Feasibility of an Outdoor Mindful Walking Program for Reducing Negative Affect in Older Adults

Implementation and evaluation of a community-based mindful walking randomized controlled trial to sustain cognitive health in older African Americans at risk for dementia

BACKGROUND

With an increasing proportion of older adults and the associated risk of Alzheimer's Disease and Related Dementias (ADRD) around the globe, there is an urgent need to engage in ADRD risk reduction efforts. African American (AA) older adults in the U.S. are disproportionally impacted by ADRD compared to other races and ethnicities. Mindful walking integrates two potentially protective factors of ADRD by elevating mindfulness and physical activity (i.e., walking), resulting in a synergistic behavioral strategy that is feasible and safe for older adults. However, the efficacy of applying this intervention for cognitive health outcomes has not been evaluated using experimental designs.

METHODS

This paper documents the goal and protocol of a community-based, mindful walking randomized controlled trial to examine the short- and longer-term efficacy on cognitive and other health-related outcomes in ADRD at-risk AA older adults. The study outcomes include various brain health determinants, including cognitive function, quality of life, psychological well-being, physical activity, mindfulness, sleep, and overall health status. In addition, the estimated costs of program implementation are also collected throughout the study period. This study will recruit 114 older adults (ages 60+ years) with elevated ADRD risk from the Midlands region of South Carolina. Older adults are randomly assigned to participate in 24 sessions of outdoor mindful walking over three months or a delayed mindful walking group (n=57 in each group). Participants in both groups follow identical measurement protocols at baseline, after 12 weeks, after 18 weeks, and after 24 weeks from baseline. The outcome measures are administered in the lab and in everyday settings. Costs per participant are calculated using micro-costing methods. The eliciting participant costs for mindful walking engagement with expected results are reported using the payer and the societal perspectives.

DISCUSSION

This study will generate evidence regarding the efficacy of mindful walking on sustaining cognitive health in vulnerable older adults. The results can inform future large-scale effectiveness trials to support our study findings. If successful, this mindful walking program can be scaled up as a low-cost and viable lifestyle strategy to promote healthy cognitive aging in diverse older adult populations, including those at greatest risk.

TRIAL REGISTRATION

ClinicalTrials.gov number NCT06085196 (retrospectively registered on 10/08/2023).

Meditative and non-meditative mindfulness-based interventions for mind and body

The present editorial synopsises the benefits and challenges in meditative and non-meditative mindfulness practices and explores shorter and more creative approaches in mind-body interventions, emphasizing inclusivity and evidence-based practices. This collection, launched in BMC Complementary Medicine and Therapies, aims to bring together research on a variety of mindful practices, to discuss their role in supporting wellbeing.

Effectiveness of mindful walking intervention in nature on sleep quality and mood among university student during Covid-19: A randomised control study

OBJECTIVE

The aim of this project was to conduct a randomised control study to examine whether outdoor mindful walking in nature can effectively improve university students' sleep quality, mood, and mindfulness during the lockdown of Covid-19 pandemic in the U.K.

METHODS

Participants were measured at T₀ (pre-study baseline), T₁ (pre-intervention), T₂ (post-intervention), and T₃ (follow-up). A total of 104 participants (female = 94) who were experiencing sleep difficulties were randomly allocated to either an experimental (i.e., nature) or control (i.e., urban) walking environments. Participants in each walking condition independently undertook a daily 35-minute walk for a week (7 days). Subjective sleep quality, total mood disturbance, mindfulness, and degree of nature, and participants' perspectives and suggestions about the intervention, were collected.

RESULTS

Findings suggest that both groups exhibited significant improvements on participant's trait mindfulness, sleep quality and mood after the intervention. However, mindful walking in nature did not bring additional mental health benefits to participants than those who walked in urban environment. Participants reflected their perspectives about the intervention, which will assist with further intervention development.

CONCLUSIONS

Findings contribute to the evidence base for the effectiveness of outdoor mindful walking interventions on mental health. Especially these findings add new knowledge of how mindful walking outdoors reduces university students' mood disturbances and improves their sleep quality and mindfulness level during the pandemic.

Mindful walking and cognition in older adults: A proof of concept study using in-lab and ambulatory cognitive measures

Mindfulness practice and walking have been linked individually to sustain cognition in older adults. This early-phase study aimed to establish proof-of-concept by evaluating whether an intervention that integrates light-intensity walking with mindfulness practices shows promising signs of improving cognition in older adults. Participants (N = 25, Mage = 72.4 ± 6.45) were community-dwelling older adults who engaged in a supervised mindful walking program over one month (8 sessions total, 2 sessions per week, 30-minute slow walking containing mindfulness skills). They completed performance-based and subjective ratings of cognitive measures in field before and after two mindful walking bouts using a smartphone app. They also completed in-lab performance-based and self-report cognitive measures at baseline and after the entire program. Controlling for demographics, potential covariates, and time trends, short-term improvements in perceived cognition and processing speed were observed from pre- to post-mindful walking sessions (i.e., 30 min) across multiple ambulatory cognitive measures (Cohen's ds range = 0.46-0.66). Longer-term improvements in processing speed and executive function were observed between baseline and end of the program (i.e., one month) across various performance-based cognitive measures (ds range = 0.43-1.28). No significant changes were observed for other cognitive domains. This early-phase study (Phase IIa) provides preliminary support that mindful walking activity is promising for sustaining cognition in older adults. Our promising findings form the building blocks of evidence needed to advance this intervention to a fully powered randomized controlled trial that examines program efficacy with a comparator. Favorable outcomes will inform the development of this lifestyle behavioral strategy for promoting healthy brain aging in late adulthood.

Exploring the Relationship between Walking and Emotional Health in China

Walking has a positive impact on people's emotional health. However, in the case of serious air pollution, it is controversial whether walking exercise can still improve individuals' emotional health. Using data from the 2014 wave of the China Labor-Force Dynamics Survey, this study explored the relationship between walking and emotional health with different levels of environmental pollution. The results indicated that respondents who took regular walks had better emotional health than those who did not walk regularly. For those whose main mode of physical exercise was walking, the average number of walks per week was significantly and positively correlated with their emotional health; however, the average duration of the walk had no significant impact on their emotional health. Moreover, for those whose main mode of physical exercise was walking and who lived in neighborhoods with a polluted environment, regular walking still had a positive impact on their emotional health. This suggests that even if environmental pollution is serious, walking still plays an important role in regulating individuals' mental health. We propose that in order to promote the emotional health of residents, it is necessary to create more public spaces for outdoor activities and simultaneously increase efforts to control environmental pollution.

Examining the Feasibility of a Mindfulness Intervention for the Prevention of Falls: A Pilot Study

This pilot study was designed to assess the feasibility of implementing a mindfulness intervention in the prevention of falls. We employed a quasi-experimental design consisting of 22 participants from two retirement homes in Ontario partaking in the regional falls prevention class. Participants were assigned to either an eight-week intervention, comprising mindfulness exercises incorporated into the standard falls prevention class, or to the standard falls prevention class. Participants were assessed using the Tinetti Balance and Gait Scale and the Timed Up and Go (TUG) test. The mindfulness intervention showed no significant effect on TUG or balance scores; however, there was a significant effect on assessments of gait. Given the ease of implementation of mindfulness-based interventions, further research may be warranted in mindfulness as a potential modality for falls prevention.

A Systematic Review and Meta-Analysis of Nature-Based Mindfulness: Effects of Moving Mindfulness Training into an Outdoor Natural Setting

Research has proven that both mindfulness training and exposure to nature have positive health effects. The purpose of this study was to systematically review quantitative studies of mindfulness interventions conducted in nature (nature-based mindfulness), and to analyze the effects through meta-analyses. Electronic searches revealed a total of 25 studies to be included, examining 2990 participants. Three analyses were conducted: Nature-based mindfulness interventions evaluated as open trials (k = 13), nature-based mindfulness compared with groups in non-active control conditions (k = 5), and nature-based mindfulness compared with similar interventions but without contact with nature (k = 7). The overall combined psychological, physiological, and interpersonal effects from pre- to post-intervention were statistically significant and of medium size (g = 0.54, p < 0.001). Moderation analyses showed that natural environments characterized as forests/wild nature obtained larger numerical effects than environments characterized as gardens/parks, as did informal mindfulness compared with formal mindfulness. The small number of studies included, as well as the heterogeneity and generally low quality of the studies, must be taken into consideration when the results are interpreted. PROSPERO registration number: CRD42017065639.