You are here

  • Home
  • Archive
  • Volume 11, Issue 9
  • Nature versus urban hiking for Veterans with post-traumatic stress disorder: a pilot randomised trial conducted in the Pacific Northwest USA

Article Text

Article menu
Mental health
Original research
Nature versus urban hiking for Veterans with post-traumatic stress disorder: a pilot randomised trial conducted in the Pacific Northwest USA
  1. Alyson J Littman1,2,3,
  2. Gregory N Bratman4,
  3. Keren Lehavot1,5,6,
  4. Charles C Engel1,5,
  5. John C Fortney1,5,
  6. Alexander Peterson7,
  7. Alex Jones8,
  8. Carolyn Klassen1,7,
  9. Joshua Brandon9,
  10. Howard Frumkin10
  1. 1Seattle-Denver Center of Innovation, VA Puget Sound Health Care System, Seattle, WA, USA
  2. 2Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA
  3. 3Seattle Epidemiologic Research and Information Center, VA Puget Sound Health Care System, Seattle, Washington, USA
  4. 4School of Environmental and Forest Sciences, University of Washington, Seattle, Washington, USA
  5. 5Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
  6. 6Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA, USA
  7. 7Seattle Epidemiologic Research and Information Center, VA Puget Sound Health Care System, Seattle, WA, USA
  8. 8Outdoors for All, Seattle, Washington, USA
  9. 9Spirit of America, Seattle, Washington, USA
  10. 10Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, WA, USA
  1. Correspondence to Dr Alyson J Littman; Alyson{at}uw.edu

Abstract

Objectives To evaluate feasibility and acceptability of a group-based nature recreation intervention (nature hiking) and control condition (urban hiking) for military Veterans with post-traumatic stress disorder (PTSD).

Design and setting A pilot randomised controlled trial conducted in the US Pacific Northwest.

Participants Veterans with PTSD due to any cause.

Interventions Twenty-six participants were randomised to a 12-week intervention involving either six nature hikes (n=13) or six urban hikes (n=13).

Primary and secondary outcome measures Feasibility was assessed based on recruitment, retention and attendance. Questionnaires and postintervention qualitative interviews were conducted to explore intervention acceptability. Questionnaires assessing acceptability and outcomes planned for the future trial (eg, PTSD symptoms) were collected at baseline, 6 weeks, 12 weeks (immediately after the final hike) and 24 weeks follow-up.

Results Of 415 people assessed for eligibility/interest, 97 were interested and passed preliminary eligibility screening, and 26 were randomised. Mean completion of all questionnaires was 91% among those in the nature hiking group and 68% in those in the urban hiking group. Over the course of the intervention, participants in the nature and urban groups attended an average of 56% and 58%, respectively, of scheduled hikes. Acceptability of both urban and nature hikes was high; over 70% reported a positive rating (ie, good/excellent) for the study communication, as well as hike locations, distance and pace. Median PTSD symptom scores (PTSD Checklist-5) improved more at 12 weeks and 24 weeks among those in the nature versus urban hiking group.

Conclusions This pilot study largely confirmed the feasibility and acceptability of nature hiking as a potential treatment for Veterans with PTSD. Adaptations will be needed to improve recruitment and increase hike attendance for a future randomised controlled trial to effectively test and isolate the ways in which nature contact, physical activity and social support conferred by the group impact outcomes.

Trial registration number NCT03997344.

  • adult psychiatry
  • trauma management
  • complementary medicine
  • public health

Data availability statement

Data are available on reasonable request. Data are available upon reasonable request. Due to legal and ethical restrictions, we are unable to share data publicly because the data contain potentially identifying and/or sensitive patient information. Subject to IRB approval, de-identified data will be released to a local Department of Veterans Affairs (VA) Puget Sound Health Care System and/or national VA research data repository for release to non-VA protocols. The VA research data repository administrator will be responsible for reviewing and responding to requests to release data to non-VA requestors. A data use agreement compliant with Veterans Health Administration Handbooks 1200.12 and 1605.1 will be required between Veterans Health Administration and the requestor. Review and approval by VA privacy officer is required prior to disclosure. Data access requests will be reviewed by the IRB of the VA Puget Sound Health Care System (contact via Dr. Littman – alyson.littman@va.gov), via mail address: 1660 S Columbian Way, Building 101 – 5W41, Seattle, WA 98108.

http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjopen-2021-051885

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    Data availability statement

    Data are available on reasonable request. Data are available upon reasonable request. Due to legal and ethical restrictions, we are unable to share data publicly because the data contain potentially identifying and/or sensitive patient information. Subject to IRB approval, de-identified data will be released to a local Department of Veterans Affairs (VA) Puget Sound Health Care System and/or national VA research data repository for release to non-VA protocols. The VA research data repository administrator will be responsible for reviewing and responding to requests to release data to non-VA requestors. A data use agreement compliant with Veterans Health Administration Handbooks 1200.12 and 1605.1 will be required between Veterans Health Administration and the requestor. Review and approval by VA privacy officer is required prior to disclosure. Data access requests will be reviewed by the IRB of the VA Puget Sound Health Care System (contact via Dr. Littman – alyson.littman@va.gov), via mail address: 1660 S Columbian Way, Building 101 – 5W41, Seattle, WA 98108.

    View Full Text

    Supplementary materials

    • Supplementary Data

      This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.

    Footnotes

    • Contributors AJL, GNB, CCE, JCF, KL, JB, and HF conceptualised the study and contributed to the intervention development and design. AJL and GNB oversaw the conduct of the trial all the authors contributed to the ongoing management of the trial. AJL, GNB, MM, AP, and CK oversaw data collection and data analysis. The manuscript was drafted by AJL. All the authors contributed to the interpretation of the findings and revised and reviewed the paper.

    • Funding This work was funded by Recreational Equipment, Inc. (REI; Award/Grant number is not applicable) and supported by equipment and outfitting contributions from Outdoor Research.

    • Disclaimer The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs, the US Government, Recreational Equipment (REI), or Outdoor Research.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.