PHENOTYPE. Therapeutic Study in Barcelona

Positive Health Effects of the Natural Outdoor Environment in Typical Populations in Different Regions in Europe. Work Package 4: Therapeutic Study in Barcelona

The study aimed to explore therapeutic effects of natural environments. To do so, the investigators evaluated the immediate and sustained changes in several indicators of well-being while people (n=26) with poor mental health were engaged in unconstrained exposures to natural (green, blue) and urban environments. The indicators included: affection, cognition, physiological responses.

Each participant was exposed to all environments for a period of 210 minutes between October 2013 and January 2014. During the exposure period, participants were instructed to do what they would usually do in that environment. Before, during (at 30 and 210 minutes) and after each exposure, several psycho-physiological measures were taken: (i) heart rate variability and heart rate using a Holter monitor, (ii) blood pressure using a digital blood pressure monitor, (iii) physical activity using the CalFIT application installed in a Smartphone, (iv) lung function using a portable computerized spirometer, (v) stress level using salivary cortisol samples collected using Salivettes, (vi) affect, perceived restoration and social interactions using questionnaires, (vii) cognitive functioning using the backwards digit-span task test.

Study Overview

• Status: Completed
• Conditions: Poor Mental Health; Natural Outdoor Environments
• Intervention / Treatment: Other: There was no intervention.

• Study Type: Observational
• Enrollment (Actual): 26

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 75 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

All the participants (n=26) were individuals that had previously participated in a survey of 1000 people in Barcelona city as part of the PHENOTYPE project. As part of the survey, they had answered the Mental Health Inventory (MHI-5) subscale from the SF-36 health questionnaire. The investigators purposively selected those individuals MHI-5 scored in the lower 50th percentile.

Description

Inclusion Criteria:

• MHI-5 scored in the lower 50th percentile of the Barcelona city PHENOTYPE sample
• willing to participate

Exclusion Criteria:

• no able to walk for 30 minutes at self-directed pace.
• with chest, abdomen surgery or heart attack during the last three months.
• with retinal detachment or eyes surgery or hospitalized for heart problem during the last month.
• with tuberculosis treatment, or respiratory infection during the last three weeks.
• being asthmatic or pregnant
• using inhaler the 24 hours previous to the study day.
• taking medication different from the usual the 24 hours previous to the study day.

Study Plan

How is the study designed?

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
Change from Baseline heart rate variability at 30 min	after 30 minutes of exposure to green/blue/urban environment
Change from Baseline heart rate at 30 min	after 30 minutes of exposure to green/blue/urban environment
Change from blood pressure at 30min	after 30 minutes of exposure to green/blue/urban environment
Change from stress level at 30min (salivary cortisol)	after 30 of exposure to green/blue/urban environment
Change from affect at 30 min (BRUMS/POMS)	after 30 minutes of exposure to green/blue/urban environment
Change from cognitive functioning at 30 min (backward digit span task)	after 30 minutes of exposure to green/blue/urban environment
Change from Baseline heart rate variability at 210 min	after 210 minutes of exposure to green/blue/urban environment
Change from Baseline heart rate at 210 min	after 210 minutes of exposure to green/blue/urban environment
Change from blood pressure at 210min	after 210 minutes of exposure to green/blue/urban environment
Change from stress level at 210min (salivary cortisol)	after 210 minutes of exposure to green/blue/urban environment
Change from affect at 210 min (BRUMS/POMS)	after 210 minutes of exposure to green/blue/urban environment
Change from cognitive functioning at 210 min (backward digit span task)	after 210 minutes of exposure to green/blue/urban environment

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
objectively measured physical activity 30	Measured with a Smartphone application (CalFIT)	During the first 30 minutes of exposure to green/blue/urban environment
perceived restoration 30 (ROS - Korpela's Restoration outcome scale)		after 30 minutes of exposure to green/blue/urban environment
subjectively recorded social interactions 30	Measurement tool developed by the research team	after 30 minutes of exposure to green/blue/urban environment
ambient air pollution exposure 30 (PM2.5)	Measured with MicroAthelometer	During the first 30 minutes of exposure to green/blue/urban environment
objectively measured physical activity 210	Measured with a Smartphone application (CalFIT)	During the first 210 minutes of exposure to green/blue/urban environment
perceived restoration 210 (ROS- Korpela's Restoration outcome scale)		after 210 minutes of exposure to green/blue/urban environment
subjectively recorded social interactions 210	Measurement tool developed by the research team	after 210 minutes of exposure to green/blue/urban environment
ambient air pollution exposure 210 (PM2.5)	Measured with MicroAthelometer	During the first 210 minutes of exposure to green/blue/urban environment
personal air pollution (CO, NO, NO2)	Personal sensors designed and built at Cambridge University, UK (CamPerS)	During all the data collection day

Collaborators and Investigators

• Sponsor: Barcelona Institute for Global Health

Publications and helpful links

General Publications

• Triguero-Mas M, Gidlow CJ, Martinez D, de Bont J, Carrasco-Turigas G, Martinez-Iniguez T, Hurst G, Masterson D, Donaire-Gonzalez D, Seto E, Jones MV, Nieuwenhuijsen MJ. The effect of randomised exposure to different types of natural outdoor environments compared to exposure to an urban environment on people with indications of psychological distress in Catalonia. PLoS One. 2017 Mar 1;12(3):e0172200. doi: 10.1371/journal.pone.0172200. eCollection 2017.

Study record dates

Study Major Dates

• Study Start: October 1, 2013
• Primary Completion (Actual): January 1, 2014
• Study Completion (Actual): January 1, 2014

Study Registration Dates

• First Submitted: December 1, 2015
• First Submitted That Met QC Criteria: December 4, 2015
• First Posted (Estimate): December 9, 2015

Study Record Updates

• Last Update Posted (Actual): April 27, 2018
• Last Update Submitted That Met QC Criteria: April 26, 2018
• Last Verified: April 1, 2018

More Information

Terms related to this study

• Other Study ID Numbers: PHENOTYPE_WP4BCN