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

Summary

The goal of this randomized crossover trial is to compare the differences in psychological and physiological effects of walking in two different outdoor environments (urban/suburban commercial environments vs. urban/suburban nature areas/preserves) in adults with prediabetes. The main questions it aims to answer are: * Do psychological measures of stress, anxiety, and affect improve more in one type of outdoor environment over the other? * Do physiological measures of stress improve more in one type of outdoor environment over the other? As this is a crossover trial, participants will serve as their own controls. Researchers will compare both the psychological and physiological effects walking in the two types of outdoor environments. Participants will: * Walk 150-minutes per week for six weeks in each of the two outdoor conditions. * Visit the clinic four times, including before and after each six-week walking period. * Collect saliva samples immediately proceeding or following the four clinic visits. * Return to their pre-study level of physical activity for a 5-week washout period between each of the two walking interventions.

Eligibility

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.

Conditions7

Locations3 sites

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