A nature-based health intervention at a military healthcare center: a randomized, controlled, cross-over study

Abstract

We describe a mixed qualitative and quantitative research study in a military facility regarding the role of nature in well-being. Study intervention included two 20-minute walks. One walk was in an intentionally designed woodland environment (Green Road) and the other was on a busy campus road in a medical treatment facility (Urban Road). Twelve volunteers from a military facility participated in both walks in a cross-over experimental design. The two walking sessions were randomly ordered and preceded by pre-walk instructions appropriate to each road’s characteristics and incorporated focused attention and present moment orientation. A semi-structured post-walk interview, the primary outcome, was conducted after the conclusion of each walk. Qualitative data analyses consisted of sentiments and themes by using NVivo 12 software. The Green Road was unanimously rated as positive (100%). Responses to Urban Road were evenly distributed among positive (33.3%), negative (33.3%), and neutral/mixed (33.3%) sentiments. The Green Road yielded predominantly positive themes such as enjoyment of nature, relaxation, and feelings of privacy and safety. Urban Road produced significantly more negative themes such as concerns for safety, dislike of noise and other noxious experiences. Quantitative assessment of distress and mindfulness with Distress Thermometer (DT) and Mindful Attention Awareness Scale-state version (MAAS) demonstrated that a walk on the Green Road significantly decreased distress and increased mindfulness compared to a walk on the Urban Road. We also observed that pre-walk instructions could direct attention to both obvious and subtle elements of experience and enhance awareness. Results support the notion that an intentional nature-based environment may produce significantly more positive experiences and result in health-promoting benefits in a military health-care setting compared to an urban environment. Future studies with clinical populations could advance our understanding of the healing value of nature-based interventions. The impact of intentional green environments may be enhanced by well-designed instructions for both recreational and therapeutic use.

What Activities in Forests Are Beneficial for Human Health? A Systematic Review

“…Ten studies examined the effect of walking on mood states [ 17 , 19 , 48 , 49 , 50 , 51 ], distress [ 52 ], perceived stress levels [ 53 ], and subjective feelings [ 44 ]. Song et al [ 49 , 51 ] demonstrated that a 15 min walk in a well-managed artificial forest led to a significant decrease in negative mood—depression, anxiety, anger, fatigue, confusion—and a significant increase in vigor compared with walking in an urban environment.…”

“…Mao et al [ 19 ] identified significant improvements in depression, anger, confusion, and fatigue, but no significant changes were observed in anxiety and vigor. Ameli et al [ 52 ] found that a 20 min walk in the forest garden significantly lowered distress level and improved mindful awareness compared with walking on an urban road. Koselka et al [ 53 ] assigned the same subjects to walk across a forest and an urban roadside for 50 min on different dates, and observed the most consistent stress reduction in forest walking.…”

“…RCTs for psychiatric disorders and stress-related diseases mainly adopted staying during the interventions [ 46 , 47 ]. The number of participants per session was single or about 7 to 12, and depending on the purpose of the intervention, social interaction was limited [ 46 , 47 , 52 , 56 , 59 ] or encouraged [ 64 ].…”

The impact of restorative green environment on mental health of big cities and the role of mental health professionals

“…Therefore, evidence on the duration and frequency of green exposure to achieve a sustainable impact on psychological health remains scarce. Although some studies suggested improving people experiencing mental health problems for sessions that lasted over 20 min [8,10,42], some would stretch up to 120–180 min [1 ▪ ,11] The frequency of green exposure is another noteworthy factor in evaluating its impact on mental health outcomes. In a study by Zhang and colleagues [54 ▪ ], long-term exposure to green environments improves positive mental health outcomes.…”

“…Immersing in nature encourages us to understand and appreciate trees, forests, birds, and animals. Some studies conducted in forest settings [7] and green spaces in the cities have demonstrated the effectiveness in enhancing well being, relieving stress, and relaxation [8][9][10][11]. Many urban dwellers are faced with increased stress levels with daily exposure to noise and environmental pollution [12].…”