Nature Based Therapy With Mindful Walks in Urban Coastal Settings for Metabolic Syndrome - Barcelona (Spain)

The main objective of the NATURE-MET-B (Barcelona) study is to analyze the effects of a Nature-based Therapy (NbT) on the biopsychological resilience of a group of sedentary patients with metabolic syndrome (MetS) and little contact with nature, through changes in: i) health-related quality of life and ii) allostatic load. The secondary objective is to provide data on the environmental, social, and economic aspects of the intervention in order to refine specific prevention programs and establish programs that include NbTas a secondary preventive measure in healthcare for MetS.

Analogous to NATURE-MET-B, two similar NbT studies will be carried out in Padua (Italy) and Salzburg (Austria) for the secondary prevention of MetS. These are not multicenter studies but three comparable studies with the same inclusion and exclusion criteria for MetS patients in all study locations. Only the types of landscape and natural exposure sites differ: Barcelona-Coastal Urban, Padua-Urban Green, Salzburg-Mountainous Rural.


Eligibility Criteria:
Inclusion Criteria:

* Medical diagnosis of metabolic syndrome according to the ATPIII (Adult Treatment Panel III of the National Cholesterol Education Program) criteria. According to the ATP III definition, metabolic syndrome is present if at least three of the following five criteria are met (NCEP, 2001):

  * Abdominal fat distribution: waist circumference \&gt;102 cm (men), \&gt;88 cm (women)
  * Serum triglycerides ≥150 mg/dL
  * HDL cholesterol: \&lt;40 mg/dL (men), \&lt;50 mg/dL (women)
  * Blood pressure: ≥130/≥85 mmHg
  * Fasting glucose: ≥110 mg/dL
* Sedentary/inactive lifestyle: Category 1 (low physical activity) of the International Physical Activity Questionnaire - Short Form (IPAQ-SF) (International Physical Activity Questionnaire, 2005)
* Low nature use (\&#34;infrequent users of nature\&#34;): Categories 1, 2, and 3 of the Monitor of Engagement with the Natural Environment Survey (MENE) - \&#34;Nature use\&#34; question (Natural England, 2020)
* Smartphone users

Exclusion Criteria:

* Acute contraindications

  - Malignant hypertension
* Contraindications or differential diagnosis

  * Severe respiratory or pulmonary disease (COPD, severe asthma, emphysema)
  * Arteriosclerotic incident (e.g., myocardial infarction) \&lt; 6 months ago
  * Heart failure
  * Uncontrolled metabolic diseases (e.g., diabetes mellitus)
  * Diagnosis or treatment of a malignant disease \&lt; 3 years ago
  * Chronic immunological diseases (e.g., rheumatoid arthritis)
  * Orthopedic conditions that prevent participation in excursions
* Factors that prevent or hinder participation in the intervention program

  * Alcohol or substance abuse (except nicotine)
  * Pregnancy
  * Insufficient knowledge of Spanish or Catalan (written and spoken/questionnaires)
  * Factors that prevent self-management
  * Moderate to severe depression (score \&lt; 13 points on the WHO-5)
  * Other untreated severe psychiatric illnesses (e.g., schizophrenia)
  * Taking certain medications
  * Use of weight loss supplements
  * Participation in another clinical intervention trial
  * Participation in therapeutic weight loss programs