Walks in Nature May Ease Stress for Heart Disease Patients

Greg Howard
21st February, 2024

Walks in Nature May Ease Stress for Heart Disease Patients

Study design: A breakdown structure depicting chronological steps (activities) to attain each of the predefined objectives

Image adapted from: Martinaitienė et al. / CC BY (Source)
Coronary artery disease (CAD) is a leading cause of death globally, and while treatments have improved, managing stress and psychological wellbeing remains a significant challenge for patients. Traditional approaches to cardiac rehabilitation often focus on physical exercise, but emerging research suggests that the environment in which that exercise takes place could also play a crucial role. A new study from the Lithuanian University of Health Sciences[1] is investigating how weather sensitivity and different walking environments affect stress responses in individuals with CAD during rehabilitation. The study, registered as NCT06139705, aims to recruit 164 patients already participating in a cardiac rehabilitation program. Researchers will gather detailed information from participants, including demographic data, their sensitivity to weather changes, physical fitness levels, personality traits, mental health status, cognitive abilities, and baseline cortisol levels – a hormone released in response to stress. Cortisol levels will be measured from saliva samples taken in the morning and afternoon before the main part of the experiment. Participants will then be randomly assigned to one of two groups: an outdoor walking group or an indoor walking group. The core of the study involves a six-hour monitoring period during which hemodynamic parameters (blood pressure measurements) are continuously recorded, alongside stress levels (assessed via cortisol measurements) and mood (using a visual analogue scale). To further assess stress response, all participants will undergo a cold stress test. This involves exposing them to a cold stimulus to observe how their bodies react, and whether the walking environment has influenced that reaction. This research builds upon existing knowledge linking psychological factors to heart health. For example, a meta-analysis found that high perceived stress is associated with a 27% increased risk of developing coronary heart disease[2]. Furthermore, studies have shown that mental distress, including anxiety and depression, can lead to dysregulated psychophysiological reactions to stress, impacting cardiovascular function[3]. Specifically, that study found that individuals with Type D personality traits (characterized by negative affectivity and social inhibition) exhibited lower heart rate responses to social stress, while those with higher trait anxiety also showed reduced heart rate. Interestingly, depressive symptoms were linked to higher blood pressure during stressful situations. The Lithuanian University of Health Sciences study aims to add another layer to this understanding by exploring the influence of environmental factors. Previous research has highlighted the impact of climate and weather on cardiovascular health, noting a “U” shaped relationship between temperature and heart disease incidence – both extreme heat and cold can increase the risk of acute coronary syndromes[4]. This new study seeks to determine if the benefits of exercise during cardiac rehabilitation can be enhanced by carefully considering the weather and the environment. The study’s design is significant because it attempts to isolate the effect of the walking environment. By keeping all other measurements and procedures consistent between the two groups, researchers can more confidently attribute any differences in stress responses to the outdoor versus indoor setting. The inclusion of cognitive function assessments is also noteworthy, as emerging evidence suggests a link between cognitive flexibility, personality traits, and weather sensitivity in individuals with CAD. The potential clinical applications of this research are substantial. If the findings demonstrate that outdoor walking, or specific weather conditions, are more beneficial for reducing stress and improving cardiovascular health in CAD patients, it could lead to tailored rehabilitation programs. This could involve scheduling outdoor exercise sessions during optimal weather conditions, or even incorporating nature-based therapies into standard cardiac care. Moreover, understanding how weather sensitivity impacts stress responses could allow healthcare providers to proactively adjust treatment plans for vulnerable individuals, particularly in light of increasing climate change and more frequent extreme weather events.

EnvironmentHealthMental Health

References

Main Study

1) A randomised controlled trial assessing the effects of weather sensitivity profile and walking in nature on the psychophysiological response to stress in individuals with coronary artery disease. A study protocol.

Published 19th February, 2024

https://doi.org/10.1186/s40359-024-01574-3

Related Studies

2) Meta-analysis of perceived stress and its association with incident coronary heart disease.

https://doi.org/10.1016/j.amjcard.2012.08.004

3) Cardiovascular Reactivity to Acute Mental Stress: THE IMPORTANCE OF TYPE D PERSONALITY, TRAIT ANXIETY, AND DEPRESSION SYMPTOMS IN PATIENTS AFTER ACUTE CORONARY SYNDROMES.

https://doi.org/10.1097/HCR.0000000000000457

4) Climatic influences on cardiovascular diseases.

https://doi.org/10.4330/wjc.v14.i3.152


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