This PhD research project is grounded in a growing body of global research that positions surfing and other nature-based activities as meaningful contributors to public health. As rates of physical inactivity and mental health conditions continue to rise, governments and health systems are seeking scalable, evidence-based interventions that promote wellbeing, deliver outcomes, and make efficient use of prevention budgets. Surfing has long shown promise in this space, but until recently lacked the data to support delivery at scale.

The research presented here bring together international studies and policy frameworks that highlight the physiological and psychological benefits and value of physical activity and blue space environments for health. This body of evidence underpins the PhD’s core objective: to demonstrate that surfing is a powerful health intervention, one that is measurable, cost-effective, and ready to be integrated into prevention strategies, social prescribing pathways, and public health policy.

Nature‑based and Blue Space Interventions

AREAS

Key evidence and policy insights

A 2021 scoping review synthesised peer‑reviewed studies on nature‑based physical activity. It found that combining nature exposure with physical activity provides greater health benefits than either alone and argued for strategies to increase nature‑based activity . The review noted that only 24–26 % of children and 53 % of adults meet recommended activity levels and that time spent outdoors has declined sharply over recent decades. This context underscores why governments are looking to new interventions such as surf therapy and blue health programmes.
A Scoping Review of the Health Benefits of Nature-Based Physical Activity - PMC

Health benefits of nature‑based physical activity (global)

An expert‑elicitation review identified 27 forms of NBIs, including green prescriptions, blue space activities and wilderness therapy, and grouped them into environmental modifications (e.g., hospital gardens, urban parks) and behavioural programmes (e.g., organised outdoor activities). Evidence shows that NBIs reduce blood pressure and allergies and lower depression and anxiety. Governments worldwide are starting to integrate NBIs into health and planning policies; the authors emphasise the need for clear guidance to ensure investment decisions are effective.
Nature–Based Interventions for Improving Health and Wellbeing: The Purpose, the People and the Outcomes

Nature‑based interventions (NBIs)

A systematic review of 33 interventions found that ‘blue care’ programmes, activities undertaken in coastal or aquatic environments, consistently improve mental health and psychosocial wellbeing. Physical health outcomes were less frequently reported, but social connectedness sometimes increased. The review noted that therapeutic nature‑based practices are outpacing policy and the evidence base, urging further research and policy integration.
Blue care: a systematic review of blue space interventions for health and wellbeing

Blue space interventions

The same review highlights growing policy interest in blue spaces as governments confront a non‑ communicable disease crisis driven by sedentary lifestyles. Programmes such as NEAR Health and BlueHealth are building evidence for integrating blue spaces into urban planning and health promotion. These initiatives support policies that prescribe nature‑based activities (including surfing) to address rising mental‑ health disorders and healthcare costs.
Green and blue space exposure and non-communicable disease related hospitalizations: A systematic review

Nature‑based solutions in policy

Surfing and Surf Therapy Research

AREAS

Key evidence and policy insights

Controlled studies show promising but varied results. A randomised controlled trial with U.S. service members found that surf therapy and hike therapy both reduced depression, but surf participants were more likely to remit at 3‑month follow‑up. A UK pilot RCT for children and adolescents reported short‑term reductions in depression and anxiety (effect sizes 0.57 and 0.43) and improvements in peer relationships. Mixed‑methods research with Australian youth reported increases in self‑esteem, resilience and social connection following an 8‑week surf programme. These studies emphasise the potential of surf therapy within social‑prescribing schemes and highlight the need for larger trials.
A randomized controlled trial of surf and hike therapy for U.S. active duty service members with major depressive disorder

Surf therapy trials and mental‑health outcomes

A 2024 commentary in npj Ocean Sustainability argues that surfing offers distinct health and wellbeing benefits compared with green‑space activities. Personal Wellbeing Index scores among Australian surfers exceed national averages, and surfing’s unique sensory experience may enhance mental‑health outcomes. The authors call for recognising surfing as a catalyst for sustainability and resilience in coastal communities and note that stress‑reduction benefits have been valued at about US $5 000 per person per year. They also observe that surf therapy benefits children with conditions such as cystic fibrosis and produce knock‑on benefits for caregivers and programme staff.
Understanding surfing as a ‘blue space’ activity for its contributions to health and wellbeing

Understanding surfing as a ‘blue space’ activity

Buckley and Cooper estimated the mental‑health value of recreational surfing using healthcare savings and productivity gains. For Australia’s Gold Coast, the mental‑health component accounts for 57–74 % of total surfing value and contributes about US $1.0–3.3 billion per year. Globally, these benefits may amount to US $0.38–1.30 trillion annually, four to twelve times greater than direct tourism income. The authors argue that including mental‑health benefits can strengthen political support for protecting surf breaks and attract philanthropic or institutional investment.
Mental health contribution to economic value of surfing ecosystem services

Economic valuation of surfing’s mental‑health benefits

Supporting Research