Green exercise and mg-ca-SO4 thermal balneotherapy for the treatment of non-specific chronic low back pain: a randomized controlled clinical trial.

BACKGROUND: Non-specific chronic low back pain (nscLBP) has a high socio-economic relevance due to its high incidence, prevalence and associated costs. Therefore, it is essential to evaluate effective therapeutic strategies. This study examines the effects of moderate mountain exercise and spa therapy on orthopedic and psychophysiological parameters. Based on a three-armed randomized controlled trial, guided mountain hiking tours and balneotherapy in thermal water were compared to a control group. METHODS: Eighty patients with diagnosed nscLBP were separated into three groups: The two intervention groups GE (green exercise) and GEBT (green exercise and balneotherapy) undertook daily mountain hiking tours, whereas the GEBT group got an additional treatment with baths in Mg-Ca-SO4 thermal water. The third group (CO) received no intervention. GE and GEBT group were treated for 6 days; all groups were followed up for 120 days. RESULTS: Compared to GE and CO group, the GEBT treatment showed significant improvements of pain, some orthopedic parameters, health-related quality of life and mental well-being in patients with nscLBP. CONCLUSIONS: The results of this study confirmed a benefit of mountain hiking combined with Mg-Ca-SO4 spa therapy as a multimodal treatment of patients with nscLBP. Further studies should focus on long-term-effects of this therapeutic approach. TRIAL REGISTRATION: ISRCTN, ISRCTN99926592 . Registered 06. July 2018 - Retrospectively registered.

Uncovering placemaking needs with(in) a kindergarten community: a cross-disciplinary approach to participatory design.

Introduction: The design of early childhood education and care facilities faces the double challenge of creating a stimulating environment for young children and a supportive workplace for staff. The existing body of research suggests that placemaking strategies serve both requirements. A promising approach to meet placemaking needs is the participation of future occupants in the building design. Methods: We pursued a participatory design study with the community of an Austrian kindergarten aiming to inform the future building renovation. We combined novel cultural fiction probes methods with conventional inquiry methods to gather information from children and teachers about their experience of the built environment. Using thematic and content analyzes we explored placemaking needs from different epistemic perspectives and converged findings through iterative exchange. Results: Returns of children and teachers were interconnected and complementary. From a design-oriented perspective, children's experience of place was relatable to spatial, temporo-spatial, and acoustic qualities as well as control needs. From a human-centered perspective, teachers' experience of place was relatable to the needs of feeling embedded, protected, enacted, and socially connected. The converged findings revealed dynamic placemaking processes involving the elements of space, time, and control at different levels. Discussion: Cross-disciplinary collaboration and research consolidation brought forth valuable insights on supportive structures for both children and teachers, facilitated timely knowledge transfer, and converted into design solutions that foster enacted placemaking. Albeit general transferability is limited, findings are interpretable within a solid framework of existing theories, concepts and evidence.

Long-Term Effects of Mountain Hiking vs. Forest Therapy on Physical and Mental Health of Couples: A Randomized Controlled Trial.

BACKGROUND: Lifelong physical activity is related to longer health span, which is reflected at an individual level, and is of substantial socioeconomic relevance. Sedentary lifestyles, on the other hand, pose an increasingly major public health problem. In addition, the COVID-19 pandemic had a negative impact on activity levels and well-being. Previous research indicates that contact with nature might improve exercise levels as well as well-being. METHODS: This randomized, controlled clinical trial (ANKER-study) investigated the effects of two types of nature-based therapies (forest therapy and mountain hiking) in couples (FTG: n = 23; HG: n = 22;) with a sedentary or inactive lifestyle on health-related quality of life, relationship quality and other psychological and physiological parameters. RESULTS: The results of this study displayed that healthy and highly functioning women and men with sedentary lifestyles mentally benefit from contact with nature (quality of life, satisfaction with life, mood, internal and external health-related control beliefs). The gender-specific effect on women is most visible in the physiological outcomes (hemopoietic system, aerobic capacity, skeletal muscle mass and hydration) of mountain hiking. Men and women showed small improvements in blood pressure as a result of the interventions. CONCLUSIONS: The ANKER-study provides a method for valid comparison of forest therapy interventions for the first time. Regarding the COVID-19 pandemic, the nature-based intervention presented could offer a multimodal contribution to maintaining a more active lifestyle, further contact with nature that affects peoples physical as well as mental health, and an improvement in social interaction.

Nature-based biopsychosocial resilience: An integrative theoretical framework for research on nature and health.

Nature-based solutions including urban forests and wetlands can help communities cope better with climate change and other environmental stressors by enhancing social-ecological resilience. Natural ecosystems, settings, elements and affordances can also help individuals become more personally resilient to a variety of stressors, although the mechanisms underpinning individual-level nature-based resilience, and their relations to social-ecological resilience, are not well articulated. We propose 'nature-based biopsychosocial resilience theory' (NBRT) to address these gaps. Our framework begins by suggesting that individual-level resilience can refer to both: a) a person's set of adaptive resources; and b) the processes by which these resources are deployed. Drawing on existing nature-health perspectives, we argue that nature contact can support individuals build and maintain biological, psychological, and social (i.e. biopsychosocial) resilience-related resources. Together with nature-based social-ecological resilience, these biopsychosocial resilience resources can: i) reduce the risk of various stressors (preventive resilience); ii) enhance adaptive reactions to stressful circumstances (response resilience), and/or iii) facilitate more rapid and/or complete recovery from stress (recovery resilience). Reference to these three resilience processes supports integration across more familiar pathways involving harm reduction, capacity building, and restoration. Evidence in support of the theory, potential interventions to promote nature-based biopsychosocial resilience, and issues that require further consideration are discussed.

Mountain Hiking vs. Forest Therapy: A Study Protocol of Novel Types of Nature-Based Intervention.

INTRODUCTION: The global rise of urbanization has much triggered scientific interest in how nature impacts on human health. Natural environments, such as alpine landscapes, forests, or urban green spaces, are potential high-impact health resources. While there is a growing body of evidence to reveal a positive influence of these natural environments on human health and well-being, further investigations guided by rigorous evidence-based medical research are very much needed. OBJECTIVE: The present study protocol aims at testing research methodologies in the context of a prospective clinical trial on nature-based interventions. This shall improve the standards of medical research in human-nature interactions. METHODS: The ANKER Study investigates the influence of two novel types of nature-based therapy-mountain hiking and forest therapy-on physiological, psychological, and immunological parameters of couples with a sedentary lifestyle. Two intervention groups were formed and spent a seven-day holiday in Algund, Italy. The "forest therapy group" participated in daily guided low-power nature connection activities. The "hiking group", by contrast, joined in a daily moderate hiking program. Health-related quality of life and relationship quality are defined as primary outcomes. Secondary outcomes include nature connection, balance, cardio-respiratory fitness, fractional exhaled nitric oxide, body composition and skin hydration. Furthermore, a new approach to measure health-related quality of life is validated. The so-called "intercultural quality of life" comic assesses the health-related quality of life with a digitally animated comic-based tool.

Winter Exercise and Speleotherapy for Allergy and Asthma: A Randomized Controlled Clinical Trial.

(1) Background: The prevalence of allergic respiratory diseases is still rising and efforts towards holistic treatments should be made. Although speleotherapy is widely applied in Europe to treat chronic airway diseases, the existing scientific evidence is rather low. Recreational winter exercise has been shown to improve allergic airway inflammation, but little is known about the combined effects of speleotherapy and recreational winter exercise. (2) Methods: In this clinical study we investigated the effects of winter exercise and speleotherapy on adults with allergic rhinitis and/or asthma. The speleotherapy group (n = 23) participated in a ten-day combined winter exercise and speleotherapy program and the exercise group (n = 18) joined a full-day winter sports program. The effects on allergic airway inflammation, quality of life, spirometry and cardiorespiratory fitness were assessed. (3) Results: No significant effects were found for fractional exhaled nitric oxide or nasal nitric oxide. Quality of life (p < 0.001 time effect) and allergic symptoms (p < 0.001 time effect) were improved in the speleotherapy and in the exercise group. (4) Conclusions: Winter exercise alone and winter exercise in combination with speleotherapy improve quality of life and allergic symptoms in adults with allergic rhinitis and/or asthma. Further studies are required to investigate the specific effects of speleotherapy. To our knowledge, this is the first investigation examining speleotherapy in combination with winter exercise. Recreational outdoor winter exercise and speleotherapy may be recommended for highly functioning patients with good disease control.

The Role of Anthropogenic Elements in the Environment for Affective States and Cortisol Concentration in Mountain Hiking-A Crossover Trial.

Green exercise might have positive effects on health and affective states. Little is known about the ideal characteristics of the natural environment, where exercise is conducted in. Thus, the primary aim of the present study was to investigate the effects of anthropogenic elements on acute stress-related physiological responses and affective states in green exercise. Using a crossover field study design, 52 healthy participants were exposed to two different mountain hiking conditions: An environment with less anthropogenic elements and an environment with more anthropogenic elements. Pre and post conditions, affective states and salivary cortisol concentration were measured. Repeated measures ANOVAs were used to analyze if pre-post changes differed between the conditions. Pre-post changes in affective states and salivary cortisol concentration did not significantly differ, partial η² < 0.06. Positive affective states showed significantly higher values post compared to pre-condition, partial η² > 0.13. The present results indicate that anthropogenic elements have a minor role in the influence on affective states and salivary cortisol concentration during mountain hiking. It is concluded that a single bout of mountain hiking independent of anthropogenic elements in the environment is effective in influencing affective states positively.

Effects of moderate mountain hiking and balneotherapy on community-dwelling older people: A randomized controlled trial.

BACKGROUND: Population aging is one of the greatest socio-economic challenges of the 21st century, as aging is a well-known risk factor for the development of chronic diseases and functional disabilities. A sedentary life-style promotes the progression of chronic diseases and impaired mobility in older people. Therefore, physical activity is essential for healthy aging. The optimal exercise program for older persons, which covers fall prevention as well as endurance and strength, still remains unclear. METHODS: We performed a longitudinal, randomized, controlled intervention study to investigate the combined effects of moderate mountain hiking and balneotherapy on gait, balance, body composition and quality of life on high-functioning people aged 65-85 years. The intervention group (n = 106) participated in a seven-day holiday with mountain hiking tours. In addition, balneotherapy was applied. The control group (n = 33) spent a typical seven-day cultural holiday with sightseeing. Medical examinations were performed before (day 0) and after the intervention week (day 7), after two months (day 60) and after half a year (day 180). Statistical analysis was done by fully nonparametric analysis of variance-type testing. RESULTS: An improvement of static balance was observed in the intervention group (treatment effect p = 0.02). No significant changes were found in dynamic balance, measured as center of pressure, gait parameters and self-assessed balance confidence. Only for gait speed, a short-term effect was observed (treatment p = 0.03). The gait speed increased in the intervention group. Although quality of life improved significantly in both groups, a sustainable effect until day 60 is only visible in the intervention group (interaction effect for treatment and day-60 p = 0.02). Significant interaction effects of treatment and time were found for total body water (p = 0.04), appendicular muscle mass (p = 0.04) and fat free mass index (p = 0.03), all indicating an increase of these variables in the intervention group. CONCLUSIONS: A seven-day intervention with moderate mountain hiking in combination with balneotherapy is an effective training for highly functioning older persons, inducing short-term improvements in static balance and quality of life.

Winter Exercise Reduces Allergic Airway Inflammation: A Randomized Controlled Study.

Background: Physical exercise is often recommended as additional treatment for people suffering from allergic rhinitis and/or asthma, but less is known about the specific effects of recreational winter outdoor exercise on allergic airway inflammation. Methods: We performed a longitudinal, randomized controlled intervention study to investigate the effects of recreational winter exercise on allergic airway inflammation, quality of life, spirometry and cardiorespiratory fitness in adults suffering from allergic rhinitis and/or asthma. The exercise group participated in a ten-day winter sports program. The control group did not receive any intervention. Results: A significant improvement of fractional oral exhaled nitric oxide (FeNO; p = 0.008, day 10) and a significant decrease in FeNO after a single 4 h hiking tour (p < 0.001, time effect) were observed for the exercise group. The nasal eosinophilic cell count revealed a short-term reduction (p = 0.021, treatment effect) in the exercise group and for the visual analogue scale sustainable improvements in allergic symptoms (p < 0.001, day 60) were found. No adverse effects of outdoor winter exercise were observed. Conclusion: Recreational winter exercise at moderately cold temperatures reduces allergic airway inflammation measured as FeNO, nasal eosinophilic cell count and induces sustainable improvements in allergic symptoms.

Does waterfall aerosol influence mucosal immunity and chronic stress? A randomized controlled clinical trial.

BACKGROUND: The specific microclimate of alpine waterfalls with high levels of ionized water aerosols has been suggested to trigger beneficial immunological and psychological effects. In the present three-armed randomized controlled clinical study, we focused on effects on (i) immunological reagibility, on (ii) physiological stress responses, and on (iii) stress-related psychological parameters. METHODS: People with moderate to high stress levels (n = 65) spent an active sojourn with daily hiking tours in the National Park Hohe Tauern (Großkirchheim, Austria). Half of the group was exposed to water aerosol of an alpine waterfall for 1 h/day (first arm, n = 33), whereas the other half spent the same time at a distant site (second arm, n = 32). A third arm (control, n = 26) had no intervention (except vaccination) and stayed at home, maintaining their usual lifestyle. The effect of the interventions on the immune system was tested by oral vaccination with an approved cholera vaccine and measuring specific salivary IgA antibody titers. Lung function was determined by peak expiratory flow measurement. Electric skin conductance, heart rate, and adaption of respiration rate were assessed as physiological stress parameters. Psychological stress-related parameters were analyzed by questionnaires and scales. RESULTS: Compared to the control group, both intervention groups showed improvement of the lung function and of most physiological stress test parameters. Analysis of the mucosal immune response revealed a waterfall-specific beneficial effect with elevated IgA titers in the waterfall group. In line with these results, exposure to waterfall revealed an additional benefit concerning psychological parameters such as subjective stress perception (measured via visual analog scale), the Global Severity Index (GSI), and the Positive Symptom Total (PST). CONCLUSIONS: Our study provides new data, which strongly support an "added value" of exposure to waterfall microclimate when combined with a therapeutic sojourn at high altitude including regular physical activity.

No Concentration Decrease of House Dust Mite Allergens With Rising Altitude in Alpine Regions.

PURPOSE: Several studies over the past 4 decades have indicated a significant reduction in house dust mite (HDM) and HDM allergen concentration in areas higher than 1,500 m above sea level. These have served as basis of allergen avoidance therapies for HDM allergy and asthma. However, modern construction techniques used in the insulation, heating, and glazing of buildings as well as global warming have changed the environmental parameters for HDM living conditions. The present study revisits the paradigm of decreasing HDM allergen concentrations with increasing altitude in the alpine region of Germany and Austria. METHODS: A total of 122 dust samples from different abodes (hotels, privates and mountain huts) at different altitudes (400-2,600 m) were taken, and concentrations of HDM allergens were analyzed. Humidity and temperature conditions, and numerous indoor environmental parameters such as fine dust, type of flooring, age of building, and frequency of cleaning were determined. RESULTS: HDM allergen concentrations did not significantly change with increasing altitude or relative humidity. At the level of indoor parameters, correlations could be found for different flooring types and the concentration of HDM allergens. CONCLUSIONS: In contrast to the widespread view of the relationship between altitude and HDM allergen concentrations, clinically relevant concentrations of HDM allergens could be detected in high-lying alpine regions in Austria and Germany. These results indicate that improvement in conditions of asthmatic patients sensitized against HDMs during a stay at high altitude can no longer be ascribed to decreased levels of HDM allergens, instead, other mechanisms may trigger the beneficial effect.