Health measurements at nature entrepreneurs

The investigation is part of the substudy on health measurements (WP6) within the Botnia-Atlantica project "Nordic Nature Health Hub".

Where was the study done?

The study was conducted at 11 nature entrepreneurs’ places, six in Sweden and five in Finland (eight were also reference companies in the project).

Here you can read some reports about the study at three of the companies in Finland:

• Health measurements at Smedisgården, Ostrobothnia 
• Test measurements on 6 Ostrobothnian moose hunters
• Alpaca hiking with test group, Aava Kertun Kotitila, Ostrobothnia

How was the study performed?

A total of 170 people visited nature entrepreneurs and at the same time underwent health measurements. The set-up varied somewhat depending on what the entrepreneurs could offer. In Finland, some entrepreneurs were responsible for all measurements themselves, but this was experienced as stressful and difficult. In Sweden, it was not possible to recruit entrepreneurs who would make measurements themselves. The structure of the project was therefore changed so that project staff recruited participants and took care of all the practicalities of the measurements, which made it easier for the entrepreneurs. A common arrangement was that the visitors arrived around 10 o'clock, had coffee together and then went out into nature. A simple lunch was served. In the afternoon, another activity or stay in nature was carried out and then the participants went home around 15 o'clock.

The participants assessed their mental state at three occasions when visiting the nature entrepreneur. Heart rhythm and physical activity were registered continuously during the stay with a recorder attached to a chest strap (Linkura). Similar registrations were also carried out during three ordinary days at home. The participants were instructed to perform the measurement at home and measurement 2 outdoor in nature at the entrepreneurs place after they had been in rest for about 15 minutes.

The Linkura-recorder was connected wirelessly to an application in the person's mobile. Results from the measurements were illustrated with calculated scores for mental stress, recovery and physical stress/activity in the mobile.

Some general questions about health were answered via the mobile. Estimation of mental state was performed with a web-based questionnaire in the mobile phone. Afterwards, a short telephone interview was conducted by some of the participants about how they experienced the nature stay, the measurements and what benefit they could have from them.

The researchers in the project also produced group results from the visitors to a certain nature entrepreneur. The nature entrepreneur was then offered the opportunity to take part of the results at a meeting with the researchers. Then a short interview was performed about how the entrepreneur experienced the measurements and possibly could benefit from them.

The study was approved by the Swedish Ethics Review Authority (Dnr: 2019-03949) and in corresponding authority in Finland.

Preliminary results

An important experience from the project is that it became too burdensome for the entrepreneurs to be responsible for the measurements themselves and make sure that everything worked. This was especially true of the HRV measurements. Measuring mental state was much easier to perform.

Preliminary results from the measurements are currently available mainly from Swedish companies, but will soon be compiled for Finnish companies as well. To illustrate preliminary results, examples are shown from company A which received 31 number of people/visitors who made health measurements.

Mental state

Measurements of mental state in the the Swedish nature companies showed higher values when staying outdoors in a natural environment compared to at home. Higher values mean that the participants rated higher in terms of relaxed, harmonious, calm, happy, alert and clear-minded. The results were similar at different Swedish companies. As an example, Figure 1 shows the results of measurements from nature entrepreneur A. Visitors also estimated higher values out in nature (measurement 2) compared with the first measurement (measurement 1) on arrival to the company.

Figure 1. Self-estimated mental state among 31 visitors to company A (mean values of six scales, scale 1-10) showed a statistically significant difference with higher values during the visit to the nature entrepreneur compared to at home (Wilcoxon test, p <0.001). There was also a clear difference immediately upon arrival at the entrepreneur (measurement 1) compared with being out in nature (measurement 2) and at the end of the visit before traveling home (measurement 3) (Friedman test, p <0.001). Higher values imply a more favorable mental state.

Mental stress, recovery and physical activity

During the visit to the nature entrepreneur, a higher degree of physical activity and a higher heart rate were registered compared with at home, see Figures 2 and 3 from entrepreneur A. There were no significant differences in heart rate variability (HRV) when being out in nature at the entrepreneur’s place compared to being at home in a more everyday situation. There were large differences between different individuals in how they reacted in terms of HRV during the visit to the nature entrepreneur.

Figure 2. Mean values of estimated scores for recovery, mental stress and physical stress for 31 visitors at entrepreneur A. The scores were calculated for each quarter of an hour and are based on registrations with the Linkura recorder. It was possible to get only one type of score at each time point. This means that the number of people at different time points in the diagrams vary.

Figure 3. Heart rate and heart rate variability (HRV index) from 31 visitors to entrepreneur A, at home and out in nature. The original raw data from the ECG recording with the Linkura recorder have been used here (averages for each quarter). It is beneficial to have a high HRV.

Summary

Self-estimation of mental state was easy to implement and the results showed clear positive effects of staying outdoors in nature.

On the other hand, there were large individual variations and different reaction patterns in terms of heart rate, heart rate variability and scores for recovery, mental stress and physical activity/stress in connection with the visits to the nature entrepreneurs. It was not possible to demonstrate any higher HRV in the natural environments. One reason for this may be the higher physical activity out in the natural environments compared to the situation at home. When the heart rate increases, HRV usually decreases at the same time. During physical activity, it therefore becomes difficult to draw definite conclusions about mental stress and recovery based on HRV data. As you often are physically active out in nature, the HRV method was not so adequate for measuring mental stress and recovery when visiting the entrepreneurs. It is methodologically more appropriate to perform standardized experiments with HRV measurements during physical rest/inactivity. But in doing so it will be a more artificial situation that differs from a regular visit to a nature entrepreneur.

In order to be able to report results from the heart rate measurements for several individuals at the same time, original raw data from the Linkura ECG registrations were used. This procedure implied that data management and compilation of results at group level became quite complicated and time-consuming.

Our recommendation to nature entrepreneurs based on experience in this project is to primarily measure health effects themselves by using self-estimations of mental state. Individual visitors could of course feel free to use an activity watch if they already have one. They can then themselves get feedback on how they react during their stay out in nature.

If the entrepreneur wishes to make other types of measurements, we currently recommend collaboration with researchers in the field. The technical development is constantly advancing and it is possible that in the future HRV methods will be offered for sale that automatically generate results at group level and thus become more user-friendly for entrepreneurs who want to evaluate health effects of their business. At the same time, the handling of sensitive personal data must be handled adequately in accordance with applicable laws. Some type of health certification for nature entrepreneurs in the future could also be valuable.

A final report from the project with health measurements will be published at Umeå University in the autumn of 2022.