Effect of nature‐based physical activity on post‐traumatic growth among healthcare providers with post‐traumatic stress

Abstract

The purpose of this randomized control trial was to observe the effect of naturebased physical activity in achieving post traumatic growth and to estimate the combined effect of nature and physical activity on the psychophysiological outcomes. A 3-month therapy was provided to participants meeting eligibility criteria to receive the walk-in nature (experimental group) or sit-in nature (control group) in the 1:1 ratio. At baseline and 3-month follow-up, participants were assessed with Trauma Symptom Checklist 40, Traumatic Stress Scale, Post-Traumatic Growth Inventory (PTGI), Cortisol, C-Reactive Protein (CRP), Interleukin-6 (IL-6), Brain-Derived Neurotropic Factor (BDNF) and heart rate variability. There was a significant effect of nature-based physical activity on traumatic stress and post-traumatic growth in comparison with the sit-in control. A significant post-interventional difference was observed in the mean PTGI score [F = 5.412, p = 0.022] between the experimental and control groups after 3 months of intervention. All the biochemical estimates, including CRP, BDNF, IL-6, and cortisol levels, were significantly altered in both post-intervention study groups (p < 0.01). Taken together, these results show that nature-based physical activity significantly improves psychophysiological outcomes induced as a result of post-traumatic growth and also reduces traumatic stress. K E Y W O R D S nature-based therapy, physical activity, post-traumatic growth, psychophysiological outcomes, traumatic stress 1 | INTRODUCTION For the past 25 years, health care providers have been severely affected by target killing and terrorism in Karachi, Pakistan. Health care providers are working in severe stress conditions, and several studies have identified that they are highly affected, and the majority of them are dealing with traumatic stress (Kerai et al., 2017). Trauma has a mutual impact on the brain and body, causing psychological and physical distress. Exposure or re-exposure to trauma can alter cognition, memory, and behaviours in different human brain developmental stages (Gur et al., 2019;Lupien et al., 2018). It can cause severe emotional dysregulation, physical disorders, somatisation, hypervigilance, etc. (D'Andrea et al., 2011; SAMHSA, 2014).However, the literature on trauma offers a philosophical shift from pathogenic to a salutogenic paradigm, mainly focussing on the positive post-trauma changes, empirically known as the domain of posttraumatic growth (PTG) (Griffin et al., 2020;Tedeschi et al., 2018).Evidence from several studies suggest that positive growth with favourable health outcomes have also been documented in individuals who discover healthy ways to cope and heal from trauma

Interactions with Nature, Good for the Mind and Body: A Narrative Review

“…Researchers of several experimental studies have measured changes in cortisol before and after spending time in nature. Several studies have reported significant decreases in cortisol after participants spent time in nature [ 158 , 177 , 226 , 227 , 228 ]. Furthermore, Hunter et al was able to estimate how much time in nature is needed to decrease cortisol; reporting that intentionally interacting with nature for 20–30 min resulted in an 18.5% decrease in cortisol per hour [ 229 ].…”

“…Additional intervention research studies have reported improvements in parasympathetic nervous system activity [ 170 , 171 , 172 , 173 , 232 ], heart rate variability [ 233 ], heart rate recovery [ 234 ], and general health [ 23 , 235 ]; and reductions in sympathetic nervous system activity [ 170 , 171 , 172 , 236 ], heart rate [ 170 , 171 , 172 , 184 , 232 , 237 , 238 , 239 ], overall blood pressure [ 184 ], systolic blood pressure [ 162 , 171 , 179 , 227 , 234 , 237 , 238 ], diastolic blood pressure [ 162 , 179 , 227 , 234 ], cardiac function [ 237 ], vascular function [ 237 ], mean arterial pressure [ 162 ], pulse pressure [ 237 ], C-reactive protein [ 226 ], interleukin 6 [ 226 ], gastrointestinal symptoms [ 240 ], and pain [ 235 ]. Researchers have also shown that, after interventions that utilize intentional interactions with nature, there are significant increases in brain-derived neurotrophic factor [ 195 , 241 ] and platelet-derived growth factor [ 241 ], which are related to memory.…”

Exercise-based rehabilitation in and with nature: a scoping review mapping available interventions

“…The included articles were from Austria [ 41 , 43 ], The Netherlands [ 50 ], Spain [ 45 , 48 ], UK [ 42 ], Japan [ 49 ], China [ 51 ], Pakistan [ 47 ], Canada [ 52 ], USA [ 46 ] and South Korea [ 44 ], published between 2015 and 2022. One was a qualitative study [ 42 ].…”

“…One on-going study identified at clinicaltrials.gov. The rest were peer-reviewed interventional effect studies: randomized controlled trials with two arms ( n = 5) [ 45 , 47 , 48 , 51 , 52 ] and three arms [ 43 ], a randomized cross-over group pilot trial [ 46 ], a comparative intervention study without randomization [ 44 ], a quasi-experimental design with a control group, no randomization [ 50 ] and two within subject experimental studies [ 41 , 49 ], with large variation in the number of included participants (range 19–262, median: 50) (see Table 3 ).…”

“…with a course of 5 weeks with one two-hour session per week [ 42 ]; and Noushad et al. provided the most extensive intervention in a 12-week long period of 5 walks per week [ 47 ]. For further details, see Table 4 .…”