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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\u2009weeks follow-up.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>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\u2009weeks among those in the nature versus urban hiking group.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Trial registration number<\/jats:title><jats:p><jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT03997344\">NCT03997344<\/jats:ext-link>.<\/jats:p><\/jats:sec>","DOI":"10.1136\/bmjopen-2021-051885","type":"journal-article","created":{"date-parts":[[2021,9,24]],"date-time":"2021-09-24T01:35:10Z","timestamp":1632447310000},"page":"e051885","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":14,"title":["Nature versus urban hiking for Veterans with post-traumatic stress disorder: a pilot randomised trial conducted in the Pacific Northwest USA"],"prefix":"10.1136","volume":"11","clinical-trial-number":[{"clinical-trial-number":"nct03997344","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4247-8286","authenticated-orcid":false,"given":"Alyson J","family":"Littman","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5982-4686","authenticated-orcid":false,"given":"Gregory N","family":"Bratman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keren","family":"Lehavot","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9232-3389","authenticated-orcid":false,"given":"Charles C","family":"Engel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John C","family":"Fortney","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1697-4259","authenticated-orcid":false,"given":"Alexander","family":"Peterson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alex","family":"Jones","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carolyn","family":"Klassen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua","family":"Brandon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Howard","family":"Frumkin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2021,9,23]]},"reference":[{"key":"2024102819034519000_11.9.e051885.1","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1037\/a0027649","article-title":"Posttraumatic stress disorder in veterans and military personnel: epidemiology, screening, and case recognition","volume":"9","author":"Gates","year":"2012","journal-title":"Psychol Serv"},{"key":"2024102819034519000_11.9.e051885.2","doi-asserted-by":"publisher","DOI":"10.1016\/j.janxdis.2015.02.003"},{"key":"2024102819034519000_11.9.e051885.3","doi-asserted-by":"publisher","DOI":"10.1007\/BF00977233"},{"key":"2024102819034519000_11.9.e051885.4","doi-asserted-by":"publisher","DOI":"10.1093\/epirev\/mxu011"},{"key":"2024102819034519000_11.9.e051885.5","doi-asserted-by":"publisher","DOI":"10.1097\/HCO.0000000000000437"},{"key":"2024102819034519000_11.9.e051885.6","unstructured":"Veterans Health Administration . 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