Background: Healthy ageing is defined as a process of preserving functional capacity to enable well-being in old age. This concept includes both a physical and a psychological component, which can be positively influenced by spending time in nature and being physically active. Mountainous areas offer diverse opportunities to be physically active in a natural environment. However, little research is available on the psychological effects of mountain environments and mountain sports, particularly in relation to healthy ageing. Summary: We analyse the extent to which the interactions of physical activity, nature exposure, and specific characteristics of mountainous regions including hypoxia may influence mental health, based on current research, and discuss the relevance of these factors individually and in combination for healthy ageing. Key Messages: In general, the benefits reported from spending time in nature or physical activity seem to be transferable to mountainous regions and/or mountain sports. The available research primarily points to positive acute and longer-term psychological (and sometimes therapeutic) effects of exposure to mountainous regions and mountain sports performed in moderate altitude on various mental health parameters, such as well-being, anxiety, and depression, which could in turn promote healthy ageing. In contrast, staying at very high or extremely high altitudes seems to be associated with negative effects on mental health. Overall, further research is needed to draw more reliable conclusions.

1.
Tremblay
JC
,
Ainslie
PN
.
Global and country-level estimates of human population at high altitude
.
Proc Natl Acad Sci USA
.
2021
;
118
(
18
):
e2102463118
.
2.
Food and Agriculture Organization of the United Nations, World Tourism Organization
.
Understanding and quantifying mountain tourism
;
2023
.
3.
Hösl
B
,
Niedermeier
M
,
Kopp
M
.
Examining acute environmental effects on affective state, expectancy, and intention in sport climbing
.
Front Psychol
.
2023
;
14
:
1258121
.
4.
Schobersberger
W
,
Leichtfried
V
,
Mueck-Weymann
M
,
Humpeler
E
.
Austrian Moderate Altitude Studies (AMAS): benefits of exposure to moderate altitudes (1,500–2,500 m)
.
Sleep Breath
.
2010
;
14
(
3
):
201
7
.
5.
Rudnicka
E
,
Napierała
P
,
Podfigurna
A
,
Męczekalski
B
,
Smolarczyk
R
,
Grymowicz
M
.
The World Health Organization (WHO) approach to healthy ageing
.
Maturitas
.
2020
;
139
:
6
11
.
6.
Abud
T
,
Kounidas
G
,
Martin
KR
,
Werth
M
,
Cooper
K
,
Myint
PK
.
Determinants of healthy ageing: a systematic review of contemporary literature
.
Aging Clin Exp Res
.
2022
;
34
(
6
):
1215
23
.
7.
Belachew
A
,
Cherbuin
N
,
Bagheri
N
,
Burns
R
.
A systematic review and meta-analysis of the socioeconomic, lifestyle, and environmental factors associated with healthy ageing in low and lower-middle-income countries
.
J Popul Ageing
.
2024
;
17
(
2
):
365
87
.
8.
Sia
A
,
Tam
WWS
,
Fogel
A
,
Kua
EH
,
Khoo
K
,
Ho
RCM
.
Nature-based activities improve the well-being of older adults
.
Sci Rep
.
2020
;
10
(
1
):
18178
.
9.
Jalali
A
,
Ziapour
A
,
Karimi
Z
,
Rezaei
M
,
Emami
B
,
Kalhori
RP
, et al
.
Global prevalence of depression, anxiety, and stress in the elderly population: a systematic review and meta-analysis
.
BMC Geriatr
.
2024
;
24
(
1
):
809
.
10.
Lopez
J
,
Perez-Rojo
G
,
Noriega
C
,
Sánchez-Cabaco
A
,
Sitges
E
,
Bonete
B
.
Quality-of-life in older adults: its association with emotional distress and psychological wellbeing
.
BMC Geriatr
.
2024
;
24
(
1
):
815
.
11.
Singh
B
,
Olds
T
,
Curtis
R
,
Dumuid
D
,
Virgara
R
,
Watson
A
, et al
.
Effectiveness of physical activity interventions for improving depression, anxiety and distress: an overview of systematic reviews
.
Br J Sports Med
.
2023
;
57
(
18
):
1203
9
.
12.
Weinstein
AA
,
van Aert
RCM
,
Donovan
K
,
Muskens
L
,
Kop
WJ
.
Affective responses to acute exercise: a meta-analysis of the potential beneficial effects of a single bout of exercise on general mood, anxiety, and depressive symptoms
.
Psychosom Med
.
2024
;
86
(
6
):
486
97
.
13.
Statistik Austria [Internet]
.
Anzahl der Senioren in Österreich von 2015 bis 2025
;
2025
[cited 2025 Mar 25]. Available from: https://de.statista.com/statistik/daten/studie/998408/umfrage/senioren-in-oesterreich/
14.
Burtscher
J
,
Millet
GP
,
Burtscher
M
.
Reduced mortality in cooler surroundings
.
Lancet
.
2023
;
401
(
10390
):
1771
.
15.
Barton
J
,
Pretty
J
.
What is the best dose of nature and green exercise for improving mental health? A multi-study analysis
.
Environ Sci Technol
.
2010
;
44
(
10
):
3947
55
.
16.
Niedermeier
M
,
Einwanger
J
,
Hartl
A
,
Kopp
M
.
Affective responses in mountain hiking-A randomized crossover trial focusing on differences between indoor and outdoor activity
.
PLoS One
.
2017
;
12
(
5
):
e0177719
.
17.
Hüfner
K
,
Ower
C
,
Kemmler
G
,
Vill
T
,
Martini
C
,
Schmitt
A
, et al
.
Viewing an alpine environment positively affects emotional analytics in patients with somatoform, depressive and anxiety disorders as well as in healthy controls
.
BMC Psychiatry
.
2020
;
20
(
1
):
385
.
18.
Jo
H
,
Ikei
H
,
Miyazaki
Y
.
Physiological and psychological benefits of viewing an autumn foliage mountain landscape image among young women
.
Forests
.
2022
;
13
(
9
):
1492
.
19.
Jackman
PC
,
Hawkins
RM
,
Burke
SM
,
Swann
C
,
Crust
L
.
The psychology of mountaineering: a systematic review
.
Int Rev Sport Exerc Psychol
.
2020
;
16
(
1
):
27
65
.
20.
Zeng
Z
,
Zhou
Y
,
Li
L
.
Acute mountain sickness predicts the emotional state of amateur mountaineers
.
Sci Rep
.
2024
;
14
(
1
):
4799
.
21.
Falla
M
,
Hüfner
K
,
Falk
M
,
Weiss
EM
,
Vögele
A
,
Jan van Veelen
M
, et al
.
Simulated acute hypobaric hypoxia effects on cognition in helicopter emergency medical service personnel: a randomized, controlled, single-blind, crossover trial
.
Hum Factors
.
2024
;
66
(
2
):
404
23
.
22.
Falla
M
,
Papagno
C
,
Dal Cappello
T
,
Vögele
A
,
Hüfner
K
,
Kim
J
, et al
.
A prospective evaluation of the acute effects of high altitude on cognitive and physiological functions in lowlanders
.
Front Physiol
.
2021
;
12
:
670278
.
23.
McMorris
T
,
Hale
BJ
,
Barwood
M
,
Costello
J
,
Corbett
J
.
Effect of acute hypoxia on cognition: a systematic review and meta-regression analysis
.
Neurosci Biobehav Rev
.
2017
;
74
(
Pt A
):
225
32
.
24.
Hübner
M
,
Lechleitner
P
,
Neumayr
G
.
Effects of a one-week vacation with various activity programs on well-being, heart rate variability, and sleep quality in healthy vacationers: an open comparative study
.
BMC Public Health
.
2022
;
22
(
1
):
2435
.
25.
Prossegger
J
,
Huber
D
,
Grafetstätter
C
,
Pichler
C
,
Weisböck-Erdheim
R
,
Iglseder
B
, et al
.
Effects of moderate mountain hiking and balneotherapy on community-dwelling older people: a randomized controlled trial
.
Exp Gerontol
.
2019
;
122
:
74
84
.
26.
Finkenzeller
T
,
Müller
E
,
Würth
S
,
Amesberger
G
.
Does a skiing intervention influence the psycho-social characteristics of the elderly
.
Scand J Med Sci Sports
.
2011
;
21
(
Suppl 1
):
69
75
.
27.
Walter
KH
,
Otis
NP
,
Ray
TN
,
Glassman
LH
,
Beltran
JL
,
Kobayashi Elliott
KT
, et al
.
A randomized controlled trial of surf and hike therapy for U.S. active duty service members with major depressive disorder
.
BMC Psychiatry
.
2023
;
23
(
1
):
109
.
28.
Sturm
J
,
Plöderl
M
,
Fartacek
C
,
Kralovec
K
,
Neunhäuserer
D
,
Niederseer
D
, et al
.
Physical exercise through mountain hiking in high-risk suicide patients. A randomized crossover trial
.
Acta Psychiatr Scand
.
2012
;
126
(
6
):
467
75
.
29.
Su
R
,
Jia
S
,
Zhang
N
,
Wang
Y
,
Li
H
,
Zhang
D
, et al
.
The effects of long-term high-altitude exposure on cognition: a meta-analysis
.
Neurosci Biobehav Rev
.
2024
;
161
:
105682
.
30.
Zhang
J
,
Liu
H
,
Yan
X
,
Weng
X
.
Minimal effects on human memory following long-term living at moderate altitude
.
High Alt Med Biol
.
2011
;
12
(
1
):
37
43
.
31.
Ma
Q
,
Jiang
W
,
Zhao
Q
,
Xia
X
,
Fang
R
.
Relationships between altitude and depressive symptoms among middle-aged and older adults in China: a longitudinal study from the China health and retirement longitudinal study
.
Front Psychiatry
.
2024
;
15
:
1436541
.
32.
Kious
BM
,
Bakian
A
,
Zhao
J
,
Mickey
B
,
Guille
C
,
Renshaw
P
, et al
.
Altitude and risk of depression and anxiety: findings from the intern health study
.
Int Rev Psychiatry
.
2019
;
31
(
7–8
):
637
45
.
33.
Basualdo-Meléndez
GW
,
Hernández-Vásquez
A
,
Barón-Lozada
FA
,
Vargas-Fernández
R
.
Prevalence of depression and depressive symptoms at high altitudes: a systematic review and meta-analysis
.
J Affect Disord
.
2022
;
317
:
388
96
.
34.
Burtscher
J
,
Niedermeier
M
,
Hüfner
K
,
van den Burg
E
,
Kopp
M
,
Stoop
R
, et al
.
The interplay of hypoxic and mental stress: implications for anxiety and depressive disorders
.
Neurosci Biobehav Rev
.
2022
;
138
:
104718
.
35.
Sudeck
G
,
Thiel
A
.
Sport, Wohlbefinden und psychische Gesundheit
. In:
Schüler
J
,
Wegner
M
,
Plessner
H
, editors.
Sportpsychologie: Grundlagen und Anwendung
.
Berlin, Heidelberg
:
Springer Berlin Heidelberg
;
2020
. p.
551
79
.
36.
Kandola
A
,
Ashdown-Franks
G
,
Hendrikse
J
,
Sabiston
CM
,
Stubbs
B
.
Physical activity and depression: towards understanding the antidepressant mechanisms of physical activity
.
Neurosci Biobehav Rev
.
2019
;
107
:
525
39
.
37.
Dietrich
A
.
Transient hypofrontality as a mechanism for the psychological effects of exercise
.
Psychiatry Res
.
2006
;
145
(
1
):
79
83
.
38.
Kaplan
S
.
The restorative benefits of nature: toward an integrative framework
.
J Environ Psychol
.
1995
;
15
(
3
):
169
82
.
39.
Bichler
CS
,
Niedermeier
M
,
Hüfner
K
,
Gálffy
M
,
Gostner
JM
,
Nelles
P
, et al
.
Climbing as an add-on treatment option for patients with severe anxiety disorders and PTSD: feasibility analysis and first results of a randomized controlled longitudinal clinical pilot trial
.
Int J Environ Res Public Health
.
2022
;
19
(
18
):
11622
.
40.
Burtscher
J
,
Samaja
M
.
Healthy aging at moderate altitudes: hypoxia and hormesis
.
Gerontology
.
2024
;
70
(
11
):
1152
60
.
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