Effects of a 12 Week Green Walking Intervention on Body Mass Index, Lipids Profile, Disease Perception, and Quality of Life in Patients With Myocardial Infarction: A Quasi-Experimental Study
Phase: NA
Conditions: Myocardial Infarction, Quality of Life
Sponsor: AYNUR CİN

Protocol Record: KTU-ACIN-9286 
Investigation of the Effect of Green Walking on Body Mass Index, Blood Lipids, Disease 
Perception, and Quality of Life in Patients with Myocardial Infarction 
Document date: 17.03.2021 Numbered: 24237859-273 
INFORMED CONSENT FORM  
Title of the Study: Investigation of the Effect of Green Walking on Body Mass Index, Blood 
Lipids, Disease Perception, and Quality of Life in Patients with Myocardial Infarction  
PLEASE READ CAREFULLY!!!  
You have been invited to participate in this study. Before you agree to take part in this study, 
you need to understand the purpose of the study and make your decision freely after this 
information. Please read this information prepared especially for you carefully and ask for 
clear answers to your questions.  
WHAT IS THE PURPOSE OF THE STUDY?  
The study will be conducted to examine the effect of green walking on anthropometric 
measurements, blood lipids, disease perception and quality of life of patients with myocardial 
infarction.  
WHAT 
ARE 
THE 
CONDITIONS 
FOR 
PARTICIPATION? 
In or  r to p rt   p t   n t  s stu y  you must      p t  nt w o   s       myo  r   l  n  r t on 
 n    s    n  ollow   up  t t   C r  olo y Poly l n   o  G m    n  St t  Hosp t l  n  
G m    n  K lk t St t  Hosp t l.  
WHAT KIND OF APPLICATION WILL BE DONE?  
You will be asked to answer the questionnaire questions at the beginning and end of the study. 
After being informed about green walking and myocardial infarction, you will be taken on a 
50- minute green walking three times a week for three months. Your vital signs will be 
measured by the researcher before and after each green walking.  
WHAT IS THE NUMBER OF PARTICIPANTS?  
The number of volunteer patients to take part in the study is 60.  
HOW LONG IS THE STUDY?  
The duration of this study is five months.  
WHAT IS THE TOTAL DURATION OF THE VOLUNTEER'S PARTICIPATION IN 
THIS 
STUDY? 
The time you are expected to take part in this study is 150 minutes per week for three months.  

 
WHAT IS THE POSSIBLE BENEFIT EXPECTED BY PARTICIPATING IN THE 
STUDY?  
With this study, you will participate in a green walk and make a healthy lifestyle change with 
green walk after myocardial infarction. Your quality of life will improve as a result of healthy 
lifestyle change. 
IS THERE ANY INSTITUTION SUPPORTING THE STUDY?  
There is no institution supporting the study.  
WILL I RECEIVE ANY PAYMENT FOR PARTICIPATING IN THE STUDY?  
No payment will be made to you for taking part in this study.  
WHAT SHOULD I DO IF I REFUSE TO PARTICIPATE IN THE STUDY OR LEAVE 
THE STUDY? 
Taking part in this research is entirely voluntary. You can refuse to take part in the study or 
withdraw from the study at any stage. The results of the study will be used for scientific 
purposes; if you withdraw from the study or are removed by the researcher, the data about you 
will not be used for scientific purposes.  
WILL CONFIDENTIALITY BE ENSURED REGARDING INFORMATION ABOUT 
NON-PARTICIPATION? 
All your medical and identifying information will be kept confidential and your identifying 
information will not be disclosed even if the study is published, but study monitors, pollsters, 
ethics committees and authorities may access your medical information when necessary. You 
can also access your own medical information at any time (In case the treatment is 
confidential, the volunteer should be informed that they can access their own medical 
information only after the analysis of the data).  
CONSENT TO PARTICIPATE IN THE STUDY:  
I have read and orally listened to the 1-page text above, which shows the information that 
should be given to the volunteer before starting the study. I have asked the investigator all the 
questions that come to my mind, I have understood in detail all the explanations given to me 
in writing and orally. I have been given enough time to decide whether I want to participate in 
the study. Under these conditions, I authorize the researcher to review, transfer and process 
my medical information and I accept the invitation to participate in this study voluntarily and 
without any coercion or pressure. I understand that by signing this form I will not lose any 
rights granted to me by local law.  
I have been given a signed and dated copy of this form.  
VOLUNTEER'S SIGNATURE NAME & SURNAME  
ADDRESS 
 

TEL. & FAX  
HISTORY  
SIGNATURE OF AN AUTHORIZED RESEARCHER IN THE RESEARCH TEAM 
NAME 
& 
SURNAME 
HISTORY  
WITNESS 
SIGNATURE 
WHERE 
NECESSARY 
NAME 
& 
SURNAME 
DUTY 
HISTORY  
2. Materials and Methods 
2.1. Type of research 
T   stu y  im   to  xp rim nt lly inv sti  t  t        t o   r  n w lkin  on  o y 
m ss in  x   loo  lipi s   is  s  p r  ption   n  qu lity o  li   in p ti nts wit  MI.   
2.2. Setting and Time of the Study 
         T     t  w r   oll  t   in t   C r iolo y Outp ti nt Clini  o  X St t  Hospit l  n  Y 
St t  Hospit l   tw  n F  ru ry  n  Jun  2022.       
2.3. Population and Sample of the Study         
T   stu y popul tion  onsist   o  p ti nts w o w r  r   ivin  outp ti nt   r   t t   
C r iolo y Outp ti nt Clini  o  X St t  Hospit l  n  Y St t  Hospit l  n       xp ri n      
myo  r i l in  r tion (MI)  t l  st t r   mont s   o. To   t rmin  t    ppropri t  s mpl  
siz     pow r  n lysis w s  on u t   usin  t   G*Pow r 3.1.9.6 pro r m   s   on   pr vious 
stu y (23) involvin  MI p ti nts. T   pow r  n lysis r sult   in   s mpl  siz  o  34 p ti nts 
in tot l  wit  17 p ti nts  llo  t   to       roup. T is s mpl  siz  w s   t rmin   to    i v  
80% pow r   n      t siz  o  0.87   n    m r in o   rror o  5%. How v r   onsi  rin  t  t 
in r  sin  t   s mpl  siz  woul     r  s  t   st n  r   rror  n  in r  s  t   stu y pow r 
(24)        roup w s in r  s    y 75%. As   r sult    tot l o  60 p ti nts  wit  30 p ti nts in 
      roup  w r  in lu    in t   stu y. 
For pr  ti  l r  sons (  o r p i  l lo  tion  workin   on itions   n  limit   
 v il  ility o  myo  r i l in  r tion (MI) p ti nts)    tot l o  30 MI p ti nts w o w r    in  
tr  t    s outp ti nts  t t   C r iolo y Outp ti nt Clini  o  Y St t  Hospit l  n      
 xp ri n    MI  t l  st t r   mont s prior w r   ssi n   to t    xp rim nt l  roup. Anot  r 
30 MI p ti nts w o w r    in   ollow   up  s outp ti nts  t t   C r iolo y Outp ti nt Clini  
o  X St t  Hospit l  n       lso  xp ri n    MI  t l  st t r   mont s    or  w r   ssi n   to 
t    ontrol  roup usin   rit rion s mplin . Crit rion s mplin  involv s s l  tin  in ivi u ls 

  s   on pr   t rmin    rit ri  or qu li i  tions  or t   stu y’s o j  tiv s (25). It is import nt 
to not  t  t in t is stu y  t    ssi nm nt o  p ti nts into  roups w s not  on  t rou   
r n omiz tion or m t  in . How v r  st tisti  l  n lys s o  t     s riptiv   n   is  s -
r l t   in orm tion o  t   p ti nts in i  t   no si ni i  nt  i   r n  s   tw  n t    roups 
(T  l  1). T is out om   on irms t  t t     s riptiv   n   is  s -r l t      r  t risti s o  t   
 roups w r  simil r  t  r  y    i vin   n  qu l  n   omo  n ous  istri ution in t   stu y. 
T   CONSORT  low  i  r m outlinin  t   pro r ssion o  t   stu y is pr s nt   in Fi ur  1. 
  
 
Figure 1. CONSORT flow diagram of the research 
2.4 . Research questions  
Research Question 1: W  t is t   imp  t o   r  n w lkin  on t    o y m ss in  x (BMI) o  
p ti nts wit  MI? 
Ex lu    
Not meeting inclusion criteria 
(n=2) 
Declined to participate in the 
study (n=3) 
An lys   (n=30) 
 Ex lu     rom  n lysis (n=0) 
 
Lost to  ollow up (n=0) 
Dis ontinu   int rv ntion (n=0) 
Gr  n w lk  roup (n=30) 
Lost to  ollow up (n=0) 
Dis ontinu   int rv ntion (n=0) 
 
Control  roup (n=30) 
An lys   (n=30) 
 Ex lu     rom  n lysis (n=0) 
Allocation  
Analysis  
Intervention  
Enrollment  
Ass ss    or  li i ility (n=65) 

Research Question 2: How does green walking influence blood lipid levels (triglycerides, 
LDL, total cholesterol, and HDL) in patients with MI? 
Research Question 3: What is the effect of green walking on the perception of the disease in 
patients with MI? 
Research Question 4: How does green walking affect the quality of life of patients with MI? 
2.5. Inclusion Criteria  
      In lusion  rit ri  w r    in  18 y  rs o      or ol  r    in    l  to  ommuni  t  v r  lly  
  in  lit r t     vin      MI  t l  st t r   mont s   o (26-28)    in   ollow   up  s  n 
outp ti nt wit  t    i  nosis o  MI in t     r iolo y outp ti nt  lini  o  X st t   ospit l  n  
Y st t   ospit l     i vin  t   six-minut  w lk t st (6MWT) (29)    vin  no o st  l  to 
w lkin  (mus ulosk l t l pro l ms  joint pro l ms   r  tur   n urop t y    roni  s v r  p in  
lim  loss)   n  volunt  rin  to p rti ip t  in t   stu y. 
2.6. Exclusion Criteria  
        Ex lusion  rit ri  w r    vin   loo  pr ssur    ov  140/90 mmH  or   low 90/60 
mmH     vin    tiv     st p in   yspn     r  y  r i   or t   y  r i     psy  i tri  
 i  nosis  visu l     rin    n   o nitiv  imp irm nt      l n   pro l m  usin    w lk r w il  
w lkin     vin  P rkinson’s  is  s     m nti   or   n  r    vin  un  r on   ny sur  ry t  t 
woul  pr v nt w lkin    n  r  usin  to p rti ip t  in t   stu y. 
2.7. Data Collection Tools 
T     t  w r   oll  t   usin  t   “Stru tur   P ti nt In orm tion Form”  t   “Bloo  
Lipi s  n  BMI Monitorin  Form”  t   “Bri   Illn ss P r  ption Qu stionn ir  (Bri   IPQ)”  
 n  t   “Myo  r i l In  r tion Dim nsion l Ass ssm nt S  l  (MIDAS)”. As  n int rv ntion  
MI p ti nts w r  m    to w lk  or 50 minut s t r     ys   w  k  or t r   mont s. 
2.7.1. The Structured Patient Information Form: D v lop    y t   r s  r   r   t r 
r vi win  t   lit r tur  (30  31)  t    orm  onsist   o  two p rts. T    irst p rt in lu    six 
qu stions to   t rmin  t   so io  mo r p i     r  t risti s o  t   p ti nts (  n  r       
  u  tion l v l  m rit l st tus   mploym nt st tus   n  o  up tion)   n  t   s  on  p rt 
in lu      tot l o  10 qu stions  in lu in   our qu stions to   t rmin  t      r  t risti s 
r l t   to t    is  s  (w  n MI o  urr    pr s n   o  MI risk    tors   t .). 
2.7.2. The Blood Lipids and BMI Monitoring Form: T is  orm w s   v lop    y t   
r s  r   r in lin  wit  t   lit r tur  (33-35). It in lu     loo  lipi s    i  t ( m)   n  w i  t 

(k ) m  sur m nts o  t   p ti nts. BMI w s   l ul t    y  ivi in   o y w i  t  y t   squ r  
m t r o    i  t (BMI=k /m2) (5). T    loo  lipi  m  sur m nt r sults o  t   p ti nts (1st-
w  k m  sur m nt; 6t -w  k int rim m  sur m nt; 12t -w  k m  sur m nt) w r  o t in   
 rom t   p ti nt  il   y t   r s  r   r  urin  C r iolo y Outp ti nt Clini  visits. 
 2.7.3. The Brief Illness Perception Questionnaire (Brief IPQ): T is s  l  w s   v lop   
 y Bro    nt  t  l. in 2006 (35). T   nin -it m s  tion o  t   s  l     in s t    motion l  n  
 o nitiv   sp  ts o  illn ss p r  ption. E    it m in t   s  l   onsists o  op n- n    
qu stions  n  is s or     tw  n 0  n  10. In t   l st it m  t   in ivi u l is  sk   to in i  t  
t r      tors t  t   /s   t inks  r  t     us  o   is/  r illn ss. T  s  it ms in lu   
 ons qu n  s  tim lin   p rson l  ontrol  tr  tm nt  ontrol  i  ntity  illn ss  on  rn  
 o  r n y   n   motion l r spons   r sp  tiv ly. T    i   st  n  low st s or s  r  80  n  0. 
On t   s  l   t   positiv  r   tion  onsists o  t   s or   iv n to t r   su - im nsions (3r   
4t    n  7t ) wit    s or    tw  n 0-10   n  t   n   tiv  r   tion  onsists o  t   s or   iv n 
to  iv  su - im nsions (1st  2n   5t   6t    n  8t ). Su - im nsion (1st  2n   5t   6t    n  
8t ) it ms  r  r v rs  s or  . Hi   s or s in i  t    n   tiv  p r  ption o  illn ss. As t   
s or  in r  s s  t   lik li oo  o    in       t    y t    is  s  in r  s s (36). In t is stu y  
t   Cron    ’s  lp   v lu  w s  oun  to    0.83. 
2.7.4. The Myocardial Infarction Dimensional Assessment Scale (MIDAS): T   Turkis  
v li ity  n  r li  ility o  t   MIDAS    vis    y D vi  T ompson  t  l. in 2002  w r  
 x min    y Uys l  t  l. (2008)   n  t   Cron      lp   v lu  o  t   s  l  w s   l ul t    s 
0.83 (37). T   s  l  in lu  s 35 it ms  n  s v n su - im nsions  in lu in  p ysi  l   tivity  
ins  urity   motion l r   tion    p n  n y   i t   on  rns ov r m  i  tion   n  si        ts. 
T   s orin  o  t   s  l  is   tw  n 0  n  100. A  i   s or  on t   s  l  in i  t s poor    lt  
st tus (37). In t is stu y  t   Cron      lp   v lu  o  MIDAS w s   t rmin   to    0.93. 
2.8. Data Collection   
2.8.1. Green Walk Group   
P ti nts w o w r    mitt   to t   C r iolo y Outp ti nt Clini  o  Y St t  Hospit l 
 n  p ss   t   6MWT  on u t    y t     r iolo y p ysi i n w r   li i l   or p rti ip tion 
in t    r  n w lk  roup. Followin  t   p ysi i n’s  x min tion  t t   C r iolo y Outp ti nt 
Clini   t   r s  r   r  on u t       -to-     int rvi ws wit  t   p ti nts in   priv t  room. 
Durin  t  s  int rvi ws  t   p ti nts w r    minist r   t   Stru tur   P ti nt In orm tion 
Form  Bloo  Lipi s  n  BMI Monitorin  Form  t   Bri   IPQ   n  t   MIDAS   n  t   

 oll  t     t  w r  r  or    on t   r sp  tiv   orms. T  n  t   r s  r   r provi      t il   
in orm tion to t   p ti nts   out  r  n w lkin . For t   r n omiz   MI p ti nts  two  roups 
w r   orm     n  t  y  n      in   50-minut   r  n w lkin  t r     ys   w  k  or 12 w  ks  
un  r t    ui  n   o  t   r s  r   r. T    r  n w lk  roup’s w lks w r  s    ul   
 i   r ntly  or t   two su  roups. T    irst su  roup     t  ir 50-minut  w lk on Mon  y  
W  n s  y   n  S tur  y  w il  t   s  on  su  roup     t  ir w lks on Tu s  y  T urs  y  
 n  Sun  y. T is  rr n  m nt  nsur     st n  r iz   tim  int rv l   tw  n  r  n w lks  or 
 ot   roups. A  ition lly     ollow-up Bloo  Lipi s  n  BMI Monitorin  Form w s 
  minist r   to t   p ti nts  urin  t  ir visit to t   C r iolo y Poly lini  in t   mi  l  o  t   
stu y (6t  w  k). At t    n  o  t   12-w  k p rio   t   p ti nts in t    r  n w lk  roup 
un  rw nt   postt st  v lu tion. 
2.8.2. Control Group: P ti nts w o w r    mitt   to t   C r iolo y Outp ti nt Clini  o  X 
St t  Hospit l  n  p ss   t   6MWT  on u t    y t     r iolo y p ysi i n w r   nroll   in 
t    ontrol  roup. Upon t  ir visit to t   outp ti nt  lini   t   p ti nts in t is  roup un  rw nt 
      -to-     int rvi w   urin  w i   t  y w r    minist r   t   “Stru tur   P ti nt 
In orm tion Form ” t   “Bloo  Lipi s  n  BMI Monitorin  Form ” t   “Bri  -IPQ ”  n  t   
“MIDAS”  s pr t sts. T   in orm tion  n    t   oll  t    rom t  s  int rvi ws w r  
r  or    on t   r sp  tiv   orms. T   p ti nts in t    ontrol  roup  ontinu   wit  t  ir 
routin    ily   tiviti s. No sp  i i  int rv ntion or    ition l m  sur s w r  impl m nt    y 
t   inv sti  tor in t is  roup. Furt  rmor      ollow-up “Bloo  Lipi s  n  BMI Monitorin  
Form” w s   minist r   to t   p ti nts  urin  t  ir visit to t   C r iolo y Outp ti nt Clini  
in t   mi  l  o  t   stu y (6t  w  k). At t    n  o  t   12-w  k p rio   t   p ti nts in t   
 ontrol  roup un  rw nt   postt st. 
2.9. Ethical Considerations  
P rmission w s o t in    rom t   Z Univ rsity F  ulty o  M  i in  S i nti i  R s  r   
Et i s Committ   (  t   M r   17  2021   n  num  r   24237859-273). Institution l 
p rmission w s o t in    rom t   G m    n  Provin i l H  lt  Dir  tor t   or X St t  
Hospit l (  t   Nov m  r 30  2021   n  num  r   E-51020271-044)  n  Y St t  Hospit l 
(  t   F  ru ry 19.02.2021  n  num  r   E-51020271-044). Writt n  n  v r  l  ons nt w s 
o t in    rom p rti ip nts.  
2.10. Data Analysis  
T    n lysis o  t   r s  r     t  w s p r orm   wit  t   IBM SPSS 26 p  k    pro r m. 
T      t t  t t   sk wn ss  n  kurtosis  o   i i nts o  t   v lu s o t in    rom t   

m  sur m nts  r  wit in t   r n   o  ±1.5 is  onsi  r    vi  n    or t   pr s n   o    
norm l  istri ution (10). I  t  r  is  t l  st on  m  sur m nt in      v ri  l  w os  sk wn ss 
 n  kurtosis  o   i i nts  r  not in t   r n   o  ±1.5  or r p  t   m  sur m nts  it is 
 ppropri t  to us  non-p r m tri  t sts  urin   n lys s   n  i  t  r  is non   it is  ppropri t  
to us  p r m tri  t sts. C i-squ r   Fri  m n t st  In  p n  nt Groups t-t st  M nn-W itn y 
U t st  Wil oxon t st  Fis  r Ex  t t st  ANOVA t st  Fis  r Fr  m n H lton t st  
Gr  n ous -G iss r t st  Bon  rroni t st   n  D p n  nt Groups t-t st w r  us   in t   
 v lu tion o  t     t . W  n t   m  sur m nt v lu s  n  s  l  s or s w r   n lyz   
   or in  to r p  t   m  sur m nts  t     p n  nt  roups’ t-t st w s us    s   p r m tri  
t st  n  t   Wil oxon t st  s   non-p r m tri  t st in  in ry m  sur m nts; t   r p  t   
m  sur s ANOVA t st w s us    s   p r m tri  t st   n  t   Fri  m n t st  s   non-
p r m tri  t st in tripl  m  sur m nts. For t   r sults  p<0.05 w s us    s t   si ni i  n   
l v l   n  t   r sults w r  wit in t   95%  on i  n   int rv l. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

 
3. Results  
Table 1. D s riptiv   n   is  s  in orm tion o  p ti nts wit  myo  r i l in  r tion (n=60) 
Descriptive 
Information  
 
Green Walk 
Group (n=30) 
Control Group 
(n=30) 
Statistical 
Analysis 
n (%)* 
n (%)* 
2 
p 
Gender  
Female  
18 (60.0) 
14 (46.7) 
1.07a 
0.301 
Male  
12 (40.0) 
16 (53.3) 
Education level  
Literate  
10 (33.3) 
6 (20.0) 
1.60 b 
0.462 
Primary school/Secondary 
school 
17 (56.7) 
19 (63.3) 
Hi   s  ool/B    lor’s 
degree/ Post-graduate degree  
3 (10.0) 
5 (16.7) 
Occupation  
Housewife  
18 (60.0) 
13 (43.3) 
3.96 a 
0.138 
Retired  
12 (40.0) 
14 (46.7) 
Tradesmen  
0 (0.0) 
3 (10.0) 
Marital status  
Married  
23 (76.7) 
22 (73.3) 
0.09 a 
0.766 
Single 
7 (23.3) 
8 (26.7) 
Spouse and children  
10 (33.3) 
10 (33.3) 
Extended family  
 7 (23.3) 
8 (26.7) 
Employment 
status  
Yes  
0 (0.0) 
8 (26.7) 
- 
0.005c 
No 
30 (100.0) 
22 (73.3) 
 
t 
p 
Age  
x ±SD 
Med (Min-Max) 
60.23±8.22 
60 (44-72) 
57.73±10.42 
58 (36-77) 
1.03d 
0.306 
Elapsed time 
since MI  
1-4 years  
15 (50.0) 
17 (56.7) 
0.27 a 
0.605 
5-14 years  
15 (50.0) 
13 (43.3) 
Diabetes  
Yes  
21 (70.0) 
16 (53.3) 
1.76 a 
0.184 
No 
9 (30.0) 
14 (46.7) 
Hypertension 
Yes  
21 (70.0) 
18 (60.0) 
0.66 a 
0.417 
No 
9 (30.0) 
12 (40.0) 
Smoking  
Yes  
6 (20.0) 
9 (30.0) 
0.80 a 
0.371 
No 
24 (80.0) 
21 (70.0) 
 C i-Squ r  T st p<0.05;  Fis  r Fr  m n H lton T st p<0.05;  Fis  r Ex  t T st p<0.05;  B In  p n  nt 
Groups t-T st p<0.05; x : Arit m ti  m  n; SD: St n  r    vi tion; M  : M  i n; Min: Minimum; M x: 
M ximum; SSI: So i l S  urity Institution; ACS: A ut  Coron ry Syn rom ; NSTEMI: Non-ST S  m nt 
El v tion Myo  r i l In  r tion; STEMI: ST S  m nt El v tion Myo  r i l In  r tion; MI: Myo  r i l 
In  r tion; *Column p r  nt    w s t k n.  
As   r sult o  t   st tisti  l  n lys s on w  t  r t     s riptiv   n   is  s  in orm tion 
 i   r     tw  n t    r  n w lkin   n   ontrol  roups  it w s   t rmin   t  t t   in orm tion 
 x  pt  or t    mploym nt st tus  i  not  i   r   tw  n t    roups (p>0.05) (T  l  1).  

Table 2. Intr  roup  n  int r roup  n lys s o  t   tim -  p n  nt    n  s in w i  t  n  
 o y m ss in  x o  t    r  n w lkin   n   ontrol  roups (n=60) 
 
Weight  
 
Green Walk Group 
(n=30) 
Control Group (n=30) 
Statistical 
Analysise 
Measurement (kg) 
 
x̄ ± SD 
x̄ ± SD 
t 
p 
1. Pr t st  
82.10±12.06 
80.63±11.40 
0.484  
0.630 
2. Int rim m  sur m nt (6. w  k) 
80.13±12.18 
82.13±11.17 
-0.663  
0.510 
3. Postt st 
78.30±12.07 
83.37±10.99 
-1.700  
0.094 
Statistical 
Analysisd 
sd 
1.27 
1.22 
 
F 
192.50 
66.66 
p 
0.000a 
0.000a 
Significant 
Differenceb 
1-2 
1-3 
2-3 
1-2 
1-3 
2-3 
p 0.000 
0.000 
0.000 
0.000 
0.000 
0.000 
BMI 
1. Pr t st  
28.42±4.07 
28.45±5.59 
-0.028  
0.978 
2. Int rim m  sur m nt (6. w  k) 
27.74±4.06 
28.98±5.57 
-0.987  
0.328 
3. Postt st 
27.10±4.02 
29.43±5.57 
-1.856  
0.069 
Statistical 
Analysisd 
sd 
1.26 
1.22 
 
F 
175.76 
72.89 
p 
0.000a 
0.000a 
Significant 
Differenceb 
1-2 
1-3 
2-3 
1-2 
1-3 
2-3 
p 0.000 
0.000 
0.000 
0.000 
0.000 
0.000 
BMI: Bo y m ss in  x; x : Arit m ti  m  n; SD: St n  r    vi tion; aGreenhouse-Geisser; bBonferroni test was 
used for multiple comparisons; Significance level p<0.001; cIndependent groups t-test; p<0.05; dStatistical 
analysis: Intragroup analysis; eStatistical analysis: Intergroup analysis. 
T  l  2 s ows t  t t   w i  t (Fw lkin =192.50  F ontrol=66.66  p<0.001)  n  BMI (Fw lkin  
=175.76  F ontrol=72.89  p<0.001) l v ls o  MI p ti nts in t    r  n w lkin   n   ontrol 
 roups  i   r   si ni i  ntly. A  or in  to t   Bon  rroni t st r sult in t   multipl  
 omp rison t sts p r orm   to   t rmin   rom w i    roup t    i   r n   ori in t    t   
w i  t  n  BMI l v ls o  MI p ti nts w o      r  n w lkin     r  s   si ni i  ntly  rom 
pr t st to postt st  w il  t   w i  t  n  BMI l v ls o  t    ontrol  roup in r  s   
si ni i  ntly  rom pr t st to postt st (T  l  2).  
 
 
 

Table 3. Intr  roup  n  int r roup st tisti  l r sults o  tim -  p n  nt    n  s in  loo  lipi  
l v ls in  r  n w lkin   n   ontrol  roup p ti nts (n=60) 
HDL 
 
Green Walk Group 
(n=30) 
Control Group (n=30) 
Statistical 
Analysisg 
Measurement  
x̄ ± SD 
x̄ ± SD 
t 
p 
1. Pr t st  
40.83±5.78 
43.30±5.32 
-1.719  
0.091 
2. Int rim m  sur m nt (6t   
w  k) 
51.93±5.88 
39.33±4.47 
9.342  
0.000 
3. Postt st 
64.93±3.32 
34.93±3.67 
33.215  
0.000 
Statistical Analysis f 
sd
2 
1.33 
 
F
477.27 
127.85 
p
0.000a 
0.000b 
Significant
Differencec
1-2 
1-3 
2-3 
1-2 
1-3 
2-3 
p 0.000 
0.000 0.000 
0.000 
0.000 
0.000 
LDL 
 
Mediand 
(25.-75. Percentile) 
Mediand 
(25.-75. Percentile) 
 
1. Pr t st  
151.50 (143.75-156.50) 
126.50 (101.25-138.25) 
189.000  0.000 
2. Int rim m  sur m nt (6t   
w  k) 
110.50 (93.25-127.25) 
158 (147.50-179.25) 
22.500  
0.000 
3. Postt st 
64 (58.50-67) 
200 (174-222) 
0.000  
0.000 
Statistical Analysisf 
sd
2 
2 
 
2
60.00 
60.00 
p
0.000 
0.000 
Significant
Differencee
1-2 
1-3 
2-3 
1-2 
1-3 
2-3 
p 0.000 
0.000 0.000 
0.000 
0.000 
0.000 
Triglyceride 
 
x̄ ± SD 
Mediand 
(25.-75. Percentile) 
x̄ ±SD 
 
1. Pr t st  
208.10±28.85 
149 (127.75-172.75) 168.70±62.10 3.152  
0.003 
2. Int rim m  sur m nt (6t  
w  k) 
152.90±23.16 
188 (174.25-196) 204.07±56.70 -4.576  
0.000 
3. Postt st 
110.80±19.80 
242.50 (228.75-
261.25) 
259.03±50.79 -14.894  
0.000 
Statistical Analysisf 
sd
1.60 
sd
2 
 
 
 
 
 
 
 
 
 
 
 
F
301.47 
2
60.00 
p
0.000b 
p
0.000 
Significant 
Differencec 
1-2 
1-3 
2-3 
Significant Differencee 
1-2 
(p=0.000) 
p 
0.000 
0.000 
0.000 
1-3 
(p=0.000) 
2-3 
(p=0.000) 
Total 
Choles
t
l
 
x̄ ± SD 
Median 
(25.-75. Percentile) 
x̄ ±SD 
 

1. Pr t st  
263.93±20.98 
228.50 (215.50-
236.50) 
236.43±34.30 3.746  
0.000 
2. Int rim m  sur m nt (6t  
w  k) 
220.63±12.95 
266.50 (255.75-
282.75) 
274.77±30.98 -8.831  
0.000 
3. Postt st 
158.87±24.63 
291 (283-303.50) 301.70±32.28 -19.266  
0.000 
Statistical Analysisf 
sd
1.41 
sd
2 
 
F
215.61 
2
60.00 
p
0.000b 
p
0.000 
Significant 
Differencec 
1-2 
1-3 
2-3 
Significan
t 
Difference
e 
1-2 
(p=0.000) 
p 
0.000 
0.000 0.000 
1-3 
(p=0.000) 
2-3 
(p=0.000) 
aSphericity was assumed; bGreenhouse-Geisser; cBonferroni test was used for multiple comparisons; dFriedman 
test was used because LDL values for the green walk and control groups and triglyceride and total cholesterol 
values for the control group did not show normal distribution; eWilcoxon test was used to determine which 
groups differed. Therefore, Bonferroni correction was made, and p-value was taken as 0.05/3=0.017 when 
Wilcoxon test was performed since there were 3 pairwise comparisons; fStatistical analysis: Intragroup 
comparisons; gStatistical analysis: Independent groups t-test was used in intergroup analysis; hM nn-W itn y U 
t st w s us   in int r roup  n lysis; x : Arit m ti  m  n; SD: St n  r    vi tion. 
T  l  3 s ows t  t (Fw lkin =477.27  F ontrol=127.85  p<0.001)  LDL (2
w lkin =60.00  
2
kontrol=60.00  p<0.001)  tri ly  ri   (Fw lkin =301.47  2
 ontrol=60.00  p<0.001)  n  tot l 
  ol st rol (Fw lkin =215.61  2
 ontrol=60.00  p<0.001) l v ls o  MI p ti nts wit   n  wit out 
 r  n w lkin   i   r   si ni i  ntly    or in  to t   w lkin  pro  ss. 
T   stu y  mploy   Bon  rroni  n  Wil oxon t sts to  urt  r inv sti  t  t   ori in o  
t    i   r n  s   tw  n  roups. T  s  t sts w r   on u t     t r p r ormin  r p  t   
m  sur s o  ANOVA  n  Fri  m n t sts. T   r sults r v  l   si ni i  nt    n  s in lipi  
l v ls   tw  n t    r  n w lk  roup  n  t    ontrol  roup. T  r  w s   si ni i  nt    r  s  
in LDL  tri ly  ri     n  tot l   ol st rol l v ls  rom pr t st to postt st  n    si ni i  nt 
in r  s  in HDL l v ls  urin  t   s m  p rio  in t    r  n w lkin    roup w il  t  r  w s   
si ni i  nt in r  s  in LDL  tri ly  ri     n  tot l   ol st rol l v ls  n    si ni i  nt 
   r  s  in HDL l v ls  rom pr t st to postt st in t    ontrol  roup (T  l  3). 
 
 

Table 4. Intr  roup  n  int r roup  omp rison o  pr t st  n  postt st  is  s  p r  ption 
l v ls o   r  n w lkin   n   ontrol  roup p ti nts (n=60) 
Positive response  
 
Green Walk Group 
(n=30 
Control Group  
(n=30) 
Statistical 
Analysisd 
Measurement  
x̄ ± SD 
x̄ ± SD 
t 
p 
1. Pr t st  
18.73±2.84 
16.33±3.85 
2.746 
0.008b 
2. Postt st 
25.50±1.72 
11.30±3.14 
21.722 
0.000b 
Statistical 
Analysisc 
t 
-17.41 
18.71 
 
p 
0.000a 
0.000a 
Negative 
response 
Tepki
1. Pr t st  
37.23±4.77 
31.37±5.93 
4.221 
0.000b 
2. Postt st 
26.43±4.77 
38.50±4.35 
-10.237 
0.000b 
Statistical 
Analysisc 
t 
26.66 
-17.82 
 
p 
0.000a 
0.000a 
 D p n  nt  roups t-t st; Si ni i  n   l v l: p<0.001;  In  p n  nt  roups t-t st; Si ni i  n   l v l: p<0.05; 
 St tisti  l  n lysis: Intr  roup  n lysis;  St tisti  l  n lysis: Int r roup  n lysis; x : Arit m ti  m  n; SD: 
St n  r    vi tion 
         T  l  4 pr s nts t  t t   positiv  (tw lkin =-17.41  t ontrol=18.71  p<0.001)  n  n   tiv  
(tw lkin =26.66  t ontrol=-17.82  p<0.001) r   tion l v ls o  t    r  n w lkin    n   ontrol 
 roup MI p ti nts  i   r   si ni i  ntly. Positiv  r   tion l v ls o  MI p ti nts w o  i  
 r  n w lkin  in r  s   si ni i  ntly  n  n   tiv  r   tion l v ls    r  s   si ni i  ntly in 
t   postt st  omp r   to t   pr t st  w il  positiv  r   tion l v ls o  t    ontrol  roup 
   r  s   si ni i  ntly   n  n   tiv  r   tion l v ls in r  s   si ni i  ntly in t   postt st 
 omp r   to t   pr t st (T  l  4). 
 
 
 
 
 
 
 
 
 

Table 5. Intr  roup  n  int r roup st tisti  l r sults o  t   pr t st  n  postt st qu lity o  li   
l v ls o  t    r  n w lkin   n   ontrol  roup p ti nts (n=60) 
      Insecurity 
 
Green Walk Group (n=30 
Control 
Group (n=30) 
Statistical 
Analysisb 
Measurement 
x̄ ± SD 
x̄ ± SD 
t 
p 
1. Pr t st  
77.22±13.02 
50.09±11.12 
8.679  
0.000 
2. Postt st 
32.31±6.58 
78.52±9.17 
-22.421  0.000 
Statistical 
Analysisa 
t 
22.28 
-37.33 
 
p 
0.000 
0.000 
Emotional 
reaction 
1. Pr t st  
72.08±15.29 
50.62±17.24 
5.101  
0.000 
2. Postt st 
36.67±10.21 
79.37±12.73 
-14.332  0.000 
Statistical 
Analysisa 
t 
11.05 
-16.08 
 
p 
0.000 
0.000 
Dependency 
1. Pr t st  
76.94±11.72 
46.11±15.74 
8.605  
0.000 
2. Postt st 
52.50±10.30 
58.06±11.88 
-1.935  
0.058 
Statistical 
Analysisa 
t 
8.25 
-5.68 
 
p 
0.000 
0.000 
Concerns 
over 
medication 
1. Pr t st  
48.75±24.64 
40.00±15.88 
1.635  
0.108 
2. Postt st 
55.83±13.82 
67.08±13.73 
-3.163  
0.002 
Statistical 
Analysisa 
t 
-1.52 
-10.34 
 
p 
0.140 
0.000 
Concerns 
over 
side 
effects  
1. Pr t st  
40.83±16.39 
47.08±14.56 
-1.561  
0.124 
2. Postt st 
58.75±12.78 
70.00±10.17 
-3.773  
0.000 
Statistical 
Analysisa 
t 
-5.90 
-8.53 
 
p 
0.000 
0.000 
Physical activity 
 
Median* 
(25.-75. Percentile) 
x̄ ±SD 
x̄ ±SD 
 
1. Pr t st  
72.92 (62.50-77.08) 69.44±10.30 
49.37±9.74 
7.754  
0.000 
2. Postt st 
33.33 (31.25-35.42) 
32.71±4.99 
76.94±7.13 
-27.838  0.000 
Statistical 
Analysisa 
Z 
-4.79 
t 
-30.35 
 
p 
0.000* 
p 
0.000 
Diet  
 
Median* 
(25.-75. Percentile) 
Median* 
(25.-75. Percentile) 
 
U 
p 
1. Pr t st  
41.67 (33.33-50.00) 
33.33 (25.00-41.67) 
334.500  0.080 
2. Postt st 
83.33 (75.00-91.67) 
16.67 (14.58-33.33) 
15.500  
0.000 
Statistical 
Analysisa 
Z 
-4.78 
-3.35 
 
p 
0.000* 
0.001* 
*Wil oxon t st w s us       us  t   v lu s o  “p ysi  l   tivity”  or t    r  n w lkin   n  “ i t”  or t    r  n 
w lk  roup  n  t    ontrol  roup  i  not s ow norm l  istri ution;  St tisti  l  n lysis: Intr  roup  n lysis; 
 St tisti  l  n lysis: In  p n  nt s mpl s t-t st w s us    or int r roup  n lysis; Si ni i  n   l v l: p<0.05; 
 St tisti  l  n lysis: M nn-W itn y U t st w s us    or intr  roup  n lysis; Si ni i  n   l v l: p<0.001; x : 
Arit m ti  m  n; SD: St n  r    vi tion. 
 

             T  l  5 s ows t  t t   l v ls o  ins  urity (tw lkin =22.28  t ontrol=-37.33  p<0.001)  
 motion l r spons  (tw lkin  =11.05  t ontrol=-16.08  p<0.001)     i tion (tw lkin =8.25  t ontrol=-
5.68  p<0.001)   ru  si        ts (tw lkin  =-5.90  t ontrol=-8.53  p<0.001)  p ysi  l   tivity 
(Zw lkin =-4.79  t ontrol=-30. 35  p<0.001)  n   i t (Zw lkin =-4.78  pw lkin  <0.001; Z ontrol=-
3.35  p ontrol<0.01) l v ls  i   r   in  ot   r  n w lkin   n   ontrol  roups   ut t   l v l o  
 on  rn   out m  i  tion  i   r   si ni i  ntly only in t    ontrol  roup (t ontrol=-10.34  
p<0.001). T   l v ls o  ins  urity   motion l r   tion    p n  n y   on  rns ov r  ru  si   
     ts  n  p ysi  l   tivity o  MI p ti nts in t    r  n w lk  roup    r  s   si ni i  ntly 
in t   postt st  omp r   to t   pr t st  w il  t   l v ls o   on  rns ov r si        ts  n   i t 
in r  s   si ni i  ntly in t   postt st. T   l v ls o  ins  urity   motion l r   tion  
  p n  n y   on  rns   out m  i  tion   ru  si        ts   n  p ysi  l   tivity o  t   
 ontrol  roup in r  s   si ni i  ntly in t   postt st  omp r   to t   pr t st  w il  t   l v ls 
o   i t    r  s   si ni i  ntly (T  l  5). 
4. Conclusion and Recommendations 
              T   stu y r sults r v  l   t  t  r  n w lkin  yi l    positiv  out om s in t rms o  
r  u in  BMI  n  w i  t  low rin  LDL  tri ly  ri     n  tot l   ol st rol l v ls  in r  sin  
HDL l v ls   n  n in  qu lity o  li     n   ost rin      vor  l  p r  ption o   is  s   mon  
p ti nts wit  myo  r i l in  r tion (MI). To  urt  r  nri   t    xistin  lit r tur   it is 
r  omm n    to  on u t  xp rim nt l stu i s o   xt n     ur tion wit  l r  r s mpl  siz s 
to  xplor  t        ts o   r  n w lkin  on HDL  LDL  tri ly  ri    tot l   ol st rol v lu s  
w i  t   n  BMI.