Welcome to this edition of Compassionate Nature which considers the benefits of experiencing water within different environmental settings and the health benefits of open water swimming.
Oh, Eeyore, you are wet!” said Piglet, feeling him.
Eeyore shook himself, and asked somebody to explain to Piglet what happened when you had been inside a river for quite a long time.
While the wonderful Eeyore from the Hundred Acre Wood might not enjoy immersing himself in a river lots of people do. Open water or wild water swimming (for this post I will use with the term open water) has seemingly increased in the last few years.
A quick internet search will bring back lots of media articles and social media posts extolling its virtues, often linked to physical and mental wellbeing benefits, with guides on the best places to go swimming and some pieces that sadly reflect the health risks through the degradation of river and sea-water due to sewage release. As with taking up most physical exercise, it is best to be informed and ensure it’s an appropriate activity for you, rather than just jumping into the often cold water. As a relatively low cost and fairly accessible activity it has attracted attention for its potential use within social prescribing or as part of a formal treatment for a clinical mental health issue.
Data from the Sport England website supports the view that it is a physical activity enjoyed by many people. The data shows around 3.5 million people regularly took part in open water swimming between November 2021-2022. The popularity of open-water swimming is often reported as being linked to the periods of covid health restrictions, although this data actually suggests more people were doing so in England before the pandemic period, which is interesting, although perhaps travel restrictions as part of public health measures may possibly be a factor in the dip.
It is suggested that the benefits of blue spaces, where water is the main feature, are distinct from green spaces, such as woodlands and parks. There is possibly more psychological research on green spaces, although it appears that imbalance is now being addressed. I wondered if similar wellbeing benefits that are often reported from green spaces are also gained from exposure to blue spaces or do they differ? Does being in the water provide more benefits than walking alongside it? What about health benefits from experiencing water in an urban setting or combined within a green space? I am interested in the possible additive benefits (well, not from swimming if honest) due to living in a village that is situated between a large river and what was once a major canal, although the barges that use the latter now are for recreation rather than transport. When I walk along the tow-path, with the canal on one side of me and a field or woodlands on the other side, what benefits might I be experiencing?
Now add water.
A few years ago I attended a conference where Marc Jones talked about research which he co-authored (Gidlow et al., 2015) which looked at the wellbeing benefits of green and blue spaces. While a small scale pilot study of 38 participants, who were mainly male with a mean age of 41, a strength of the study was the use of both self-report measures and physiological measures to assess the benefits. Each participant was randomly allocated to complete a 30 minute walk either in a quiet residential setting (urban space), a park within a city (green-space) or along a canal (blue space). A number of measurements were taken before and after the walk, followed by 30 minutes after completion, including mood, cognitive functioning via a simple working memory test, and sense of restoration. Heart rate (HR), heart rate variability (HRV) and cortisol levels in salvia were also recorded to assess stress levels.
Research geek aside - the steroid cortisol is a hormone involved in the response to stress and can be measured non-invasively from samples of salvia or hair. A stress response consists of two parts, a fast and slow process, with cortisol managing the slow process by ensuring that physiological processes that support a “flight or fight” response receive the energy required, while those not involved, for example digestion, are restricted. This is why if we remain in a prolonged stressed state with high levels of cortisol then the restorative processes which support growth, immunity and replenishment continue to be depleted of energy, potentially resulting in reduced health and mental wellbeing. Heart rate variability measures the timing variation between heart beats and during times of stress the variation tends to be lower.
The study results suggested that participants cognitive function improved along with a greater perceived sense of restoration from walking in the natural environments compared to the urban one, with the benefits still present 30 minutes after the walk finished. The study did not find any difference in self-report mood measures nor in the physiological measures across the different spaces, with statistically significant decreases in cortisol levels in all three. It is a small scale study of healthy adults with low baseline levels of stress and the results suggest the physical activity was the dominant factor in reducing stress as measured by cortisol, although walking in the green space was perceived to be more restorative.
So that doesn’t suggest any difference in blue or green space, they appear to afford similar benefits. A more recent, similar study may shed more light on the additive benefits of water. Jie Yin and colleagues (2023) considered the benefits of experiencing water during a walk within an urban or a natural space, with the assessment also including physiological measures. It is again a small scale study of 20 young Taiwanese adults, predominately male and aged 20-26, who each completed 4 walks of 30 minutes in an urban space without water, an urban space with water, a green space with water and a green space without water. The green space was a park with a lake while the urban space included a canal and the walks were held over a short time period, with each participant doing each walk in a random order. The self-report measures included mood and sense of restoration, while HR and HRV provided physiological measurements. The results found the addition of water to the urban space provided mental health benefits relating to positive affect, self-esteem and provided a sense of being away from daily life, while the addition of water in the green space appeared to support the benefits of restoration and nature connection, with a reduction in negative affect and increase in positive affect indicators. The study is limited by the sample size and demographic representation, as well as the consideration of any experiential differences between the lake and the canal settings. It was undertaken during a warmer seasonal period, so further studies could consider any seasonal variations. Overall the findings indicate that positive mood improvements from the addition of water were greater in the urban setting than the natural setting, which is perhaps not surprising given the element of nature that the canal brought into that setting. This does have implications for urban planning, to consider water features and blue spaces as well as green spaces to support wellbeing, given that urban areas are often found to have greater levels of poor mental health in comparison to rural areas. This is especially important given the increasing levels of urbanisation.
Jump in, the water’s lovely!
Those studies all featured walking near water - what about getting into the water? While Eeyore failed to appreciate the benefits of being in the water, a scoping review by Katie Overbury and colleagues (2023) may help to illustrate reported benefits of open water swimming from their analysis of several studies.
Research geek aside - a scoping review is not the same as a systematic review of research, with the latter being more focused on addressing a specific research question by critically assessing quality and findings of relevant studies. A scoping review provides an overview of the available evidence relating to a topic, to provide evaluation of the current level of research , as well as summarising key elements of the related research. This is useful in spotting gaps in research, quality of evidence base and may inform a later systematic review, as well as being a robust standalone piece of work.
The scoping review aimed to examine what the identified mental health benefits from open water swimming were and what level of supporting evidence was available. After screening potential studies, the review selected 14 studies, consisting of 5 quantitative, 8 qualitative and 1 mixed methods. 10 studies were based on swimming in the sea with the rest covering rivers, lakes or lochs. The studies were from different countries, mainly European, plus Australia and Finland.
Of the 5 quantitative studies, 4 provided evidence supporting mental health benefits of open water swimming, while 1 had unclear results. However there are limitations that affect these findings. One study provided no statistical data as it was a longitudinal single case study, with the benefits assessed against the reduction in symptoms of clinical depression as opposed to using standard measures. Another study compared the perceived additional benefits obtained by winter swimmers to non-winter swimmers with both reporting psychological benefits, but this means the results are to a specific population. Other studies also used non-representative samples, presenting the risk of bias from self-selection and lack of blind allocation within conditions. One of the studies used a non-validated measure, while another had a sample size that that was insufficient to support the statistical analysis. A number of the studies had high attrition rates of participants which may indicate a participatory barrier to open water swimming that requires more research to fully explore. These limitations should be acknowledged when considering the reported psychological benefits, which included reductions in stress and anxiety, improved mood and affect, with a couple of studies noting physical improvements of participants feeling less fatigue and more energised.
The quality of the selected qualitative studies was perhaps higher than the quantitative although limitations were noted across several, including limited analysis, inadequate detail on participants, and uncertainty around the research question that the study was addressing. The collected data of the qualitative studies was analysed using thematic analysis to identify two key themes of water connection and social connection. Water connection included participants reporting a strong relationship with and attachment to the places they swam in, with the experience providing a multi-sensory engagement to nature. The immersion in the water was perceived as being more therapeutic and beneficial than walking in a blue space. Increased awareness of the risks involved in open water swimming aided understanding both physical and mental strengths and limitations. Being supported by the water was perceived as providing a sense of freedom and embodiment, where the focus is more on the physical sensations and diverted focus away from thinking about daily life. The wellbeing benefits were reported to increase over time as experiences and instances of open water swimming increased. The social connection theme highlighted that swimming encouraged a sense of purpose and belonging, as well as providing positive interactions with people doing the same activity. The presence of others afforded a sense of safety and support, with some older participants highlighting regular sessions provided them with a routine. Swimming invoked childhood memories or resulted in childlike behaviour which added to the positive experience. Some negative comments were mentioned, from being worried about being judged when in a swimming group and negative emotions in response to being aware of impacts to the water through human activities.
Overall the scoping review found that there is limited robust evidence of the benefits of open water swimming. This is not to say there are not mental and physical benefits that can be obtained from the activity, rather that the evidence base identified by the review suggests that more research is needed, especially to help inform the potential use of open water swimming as a formal health intervention. The reviewed studies do indicate that open water swimming offers a multi-sensory physical activity that supports nature connection and social connection, which all have strong evidence bases highlighting their importance to physical wellbeing and mental health.
Swimming and meaning.
It is rare to read an academic journal article and be emotionally moved. As I was reviewing the two 2023 papers for this post a paper was published by Emma Boocock (2024) based on her experience of open-water swimming and grief. Emma presents an autoethnographic account, which is a blend of personal experience coupled with research, to explore how swimming helped following the traumatic bereavement of her father. Reflecting some of the qualitative findings from the scoping review, the role of immersion and embodiment from being in the water is considered as a key element, along with how water fulfils a role within a therapeutic landscape. The heightened sensory experience of being in the water helps to connect with nature and to oneself, with the repetitiveness of the swimming action helpful to reduce levels of thinking and provide a respite from grief. Although Emma swam within a group, initially social connection was avoided although over time and unwittingly she became part of the community, which helped provided a sense of identity and belonging, elements which grief can often shatter. The benefits from swimming seemed to increase over time, again reflecting comments in the review, helping to address a numbness following the bereavement. Rather than being a healing process, Emma presents open water swimming as a form of palliative care which provides restoration and respite towards addressing the grief and trauma relating to the events around her father’s death. It is a very well-written and informative open access paper which I recommend reading in full.
Exposure to blue spaces can offer respite from daily life, especially within urban settings and add to the restorative elements within green spaces. Specific benefits of open water swimming appear to relate to the multi-sensory engagement with a natural environment, which for some may be of greater therapeutic benefit than a walk.
I don’t think I will be digging out the swimming trunks quite yet, probably to the great relief of the barge owners on the local canal, but perhaps Eeyore did feel a little better than he realised after his dip in the river.
I would love to hear your thoughts on this or any previous posts, please feel free to add a comment, send an email to TheCompassionateNatureHub@gmail.com or add a reply if you see it via social media. Please also feel free to share the post on to anyone you think may be interested.
References
Boocock, E. (2024). Navigating grief: an autoethnographic tale of open water swimming and loss. Leisure Studies, 1-13. https://doi.org/10.1080/02614367.2024.2302345
Gidlow, C. J., Jones, M. V., Hurst, G., Masterson, D., Clark-Carter, D., Tarvainen, M. P., ... & Nieuwenhuijsen, M. (2016). Where to put your best foot forward: Psycho-physiological responses to walking in natural and urban environments. Journal of environmental psychology, 45, 22-29. https://doi.org/10.1016/j.jenvp.2015.11.003
Overbury, K., Conroy, B.W., Marks, E. (2023) Swimming in nature: A scoping review of the mental health and wellbeing benefits of open water swimming, Journal of Environmental Psychology, 90, 102073 https://doi.org/10.1016/j.jenvp.2023.102073
Yin, J., Ramanpong, J., Chang, J., Wu, C. D., Chao, P. H., & Yu, C. P. (2023). Effects of blue space exposure in urban and natural environments on psychological and physiological responses: A within-subject experiment. Urban Forestry & Urban Greening, 87, 128066. https://doi.org/10.1016/j.ufug.2023.128066