Walking in nature versus urban areas for adults with prediabetes

Effects of Walking in Greenspace and the Built Environment in Adults With Prediabetes: A Randomized Crossover Trial

This study tests whether walking in nature instead of city areas can help adults with prediabetes improve their health and reduce stress.

Quick facts

• Phase: Not applicable
• Study type: Interventional
• Enrollment: 216 (estimated)
• Ages: 25 Years to 64 Years
• Sex: All
• Sponsor: University of Minnesota (Academic / other)
• Locations: 3 sites (Lake Forest, Illinois and 2 other locations)
• Trial ID: NCT06365723 on ClinicalTrials.gov

What this trial studies

This trial investigates the effects of walking in greenspaces compared to built environments on adults diagnosed with prediabetes. Participants will engage in both types of walking to assess differences in physical activity levels, stress reduction, and overall health benefits. The study aims to explore how exposure to nature can influence health outcomes in a population at risk for developing chronic metabolic diseases. By focusing on behavioral and environmental interventions, the trial seeks to provide insights into effective diabetes prevention strategies.

Who should consider this trial

Good fit: Ideal candidates are adults aged 25-64 who are overweight or obese and have a documented diagnosis of prediabetes.

Not a fit: Patients who are not classified as overweight or obese or those with contraindications to exercise may not benefit from this study.

Why it matters

Potential benefit: If successful, this study could lead to improved health outcomes and preventive strategies for individuals with prediabetes.

How similar studies have performed: Other studies have shown positive health benefits from exposure to greenspaces, suggesting this approach may be effective.

Eligibility criteria

Inclusion Criteria:

* 25-64 years old.
* Classified as overweight or obese with BMI 20.0-39.9 kg/m2 per self-report and a BMI of 20.0- 41.9 kg/m2 upon actual measure.
* Documentation\* of a PreD diagnosis within one year of enrollment by physician or primary care provider based on lab tests showing a fasted blood glucose of 100-125 mg/dL, a 2-hour oral glucose tolerance test of 140-199 mg/dL, or an HbA1c level of 5.7%-6.49%271; OR a study screening lab value of HbA1C within the aforementioned range.
* Currently engaged in ≤100 min/week of moderate to vigorous exercise -confirmed via a 7-day activity recall.
* No exercise contraindications as assessed by the Physical Activity Readiness Questionnaire (PAR-Q) -this Questionnaire involves seven "yes" or "no" questions regarding an individual's health status. Answering "yes" to any one of these questions may require a prospective participant to acquire a written doctor's note stating they can safely participate in the trial's exercise intervention. The participant would not be enrolled until this doctor's note is received.
* Stable weight over the last 3 months (less than 10% change).
* Not currently pregnant, planning to become pregnant, or currently breastfeeding.
* Willing to maintain current dietary and exercise habits, aside from any changes to be made per the study exercise protocol.
* Must own a smartphone and be willing and able to download the Garmin Connect app
* Ability to speak and understand English.
* Any level of income
* Any race/ethnicity

Exclusion Criteria:

* Individuals \<25 or \>64: younger individuals may have not yet reached physiological maturity and in whom PreD prevalence is low; older individuals are more likely to have contraindications to PA and other comorbidities.
* BMI \<20 or ≥42.
* Individuals with an HbA1c level \<5.7% or \>6.4%.
* Currently engaged in \>100 min/wk of PA.
* Individuals with contraindications to exercise participation as indicated by the PAR-Q.
* A self-reported physical/mental disability that would prevent them from being able to adhere to the intervention.
* Past or current diagnosis of Diabetes (Type 1, 1.5 or 2) or use of diabetic medications (e.g. medications to control blood sugar)
* Any history of a cardiovascular disease event (e.g. heart attack, ablation, pacemaker, stroke)
* Current treatment for cancer or heart disease (lipid and hypertensive medications acceptable but will be tracked closely).
* Any change within the last 3 months, or anticipated changes, of any medications that would affect study outcomes (e.g. medications for lipids, blood pressure, anxiety, depression)
* The use of any medication that significantly interferes with the autonomic nervous system
* Current tobacco or nicotine users, or those who have quit within the last six months
* Excessive alcohol (on average\>1 drinks/day for women and \>2 drinks/day for men) or excessive recreational drug use (reported usage of once a week or more).
* Unstable weight over the last three months (\>10% change).
* Those with major surgery planned or recent history of bariatric surgery (within last 2 years) or a history of other medical interventions that would interfere with study outcomes
* Currently within one-year postpartum, currently pregnant, or planning to become pregnant during the study period.
* Currently breastfeeding.
* Unwilling to comply with study randomization procedures.
* Unwilling to maintain current dietary and exercise habits, aside from any changes to be made per the study exercise protocol.
* Current participation in another interventional clinical trial.
* Previous randomization in this study.

Where this trial is running

Lake Forest, Illinois and 2 other locations

• Lake Forest Hospital — Lake Forest, Illinois, United States (Recruiting)
• Central DuPage Hospital — Winfield, Illinois, United States (Recruiting)
• Epidemiological Clinical Research Center — Minneapolis, Minnesota, United States (Recruiting)

Study contacts

• Principal investigator: Mark Pereira, PhD — University of Minnesota
• Study coordinator: Sarah Rydell, MPH

Conditions PreDiabetes; Heart Rate Variability; Stress and Anxiety; Stress Biomarkers; walking intervention; built environment; outdoor environment; prediabetes