A mixed-methods evaluation of a group based trail walking program to reduce anxiety in cancer survivors

Abstract

Background Cancer survivorship results in an increased number of physical and psychosocial health issues. Engaging in physical activity in natural environments is often thought of as restorative. Despite the potential benefits of engaging in physical activity in natural environments there are no sustainable community-based programs for cancer survivors that employ this form of physical activity. This study aims to evaluate the impact of an 8-week trail-walking (TW) program on anxiety in a population of adult cancer survivors. Methods The TW program consisted of two trail walks per week for 8 weeks led by a hiking guide. Individuals were eligible to participate if they were 19 years or older, were a cancer survivor, were not on active immunotherapy, and had medical clearance from their physician for physical activity. While 12 participants signed up for the program, 9 participants (N = 9, 8 F, 1 M) completed the program. A mixed methodology included pre-and-post quantitative program surveys and post-program interviews. Questionnaires measured generalized anxiety, sleep disturbances, self-efficacy, self-esteem, psychological well-being and depression as well as pre-and-post hike state anxiety. Data was analysed using paired t-tests. Interviews were transcribed verbatim and an inductive thematic analysis was conducted to consolidate meaning and identify themes using NVivo 11 software. Results Average attendance was 74% of the 16 hikes. There was no significant reduction in the primary outcome of generalized anxiety (p = .38). There was a significant reduction in perceived stress after 8-weeks (p = .03) and a significant reduction in state anxiety after TW (p < .001). None of the other secondary outcomes were statistically significant (p > .05). Four overarching themes, or benefits, emerged from qualitative data analysis: (a) benefits of program design (b) physical benefits, (c) psychological benefits, and (d) social benefits. Conclusions These findings demonstrate the utility of a TW program for cancer survivors in order to promote physical, psychological and social health. Feasibility of a TW program would be contingent on access to natural areas for TW and an instructor-led program with other cancer survivors.

Active by nature: exploring cancer survivors’ exercise barriers, facilitators, preferences, and psychosocial benefits of engaging in outdoor physical activity

“…Similarly, we found that cancer survivors who participated in more outdoor physical activity reported greater physical activity enjoyment and benefit. We also found that a significant reduction in perceived stress in cancer survivors who participated in a bi-weekly 8-week trail walking program and a significant reduction in state anxiety after each trail walk [ 17 ].…”

“…In a systematic review, half of the reviewed studies found a significant relationship between social support and physical activity engagement in cancer survivors [ 1 ]. We also found this in our trail walking program for cancer survivors where social support was stated as highly important and ensured accountability especially in an outdoor setting with potential for adverse weather conditions [ 17 ]. However, it is important to note that there was also concern over a group environment, with group physical activity being a potential barrier if there were poor group dynamics or scheduling of activity was prohibitive to engagement.…”

Effect of Nature Walks on Depression and Anxiety: A Systematic Review

“…Here, we systematically reviewed the literature for evidence of the effect of nature walks on anxiety and depression outcomes. Nature walks are walks on a trail in a natural setting such as forests, woodlands, or parks [30] that can take any time from 15 min [31] to a few hours [32]. Nature walks can be undertaken by diverse populations (e.g., cancer survivors [32], university students [33]) and conducted in any season of the year [31,34].…”

Are Long-Distance Walks Therapeutic? A Systematic Scoping Review of the Conceptualization of Long-Distance Walking and Its Relation to Mental Health

“…Among the longitudinal, the association was more inconsistent; three found an association while two did not. The two studies that did not find an association focused on notions of well-being [39,45], whereas the three that did, focused on enjoyment, quality of life, and mindfulness [38,43,56].…”

“…The only study that did not find a positive effect found that long-distance walking did not have a negative effect [40]. One study [39] examined both measures of emotional distress and well-being and found that long-distance walking was not related to wellbeing but was related to a significant reduction in some measures of emotional distress. This, however, depended on the measure of emotional distress, finding non-significant reductions in depression and generalized anxiety, but significant reductions with regards to stress and state anxiety.…”