Targeted health promotion with guided nature walks or group exercise: a controlled trial in primary care

Abstract

BackgroundContact with nature promotes wellbeing through diverse pathways, providing a potential way of supporting health especially in primary care, where patients commonly suffer from multimorbidity and poor general health. Social prescribing is a non-pharmaceutical approach for improving health as well as social inclusion. This field study explores and compares the effects of a nature-based and an exercise-based social prescribing scheme on mental wellbeing and sleep, in a primary care population.MethodsPrimary care patients identified to benefit from a general improvement to their health were recruited by nurses, doctors, or social workers to this non-randomized, intention-to-treat, pilot field-study. Participants (n = 79) chose between the group interventions, either taking part in guided walks in nature, including immersion in a forest with high biodiversity, or participating in a versatile sports program. Mental wellbeing was assessed with the Warwick-Edinburgh Mental Well-Being Scale (WEMWBS), with additional questions evaluating self-rated health and sleep. Impact on mental wellbeing was explored in relation to perceived health. The amount and quality of sleep was measured with wrist-worn accelerometers. With a focus on everyday life impacts, the assessments took place before and after the 8-week intervention. All participants lived in Sipoo, Finland, an area with abundant accessible green space.ResultsParticipants (mean age 57 years, 79% female) rated their general and mental health lower than the general population. Participation in the Nature-group resulted in improved mental wellbeing (change in WEMWBS by 3.15, p = 0.008), with a positive change for feeling relaxed, being cheerful, having energy to spare, feeling able to deal well with problems, feeling good about oneself and feeling close to other people. The Sports-group was beneficial for those initially rating their health as good. Sleep duration improved in the Sports-group, while participants in the Nature-group reported better sleep quality. Following the interventions there was improvement in perceived health and ability to function in both groups, while perceived mental health improved only in the Nature-group.ConclusionWe attest that even in areas surrounded by greenery, active interventions can further improve health in a primary care population, and that nature-based interventions are beneficial for those in poor health.Clinical trial registrationClinicalTrials.gov, Identifier NCT05893212.

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

“…The evidence suggesting a positive relationship between intentional interactions with nature and mental health has led to the development of experimental studies. Improvements in mental health have consistently been reported, as indicated by increases in wellbeing [ 147 , 148 , 149 , 150 , 151 , 152 , 153 , 154 , 155 , 156 , 157 ] and positive affect [ 55 , 56 , 147 , 148 , 149 , 150 , 158 , 159 , 160 , 161 , 162 ]; and decreases in depression [ 149 , 151 , 152 , 163 , 164 , 165 , 166 , 167 , 168 , 169 ], anxiety [ 148 , 149 , 151 , 154 , 159 , 163 , 165 , 166 , 169 , 170 , 171 , 172 , 173 , 174 ], stress [ 148 , 158 , 159 , 165 , ...…”

Quality criteria of nature-based interventions in healthcare facilities: a scoping review

“…In line with the IPBES report, an NBI can also be designed in such a way that consciously considers not only the instrumental values that nature offers, but also the intrinsic and relational values of nature ( 71 ). For example, a recent large-scale study shows how primary healthcare patients were taken into a highly biodiverse forest and were guided in sensorial exercises, with a positive impact on sleep duration and enhanced feeling of nature connectedness ( 72 ).…”

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“…In addition, teaching about implementation science frameworks (34, 37), complexity science and systems thinking used in the healthcare context (56)(57)(58) could also be valuable. Educating HCPs about the specificity of nature interaction quality, intensity, duration, length and frequency (32) and the risk factors that biodiversity can pose for health (e.g., allergic reactions to insect bites, pollen allergies, potential psychological harm related to fear) (30,59) should also be considered. Furthermore, developing "nature-connected care awareness" (60) by the involved professionals in iNBI, NM and medical students could provide them with insights into their relationship with nature, which is an advantage in the transition to sustainability (2,7) and being a role model (60).…”

“…1 https://www.who.int/groups/one-health-high-level-expert-panel 2 https://www.planetaryhealthalliance.org/ Then, in response to the social-ecological crises, and in the light of sustainable healthcare, HCFs in Flanders also show interest in the topic of biodiversity restoration in the vicinity of their HCF. Moreover, evidence of the positive links between biodiversity and health (28)(29)(30)(31) also fuels this interest. This common interest within an HCF brings nature management (NM) and healthcare together in the design and implementation, what we refer to as 'integrated nature-based interventions' (iNBIs).…”