevards. You will definitely bump into a few of them wherever you go. Whether you are interested in memorial, historic parks, parks of wildlife or you just want to have a calm break from the speedy city life – city parks have something special for everyone.

Moscow leisure parks

The leisure Moscow parks are undoubtedly the most popular and famous with the locals and travelers. Today such parks provide a great number of exciting entertainments for Muscovites and city guests, adults and children.

The Gorky Park

Gorky Park opened in 1928 and was the first holiday park in the Soviet Union with playgrounds, a sports stadium, exhibition halls and attractions for kids. Today it has a fresh, vibrant appearance. The park features bike rental stations, a comfortable business area with Wi-Fi, an outdoor movie theatre and a greenhouse where you can buy fresh greens such as basil and lettuce. To contemplate the sky and the stars, go to the observatory and look through the telescope while listening to fascinating stories from astronomers. Enjoy many sports in the park: volleyball, handball, football or a peaceful jog around the beautiful surroundings.

Zaryadye Park

Opened in September 2017, Zaryadye is the youngest on our list. Located just a few minutes away from Red Square, it includes various activities like the floating bridge with its thin V-form extension, an ice cave, also concert hall and an amphitheater. The entire territory of the park was divided into four zones of Russia: forest, steppe, tundra, and the floodplains.

Neskuchny Sad

By walking along the Moskva River’s bank from the Gorky Park towards Vorobievy Gory (Sparrow Hills) you’ll reach Neskuchny Sad («Not Boring» garden), a wonderful place in the Moscow center, one of Moscow’s oldest parks, charming slice of wildlife. The park mostly consists of pristine forest, dotted with old summer pavilions, ponds and quaint little stone bridges. There are a lot of opportunities for different activities lots of children playground, a ping-pong and chess clubs, football fields and tennis courts, horse riding, tree climbing and having rest in one of the nice cafes.

Museon Park

Hermitage Garden

Hermitage Garden has always been known as an amusement, entertainment center with theatres, shows, cafes, summer pavilions, pergolas since 1830. Shalyapin, Sobinov, Nezhdanova – great Russian opera singers starred on the garden stage. Famous Russian composer Rakhmaninov conducted the orchestra. Sara Bernar, Maria Yermolova, outstanding actresses, played in the open air performances. Tolstoy and Lenin had a stroll in the garden. So lots of celebrities from different epoques liked it a lot and spent their time in Hermitage Garden. You can find here three theatres in the garden: Hermitage, Sphere and New Opera. During winter an ice rink works here and in summer a musical stage is assembled to host jazz and brass band festivals.

In Sokolniki Park visitors can play billiard, chess or draughts, table tennis, as well as go cycling, roller blading and swimming in the summer and ice skating or skiing in winter. Each season is highlighted by special memorable and bright events, for example, Summer Jazz Festival or Baby Fest (for future mums), open air beach disco parties, Ice Cream Day, International Clown Festival and many other shows and exhibitions. The park has an observatory, kids center and a co-working zone with free Wi-Fi which is really nice for spending high quality work time there.

Moscow nature parks

The nature parks are national reserves with the amazing forestry and incredible variety of animals and plants there. The breath of wildlife and the chance to be closer to the virgin nature excites both children and grownups. Hundreds of different species of animals can be found in Moscow nature parks. The richest woodlands with old and even ancient trees, like a 200 years pine-tree in the Elk Island National Nature Park, are the point of passionate interest for visitors.

Aptekarsky Ogorod

Aptekarsky Ogorod (Apothecary Garden)

Aptekarsky Ogorod (Apothecary Garden) is one of the oldest gardens in Moscow. It was founded in the XVIII century by Peter the First (great Russian emperor). A larch that he planted himself still grows in the garden, so it’s more than 250 years old. At the time of its foundation, it was a garden with herbs and medicinal plants and was used as an educational center for doctors. Today there are the orangery with its tropical palms, the carp pond, and the immense trees that dot the landscape and turn wonderful golden shades in the autumn. Several restaurants and cafes work here making it a very nice spot for relaxation no matter what season it is. You can book a special tour or join the guided excursion group.

Losiny Ostrov

Losiny Ostrov (Elk Island Park)

Losiny Ostrov (Elk Island Park) is located at the north of Moscow. It covers 22 km from the west to the east and 10 km from the north to the south and it’s one of the most beautiful national parks in Moscow. Two rivers, Yausa and Pechorka begin here. You can find lots of fields, ponds, meadows, streams in the park as well as elks. Here you can enjoy guided tours, available in English. You can choose a guided tour about flora and fauna of the area, you’ll learn why elks are there, which animals are their neighbors. Or enjoy another excursion, which is totally devoted to historical past of ancient tribes once lived there, you’ll know about old Russian mythology, rituals and traditions.

Serebyany Bor

Serebyany Bor (Silver Forest)

Serebyany Bor (Silver Forest) is a famous pine forest in the west of Moscow. The park has 230 forms of plant life, and is also home to watersports complex, providing a lot of activities for visitors. The layout of Serebryany Bor is unusual, as it is located on an artificial island between a meander in the Moscow River and a channel. There is an artificial lake, the Deep Gulf and picturesque Bezdonnoe (Bottomless) Lake in the depths of the forest. Serebryany Bor’s beaches are the cleanest in the city and very popular among Muscovites. On weekends it is difficult to find a free spot here, especially because a whole range of services are offered to visitors, from simple deckchairs to catamaran and yacht rides. Driving is prohibited on the territory of the island so be ready to use trolleybus to reach the entrance.

Botanichesky Sad

Greenhouse of Botanical Garden

Main Botanical Garden of The Russian Academy of Sciences is the largest and most famous is Moscow. The garden is a real museum of nature with a very rich (more than 18000 types) collection of plants. The park was founded in 1945 at the place of the 17th century Apothecaries’ Gardens. The garden’s collection is turned into botanical expositions, made with use of modern receptions of landscape architecture. Here you can see a tree nursery, a shadow garden, hothouse complex, collection of flowers, a rosary, exposition of coastal plants, garden of continuous blossoming, Japanese garden and expositions of cultural plants and natural flora plants. The biggest part of Garden is the Tree nursery occupying the space of 75 hectares. About 2 thousand wood plants grow here. Another big exposition of the Garden is nature Flora, divided into six botanic-geographical collections: European part of Russia, Caucuses, Central Asia, Siberia and Far East. Pride of the Main Botanical Garden is the collection of tropical, coastal and water plants, which is considered as the best in Europe. The Japanese garden, a great model of Japanese landscape gardening art has a 13-level stone pagoda of the 18th century, stone Japanese lamps, ponds, falls and streams, tea lodges and more than 100 species of the most character Japan plants. It is especially decorative in spring, during Oriental cherry blossoming and in fall, when foliage blazes in crimson colors.

Moscow historic parks

Historic nature parks and estates once were the mansions of the Moscow aristocracy. At that far times the estates were outside the Moscow city limits, but after the city expansion and urbanization, they became easily accessible.

Kolomenskoye

Kolomenskoye Museum and Park

The chief attraction of the park is undoubtedly the stone Church of the Ascension of the Lord. It was constructed in 1532 by order of Tsar Vasily III to commemorate the birth of his son and heir, Ivan the Terrible. But there is a lot more to see in the park: the pretty Church of the Icon of Our Lady of Kazan – with its bright azure domes and plenty of gold. Further into the park there is a charming Church of the Beheading of St John the Baptist, built by Ivan the Terrible to mark his coronation.

Kuskovo Park

Kuskovo Park is one of the oldest country estates in Moscow. It was given to General Sheremetev by Peter the Great in 1715, but was left to fall into neglect before being plundered by Napoleon’s troops in 1812. Nowadays the estate has been restored to its former glory and is a good example of Russian 18th Century imperial architecture. The palace is a fine and rare example of wooden neoclassicism. It was completed in 1775, and the rich interiors remain unchanged since 1779. It includes a room hung with exclusive exquisite Flemish tapestries, an abundance of silk wallpaper and an impressive collection of 18th century European and Russian paintings. The palace looks onto the lake, which is surrounded by smaller pavilions: pretty Italian, Dutch and Swiss Cottages, Blank’s Hermitage and the old Orangery, where the State Ceramics Museum is located now, an extensive and absorbing collection of porcelain from the 18th century to the present day. On the other side of the lake is a large wood popular with local cyclists and joggers.

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Palouse Nature Center

Welcome to the palouse nature center.

Visitors are always welcome at the Palouse Nature Center!  Located at 1040 Rodeo Drive in Moscow, Idaho, our 26.2-acre Nature Center is open dawn to dusk 7 days a week. Enjoy many unique features such as:

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EV Charging at the Nature Center

Thanks to a generous donation from a local PCEI supporter, you can now find an electric vehicle charging station featuring three chargers at the Palouse Nature Center! The public is invited to come charge Tesla or non-Tesla electric vehicles anytime, 24/7. There’s no cost to charge, but we appreciate all donations toward electric use. Payments can be made with credit or debit cards online , and cash or checks can be deposited in the donation frog across the parking lot.

Find PCEI’s charging station on Tesla’s website as well as on the app PlugShare . While your vehicle charges, take a walk around the Nature Center or have a picnic under the trees. We’re grateful to the donor who made this charging station possible!

How to Get Here

From downtown Moscow by car: Head north on Main Street past Moscow Building Supply. Turn right on Rodeo Drive, cross North Polk extension and continue on Rodeo Drive to the end of the road.

From downtown Moscow by bike or foot: Head north on Main Street. Turn right on ‘E’ Street and head east. Turn left (north) on Polk Street and continue until Rodeo Drive. Turn right onto Rodeo Drive to the end of the road.

Click here for a PDF of the Palouse Nature Center map.

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“Feed the Frog” the next time you visit and we’ll put your donation to good use to maintain and improve the Palouse Nature Center. Thank you for your support! Give us a call at 208.882.1444 or email [email protected] if you have any questions.

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• Published: 05 June 2024

Does time of intraoperative exposure to the aerobiome increase microbial growth on inflatable penile prostheses?

• Vinayak Madhusoodanan   ORCID: orcid.org/0000-0002-5499-7876 1 ,
• Maria Camila Suarez Arbelaez 1 ,
• Aymara Evans 1 ,
• Adele Raymo   ORCID: orcid.org/0000-0003-0322-4993 1 ,
• Armin Ghomeshi 2 ,
• Beatriz Hernandez 3 ,
• Maxwell Towe 1 &
• Ranjith Ramasamy 1  

International Journal of Impotence Research ( 2024 ) Cite this article

Metrics details

• Erectile dysfunction
• Risk factors
• Sexual dysfunction

Inflatable penile prosthesis (IPP) implantation is a surgical approach for the management of erectile dysfunction (ED). A feared complication is IPP infection, and increased operative time is a risk factor for infection. Exposure of an IPP implant to ambient air in the operating room (OR aerobiome) is thought to contribute to risk of infection from increased operative time, but this is not well-supported. The objective of this study was to evaluate if exposure to the OR aerobiome increased microbial colonization of IPPs. This was an ex vivo study using an uncoated IPP, observing standard surgical sterility and OR conditions. A sterile swab was collected every 30 min for 3 h from each IPP component. Positive controls consisted of swabs exposed to unprepped scrotal skin during in-office vasectomies. All swabs underwent quantitative polymerase chain reaction (qPCR) and next generation sequencing (NGS). Bioinformatic processing was carried out and taxonomic assignment was performed. No microbial growth was detected on any component of the IPPs at any time point, while positive control swabs all detected various skin flora, including bacterial and fungal growth. These findings suggest that exposure to the OR aerobiome does not increase the risk of IPP microbial colonization, at least within a 3-hour period. Further in vivo studies are needed.

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Data generated and analyzed during this study can be found within the published article and supplementary material, and additional data as applicable can be produced by the corresponding author upon reasonable request.

Kohn TP, Rajanahally S, Hellstrom WJG, Hsieh TC, Raheem OA. Global trends in prevalence, treatments, and costs of penile prosthesis for erectile dysfunction in men. Eur Urol Focus. 2022;8:803–13.

Article   PubMed   Google Scholar  

Lux M, Reyes-Vallejo L, Morgentaler A, Levine LA. Outcomes and satisfaction rates for the redesigned 2-piece penile prosthesis. J Urol. 2007;177:262–6.

Govier FE, Gibbons RP, Correa RJ, Pritchett TR, Kramer-Levien D. Mechanical reliability, surgical complications, and patient and partner satisfaction of the modern three-piece inflatable penile prosthesis. Urology. 1998;52:282–6.

Article   CAS   PubMed   Google Scholar  

Carson CC 3rd, Mulcahy JJ, Harsch MR. Long-term infection outcomes after original antibiotic impregnated inflatable penile prosthesis implants: up to 7.7 years of followup. J Urol. 2011;185:614–8.

Grewal S, Vetter J, Brandes SB, Strope SA. A population-based analysis of contemporary rates of reoperation for penile prosthesis procedures. Urology. 2014;84:112–6.

Dhar NB, Angermeier KW, Montague DK. Long-term mechanical reliability of AMS 700CX/CXM inflatable penile prosthesis. J Urol. 2006;176:2599–601.

Wilson SK, Delk JR, Salem EA, Cleves MA. Long-term survival of inflatable penile prostheses: single surgical group experience with 2,384 first-time implants spanning two decades. J Sex Med. 2007;4:1074–9.

Henry GD, Donatucci CF, Conners W, Greenfield JM, Carson CC, Wilson SK, et al. An outcomes analysis of over 200 revision surgeries for penile prosthesis implantation: a multicenter study. J Sex Med. 2012;9:309–15.

Quesada ET, Light JK. The AMS 700 inflatable penile prosthesis: long-term experience with the controlled expansion cylinders. J Urol. 1993;149:46–8.

Jarow JP. Risk factors for penile prosthetic infection. J Urol. 1996;156:402–4.

Abouassaly R, Angermeier KW, Montague DK. Risk of infection with an antibiotic coated penile prosthesis at device replacement for mechanical failure. J Urol. 2006;176:2471–3.

Carvajal A, Henry GD. Prevention of Penile Prosthesis Infection. Curr Urol Rep. 2022;23:75–81.

Baird BA, Parikh K, Broderick G. Penile implant infection factors: a contemporary narrative review of literature. Transl Androl Urol. 2021;10:3873–84.

Article   PubMed   PubMed Central   Google Scholar  

Swanton AR, Munarriz RM, Gross MS. Updates in penile prosthesis infections. Asian J Androl. 2020;22:28–33.

Pineda M, Burnett AL. Penile prosthesis infections-a review of risk factors, prevention, and treatment. Sex Med Rev. 2016;4:389–98.

Stocks GW, Self SD, Thompson B, Adame XA, O’Connor DP. Predicting bacterial populations based on airborne particulates: a study performed in nonlaminar flow operating rooms during joint arthroplasty surgery. Am J Infect Control. 2010;38:199–204.

Song Z, Borgwardt L, Høiby N, Wu H, Sørensen TS, Borgwardt A. Prosthesis infections after orthopedic joint replacement: the possible role of bacterial biofilms. Orthop Rev (Pavia). 2013;5:65–71.

PubMed   Google Scholar  

Ribeiro M, Monteiro FJ, Ferraz MP. Infection of orthopedic implants with emphasis on bacterial adhesion process and techniques used in studying bacterial-material interactions. Biomatter. 2012;2:176–94.

Titan® Penile Implant [cited 2024 01/02/2024]. Coloplast Titan Product Description]. Available from: https://products.coloplast.co.uk/coloplast/implantable-devices/mens-health/erectile-dysfunction/titan-penile-implant/ .

McEvoy JP, Martin P, Khaleel A, Dissanayeke S. Titanium kirschner wires resist biofilms better than stainless steel and hydroxyapatite-coated wires: an in vitro study. Strategies Trauma Limb Reconstr. 2019;14:57–64.

Baas W, O’Connor B, Welliver C, Stahl PJ, Stember DS, Wilson SK, et al. Worldwide trends in penile implantation surgery: data from over 63,000 implants. Transl Androl Urol. 2020;9:31–7.

Rodriguez KM, Kohn TP, Davis AB, Hakky TS. Penile implants: a look into the future. Transl Androl Urol. 2017;6:S860–s6.

Martinez RM, Bowen TR, Foltzer MA. Prosthetic device infections. Microbiol Spectr. 2016;4.

Mulcahy JJ. Current approach to the treatment of penile implant infections. Ther Adv Urol. 2010;2:69–75.

Eid JF, Wilson SK, Cleves M, Salem EA. Coated implants and “no touch” surgical technique decreases risk of infection in inflatable penile prosthesis implantation to 0.46. Urology. 2012;79:1310–5.

Napoli C, Tafuri S, Montenegro L, Cassano M, Notarnicola A, Lattarulo S, et al. Air sampling methods to evaluate microbial contamination in operating theatres: results of a comparative study in an orthopaedics department. J Hosp Infect. 2012;80:128–32.

Fernstrom A, Goldblatt M. Aerobiology and its role in the transmission of infectious diseases. J Pathog. 2013;2013:493960.

Sadrizadeh S, Pantelic J, Sherman M, Clark J, Abouali O. Airborne particle dispersion to an operating room environment during sliding and hinged door opening. J Infect Public Health. 2018;11:631–5.

Sunagawa S, Koseki H, Noguchi C, Yonekura A, Matsumura U, Watanabe K, et al. Airborne particle dispersion around the feet of surgical staff while walking in and out of a bio-clean operating theatre. J Hosp Infect. 2020;106:318–24.

Scigliano NM, Carender CN, Glass NA, Deberg J, Bedard NA. Operative time and risk of surgical site infection and periprosthetic joint infection: a systematic review and meta-analysis. Iowa Orthop J. 2022;42:155–61.

PubMed   PubMed Central   Google Scholar  

Hebert KJ, Kohler TS. Penile prosthesis infection: myths and realities. World J Mens Health. 2019;37:276–87.

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Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL, USA

Vinayak Madhusoodanan, Maria Camila Suarez Arbelaez, Aymara Evans, Adele Raymo, Maxwell Towe & Ranjith Ramasamy

Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA

Armin Ghomeshi

Tecnologico de Monterrey, School of Medicine and Health Sciences, Nuevo Leon, Mexico

Beatriz Hernandez

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VM: Experiment Design, Experiment Execution, Result Interpretation, Manuscript Writing, Manuscript Revision. MCSA: Experiment Design, Experiment Execution, Result Interpretation, Manuscript Revision. AE: Experiment Design, Experiment Execution, Result Interpretation, Manuscript Revision. AR: Result Interpretation, Manuscript Writing, Manuscript Revision. AG: Result Interpretation, Manuscript Writing, Manuscript Revision. BH: Result Interpretation, Manuscript Revision. MT: Experiment Design, Result Interpretation, Manuscript Revision. RR: Experiment Design, Result Interpretation, Manuscript Writing, Manuscript Revision.

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Correspondence to Vinayak Madhusoodanan .

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RR: Is a consultant and grant recipient of both Coloplast and Boston Scientific.

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Madhusoodanan, V., Suarez Arbelaez, M.C., Evans, A. et al. Does time of intraoperative exposure to the aerobiome increase microbial growth on inflatable penile prostheses?. Int J Impot Res (2024). https://doi.org/10.1038/s41443-024-00906-6

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Received : 11 January 2024

Revised : 30 April 2024

Accepted : 08 May 2024

Published : 05 June 2024

DOI : https://doi.org/10.1038/s41443-024-00906-6

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