Psychological and functional outcomes following a randomized controlled trial of surf and hike therapy for U.S. service members - PubMed (original) (raw)

Psychological and functional outcomes following a randomized controlled trial of surf and hike therapy for U.S. service members

Kristen H Walter et al. Front Psychol. 2023.

Abstract

Introduction: Exercise-based interventions have established benefits for the treatment of depression and other psychological outcomes; however, limited data exist evaluating psychological, social, and functional outcomes for exercise outdoors.

Methods: The current study sought to expand knowledge about the breadth of effects following outdoor exercise interventions by using data from a randomized control trial comparing Surf and Hike Therapy among 96 U.S. active duty service members with major depressive disorder (MDD). Assessments examining psychological symptoms and functioning were completed before and after the 6-week programs, and 3 months following program completion. Participants also completed assessments before and after each exercise session. Multilevel modeling was used to determine whether psychological and functional outcomes (anxiety, positive and negative affect, resilience, pain, and physical and social functioning) improved for service members receiving Surf or Hike Therapy, and whether improvements differed by intervention.

Results: Study findings showed improved anxiety (p < 0.001), negative affect (p < 0.001), psychological resilience (p = 0.013), and social functioning (p < 0.001) following program participation, with no differences by intervention. Positive affect, pain, and physical functioning did not significantly improve after the program. Within sessions, positive affect (p < 0.001) and pain (p = 0.036) changed, and to a greater extent for those in the Surf Therapy condition.

Conclusion: Study results suggest that both Surf Therapy and Hike Therapy can improve psychological symptoms and social functioning impairments that commonly co-occur among service members with MDD, but Surf Therapy may provide enhanced immediate effects on positive affect and pain.

Clinical trial registration: ClinicalTrials.gov, NCT03302611.

Keywords: exercise; major depressive disorder; military; natural environment; nature exposure; nature-based recreation therapy; outdoor activity.

Copyright © 2023 At least a portion of this work is authored by Walter, Kobayashi Elliott and Michalewicz-Kragh on behalf of the U.S. Government and as regards Dr. Walter, Dr. Kobayashi Elliott and Dr. Michalewicz-Kragh and the U.S. Government, is not subject to copyright protection in the United States. Foreign and other copyrights may apply.

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Conflict of interest statement

The spouse of KW is an employee of Google LLC and has stock options as part of compensation package. Google LLC owns Fitbit products, which were used in the study for secondary data collection. Fitbit data are not reported in the current manuscript. When published, results are not expected to affect the value of the company’s stock. NO, EM, TR, and LG are employed and JB was employed by Leidos. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1

Figure 1

CONSORT flowchart of participants. Intervention “completion,” as determined by the NMCSD programs, was defined as completing all but two of the available sessions (up to six sessions) for each modality. The programs were halted due to the COVID-19 pandemic; participants in this cohort (n = 8) were counted neither as completers nor non-completers. Their data were analyzed as intent-to-treat. Total lost to follow-up is greater than the total number allocated because many participants completed either the postprogram assessment or the follow-up assessment and are thus counted twice. RCT, randomized controlled trial; COVID-19, coronavirus disease 2019.

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