Therapeutic engagement with blue spaces supports enhanced well-being for a variety of populations Blue care is a therapeutic approach that utilizes natural blue space environments, such as rivers, lakes, and oceans, to enhance health and well-being. This literature review examined how blue care, as a therapeutic nature-based intervention (NBI), can benefit physical, emotional, and psychological well-being. The review was also conducted to explore how blue care can inform recreational therapy (RT) practice. RT is an approach that utilizes recreation-based activities to promote well-being for individuals with illnesses, disabilities, or other health conditions. The review is supported by the Stress Reduction Theory, which provides a framework for understanding how the restorative effects of nature, including blue space, may support psychological and physiological well-being.
A search of the existing literature was conducted to identify peer-reviewed articles that examined the therapeutic benefits of blue space. The search prioritized studies that presented original research data or that were aligned with RT practice and focused on physical, emotional, cognitive, or social well-being. Studies of interventions that involved active engagement with blue space, such as swimming, paddleboarding, surfing, sailing, and water exercise, were considered for inclusion. Studies that examined passive exposure to blue spaces, such as living near blue space environments or passively observing blue spaces (including images or virtual reality), were also considered. Only studies that examined natural aquatic settings and were published after 2005 were eligible for inclusion in the literature review. The search yielded 25 studies that employed a range of methodologies, including 21 original studies and four literature reviews. The studies involved a variety of populations, which included children (with and without disabilities), adolescents, families, college students, adults, seniors, individuals with psychiatric disorders, and veterans with post-traumatic stress disorder (PTSD). The majority of studies were conducted in the United Kingdom.
Overall findings of the review indicate that, “whether through direct immersion, visual exposure, or structured activities, blue care offers a comprehensive approach to enhancing well-being.” The review identified therapeutic benefits related to physical, emotional, and psychological well-being. Findings regarding physical well-being highlighted the opportunities for physical activity that blue spaces afford. Engagement with blue space was linked to increased physical activity, improved weight, and decreased risk of obesity. Living near blue space was linked to active, healthy lifestyles and indicators of physical well-being. Studies also indicated that active and passive interactions with blue spaces contribute to emotional well-being, including increased positive emotions and decreased depressive symptoms. For parents and children, beach visits promoted feelings of happiness, restoration, and relaxation. For older adults, living near the coast was associated with decreased depressive symptoms. Studies reported that actively engaging with blue spaces was linked to satisfaction with body image, positive moods, relaxation, and restoration. Viewing images of blue spaces also promoted positive moods and restoration. Psychological well-being benefits reported by the studies indicate that blue space can have a positive effect on mental health conditions such as PTSD symptoms. Exposure to blue spaces may also contribute to long-term psychological well-being, with one study reporting an association between blue space exposure and a reduced risk of subsequent psychiatric disorders and anxiety in adults. The review also considered factors that can limit the effectiveness of blue care. For example, research indicates that water pollution or littered beaches reduces the restorative effects of blue space.
The review highlights a range of well-being outcomes that may be supported through blue care. Across studies, these outcomes were consistently focused on physical activity, positive body image, emotional well-being, and psychological restoration. Importantly, these benefits were observed across a variety of blue care settings and intervention types. The review also calls attention to the close alignment between the aims and approaches of blue care and recreational therapy. The authors conclude that “the consistency of blue care outcomes across diverse populations and settings highlights the potential for blue care to be incorporated as an effective therapeutic intervention in RT.” Researchers should continue to explore the outcomes associated with specific types of blue space to clarify how particular environmental characteristics influence therapeutic responses. An improved understanding of such processes would enable more “personalized and effective treatment planning, ensuring that blue care interventions are matched to the unique needs and goals of the client.”
The Bottom Line