Christopher Ball

UNC DPT c/o 2015

Recently completed 2014 randomized control trials (RCT) have presented evidence that indicates long term completion (9 months) of a one easy to moderate hiking session (500 meter altitude gain in 3 hours) per week elicited a mean net energy expenditure between 445-574 kcal per hike and thought to be a safe and viable means to elicit gains in aerobic capacity and improving severity of hypertension in the elderly adult.21 A RCT by Neumayr et al investigated the cardiovascular effects of a 3-week hiking program guided by health professionals four hours per week, average duration 2.5 hours per bout at 55-65% of maximum heart rate within a cohort of elderly males possessing multiple cardiovascular risk factors. The results showed similar benefits including significant decreases in body weight, subject’s weight to height ratio, decreased body fat percentage and waist circumference.22 The hiking regimen again showed a lowering effect in the blood pressure of participants; with deductions in SBP,DBP, mean arterial blood pressure as well as promoted lower heart rate with mean decreases between 3-5 beats/min.22 These results are again intervention specific and support hiking as an evidenced based means of achieving positive outcomes related to participation in outdoor hiking and the prevention and/or reversal of risk factors associated with the targeted chronic disease condition/s and prospective population of elder-adults within our health promotion model. Furthermore, the importance of integrating trained health care professionals such as physical therapist to ensure hiking and other forms of functional activity in more unpredictable outdoor environments are safe for elder adults with or without the presence of cardiovascular risk factors. Body weight is a common risk factor, which leads to chronic disease. Participation in community gardening has been shown to correlate with healthy body weight and appropriate BMI level compared to non-gardening neighbors, siblings and spouses adjusted for age and gender. Female community gardeners’ average BMI was 1.48 points lower than their neighbors and were 46% less likely to be overweight or obese.20 Male gardeners had an average BMI that was 2.52 points lower than their neighbors with a 62% reduction in the likelihood of being overweight or obese.20 This Translated into approximately an 11-pound weight difference for a 5’5” tall woman and 16-pound weight difference for a 5’10” man.20 These results indicate community gardens may be a valuable element of land use diversity that merits consideration by public health officials who want to identify neighborhood features that promote health.20 Group walks/hikes as well as gardening are able to integrate the targeted population’s outdoor environment and take into account population determinants such as interpersonal as well as intrapersonal factors when establishing positive health behavior change. Taking into account population determinants will better facilitate self- enjoyment, peer-interaction within the community and help establish an emotional sense of well-being.1,2,4 The Centers for Disease Control and Prevention recommends walking in a group to increase walking behavior, as the social environment of the walking group may augment adherence to walking.(26) Group walks in the natural environment has been shown to significantly improve emotions and self-esteem when compared to a group walk indoors.23 The rational explaining positive affects on emotional well being related to natural environment exposure have been extensively reviewed and a cornerstone to the enhanced efficacy of the health promotion interventions proposed in achieving long-term behavior change with the older-adult population and continued success within the rural and underserved community.11,12,13 The Attention Restoration Theory (ART) posits natural environments contain stimuli that allow for the restoration from mental fatigue due to unconscious attraction of an individual’s involuntary attention, allowing for the restoration of direct attention to themselves or others.(23) The psycho-physiological stress reduction framework, posits that nature initiates innate emotional, physiological, cognitive and behavioral responses including reduced negative affect and physiological arousal as well as enhanced positive effect on attention.24 Evidence also indicates the specific type of natural environment and whether this is urbanized or not can affect individual psychological/emotional well being, walking behavior and physical activity level achieve larger positive outcomes and further support implementing walk/hiking groups within the rural and underserved community.25 Walking in urban green space and urban public space is typically significantly less in duration compared to walks in natural environments, green corridor, and farmland.25 Additionally, walks in urban public space tend to be significantly less duration than walks in coastal and mixture environments25 Participants who frequently attend group walks in farmland environments are associated with greater mental well-being in comparison with those walking in urban public spaces.25