Nature-Based Interventions and Mind-Body Interventions: Saving Public Health Costs Whilst Increasing Life Satisfaction and Happiness

Green spaces and the impact on cognitive frailty: a scoping review

Some literature indicates that contact with green spaces can benefit health and wellbeing, but it is unclear whether this is protective of cognitive health in older people. Using Arskey and O'Malley's framework the aim was to investigate ageing, cognitive frailty and the effects of green access including any causality. The evidence was somewhat inconsistent but suggestive for a beneficial role of green space exposure on cognitive functions. Results suggested that globally, the poorer urban environments are high risk for older people's mental health and these places often lack parks and green spaces. There is evidence that the level of activity and social participation may be greater with access to green spaces and therefore reduces health risks. Green spaces seem to have a role in preventing cognitive frailty, especially for more vulnerable older populations living in poorer urban environments.

The mechanisms of nature-based therapy on depression, anxiety, stress, and life satisfaction: examining mindfulness in a two-wave mediation model

Background

Nature-based therapy (NBT), which centers around engaging in activities within natural surroundings, has consistently demonstrated therapeutic benefits for mental health. While NBT highlights the potential of nature as a therapeutic resource for promoting mental health, there is limited knowledge regarding its underlying mechanisms.

Methods

Two hundred seventy-six Korean participants (204 women, mean age = 54.99 ± 23.25 years) participated in a 30-session gardening program held twice weekly for 15 weeks. Structural equation modeling with a two-wave autoregressive cross-lagged model was used to investigate the mediating effects of mindfulness.

Results

NBT significantly improved the mean scores of all psychological variables. The mediation model was partially confirmed, with mindfulness at post-intervention (T2) mediating the relationship between baseline (T1) depression and anxiety and post-intervention (T2) life satisfaction. However, no significant indirect effect was observed between the path from stress (T1) to life satisfaction (T2).

Conclusion

Mindfulness is a crucial component for improving mental health outcomes. This study underscores the need to prioritize and emphasize mindfulness practices in NBT.

The significance of green exercise for the health and wellbeing of Italian immigrants in Norway: a mixed-methods study

BACKGROUND

Green exercise (physical activity in presence of nature) has beneficial effects for health and wellbeing. Green exercise is a popular form of recreation in the Nordic countries, but participation is lower among the immigrant population from non-Western countries. However, no attention has been given to immigrants from the European Economic Area regarding this topic. Given the cultural and structural differences that surround green exercise in Italy and Norway, the case of the Italian immigrants in Norway is of interest to enrich our understanding of green exercise and its significance for health and wellbeing among immigrants in the Nordic countries.

METHODS

This convergent mixed methods study investigated the pathways that link green exercise to health and wellbeing among Italian immigrants in Norway. Quantitative data were collected through an online survey (n = 321), which was oversampled to better reflect the sociodemographic profile of the reference population. Logistic regression was used to model the association of green exercise with self-rated health (SRH) or satisfaction with life (SWL) before and after controlling for selected confounders (age, gender, educational level, language proficiency, social support, and childhood experiences with green exercise). Qualitative data were collected through semi-structured in-depth interviews (n = 14) and analysed thematically. Merging of the two strands was done using a simultaneous bidirectional approach.

RESULTS

The logistic regression found a significant bivariate association of green exercise with both SRH and SWL, though the association remained significant only for SWL after controlling for confounders. From the thematic analysis, three themes were identified: Green exercise opportunities contributing to overall satisfaction, Closeness to nature, and Embracing a new lifestyle. The integrated findings indicate that green exercise supported the immigrants' wellbeing, especially by providing stress relief, though socioeconomic status and acculturation may have a major impact on general health. Familiarity, appreciation of nature benefits, social support, and acculturation were identified as facilitating factors.

CONCLUSIONS

This study provides novel insights into how green exercise supports health, wellbeing, and inclusion among immigrants to the Nordic countries and emphasizes the importance of developing culturally adapted strategies to enhance this health-promoting activity among immigrant populations.

Factors influencing the effectiveness of nature-based interventions (NBIs) aimed at improving mental health and wellbeing: Protocol of an umbrella review

Several systematic reviews support the use of nature-based interventions (NBIs) as a mechanism of enhancing mental health and wellbeing. However, the available evidence for the effectiveness of these interventions is fragmentary and mixed. The heterogeneity of existing evidence and significant fragmentation of knowledge within the field make it difficult to draw firm conclusions regarding the effectiveness of NBIs. This mixed method umbrella review aims to synthesise evidence on the effectiveness of nature-based interventions through a summative review of existing published systematic reviews and meta-analyses. A systematic search in PsycINFO, PubMed, Greenfile, Web of Science, Embase, Scopus, Academic Search Complete (EBSCO), Environment Complete (EBSCO), Cochrane Library, CINAHL, Health Policy Reference Centre and Google Scholar will be performed from inception to present. The search strategy will aim to find published systematic reviews of nature-based interventions (NBIs) where improving health and wellbeing is an explicit goal. This is a mixed method review, and systematic reviews with both quantitative and qualitative data synthesis will be considered. Two authors will independently perform the literature search, record screening, data extraction, and quality assessment of each included systematic review and meta-analysis. The individual qualitative and quantitative syntheses will be conducted in parallel and combined in an overarching narrative synthesis. The quantitative evidence will be used to assess the strength and direction of the effect of nature-based interventions on mental health and wellbeing outcomes. Evidence drawn from qualitative studies will be analysed and synthesised to understand the various pathways to engagement, involvement process and experiential factors that may mediate experiences. The risk of bias of the systematic reviews will be assessed using a 16-item Assessment of Multiple Systematic Reviews 2 (AMSTAR2) checklist. Trail registration: This review is registered on PROSPERO (CRD42022329179).

Effects of a community gardening intervention on diet, physical activity, and anthropometry outcomes in the USA (CAPS): an observer-blind, randomised controlled trial

BACKGROUND

Unhealthy diet, physical inactivity, and social disconnection are important modifiable risk factors for non-communicable and other chronic diseases, which might be alleviated through nature-based community interventions. We tested whether a community gardening intervention could reduce these common health risks in an adult population that is diverse in terms of age, ethnicity, and socioeconomic status.

METHODS

In this observer-blind, randomised, controlled trial, we recruited individuals who were on Denver Urban Garden waiting lists for community gardens in Denver and Aurora (CO, USA), aged 18 years or older, and had not gardened in the past 2 years. Participants were randomly assigned (1:1), using a randomised block design in block sizes of two, four, or six, to receive a community garden plot (intervention group) or remain on a waiting list and not garden (control group). Researchers were masked to group allocation. Primary outcomes were diet, physical activity, and anthropometry; secondary outcomes were perceived stress and anxiety. During spring (April to early June, before randomisation; timepoint 1 [T1]), autumn (late August to October; timepoint 2 [T2]), and winter (January to March, after the intervention; timepoint 3 [T3]), participants completed three diet recalls, 7-day accelerometry, surveys, and anthropometry. Analyses were done using the intention-to-treat principle (ie, including all participants randomly assigned to groups, and assessed as randomised). We used mixed models to test time-by-intervention hypotheses at an α level of 0·04, with T2 and T3 intervention effects at an α level of 0·005 (99·5% CI). Due to potential effects of the COVID-19 pandemic on outcomes, we excluded all participant data collected after Feb 1, 2020. This study is registered with ClinicalTrials.gov, NCT03089177, and data collection is now complete.

FINDINGS

Between Jan 1, 2017, and June 15, 2019, 493 adults were screened and 291 completed baseline measures and were randomly assigned to the intervention (n=145) or control (n=146) groups. Mean age was 41·5 years (SD 13·5), 238 (82%) of 291 participants were female, 52 (18%) were male, 99 (34%) identified as Hispanic, and 191 (66%) identified as non-Hispanic. 237 (81%) completed measurements before the beginning of the COVID-19 pandemic. One (<1%) participant in the intervention group had an adverse allergic event in the garden. Significant time-by-intervention effects were observed for fibre intake (p=0·034), with mean between-group difference (intervention minus control) at T2 of 1·41 g per day (99·5% CI -2·09 to 4·92), and for moderate-to-vigorous physical activity (p=0·012), with mean between-group difference of 5·80 min per day (99·5% CI -4·44 to 16·05). We found no significant time-by-intervention interactions for combined fruit and vegetable intake, Healthy Eating Index (measured using Healthy Eating Index-2010), sedentary time, BMI, and waist circumference (all p>0·04). Difference score models showed greater reductions between T1 and T2 in perceived stress and anxiety among participants in the intervention group than among those in the control group.

INTERPRETATION

Community gardening can provide a nature-based solution, accessible to a diverse population including new gardeners, to improve wellbeing and important behavioural risk factors for non-communicable and chronic diseases.

FUNDING

American Cancer Society, University of Colorado Cancer Centre, University of Colorado Boulder, National Institutes of Health, US Department of Agriculture National Institute of Food and Agriculture, Michigan AgBioResearch Hatch projects.

Connecting the health of country with the health of people: Application of "caring for country" in improving the social and emotional well-being of Indigenous people in Australia and New Zealand

Emerging evidence from the western literature suggests an increasing focus on applying nature-based interventions for mental health improvements. However, in Indigenous communities, caring for country has always been central to the Indigenous way of life. Knowing that nature-based interventions effectively improve mental health outcomes, this review collated evidence on the application of caring for country in improving social and emotional well-being (SEWB) of Indigenous peoples in Australia and New Zealand. Three studies from Australia and one from New Zealand, explored the role of country or whenua (land) in the lives of Indigenous people. Participation in caring-for country activities was associated with lower levels of psychological distress and strengthened guardianship relationship with country, which positively affected SEWB. This systematic review offers preliminary evidence on the role of caring for country activities in improving the SEWB of Indigenous peoples and highlights the need for strengths-based approaches to improve the SEWB of Indigenous peoples.

Funding

None.

Therapeutic Community Gardening as a Green Social Prescription for Mental Ill-Health: Impact, Barriers, and Facilitators from the Perspective of Multiple Stakeholders

The UK government has invested £5.77 million in green social prescribing to prevent and tackle mental ill-health. Therapeutic community gardening, one type of green social prescription, provides a range of health outcomes. However, for increased accessibility, a greater understanding of how it impacts mental health and the facilitators and barriers to referral, uptake, and attendance by individuals with mental health problems is required. We conducted and thematically analysed interviews with thirteen stakeholders including social prescribing link workers and garden staff; and focus groups with twenty garden members. The mechanisms by which therapeutic community gardening were suggested to impact mental health were by engaging members with nature and the outdoors, providing hope for the future and facilitating social support and relationships. Factors facilitating referral, uptake, and attendance included a holistic and person-centred approach, which is flexible around health needs. Barriers included awareness of the full offering of therapeutic community gardens and accessibility, in terms of physical location and waiting lists. Given that nature-based interventions have the potential to protect and enhance population health and offer cost savings through reduced reliance on other health services; overcoming these barriers is key to ensuring that therapeutic community gardening is more widely available as an additional mental health treatment.

The Impact of Therapeutic Community Gardening on the Wellbeing, Loneliness, and Life Satisfaction of Individuals with Mental Illness

BACKGROUND

literature on the mental health benefits of therapeutic community gardening is not specific to individuals with mental illness and reports short-term outcomes. The impact of the coronavirus pandemic on intervention effectiveness is also unknown. This study examined the impact of therapeutic community gardening prior to and across the pandemic on the wellbeing of individuals referred for support with their mental illness.

METHODS

garden members (n = 53; male = 36, female = 17) aged 47.38 ± 13.09 years reported their wellbeing at baseline and four follow-up points (FU1-FU4) across the pandemic.

RESULTS

there was significant quadratic growth in wellbeing (-1.248; p < 0.001) that varied between genders (p = 0.021). At baseline, male wellbeing scores were significantly lower (p = 0.020) than the UK population norm, but there were no significant differences at any other follow-up point. Female wellbeing was significantly lower than the UK population norm at baseline (p < 0.001), FU1 (p = 0.012) and FU2 (p < 0.001), but not FU3 and FU4.

CONCLUSION

therapeutic community gardening can improve and maintain the wellbeing of individuals with mental illness, even when wellbeing is deteriorating nationally. Future research should further demonstrate the long-term and cost-effectiveness of interventions.

The effects of loving-kindness and compassion meditation on life satisfaction: A systematic review and meta-analysis

Loving-kindness and compassion meditation (LKCM) was a promising intervention for improving life satisfaction, but previous findings have been inconsistent. The current study provides a systematic review and meta-analysis, including 23 empirical studies on LKCM with life satisfaction as an outcome variable. The primary meta-analysis indicated that LKCM significantly enhanced life satisfaction in pre-post design (g = 0.312, k = 15, n = 451), but the significance disappeared in the additional meta-analysis based on randomized controlled trials (g = 0.106, k = 6, n = 404). Moderator analyses found significant effects for type of control (i.e., the effects of LKCM were inferior to active control group, but superior to waitlist condition), but not for other moderators (i.e., participant type, previous meditation experience, specific protocol, components of LKCM, combination with mindfulness mediation, and intervention length). Narrative review identified self-compassion and positive emotions as important mediators. The practice time of LKCM had indirect but not direct association with life satisfaction. The findings supported that LKCM is promising in increasing life satisfaction, but more studies are needed to investigate the effects with more rigorous designs. Future studies should investigate other potential mechanisms and clarify whether LKCM change the reality or the perception of life.

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

PURPOSE OF REVIEW

To provide an update on insights into the effectiveness of the green environment and forest on the mental health of city dwellers; and the role of mental health professionals in advocating green restorative therapies.

RECENT FINDINGS

The studies reviewed in this paper confirmed the mental health benefits on individuals who engaged in the green environment and forest. Results of studies showed that the participants reported significantly higher positive effects. However, it is difficult to compare studies because of marked differences in methodology and often lack of biological markers. With the recent global concern about climate warming, mental health professionals have a critical role to influence city planners on the importance of the green environment and the forest. In Singapore, the 'Therapeutic Garden' project and 'Therapeutic Rainforest' program are examples of mental health professionals working with government agencies for a 'city in nature'.

SUMMARY

The benefits of the green environment and forest are emphasized especially on the psychological well being. In the light of the danger of climate warming, this review highlights the need for city planners to collaborate with mental health professionals to incorporate high-quality green spaces when planning the city of the future. There is an urgent need for better consultation between health agencies and local city government to create an appealing and diverse green environment within the city.

A mixed-methods exploration of virtual reality as a tool to promote green exercise

The salutogenic effects of green exercise are widely recognised, yet many individuals do not engage in this health-related behaviour. Using a convergent mixed methods approach, this study explored the impact of experiencing nature through Virtual Reality (VR) on the decision-making process relating to green exercise. Three experimental trials were conducted (overall n = 136), in which healthy adults were exposed to different VR scenarios reproducing a virtual walk in an existing urban green area. Participants reported medium–high rating of intent to visit the location. Significant pre-to-post increments in future green exercise intention were observed after the VR exposure, though a significance difference was not achieved in comparison with a control condition. Qualitative analysis revealed the impact of the VR experience on behaviour regulation, and highlighted the pivotal role of anticipated emotional benefits. Despite scepticism, the VR experience was effective in arousing curiosity to explore natural environments, which was associated with environmental perceptions as well as nostalgic and socio-cultural perspectives.

The Wildman Programme-Rehabilitation and Reconnection with Nature for Men with Mental or Physical Health Problems-A Matched-Control Study

Men with health problems refuse to participate in rehabilitation programmes and drop out of healthcare offerings more often than women. Therefore, a nature-based rehabilitation programme was tailored specific to men with mental health problems, and long-term illnesses. The rehabilitation programme combines the use of nature, body, mind, and community spirit (NBMC) and is called the 'Wildman Programme'. The presented study was designed as a matched-control study with an intervention group participating in the Wildman Programme (N = 114) compared to a control group receiving treatment as usual (N = 39). Outcomes were measured at baseline (T1), post-intervention (T2), and 6 months post-intervention (T3). The primary outcome was the participants' quality of life measured by WHOQOL-BREF, which consists of four domains: physical health, psychological health, social relationships, and environment. The secondary outcomes were the level of stress measured by the Perceived Stress Scale (PSS), and the participants' emotional experience in relation to nature, measured by the Perceived Restorativeness Scale (PRS). The intervention group improved significantly in the physical and psychological WHOQOL-BREF domains and in PSS at both follow-ups. The participants' interest in using nature for restoration increased significantly as well. The only detectable difference between the control group and the intervention group was in the WHOQOL-BREF physical domain at the 6-month follow-up. For further studies, we recommend testing the effect of the Wildman Programme in an RCT study.

How Does Being Solo in Nature Affect Well-Being? Evidence from Norway, Germany and New Zealand

Background: Solo—being intentionally solitary in nature—is receiving growing attention as a valuable outdoor education program component. Its practice and history have been researched in the context of experiential learning, but few studies have explicitly examined how solo experiences can affect dimensions of well-being. This study investigated a broad range of well-being pathways provided by being solo, based on data from Norway, Germany, and New Zealand. Methods: Using qualitative content analysis (QCA), the solo debrief responses of 40 participants (26 females, age: 19–64 years) were analysed, applying the PERMA-V framework (emotions, engagement, relationship, meaning, achievement, and vitality). Variations in the reports were explored as a function of the national sample, gender, age, prior solo experiences and expectations. Results: The study suggests that hedonic and eudemonic well-being pathways, represented by the six PERMA-V pillars, interrelate strongly. The experience of a range of positive emotions and connecting process during solo highlights two of the most frequent findings related to well-being pathways. The secondary findings suggest minor variations in the well-being pathways for the different national samples, gender and age. Expectations and prior experiences with solo were identified as context factors with minor impact. Further, the data-driven analysis identified specific physical activities, landscape features, sense-activation, perception of time and ‘good’ weather as relevant to the specific experience. Conclusions: Solo experiences provide for well-being-related pathways in a multitude of ways, which highlights the well-being potential of solo implementation across practical fields beyond outdoor education, such as wilderness therapy, and environmental and planetary health initiatives. Future studies should continue to explore solo’s well-being potential in different settings, especially in the context of non-Western samples.