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Herring TE, Knowles LM, Alschuler KN. Outdoor Adventure Programs for Persons with Multiple Sclerosis: A Review and Agenda for Future Research. Int J MS Care 2021; 23:186-192. [PMID: 34483758 DOI: 10.7224/1537-2073.2020-066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Persons with multiple sclerosis (MS) often experience myriad symptoms that affect functioning and quality of life (QOL). Although there are a growing number of nonpharmacologic interventions designed to improve symptom severity and interference and maximize QOL, these particular treatments are limited by barriers to accessibility and, at times, a poor patient-intervention fit. Thus, it is important to consider alternative or supplemental nonpharmacologic treatments for people with MS. Outdoor adventure programs-group-based outdoor adventures aimed at enhancing QOL and fostering personal growth-could be one such alternative or supplemental approach. This topical review provides an overview of outdoor adventure programs; explores the current literature on these types of programs for the general population and medical populations; examines how outdoor adventure programs could enhance mood, functioning, and QOL for individuals with MS; and suggests future directions for research on outdoor adventure programs tailored to persons with MS.
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Shanahan DF, Astell-Burt T, Barber EA, Brymer E, Cox DTC, Dean J, Depledge M, Fuller RA, Hartig T, Irvine KN, Jones A, Kikillus H, Lovell R, Mitchell R, Niemelä J, Nieuwenhuijsen M, Pretty J, Townsend M, van Heezik Y, Warber S, Gaston KJ. Nature-Based Interventions for Improving Health and Wellbeing: The Purpose, the People and the Outcomes. Sports (Basel) 2019; 7:E141. [PMID: 31185675 PMCID: PMC6628071 DOI: 10.3390/sports7060141] [Citation(s) in RCA: 85] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Revised: 05/22/2019] [Accepted: 05/24/2019] [Indexed: 11/16/2022] Open
Abstract
Engagement with nature is an important part of many people's lives, and the health and wellbeing benefits of nature-based activities are becoming increasingly recognised across disciplines from city planning to medicine. Despite this, urbanisation, challenges of modern life and environmental degradation are leading to a reduction in both the quantity and the quality of nature experiences. Nature-based health interventions (NBIs) can facilitate behavioural change through a somewhat structured promotion of nature-based experiences and, in doing so, promote improved physical, mental and social health and wellbeing. We conducted a Delphi expert elicitation process with 19 experts from seven countries (all named authors on this paper) to identify the different forms that such interventions take, the potential health outcomes and the target beneficiaries. In total, 27 NBIs were identified, aiming to prevent illness, promote wellbeing and treat specific physical, mental or social health and wellbeing conditions. These interventions were broadly categorized into those that change the environment in which people live, work, learn, recreate or heal (for example, the provision of gardens in hospitals or parks in cities) and those that change behaviour (for example, engaging people through organized programmes or other activities). We also noted the range of factors (such as socioeconomic variation) that will inevitably influence the extent to which these interventions succeed. We conclude with a call for research to identify the drivers influencing the effectiveness of NBIs in enhancing health and wellbeing.
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Affiliation(s)
| | - Thomas Astell-Burt
- Population Wellbeing and Environment Research Lab (PowerLab), School ofHealth and Society, University of Wollongong, 2522 Wollongong, Australia.
| | - Elizabeth A Barber
- School of Public Health, University of Queensland, Brisbane, 4006 Queensland, Australia.
| | - Eric Brymer
- UK. Discipline of Psychology, Australian College of Applied Psychology, Brisbane, 4000 Queensland, Australia.
| | - Daniel T C Cox
- Environment & Sustainability Institute, University of Exeter, Cornwall TR10 9EZ, UK.
| | - Julie Dean
- School of Public Health, University of Queensland, Brisbane, 4006 Queensland, Australia.
| | - Michael Depledge
- European Centre for Environment and Human Health, University of Exeter Medical School, Exeter EX1 2LU, UK.
| | - Richard A Fuller
- School of Biological Sciences, University of Queensland, Brisbane, 4072 Queensland, Australia.
| | - Terry Hartig
- Institute for Housing and Urban Research, Uppsala University, 75120 Uppsala, Sweden.
| | - Katherine N Irvine
- Social, Economic and Geographical Sciences, James Hutton Institute, Aberdeen AB15 8QH, UK.
| | - Andy Jones
- Norwich Medical School, University of East Anglia, Norwich, Norfolk NR15 1LT, UK.
| | - Heidy Kikillus
- Centre for Biodiversity and Restoration Ecology, Victoria University of Wellington, 6012 Wellington, New Zealand.
| | - Rebecca Lovell
- European Centre for Environment and Human Health, University of Exeter Medical School, Truro TR1 3HD, UK.
| | - Richard Mitchell
- Centre for Research on Environment, Society and Health, University of Glasgow, Glasgow G12 8QQ, UK.
| | - Jari Niemelä
- Department of Environmental Science, University of Helsinki, 00014 Helinski, Finland.
| | - Mark Nieuwenhuijsen
- ISGlobal, Barcelona Institute for Global Health, Barcelona Biomedical Research Park (PRBB), 08003 Barcelona, Spain.
| | - Jules Pretty
- Department of Biological Sciences, University of Essex, Colchester, Essex CO4 3SQ, UK.
| | - Mardie Townsend
- School of Health & Social Development, Deakin University, 3217 Geelong, Australia.
| | | | - Sara Warber
- Integrative Medicine, The University of Michigan, Michigan, MA 48710, USA.
| | - Kevin J Gaston
- Environment & Sustainability Institute, University of Exeter, Cornwall TR10 9EZ, UK.
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Mygind L, Kjeldsted E, Hartmeyer RD, Mygind E, Bølling M, Bentsen P. Immersive Nature-Experiences as Health Promotion Interventions for Healthy, Vulnerable, and Sick Populations? A Systematic Review and Appraisal of Controlled Studies. Front Psychol 2019; 10:943. [PMID: 31130890 PMCID: PMC6509207 DOI: 10.3389/fpsyg.2019.00943] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 04/09/2019] [Indexed: 02/02/2023] Open
Abstract
In this systematic review, we summarized and evaluated the evidence for effects of, and associations between, immersive nature-experience on mental, physical, and social health promotion outcomes. Immersive nature-experience was operationalized as non-competitive activities, both sedentary and active, occurring in natural environments removed from everyday environments. We defined health according to the World Health Organization's holistic and positive definition of health and included steady-state, intermediate, and health promotion outcomes. An electronic search was performed for Danish, English, German, Norwegian, and Swedish articles published between January 2004 and May 2017. Manual approaches, e.g., bibliographies from experts, supplemented the literature search. Data were extracted from 461 publications that met the inclusion criteria. To assess the status and quality of the evidence for health promotion effects of immersive nature-experience, we focused on the subset of studies based on controlled designs (n = 133). Outcome level quality of the evidence was assessed narratively. Interventions most often involved adventure-based activities, short-termed walking, and seated relaxation in natural environments. We found positive effects on a range of health promotion outcomes grouped under psychological wellbeing (n = 97; ≈55% positive; ≈13% mixed; ≈29% non-significant; 2% negative); psychosocial function (n = 67; ≈61% positive; ≈9% mixed; ≈30% non-significant); psychophysiological stress response (n = 50; ≈58% positive; ≈18% mixed; ≈24% non-significant), and cognitive performance (n = 36; ≈58% positive; ≈6% mixed; ≈33% non-significant; 3% negative); and social skills and relationships (n = 34; ≈70% positive; ≈7% mixed; ≈22% non-significant). Findings related to outcomes categorized under physical health, e.g., risk of cardiovascular disease, were less consistent (n = 51; ≈37% positive; ≈28% mixed; ≈35% non-significant). Across the types of interventions and outcomes, the quality of the evidence was deemed low and occasionally moderate. In the review, we identify, discuss, and present possible solutions to four core methodological challenges associated with investigating immersive nature-experience and health outcomes: (1) intervention and program complexity; (2) feasibility and desirability of randomization; (3) blinding of participants and researchers; and (4) transferability and generalizability. The results of the review have been published as a popular-scientific report and a scientific research overview, both in Danish language.
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Affiliation(s)
- Lærke Mygind
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | | | | | - Erik Mygind
- Department of Geosciences and Natural Resource Management, University of Copenhagen, Copenhagen, Denmark
| | - Mads Bølling
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Peter Bentsen
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
- Department of Geosciences and Natural Resource Management, University of Copenhagen, Copenhagen, Denmark
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Rojhani S, Stiens SA, Recio AC. Independent sailing with high tetraplegia using sip and puff controls: integration into a community sailing center. J Spinal Cord Med 2017; 40:471-480. [PMID: 27415644 PMCID: PMC5537965 DOI: 10.1080/10790268.2016.1198548] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND We are continually rediscovering how adapted recreational activity complements the rehabilitation process, enriches patients' lives and positively impacts outcome measures. Although sports for people with spinal cord injuries (SCI) has achieved spectacular visibility, participation by high cervical injuries is often restricted due to poor accessibility, safety concerns, lack of adaptability, and high costs of technology. METHODS We endeavor to demonstrate the mechanisms, adaptability, accessibility, and benefits the sport of sailing creates in the rehabilitative process. Our sailor is a 27-year-old man with a history of traumatic SCI resulting in C4 complete tetraplegia. RESULTS The participant completed an adapted introductory sailing course, and instruction on the sip-and-puff sail and tiller control mechanism. With practice, he navigated an on-water course in moderate winds of 5 to 15 knots. DISCUSSION Despite trends toward shorter rehabilitation stays, aggressive transdisciplinary collaboration with recreation therapy can provide community and natural environment experiences while inpatient and continuing post discharge. Such peak physical and psychological experiences provide a positive perspective for the future that can be shared on the inpatient unit, with families and support systems like sailing clubs in the community. CONCLUSION Rehabilitation theory directs a team process to achieve patient self-awareness and initiate self-actualization in spite of disablement. Utilization of local community sailing centers that have provided accessible assisted options provides person-centered self-realization of goals as assisted by family and natural supports. Such successful patients become native guides for others seeking the same experience.
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Affiliation(s)
- Solomon Rojhani
- Department of Physical Medicine & Rehabilitation, The Johns Hopkins School of Medicine, Baltimore, MD, USA,Correspondence to: Solomon Rojhani, Chief Resident 2016-2017, The Johns Hopkins University School of Medicine, Department of Physical Medicine & Rehabilitation, 600 North Wolfe Street Phipps 160, Baltimore, MD, USA, 21287. E-mail:
| | - Steven A. Stiens
- Department of Rehabilitation Medicine, University of Washington, VA Puget Sound Health Care System, Seattle, WA, USA
| | - Albert C. Recio
- International Center for Spinal Cord Injury, Hugo W. Moser Research Institute at Kennedy Krieger & Department of Physical Medicine & Rehabilitation, The Johns Hopkins School of Medicine, Baltimore, MD, USA
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Zachor DA, Vardi S, Baron-Eitan S, Brodai-Meir I, Ginossar N, Ben-Itzchak E. The effectiveness of an outdoor adventure programme for young children with autism spectrum disorder: a controlled study. Dev Med Child Neurol 2017; 59:550-556. [PMID: 27911014 DOI: 10.1111/dmcn.13337] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/29/2016] [Indexed: 11/28/2022]
Abstract
AIM Outdoor adventure programmes aim to improve interpersonal relationships using adventurous activities. The current study examined the effectiveness of an outdoor adventure programme in children with autism spectrum disorders (ASD). METHOD The study included 51 participants (40 males, 11 females; age 3y 4mo-7y 4mo) enrolled in ASD special education kindergartens. Only the intervention group (n=30) participated in the outdoor adventure programme for 13 weeks, completing challenging physical activities that required cooperation and communication with peers and instructors. The control group (n=21) was not significantly different from the research group in age, sex, cognitive, and adaptive behaviour measures. RESULTS Outcomes after the intervention revealed significant improvement in social-communication and different directions in the two groups in the social cognition, social motivation, and autistic mannerisms subdomains of the Social Responsiveness Scale. While the group that received an outdoor adventure programme showed a tendency toward a reduction in severity, the control group showed the opposite (p<0.010). INTERPRETATION The outdoor adventure programme required problem-solving skills and forced the child to communicate in exciting situations. This study suggests that an outdoor adventure programme may be an effective intervention in addition to traditional treatments in young children with ASD. Future studies should examine the outcome of outdoor adventure programmes delivered for longer periods of time and maintenance of the achievements over time.
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Affiliation(s)
- Ditza A Zachor
- Department of Pediatrics, The Autism Center, Assaf Harofeh Medical Center, The Sackler School of Medicine, Tel Aviv University, Zerifin, Israel
| | - Shira Vardi
- Department of Human Services, The Max Stern Yezreel Valley College, Emek Yezreel, Israel
| | - Shani Baron-Eitan
- Department of Communication Disorders, Ariel University, Ariel, Israel
| | - Inbal Brodai-Meir
- The Israeli National Association for Children with Autism (ALUT), Givataim, Israel
| | - Noa Ginossar
- The Israeli National Association for Children with Autism (ALUT), Givataim, Israel
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