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Formålet med manualen er, at give inspiration til og vejledning i at integrere naturen i sundhedsfremmende forløb for mennesker med senfølger efter hjernerystelse. Manualen er baseret på principperne for evidensbaseret praksis med integration af anbefalingerne fra nationale kliniske retningslinjer (NKR), samt evidens om naturens sundhedsfremmende effekter og viden om målgruppen.

Introduction Exercise is an effective component in rehabilitation of a range of chronic conditions. There is a growing interest in the use of exercise-based nature interacted rehabilitation (EBNIR), but an overview of current evidence is missing. To provide an informed base for future work within this field of EBNIR, the objective of this scoping review was to map existing exercise-based rehabilitation interventions conducted with incidental or intentional nature interaction focusing on its populations, types of outcomes, and theoretical rationale for people with physical and mental disabilities. Methods This scoping review identified peer-reviewed publications, registered upcoming trials and grey literature. To map all available knowledge, we performed a comprehensive search of selected databases (MEDLINE; EMBASE; CINAHL; Cochrane; Web of Science; Pedro) from inception to October 2022. Data was synthesised in a thematic presentation guided by TIDieR, supplemented by a checklist developed for this study accounting nature incidental or intentional interaction by measuring all nature elements implemented in the intervention. Results Twelve studies including 856 participants met the inclusion criteria. 11 were completed trials and 1 was registered in clinicaltrials.gov to be run in 2023. A total of 856 patients were enrolled in the 12 studies (range 18-262, median 50). The included studies were different in terms of design (observational n=4, qualitative n=1, RCT=7), intervention dosage and frequency, control intervention, diagnosis, number of patients, and outcomes included. The used exercise-based interventions consisted of outdoor walks, neck exercises and surfing interventions in patients with physical or mental health conditions. The interventions were incidental or intentional interacted with nature to a varying degree. Conclusion This scoping review presents an overview of limited and diverse evidence within the field of exercise-based rehabilitation in

Introduction: Exercise is an effective component in rehabilitation of a range of chronic conditions. There is a growing interest in the use of exercise-based nature interacted rehabilitation (EBNIR), but an overview of current evidence is missing. The objective of this scoping review was to map existing exercise-based rehabilitation interventions conducted with incidental or intentional nature interaction focusing on its populations, types of outcomes, and theoretical rationale for people with physical and mental disabilities. Methods: This scoping review identified peer-reviewed publications, registered upcoming trials and grey literature. To map all available knowledge, a comprehensive search of selected databases (MEDLINE; EMBASE; CINAHL; Cochrane; Web of Science; Pedro) from inception to October 2022. Data were synthesized in a thematic presentation guided by TIDieR, supplemented by a checklist developed for this study accounting nature incidental or intentional interaction. Results: Twelve studies including 856 participants met the inclusion criteria. Eleven were completed trials and one was registered in clinicaltrials.gov to be run in 2023. A total of 856 patients were enrolled in the 12 studies (range 18–262, median 50). The included studies had great variation. The incidental or intentional interacted exercise-based interventions consisted of outdoor walks, neck exercises and surfing interventions in patients with physical or mental health conditions. Conclusions: This scoping review presents an overview of limited and diverse evidence within the field of EBNIR, in patients with physical or mental health conditions. Our review provides an overview that will be helpful in the design of future EBNIR trials.

Formålet med grønbogen er at skabe et fælles grundlag for det videre arbejde med at fremme naturen som ressource i sundhedsindsatserne i Danmark og dermed skabe et afsæt for en videreudvikling og et kvalitetsløft af disse indsatser

Background A limited amount of research has examined how nature-based palliative rehabilitation can be implemented in nursing homes for people with dementia, even though evidence suggests that these gardens are underused. This paper will present the study protocol of an intervention study co-designed in an interdisciplinary collaboration with a nursing home for people with dementia, to develop a tailored nature-based palliative rehabilitation program to increase qualified use of garden with the purpose of promoting a range of health outcomes. Methods The study is a single-cased quasi-experimental mixed methods study. The intervention will be developed, designed, and implemented in collaboration with the nursing home, using different co-design tools and methods. The effect of the intervention will be evaluated using the The Neuropsychiatric Inventory Nursing Home version in combination with medication use, a survey on staff burnout, and cameras in the garden to register garden use. A process evaluation with single- and focus group interviews consisting of various stakeholders in the study will be used to gain knowledge on the intervention processes and implementation. Discussion The paper presents new approaches in the field of palliative rehabilitation for people with dementia using nursing home gardens, through interdisciplinary collaboration, participatory co-design approach and mixed methods design. Using both effect and process evaluation, the study will provide unique insights in the role and importance of participatory process, interdisciplinary collaboration, and tailoring palliative rehabilitation activities in gardens at nursing homes to local needs and wishes. These results can be used to guide other nursing homes and renewal projects in the future.

Introduction: Nature-based therapy (NBT) has shown positive effects on different health-related outcomes and is becoming a more frequent approach in various rehabilitative interventions. Economic evaluations are widely used to inform decision makers of cost-effective interventions. However, economic evaluations of NBT have not yet been reviewed. The aim of this review was to uncover existing types and characteristics of economic evaluations in the field of nature-based therapeutic interventions. Methods: In this scoping review available knowledge about the topic was mapped. A comprehensive search of selected databases (MEDLINE; EMBASE; CINAHL; Scopus; Cochrane; PSYCinfo; Web of Science) and grey literature was conducted in November 2021. Data was synthesised in a thematic presentation. Results: Three papers met the inclusion criteria, containing differences in design, types and dose of nature-based therapeutic interventions, outcome measures and target groups (n = 648). The papers showed tendencies toward a good treatment effect and positive economic effect in favour of NBT. Conclusions: Three different cohort studies have tried calculating the economic impact of NBT indicating a good effect of the NBT. The evidence on the economic benefits of NBT is still sparse though promising, bearing the limitations of the studies in mind. Economic evaluation of NBT is a new area needing more research, including high-quality research studies where the economic evaluation model is included/incorporated from the beginning of the study design. This will enhance the credibility and usefulness to policy makers and clinicians.

The unemployment rate among newly arrived refugees in European countries is high and many experience mental health problems. This has negative consequences on integration and mental well-being. In this case series study we investigated the effect of a 30-week program that included horticulture activities, nature-based therapy, and traditional job training on job market affiliation and mental well-being. Fifty-two refugees met initial screening criteria and twenty-eight met all inclusion criteria and were enrolled. The program took place in a small community and consisted of informal therapeutic conversations, exercises aimed at reducing psychological stress, increasing mental awareness and physical wellbeing. At the end of the program traditional job market activities were led by social workers. Provisionary psychiatric interviews showed that at baseline 79% met criteria for either an anxiety, depression, or PTSD diagnosis. After the program, statistical analyses revealed an increase in the one-year incidence of job market affiliation (n = 28) and an increase in mental health according to two of four questionnaire measures (nrange = 15–16). The results strengthen the hypothesis that horticulture and nature-based therapy can help refugees enter the job market. However, the small sample size emphasizes the need for methodologically stronger studies to corroborate these preliminary findings.

Being in nature and doing nature-based activities has been shown to reduce stress-related illnesses such as trauma and post-traumatic stress disorders. In 2016, the crisis shelter Danner in Denmark decided to implement a programme based on the therapeutic use of nature as a recovery method for their residents: women and children exposed to domestic violence. This was done in collaboration with the research group of University of Copenhagen. This paper describes the objectives of the project, the development of an educational programme and the implementation of nature-based therapy. The Danish model for qualifications in education developed by the Danish Ministry of Education was the overall structural framework for the programme. The education programme contained four overall elements: (1) a theoretical part on the nature–health relationship; (2) performance and development of practical nature activities in collaboration with staff; (3) case stories about the challenges of implementing nature-based therapy for the residents in the crisis shelter; and (4) the implementation phase of nature-based therapy at Danner. Developing qualifications related to the use of nature-activities and the use of nature-environment might be useful for social workers and strengthen their competences in their work with battered women and children.

Binge eating disorder (BED), characterized by recurrent episodes of binge eating with a subjective experience of lack of control, is the world’s most common eating disorder. The aim of the present pilot study was to examine the feasibility of implementing nature-based therapy (NBT) in the treatment of BED. The NBT intervention was compared to Support Group Meetings (SGMs), which are the only publicly available form of support for people diagnosed with BED in Denmark. Twenty participants with a BED diagnosis were included in the study, which had a mixed-methods design including Eating Disorder Examination interviews, semi-structured interviews, and questionnaires measuring well-being (The Psychological GeneralWell-Being Index) and self-esteem (Rosenberg’s Self-Esteem Scale). Both the NBT and the SGMs showed positive results on all outcome measures (decreases in binge eating episodes and increases in general psychological well-being and self-esteem). The interviews indicated that the NBT context made the psychotherapeutic content more accessible to the participants and further helped them transfer the therapeutic gains to daily life after completing treatment. However, these results should be interpreted with caution due to the small sample size—ideally, they would need to be tested on a larger, randomized sample.

Serving in the military leads to mental diseases, such as post-traumatic stress disorder (PTSD), for a percentage of soldiers globally. The number of veterans with PTSD is increasing and, although medication and psychological treatments are offered, treatment results could be improved. Historically, ifferent forms of nature-based therapy have been used for this target group. However, in spite of anecdotally good results, studies measuring the effect of this form of therapy are still lacking. The aim of this study is to explore how veterans with PTSD manage their everyday lives during and after a ten-week nature-based intervention in a therapy garden. Methods: Eight veterans participated in qualitative interviews, which were conducted during a one-year period and were analyzed using interpretative phenomenological analysis (IPA). Results: Five themes emerged from the IPA analysis: Bodily symptoms; relationships; building new identities; the future; and lessons learned. All the participating veterans gained a greater insight into and mastering of their condition, achieved better control of their lives, and developed tools to handle life situations more appropriately and to build a new identity. This improved their ability to participate in social activities and employment. Conclusion: The results should be considered in the future treatment of veterans with PTSD.

Evidence confirms that nature-based therapy (NBT) has a positive effect on people with mental illnesses. However, there is a lack of evidence on the meaning of NBT for specific patient groups. The Nacadia® Therapy Garden was designed according to an evidence-based design process, and an NBT programme was developed. The aim of the study was to illuminate the phenomenon of participants’ lived experience of the NBT in Nacadia. Fourteen participants took part in semi-structured interviews (SSIs), and by way of reflective lifeworld research, the SSIs were analysed to identify and describe the meanings of the phenomenon. The essence of the phenomenon was found to be a process of adopting a searching approach to NBT and Nacadia to become familiar with the conditions. This familiarity stimulated the development of confidentiality and attachment to Nacadia. Feeling protected, safe, cared for, and not exposed was important, and motivated feelings of freedom, reduced demands, and increased the ability to access and try a spectrum of NBT activities. It encouraged participants to develop personal approaches and coping strategies to implement in their everyday lives for moving on.