{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T08:30:55Z","timestamp":1790929855004,"version":"4.1.0"},"reference-count":71,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,8,24]],"date-time":"2023-08-24T00:00:00Z","timestamp":1692835200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Contact with nature promotes wellbeing through diverse pathways, providing a potential way of supporting health especially in primary care, where patients commonly suffer from multimorbidity and poor general health. Social prescribing is a non-pharmaceutical approach for improving health as well as social inclusion. This field study explores and compares the effects of a nature-based and an exercise-based social prescribing scheme on mental wellbeing and sleep, in a primary care population.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Primary care patients identified to benefit from a general improvement to their health were recruited by nurses, doctors, or social workers to this non-randomized, intention-to-treat, pilot field-study. Participants (<jats:italic>n<\/jats:italic>\u2009=\u200979) chose between the group interventions, either taking part in guided walks in nature, including immersion in a forest with high biodiversity, or participating in a versatile sports program. Mental wellbeing was assessed with the Warwick-Edinburgh Mental Well-Being Scale (WEMWBS), with additional questions evaluating self-rated health and sleep. Impact on mental wellbeing was explored in relation to perceived health. The amount and quality of sleep was measured with wrist-worn accelerometers. With a focus on everyday life impacts, the assessments took place before and after the 8-week intervention. All participants lived in Sipoo, Finland, an area with abundant accessible green space.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Participants (mean age 57\u2009years, 79% female) rated their general and mental health lower than the general population. Participation in the Nature-group resulted in improved mental wellbeing (change in WEMWBS by 3.15, <jats:italic>p<\/jats:italic>\u2009=\u20090.008), with a positive change for feeling relaxed, being cheerful, having energy to spare, feeling able to deal well with problems, feeling good about oneself and feeling close to other people. The Sports-group was beneficial for those initially rating their health as good. Sleep duration improved in the Sports-group, while participants in the Nature-group reported better sleep quality. Following the interventions there was improvement in perceived health and ability to function in both groups, while perceived mental health improved only in the Nature-group.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>We attest that even in areas surrounded by greenery, active interventions can further improve health in a primary care population, and that nature-based interventions are beneficial for those in poor health.<\/jats:p><\/jats:sec><jats:sec><jats:title>Clinical trial registration<\/jats:title><jats:p><jats:ext-link>ClinicalTrials.gov<\/jats:ext-link>, Identifier NCT05893212.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpubh.2023.1208858","type":"journal-article","created":{"date-parts":[[2023,8,25]],"date-time":"2023-08-25T01:17:38Z","timestamp":1692926258000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":14,"title":["Targeted health promotion with guided nature walks or group exercise: a controlled trial in primary care"],"prefix":"10.3389","volume":"11","author":[{"given":"Annika","family":"Kolster","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Malin","family":"Heikkinen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adela","family":"Pajunen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anders","family":"Mickos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heini","family":"Wennman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timo","family":"Partonen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2023,8,24]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"e718","DOI":"10.1016\/S2542-5196(21)00229-1","article-title":"Green space and mortality in European cities: a health impact assessment study","volume":"5","author":"Barboza","year":"2021","journal-title":"Lancet Planet Health"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"e469","DOI":"10.1016\/S2542-5196(19)30215-3","article-title":"Green spaces and mortality: a systematic review and meta-analysis of cohort studies","volume":"3","author":"Rojas-Rueda","year":"2019","journal-title":"Lancet Planet Health"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"207","DOI":"10.1146\/annurev-publhealth-032013-182443","article-title":"Nature and health","volume":"35","author":"Hartig","year":"2014","journal-title":"Annu Rev Public Health"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"1783","DOI":"10.1007\/s40520-020-01710-0","article-title":"Green space exposure on mortality and cardiovascular outcomes in older adults: a systematic review and meta-analysis of observational studies","volume":"33","author":"Yuan","year":"2021","journal-title":"Aging Clin Exp Res"},{"key":"ref5","unstructured":"2018"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"9010","DOI":"10.3390\/ijerph18179010","article-title":"Relationship between green and blue spaces with mental and physical health: a systematic review of longitudinal observational studies","volume":"18","author":"Geneshka","year":"2021","journal-title":"Int J Environ Res Public Health"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"297","DOI":"10.1007\/s40572-019-00251-7","article-title":"Nature-based social prescribing in urban settings to improve social connectedness and mental well-being: a review","volume":"6","author":"Leavell","year":"2019","journal-title":"Curr Environ Health Rep"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"102338","DOI":"10.1016\/j.healthplace.2020.102338","article-title":"Greenspace interventions for mental health in clinical and non-clinical populations: what works, for whom, and in what circumstances?","volume":"64","author":"Masterton","year":"2020","journal-title":"Health Place"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"1427","DOI":"10.3390\/healthcare9111427","article-title":"Can different Forest structures Lead to different levels of therapeutic effects? 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