Targeted Health Promotion With Guided Nature Walks or Group Exercise: a Controlled Trial in Primary Care
Trial Snapshot
- Phase
- Not Applicable
- Status
- Completed
- Sponsor
- University of Helsinki
- Enrollment
- 79
- Locations
- 2
- Primary Endpoint
- Change in self rated mental health
Study Overview
Brief Summary
Contact with nature promotes human wellbeing through diverse pathways, providing a potential way to support health especially in primary care, where patients commonly suffer from multimorbidity and poor general health. Social prescribing as a non-pharmaceutical treatment is a promising method to improve health as well as inclusion. This study explores and compares the effects of a nature based and an exercise based social prescribing scheme on mental wellbeing, physical activity and sleep, in a primary care population.
Detailed Description
In this non-randomized, intention-to-treat, pilot study we recruited clients at the health and social service centre in Sipoo, Finland.
Participants (n=79) chose between two social prescribing programs, either taking part of guided walks in nature, including immersion in a forest with high biodiversity, or taking part in a sports group with a versatile program. Inclusion was not based on diagnosis, but an identified need of improving health. Mental wellbeing was assessed using the 14-item Warwick-Edinburgh Mental Well-Being Scale (WEMWBS), additional questions evaluated perceived health and sleep. Amount and quality of sleep and physical activity were measured using wrist-worn accelerometers.
Assessments took place before and after the 8-week intervention, as we were interested in the effect on everyday life. Even though participants lived in an area with abundant green space, taking part in the prescribed nature program improved mental wellbeing. Those who initially rated their health and mental health as good did achieve benefit from both programs, while those in poor health received better aid from the nature group.
Initial study plan aimed for 160 participants, with an equal distribution between the groups. The programs were completed in 2018-2019 (spring + autumn) The COVID-19 outbreak hindered group activities 2020, a nature-group was organized in autumn 2020.
Study Design
- Study Type
- Interventional
- Allocation
- Non Randomized
- Intervention Model
- Parallel
- Primary Purpose
- Supportive Care
- Masking
- None
Masking Description
Care provider recommended participation in either group, based on discussion with participant. All data is anonymized and stored at the Finnish Institute for Health and Welfare and outcomes assessor has access to this data, however, it includes knowledge of group participation.
Eligibility Criteria
- Ages
- 18 Years to — (Adult, Older Adult)
- Sex
- All
- Accepts Healthy Volunteers
- No
Inclusion Criteria
- •Need of health promotion or secondary prevention of disease as identified by health care professionals or by social care professionals working in a public health care center (nurse, doctor, or social worker).
- •Enrolment was not based on a diagnosis, but health care and social care professionals were instructed to identify patients/clients they felt could benefit from a targeted health intervention and involve particularly those in poor general health.
- •Adults with a physical ability to slowly walk approximately 3 km in a slow tempo.
- •Ability to understand and give consent to participation.
- •Age 18 years or older.
Exclusion Criteria
- •Untreated medical condition hindering physical activity or symptomatic condition demanding continuous attention.
- •Disability preventing ability to move in terrain.
- •Inability to take part in group-based activities due to, e.g., behavioral challenges.
- •Although reason of referral is not reported, enrolment in intervention was part of real-life treatment.
- •Eligibility was assessed by professionals referring to the intervention, as well as at the introductory meeting organized by the staff at the public health care center taking place before the intervention started.
- •It was possible to take part in the intervention but not the study, participants in the study signed an informed consent allowing use of data and giving permission for later contact. Participants were free to withdraw from the study at any time without giving a reason, and this did not interfere with their care in any way.
Outcomes
Primary Outcomes
Change in self rated mental health
Time Frame: At beginning of study (day 0), 4.th meeting (day 28) and at end of study (day 56-58)
Question: How is your mental health at the moment? Likert-like scale: 1- 5 (much/good/well).
Change in functioning ability
Time Frame: At beginning of study (day 0), 4.th meeting (day 28) and at end of study (day 56-58)
Question: How is your functioning ability at the moment? Likert-like scale: 1-5
Change in positive mental well-being
Time Frame: At beginning of study (day 0), 4.th meeting (day 28) and at end of study (day 56-58)
Self-assessed mental wellbeing measured with the 14-item Warwick-Edinburgh Mental Well-Being Scale (WEMWBS).
Change in percieved sleep
Time Frame: At beginning of study (day 0), 4.th meeting (day 28) and at end of study (day 56-58)
Question: How do you sleep at the moment? Likert-like scale: 1-5
Change in self rated health
Time Frame: At beginning of study (day 0), 4.th meeting (day 28) and at end of study (day 56-58)
Question: How is your health at the moment? Likert-like scale: 1-5
Secondary Outcomes
- Change in time in bed.(Before starting intervention (day 0) and after intervention (day 56-60))
- Change in sleep efficiency(Before starting intervention (day 0) and after intervention (day 56-60))
- Change in vigorous physical activity(Before starting intervention (day 0) and after intervention (day 56-60))
- Change in total sleep time(Before starting intervention (day 0) and after intervention (day 56-60))
- Change in number and length of awakenings after sleep onset(Before starting intervention (day 0) and after intervention (day 56-60))
- Change in light physical activity(Before starting intervention (day 0) and after intervention (day 56-60))
- Change in moderate physical activity(Before starting intervention (day 0) and after intervention (day 56-60))
- Change in importance of nature and physical activity(Before starting intervention (day 0) and after intervention (day 56))
- Change in importance physical activity(Before starting intervention (day 0) and after intervention (day 56))
Investigators
Annika Kolster
Doctoral researcher
University of Helsinki