Effects of Urban Nature on Stress and Quality of Life

Study Overview
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Brief Summary
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The aim of this study is to investigate the effects of regular nature therapy in urban nature with guidance of a licensed nature therapist on stress, quality of life and physical symptoms of subjects with elevated stress levels.

Official Title
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Effects of Urban Nature on Stress and Quality of Life of Subjects With Elevated Stress Levels - a Three-armed Randomized Controlled Study

Conditions
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Stress, Psychological

Intervention / Treatment
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* Behavioral: Nature therapy in urban nature
* Behavioral: City Walk


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: stress with at least 4 of 10 points on the Numeric Analogue Scale (NAS) at least 1 month at least 3 of the following 8 stress-associated symptoms: sleep disturbances, inappetence or increased appetite, shoulder neck tension/back pain, tension headache, concentration disturbances, exhaustion, nervousness/irritability, stress-associated digestive complaints. Exclusion Criteria: serious acute or chronic diseases pregnancy or lactation known serious mental illness immobility or restriction for gymnastics exercises due to orthopaedic, neurological or other medical cause participation in another study

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 70 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Nature therapy in urban nature<br>Subjects receive a 90-minute nature therapy session once per week for 8 weeks with a licensed nature therapist, who explains exercises on perceiving nature and the connection between nature and health. | Behavioral: Nature therapy in urban nature<br>* Nature therapy means visits in nature, actively perceiving the flora and fauna<br>|
| Active Comparator: City Walk<br>Subjects receive a 90-minute city walk through urban sourroundings once per week for 8 weeks with a city guide, who talks about city architecture and gives information about the history of the surroundings. | Behavioral: City Walk<br>* City Walk means walking through urban surroundings (houses, streets, concrete..) with as little as possible contact to nature<br>|
| No Intervention: Waiting List<br>Subjects don't receive any therapy. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Stress questionnaire (Cohen Perceived Stress Scale, CPSS) | Change from Baseline in the CPSS, range from 0 to 4 in each item. Scores are obtained by reversing responses (e.g., 0 = 4, 1 = 3, 2 = 2, 3 = 1 & 4 = 0) to the positively stated items and then summing across all scale items while higher values meaning a higher grade of perceived stress. | Date of Inclusion (Baseline), after 8 weeks and after 16 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Zerssen symptom list (B-LR and B-LR') | Assessing full scale, range 20-80, higher score meaning a better outcome | Date of Inclusion (Baseline), after 8 weeks and after 16 weeks | 
| International Physical Activity Questionnaire (IPAQ) | MET minutes represent the amount of energy expended carrying out physical activity. To get a continuous variable score from the IPAQ (MET minutes a week) we will consider walking to be 3.3 METS, moderate physical activity to be 4 METS and vigorous physical activity to be 8 METS; higher score meaning better outcome; range 0 to around 3000 MET minutes a week | Date of Inclusion (Baseline), after 8 weeks and after 16 weeks | 
| Maslach Burnout Inventory (MBI) | Assessing full scale, range 0-96, higher score meaning a better outcome | Date of Inclusion (Baseline), after 8 weeks and after 16 weeks | 
| Mindfulness (Freiburger Fragebogen zur Achtsamkeit, FFA) | Assessing full scale, range 0-56, higher score meaning a better outcome | Date of Inclusion (Baseline), after 8 weeks and after 16 weeks | 
| General Self-Efficacy Short Scale-3 (GSE-3) |  | Date of Inclusion (Baseline), after 8 weeks and after 16 weeks | 
| Perceived Benefits of Nature Questionnaire (PBNQ) | mean score of the 11 items, range 1-7, lower score meaning a better outcome | Date of Inclusion (Baseline), after 8 weeks and after 16 weeks | 
| Subjective Vitality Scale (SVS-G state) | Assessing full scale, range from 0-28, lower score meaning a better outcome | Date of Inclusion (Baseline), after 8 weeks and after 16 weeks | 
| Flourishing Scale (FS) | Assessing full scale, range 8-56, higher score meaning a better outcome | Date of Inclusion (Baseline), after 8 weeks and after 16 weeks | 
| Hospital Anxiety and Depression Scale (HADS) |  | Date of Inclusion (Baseline), after 8 weeks and after 16 weeks | 
| Profile of Mood States (POMS) |  | Date of Inclusion (Baseline), after 8 weeks and after 16 weeks | 
| Sociodemographic Measurements | Age, gender, marital status, number of people in household, education level, employment status, job, personal net income, household income | Date of Inclusion (Baseline) | 
| Behavioural questions: doctor visits and health | amount of doctor visits, amount of sick leave days in the last 2 months | Date of Inclusion (Baseline), after 8 weeks and after 16 weeks | 
| Expectation questions | for intervention 1 and 2 on a 6-point likert scale from 1 (very strong) to 6 (nothing at all) | Date of Inclusion (Baseline) | 
| Behavioural questions: cigarette consumption | Number of cigarettes on average per day in the last month | Date of Inclusion (Baseline), after 8 weeks and after 16 weeks | 
| Behavioural questions: alcohol consumption | Number of alcoholic beverages on average per week in the last month | Date of Inclusion (Baseline), after 8 weeks and after 16 weeks | 
| Behavioural questions: time in nature | amount of hours spent in nature per week in the last month | Date of Inclusion (Baseline), after 8 weeks and after 16 weeks | 
| Behavioural questions: nature as priority | if spending time in nature is seen as a priority on a 6-point likert scale 1 (very strong) to 6 (nothing at all) | Date of Inclusion (Baseline), after 8 weeks and after 16 weeks | 
| Heart Rate (HR) | 24h measuring by faros 180 | Date of inclusion (baseline), after 8 weeks, after 16 weeks | 
| Heart Rate Variability (HRV) | 24h measuring by faros 180 | Date of inclusion (baseline), after 8 weeks, after 16 weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Nature therapy, Stress