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Mindful Walking in Psychologically Distressed Individuals: A Randomized Controlled Trial

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Background. The aim of this randomized, controlled study was to investigate the effectiveness of a mindful walking program in patients with high levels of perceived psychological distress. Methods. Participants aged between 18 and 65 years with moderate to high levels of perceived psychological distress were randomized to 8 sessions of mindful walking in 4 weeks (each 40 minutes walking, 10 minutes mindful walking, 10 minutes discussion) or to no study intervention (waiting group). Primary outcome parameter was the difference to baseline on Cohen's Perceived Stress Scale (CPSS) after 4 weeks between intervention and control. Results. Seventy-four participants were randomized in the study; 36 (32 female, 52.3 ± 8.6 years) were allocated to the intervention and 38 (35 female, 49.5 ± 8.8 years) to the control group. Adjusted CPSS differences after 4 weeks were -8.8 [95% CI: -10.8; -6.8] (mean 24.2 [22.2; 26.2]) in the intervention group and -1.0 [-2.9; 0.9] (mean 32.0 [30.1; 33.9]) in the control group, resulting in a highly significant group difference (P < 0.001). Conclusion. Patients participating in a mindful walking program showed reduced psychological stress symptoms and improved quality of life compared to no study intervention. Further studies should include an active treatment group and a long-term follow-up.
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Evidence-Based Complementary and Alternative Medicine
Volume , Article ID , pages
http://dx.doi.org/.//
Research Article
Mindful Walking in Psychologically Distressed
Individuals: A Randomized Controlled Trial
M. Teut,1E. J. Roesner,1M. Ortiz,1F. Reese,1S. Binting,1S. Roll,1H. F. Fischer,1,2
A. Michalsen,1,3 S. N. Willich,1and B. Brinkhaus1
1Institute for Social Medicine, Epidemiology and Health Economics, Charit´
e-Universtit¨
atsmedizin Berlin,
Luisenst raße 57, 10117 Berlin, Germany
2Department of Psychosomatic Medicine, Charit´
e-Universtit¨
atsmedizin Berlin, 10117 Berlin, Germany
3Immanuel Krankenhaus, Abteilung f¨
ur Naturheilkunde, 14109 Berlin, Germany
Correspondence should be addressed to M. Teut; michael.teut@charite.de
Received  May ; Accepted  July 
Academic Editor: Gregory L. Fricchione
Copyright ©  M. Teut et al. is is an open access article distributed under the Creative Commons Attribution License, which
permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Background. e aim of this randomized, controlled study was to investigate the eectiveness of a mindful walking program in
patients with high levels of perceived psychological distress. Methods. Participants aged between  and  years with moderate to
high levels of perceived psychological distress were randomized to  sessions of mindful walking in  weeks (each  minutes
walking,  minutes mindful walking,  minutes discussion) or to no study intervention (waiting group). Primary outcome
parameter was the dierence to baseline on Cohens Perceived Stress Scale (CPSS) aer  weeks between intervention and control.
Results. Seventy-four participants were randomized in the study;  ( female, . ±. years) were allocated to the intervention
and  ( female, . ±. years) to the control group. Adjusted CPSS dierences aer  weeks were . [% CI: .; .]
(mean . [.; .]) in the intervention group and . [.; .] (mean . [.; .]) in the control group, resulting in a
highly signicant group dierence (𝑃 < 0.001). Conclusion. Patients participating in a mindful walking program showed reduced
psychological stress symptoms and improved quality of life compared to no study intervention. Further studies should include an
active treatment group and a long-term follow-up.
1. Background
General psychological distress and stress-related diseases are
considered to be an important health issue in Western soci-
eties. A recent survey with a representative sample showed
that between % and % of the adult German population
reported symptoms of marked psychological distress in the
last  months, the frequency of chronic stress being higher
among women than men [,]. Another survey suggests
that up to % of the German population feels distressed
frequently, up to % most of the time []. It is also assumed
that the share of workers who experience stress and psycho-
logical trouble due to their working conditions is increasing.
In a recent German survey, one-h of  employees felt
overburdened on work; % reported that they experienced
an increase of stress and work pressure in the last years [].
Whereas a certain level of stress is generally considered to be
of benet to improve performance, continuous stress aects
physical and mental health [,].
In several studies, mindfulness training and physical
exercise have demonstrated eects in reducing symptoms
of psychological distress [,]. Mindfulness training is
a treatment strategy derived from Buddhist mindfulness
meditation practice. It is described as the tendency to
encounter moment-to-moment experiences without being
lost in unhelpful or distressing thoughts triggered by the
experience []. e most commonly studied mindfulness
training program is mindfulness-based stress reduction
(MBSR) that has demonstrated eects not only a wide range
of mental and physical disorders, but also on stressed healthy
people [,]. A direct relationship between physical exercise
and prevention or improvements of health has not only
been established for many somatic diseases, but seems also
plausible for psychological distress [].
Evidence-Based Complementary and Alternative Medicine
For the future, it is an important public health issue to
develop and evaluate simple and cost-eective nonpharma-
cological therapies for the general population to prevent and
treat individuals with acute or chronic psychological distress.
Hypothetically it could be a good concept to combine
mental and physical stress reduction strategies, especially
if the combined exercise program would be easy to learn
and run on low costs. Up to date, a combination between
walking exercise and mindfulness has not been systematically
evaluated. erefore, we developed an easy to follow training
program that combines mindfulness with walking. e aim
of this randomized, controlled study was to investigate the
eectiveness of mindful walking in patients with high levels
of subjectively perceived psychological distress.
2. Methods
2.1. Design. is study was designed as an open, single-center
randomized controlled trial including two parallel groups.
All study participants gave their written informed consent
before inclusion. e study was carried out at the outpatient
clinic for Complementary and Alternative Medicine (CAM)
at Charit´
eUniversit
¨
atsmedizin Berlin, Germany. e mindful
walking training was performed in the surrounding streets
and parks.
Patients were allocated to treatment groups by a ran-
domization with a  : ratio. e random allocation sequence
was generated using SAS . soware (SAS Institute Inc.,
Cary, NC, USA). Aer signing the informed consent form
and completing the baseline assessment questionnaires, the
subjects were centrally assigned to intervention or control
group by an independent study nurse on the telephone line.
Allocation was concealed according to the randomization list.
e study was reviewed and approved by the Ethics
Committee of the Charit´
eUniversit
¨
atsmedizin, Berlin, Ger-
many (EA// - ..). e study was registered at
ClinicalTrials.gov (NCT).
2.2. Participants. Participants were recruited through adver-
tisements in local daily newspapers. Study information and
prescreening were undertaken by phone by a study nurse and
a student of health science. Eligible subjects that reported
a high level of psychological distress were invited for a
personal consultation with a study physician for information,
informed consent, and the assessment of inclusion or exclu-
sion. Inclusion criteria were
(i) men and women between  and  years,
(ii) increased level of psychological distress (visual analog
scale > mm; range: – mm, higher values indi-
cating more stress).
Exclusion criteria were
(i) regular walking training in the last  weeks (at least
one regular training session per week),
(ii) psychopharmacological drugs,
(iii) regular mindfulness training (at least one regular
training session per week),
(iv) other CAM treatments against stress in the last 
weeks,
(v) acute diseases or chronic disease at baseline,
(vi) inability to walk.
e visual analogue scale for the detection of increased level
of psychological distress was mainly chosen for practical
reasons—VAS assessment is easily and quickly done.
2.3. Study Intervention. e intervention protocol was devel-
oped in a consensus process including a mindfulness-based
stress reduction trainer, a sports therapist, and two medical
doctors. Subjects allocated to the intervention group received
 sessions of -minute mindful walking training within four
weeks. Each training group consisted up to  individuals.
e intervention was delivered by two sports therapists
that were also trained in mindfulness-based stress reduction
techniques. Each session was structured as follows:
(i) meeting at a dened meeting point and greetings (
minutes);
(ii) walking to a park ( minutes);
(iii) gymnastic exercises to warm up and short walking
instructions ( minutes);
(iv) walking ( minutes);
(v) mindful walking ( minutes). Participants were
instructed to mindfully observe and focus on their
bodily sensations while walking remaining focused
on their moment-to-moment experiences without
being lost in unhelpful or distressing thoughts trig-
gered by the experience. If this was experienced
as a problem, the participants were instructed to
focus their awareness on their breath while in- and
exhaling,
(vi) a feedback round was used to share and discuss the
experiences ( minutes),
(vii) walking ( minutes),
(viii) gymnastic exercises ( minutes),
(ix) walking back to the meeting point ( minutes).
Participants of the intervention group were encouraged and
advised to keep on exercising for themselves aer completing
the -week program.
Participants allocated to the control group received no
mindful walking training in the -week duration of the study
(waiting list group). ey were only sent study questionnaires
aer  and  weeks by postal service and had no consulta-
tions with the study physicians between baseline and week
.
Aer the trial was completed, all subjects of the control
group were oered the previously intervention in the above
described manner for free.
2.4. Outcome Measures. Patients completed standardized
questionnaires including outcomes at baseline and aer  and
 weeks. As a primary outcome measure, we dened the
Evidence-Based Complementary and Alternative Medicine
Assessed for eligibility
(n = 168)
Enrollment
Randomized
(n=74)
Allocated to walking group
(n=36)
Allocated to control group
(n=38)
Lost to follow-up
(n=0)
Withdrawn
(n=6)
Lost to follow-up
(n=0)
Withdrawn
(n=5)
Analyzed
(n=36)
Excluded from analysis
(n=0)
Analyzed
(n=38)
Excluded from analysis
(n=0)
Excluded (n=94)
- Inclusion criteria not met (n=46)
- Refused to participate (n=18)
- Not reached for appointment (n=28)
- Other reasons (n=2)
F : Trial ow chart.
change to baseline of the score of Cohen’s Perceived Stress
Scale (CPSS) [] aer  weeks. e CPSS consists of  items
including current levels of experienced and perceived stress.
As secondary outcomes, we dened CPSS aer  weeks, the
subjective levels of psychological stress of the last week on a
VAS (– mm, higher scores indicate higher levels of stress)
[] and health-related quality of life (QoL) by the SF-
questionnaire [] (higher scores indicate higher QoL) aer 
and  weeks. Sociodemographic data of all participants was
assessed at baseline. Adverse events were monitored by the
mindful walking trainers throughout the study.
2.5. Statistical Analysis. e study was designed to detect
a dierence of the primary outcome parameter (dierence
between CPSS score to baseline) of  points between inter-
vention and control group with a power of % including a
dropout rate of approximately %. erefore, we included 
participants per group.
Data analysis is based on intention-to-treat population.
Missing values were replaced by last observed value (last value
carried forward). Primary and secondary outcome parame-
ters were analyzed with analysis of covariance (ANCOVA),
adjusted for the respective baseline value, two-sided with a
signicance level of %. e ANCOVA models were used to
calculate adjusted dierences with % condence intervals.
All statistical analyses were conducted in R .. [].
3. Results
Participants were included in the study from February to May
. Study intervention and followups were completed by
September . A total of  subjects were screened for
eligibility;  could not be included. e main reason for
noninclusion was not meeting the inclusion criteria mainly
due to the subject reporting a perceived level of stress below
 mm on the VAS (Figure ). Seventy four patients were
randomized with  allocated to the intervention,  to the
control group. Five participants of the intervention group
andfromthecontrolgroupdecidedtoterminatethestudy
intervention program before their individual study end for
several reasons: lost his house in a re (𝑛=1), moving out
of the city (𝑛=1), disease (𝑛=1), not explained (𝑛=2)
in the intervention group and job-related stress (𝑛=1), not
explained (𝑛=5) in the control group.
At baseline, the SF- Mental Component Score was
signicantly higher at baseline in the control group (36.3 ±
10.2)thanintheinterventiongroup(31.7 ± 8.8), all
other characteristics showed comparable values (Table  ). e
mean age of the participants was 52.3 ± 8.6 (SD) in the
intervention and 49.5 ± 8.8 in the control group at baseline.
Participants were in both groups predominantly women. e
perceived stress intensity in the last week on the VAS can
be considered as elevated at baseline in both groups (71.3 ±
13.1mm in the study intervention and with 70.7 ± 12.4 in
Evidence-Based Complementary and Alternative Medicine
T : Baseline characteristics of participants in both study groups.
Mindful walking intervention
(𝑛 = 36) No intervention control
(𝑛=38)
Age (mean ±SD) . ±. . ±.
Gender (male, %)  (.%)  (.%)
Body mass index (mean ±SD) . ±. . ±.
Level of perceived psychological distress on visual analogue scale
(mean ±SD)∗∗ . ±. . ±.
Cohen’s Perceived Stress Scale (mean ±SD)∗∗ . ±. . ±. 
Quality of life: SF-—physical component score (mean ±SD). ±. . ±.
Quality of life: SF-—mental component score (mean ±SD). ±. . ±.
Expectation of improvement (𝑛, %)  (.%)  (.%)
Higher values indicating better QoL, ∗∗lower values indicating less distress.
0
5
10
15
20
25
30
35
40
45
50
55
60
412
Week s
Intervention
Control
CPSS: adjusted means (95% CI)
P < 0.001 P = 0.031
F : Adjusted means and % condence intervals of Cohens
Perceived Stress Scale (CPSS) at  and  weeks with 𝑃values
comparing mindful walking with no intervention (lower values
indicating less psychological distress).
the control group). SF- Mental Component Score values
in both groups were below the reported German average of
thepopulationwhereasthePhysicalComponentScorewas
comparable to the German average (both 50.0 ± 10.0)[].
Adjusted CPSS dierences to baseline aer  weeks as
primary outcome parameter were . [% CI .; .]
(mean . [.; .]), in the intervention group and .
[.; .] (mean . [.; .]) in the control group, result-
ing in a statistically signicant group dierence (𝑃 < 0.001)
(Table ,Figure ). Twelve weeks aer baseline and  weeks
aer study intervention, CPSS remained still signicant (𝑃=
0.031) between study groups with a dierence to baseline of
.  [ .; .] in the intervention group and . [.;
.] in the control group.
Signicant group dierences were also found aer 
weeksfortheVASdierencetobaselinewith. [.;
.] (mean . [.; .]) mm in the intervention group
compared to . [.; .] (mean . [.; .]) mm
Intervention
Control
0
5
10
15
20
25
30
35
40
45
50
55
60
65
70
75
80
85
90
95
100
412
Weeks
VAS: adjusted means (95% CI)
P = 0.010 P = 0.562
F : Adjusted means and % condence intervals of per-
ceived psychological dist ress on VAS (– mm) at and  weeks
with 𝑃values comparing mindful walking with no intervention
(lower values indicating less psychological distress).
(𝑃 = 0.010) in the control group but not aer  weeks
(Table ,Figure ).
An improvement in the quality of life was observed for
the SF- Mental Component Score aer  weeks with a
dierence of . (.; .) versus . (.; .) (𝑃 < 0.001)
and  weeks with a dierence of . (.; .) versus .
(.; .) (𝑃 = 0.021) but not for the Physical Component
Score (Table ,Figures,and). Signicant group dierences
in favor of the study intervention were observed for the SF-
 scales mental health, vitality, emotional role function, and
social role function aer  weeks but only for the emotional
role function aer  weeks (Ta b le ).
Five participants of the intervention group reported that
they kept on practicing the exercises regularly between  and
 weeks whereas  participants reported noncontinuous or
irregular practice. No serious adverse events were observed
during the study.
Evidence-Based Complementary and Alternative Medicine
T : Outcome measures at  weeks and  weeks (means and % condence intervals adjusted for respective baseline value).
Outcomes
Adjusted dierences
to baseline
(% CI)
mindful walking
𝑛=36
Adjusted dierences
to baseline
(% CI) control
(no intervention)
𝑛=38
Adjusted means
(% CI)
mindful walking
𝑛=36
Adjusted means
(% CI) control
(no intervention)
𝑛=38
𝑃value
At 4 weeks
Cohen’s Perceived Stress
Scale ( items)∗∗ . (.; .) . (.; .) . (.; .) . (.; .) <.
Visual analogue scale
(– mm)∗∗ . (.; .) . (.; .) . (.; .) . (.; .) .
SF-—mental component
score. (.; .) . (.; .) . (.; .) . (.; .) <.
SF-—physical
component score. (.; .) . (.; .) . (.; .) . (.; .) .
SF-—vitality scale. (.; .) . (.; .) . (.; .) . (.; .) .
SF-—physical
functioning scale. (.; .) . (.; .) . (.; .) . (.; .) .
SF-—bodily pain scale. (.; .) . (.; .) . (.; .) . (.; .) .
SF-—general health
perceptions scale. (.; .) . (.; .) . (.; .) . (.; .) .
SF-—physical role
functioning scale. (.; .) . (.; .) . (.; .) . (.; .) .
SF-—emotional role
functioning scale. (.; .) . (.; .) . (.; .) . (.; .) .
SF-—social role
functioning scale. (.; .) . (.; .) . (.; .) . (.; .) .
SF-—mental health
scale. (.; .) . (.; .) . (.; .) . (.; .) <.
At 12 weeks
Cohen’s Perceived Stress
Scale∗∗ .  ( .; .) . (.; .) . (.; .) . (.; .) .
Visual analogue scale∗∗ . (.; .) . (.; .) . (.; .) . (.; .) .
SF-—mental component
score. (.; .) . (.; .) . (.; .) . (.; .) .
SF-—physical
component score. (.; .) . (.; .) . (.; .) . (.; .) .
SF-—vitality scale. (.; .) . (.; .) . (.; .) . (.; .) .
SF-—physical
functioning scale. (.; .) . (.; .) . (.; .) . (.; .) .
SF-—bodily pain scale. (.; .) . (.; .) . (.; .) . (.; .) .
SF-—general health
perceptions scale. (.; .) . (.; .) . (.; .) . (.; .) .
SF-—physical role
functioning scale. (.; .) . (.; .) . (.; .) . (.; .) .
SF-—emotional role
functioning scale. (.; .) . (.; .) . (.; .) . (.; .) .
SF-—social role
functioning scale. (.; .) . (.; .) . (.; .) . (.; .) .
SF-—mental health
scale. (.; .) . (.; .) . (.; .) . (.; .) .
Abbreviations: higher values indicating better QoL, ∗∗lower values indicating less distress.
Evidence-Based Complementary and Alternative Medicine
Intervention
Control
0
5
10
15
20
25
30
35
40
45
50
55
60
65
70
75
80
412
Weeks
SF-36 physical CS: adjusted means (95% CI)
P = 0.492 P = 0.989
F : Adjusted means and % condence intervals of SF-
 Physical Component Score at  and  weeks with 𝑃values
comparing mindful walking with no intervention (higher values
indicating higher QoL).
Intervention
Control
0
5
10
15
20
25
30
35
40
45
50
55
60
65
70
75
80
412
Weeks
SF-36, mental CS: adjusted means (95% CI)
P < 0.001 P = 0.021
F : Adjusted means and % condence intervals of SF-
Mental Component S core at  and  weeks with 𝑃values comparing
mindful walking with no intervention (higher values indicating
higher QoL).
4. Discussion
In this study, statistically signicant dierences for CPSS,
VAS, and SF- Mental Component Score were observed
comparing mindful walking program to a no-treatment
control group (waiting group) aer  weeks. Aer  weeks
from intervention start and  weeks aer end of active
treatment, the group dierences were less marked, but CPSS
and SF- Mental Component Score still showed a signicant
group dierence. No serious adverse events were observed.
Mindful walking might be a useful new treatment strategy
to reduce subjectively perceived symptoms of stress. In
Germany, the normal charge for participation in an exercise
classasthisisEuroperhourandparticipant(US).e
whole intervention costs  Euros ( US) per participant.
Our study does not allow us to conclude if the combination
of walking and mindfulness is superior to walking or mind-
fulness alone, but it denitely is a low-cost and easy to learn
and implement exercise program.
Ourdatasuggeststhatitisnecessarytocontinuously
practice mindful walking to obtain the best eects. However,
only  participants of the intervention group kept on practic-
ing regularly aer the end of the intervention period although
it was recommended to continue practicing.
Strengths of this study include the use of highly experi-
enced therapists, a conrmatory design, and a comparably
high number of participants.
However, there are some limitations which need to be
discussed. A limitation of this study is the open design. Due to
the nature of this trial, a blinding of the participants or study
team was not possible. Also, this design makes it impossible
to assess which components of the intervention were eective
in reducing the stress. Possible eectors could have been exer-
cise (walking), mindfulness practice, participating in a group,
the expectation of improvement ( of  subjects in both
groups expected improvements) (Table ), the suggestion that
theprogrammayreducestress,orthereceivedattention
through study personnel.
In addition, a design with a no-treatment control group
imitates the situation of a patient who is asking himself:
“Should I try this treatment or better do nothing and wait?”
But this model does not answer the question about the
best treatment or the most eective component. Another
limitation is the low number of males participating. It is thus
unclear whether the results of this trial are valid also for a
male population. Generally a higher percentage of female
participants do practice mind body therapies []andwere
also observed in an earlier study investigating the role of
mindfulness in stress reduction [].
To the best of our knowledge, this is the rst ran-
domized trial evaluating a mindful walking program for
the treatment of perceived general psychological distress.
ere are not many stress reduction programs combining
exercise with mindfulness practice or relaxation. Michalsen
et al. [] recently reported the results of a three-armed
study where Iyengar yoga eectively reduced distress and
improved related psychological and physical outcomes in
seventy-two females. e practice of yoga consists of physical
movements with isometric muscle strengthening, stretching,
andexibility,combinedwithamentalfocusandanemphasis
on mindfulness of body movements and consideration of
breathing patterns. Other stress reduction programs showing
positive results and combining exercise with mindfulness
practice are Tai Chi []andQiGong[,].
In this study, the exercise component consisted only of
walking, which is easier to practice than yoga exercises, but
misses the specic stretching and exibility component. On
the other hand, walking improves cardiovascular tness and
therefore might especially be valuable for individuals showing
cardiovascular risk proles.
Evidence-Based Complementary and Alternative Medicine
Further studies about mindful walking in psychologically
distressed individuals should compare the eects of the
intervention with other active stress-reducing interventions.
Comparing with a control arm delivering only guided walks
(without a mindfulness component) and also a no-treatment
control arm would allow to determine the eects of walking
alone and additional mindfulness.
Another subject for research could evaluate gender-
specic eects with the research question aimed to determine
if mindful walking is also eective in men because the small
percentage of men who participated in the trial allows no
answer for this question.
5. Conclusion
Our results indicate that a -week mindful walking program
might be a helpful tool to reduce subjectively perceived
psychological distress compared to no intervention.
Conflict of Interests
e authors declare that they have no conict of interests.
Authors’ Contributions
Study concept and design: M. Teut, E. J. Roesner, B.
Brinkhaus. Organisation and data management: E. J. Roesner,
M.Teut,B.Brinkhaus,S.Binting.Developmentofinterven-
tion:E.J.Roesner,F.Reese,M.Teut,B.Brinkhaus.Delivering
intervention:E.J.Roesner,F.Reese.Statisticaldesignand
analysis:S.Roll,F.Fischer.Interpretationanddiscussionof
data:M.Teut,E.J.Roesner,F.Fischer,S.Roll,B.Brinkhaus,
S. N. Willich, A. Michalsen. Draing the paper: M. Teut, B.
Brinkhaus. All authors read, commented on, and approved
the nal paper.
Acknowledgments
e authors gratefully acknowledge the work of their study
nurseMargitCree,themedicaldoctorsBirgitLochbrunner
and Ileni Donachie, and their medical students Katharina
Gloger and Jenny Pistol for their great support to realize this
study.
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... Nine multi-session studies evaluated the effects of meditative or mindful walking on mental health (14,30,31,38,42,44,46,50,53). All studies except one (46) reported significant improvements on at least one measure of mental health, including affect (14,53), anxiety (30), depression (30,38), distress (50), emotional awareness (31), stress (42), post-traumatic thoughts (44), quality of life (50), ruminative thoughts (44), self-worth (44), state mindfulness (overall) (53), and stress (50). ...
... A natural area may play a role in mindful walking decreasing distress. However, this role is uncertain because the only multi-session study to report distress showed mindful walking does not have to occur in a natural area to decrease distress (50). ...
... The study by Teut et al. (2013) assigned distressed adults to a wait-list control or mindful walking intervention. The intervention was 60-minute sessions that included 10 minutes of mindful walking on city streets and in parks two days per week for four weeks. ...
Article
Full-text available
International Journal of Exercise Science 15(2): 1692-1734, 2022. Meditative and mindful exercise are types of physical exercise during which people pay attention, on purpose, to each new present moment without judging their experience. The goal is to apply an accepting awareness of the environment, bodily sensations, thoughts, and emotions without labeling them (e.g., good or bad). The literature centers on qigong, tai chi, and yoga, which are types of mindful exercise that improve mental and cardiovascular health. It is unclear if meditative and mindful walking also improve these health domains. To the authors' knowledge, this question has not been addressed by a published systematic review. The purpose of this systematic review without a meta-analysis was to synthesize the literature on meditative and mindful walking to determine their effects on mental and cardiovascular health. The protocol follows the PRISMA guidelines, is registered in PROSPERO (CRD42021241180), and is published elsewhere in a peer-reviewed journal. The systematic review contains 14 studies that had various populations, interventions, and outcomes. In 13 studies, the interventions statistically significantly improved scores on at least one outcome of mental or cardiovascular health (e.g., affect, anxiety, depression, distress, state mindfulness, stress, blood pressure, and six-minute walk distance). The improved outcomes should be interpreted cautiously because their clinical meaningfulness is unclear, and the studies had severe methodological limitations. Determining if meditative and mindful walking meaningfully improve mental and cardiovascular health will require randomized controlled trials that use rigorous designs, transparent protocols, and clinically meaningful outcomes that indicate physical function, mental wellbeing, morbidity, and mortality.
... In several studies, mindfulness training and physical exercise have demonstrated effects in reducing symptoms of psychological distress (Chiesa and Serretti 2009;Gerber and Puhse 2009). Results of Teut et al. (2013) show that a 4-week mindful walking program is supportive to reduce psychological distress. Gainey et al. (2016) researched the effect of Buddhist walking meditation on patients with diabetes 2. The results showed that it has a positive effect on the reduction of the blood glucose concentration, improving 'aerobic fitness level' as well as reducing stress. ...
... Chapter 3.7 showed that walking in combination with mindfulness has a positive impact of the psychological state of people. Walking implies to improve one's self-confidence, mood and mindfulness skills (Barton et al. 2009;Gotink et al. 2016) and it works against diseases, stress and depressions (Chiesa and Serretti 2009;Gainey et al. 2016;Gerber and Puhse 2009;Nabkasorn et al. 2006;Pickett et al. 2012;Salmon 2001;Scully et al. 1998;Teut et al. 2013;Vries and Weijer 2020). I am not suggesting a role for BSCG as a wellness trainer, however, I do suggest that walking meditation includes a package of positive side effects that can contribute to the holistic cure and wellbeing of a client. ...
... Also research has shown the potential of talking therapy in natural outdoor spaces (Cooley et al. 2020). Walking meditation in the outdoor space has only been researched by Teut et al. (2013). It did show that a mindful walking program is supportive to reduce psychological distress. ...
Thesis
Full-text available
Buddhist spiritual care (BSC) is being practiced in numerous domains and usually takes place in the form of sitting and talking, rituals, and seated meditation. Little research has been done on the effects, potential and challenges of walking meditation and mindful walking. Even though walking meditation is very present in many Buddhist traditions, literature into the role of walking meditation in BSC is scarce. The aim of this thesis is to understand the role of walking meditation for BSC. An analysis of literature on walking meditation in the Early Buddhist sources and selected contemporary practices has been conducted. The different applications of walking meditation have been assessed and insights into the opportunities and challenges of applying this practice in BSC have been provided. Secondary research methods have been applied in this research. First, findings and theories from quality academic literature have been incorporated. Analysis of existing literature about walking meditation in different Buddhist traditions have been conducted. Furthermore, the role and potentiality of walking meditation for BSC, its opportunities and challenges and its applicability have been carried out by employing a systematic literature review methodology. The results show that walking meditation could contribute to the cultivation of factors that according to the literature have the potential to eradicate craving, aversion, and delusion, and liberate one from suffering. Further, walking meditation includes significant aspects of contemplative care, which comprises contemplation with Buddhist teachings, the elements, nature, and the interconnectedness of life. At the same time, the analysis showed relevant health benefits as well as psychological effects such as 'grounding' and 'decentring' from walking meditation. Moreover, the analysis implies that when one is able to be 'heartful' and concentrated while walking, the factors of concentration, mindfulness, lovingkindness and compassion will not be lost in any other posture, and one can apply those qualities in all of life's activities. Moreover, the interactional sphere generated during a mindful walk or a guidance of a walking meditation is an open space of trust and compassion. Lastly, literature on nature and outdoor therapies and walks showed to be a supportive environment to potentially consider for walking meditation in BSC. All of the above findings call for further research into the relationship between walking meditation and BSC, and interfaith spiritual care. Equally significant for future research is the exploration of the effects of walking meditation on the psychological and spiritual processes in different domains such as prisons, hospitals, psychiatric centres, elderly homes, and the army. At the same time the effect of the outdoor/natural settings need further exploration. The major limitation in this thesis lies in the lack of focus on a specific group of people and/or institutions where walking meditation could be applied. This has to be considered in further research.
... [30][31][32] We developed a combination of walking and mindbody medicine techniques, that addresses physical exercise through walking as well as stress reduction and relaxation through mindfulness meditation. The intervention was proved successfully in psychologically distressed individuals, 33 however the effects of a mindful walking intervention have not yet been established for BC patients. ...
... A stress reducing effect could be found in randomized controlled trials and metaanalysis for MBSR interventions compared to usual care or "no MBSR" control conditions in cancer patients. [25][26][27]30 Comparing a 4-week mindful walking intervention to a waiting list, Teut et al 33 showed large positive effects of mindful walking in healthy individuals with elevated subjectively perceived stress levels in a randomized controlled trial. However, in comparison to our study, the effects shown by Teut et al might have been larger because the patients were psychologically distressed individuals without a chronic disease, such as BC, and the control group was a mere waiting group without an active study intervention. ...
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Introduction: Breast cancer (BC) survivors often suffer from disease- and therapy-related long-term side-effects. The study aim was to explore the feasibility, adherence, and individual experiences as well as possible effects of 2 different walking interventions in BC patients. Methods: This randomized controlled, pragmatic pilot trial included a qualitative study component. BC patients were randomized to either mindful walking (MFW) with mindfulness exercises and walking or moderate walking (MW) alone in weekly group sessions over 8 weeks. After 8 and 16 weeks, satisfaction, and self-perceived effectiveness as well as different health-related outcomes including health-related (WHOQOL-BREF) and disease-specific quality of life (FACT-G), perceived stress (PSQ) and cancer-related fatigue (CFS-D) were assessed. ANCOVA was used to evaluate differences in study outcomes. Qualitative data included 4 focus group interviews including 20 patients and were analyzed using a directed qualitative content analysis approach. Results: Altogether, 51 women (mean age 55.8 years (SD 10.9)) were randomized (n = 24 MFW; n = 27 MW). Both groups would recommend the course to other BC patients (MFW 88.9%; MW 95.2%) and showed possible improvements from baseline to week 8, without statistically significant difference between groups: WHOQOL-BREF (MFW: adjusted mean 65.4 (95% confidence interval (CI), 57.1-73.7); MW: 61.6 (53.6-69.6)); FACT-G (MFW: 76.0 (71.5-80.5); MW: 73.0 (68.5-77.4)); PSQ (MFW: 45.3 (40.5-50.1); MW: 45.4 (40.8-50.0)); CFS-D (MFW: 24.3 (20.8-27.8); MW: 25.5 (22.1-28.8)). Improvements lasted until the 16-weeks follow-up. The qualitative analysis suggested that MFW primarily promoted mindfulness, self-care, and acceptability in BC patients, whereas MW activated and empowered the patients as a result of the physical exercise. Conclusion: Both study interventions were positively evaluated by patients and showed possible pre-post effects in disease-specific health-related outcomes without differences between groups. The qualitative analysis results indicate that different resources and coping strategies were addressed by the 2 study interventions. Trial registration: DKRS00011521; prospectively registered 21.12.2016; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00011521.
... Being aware of the physical sensations of each step allows the practitioner to constantly return to the present moment (Kabat-Zinn, 1990). Studies have shown that in addition to an increase in mindfulness, participation in walking meditation training resulted in a significant reduction in psychological stress symptoms and depression and an increase in positive affect and perceived quality of life (Gotink et al., 2016;Prakhinkit et al., 2014;Teut et al., 2013). Similar effects have been found in studies on the effects of physical endurance programs that had moderate intense walking as the focus activity, but meditation was not included (Dasilva et al., 2011;Ekkekakis et al., 2000;Focht, 2009). ...
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Objectives The present longitudinal field study investigated whether hiking the Camino Francés strengthened self-compassion and tested covered distance, hikers’ motives, and walking alone vs. with other hikers as predictors of the increase. Method In the prospective main study with 104 hikers, 67.3% female, M = 36.3 years (SD = 14.2), change was measured by the difference between the first measurement taken on the way and the second measurement at arrival. Additionally, 21 participants, 52.4% female, M = 34.3 years (SD = 14), were recruited upon arrival and reported their actual and their retrospectively rated self-compassion at the start of their tour. Two follow-ups were conducted after 3 weeks and 6 months. Participants completed the Self-Compassion Scale (SCS) along with measures for mood and life satisfaction. Results An increase in self-compassion was observed with d = 0.22 (p = 0.024) in the prospective data, and d = 0.56 (p = 0.018) in the retrospective data, which persisted throughout the follow-ups. In the prospective study, self-compassion was a stronger predictor of mood across time than vice versa. The increase in self-compassion was stronger in participants who walked longer distances (β = .25) and underwent a critical life event (β = .21). Conclusions The results suggest long-distance walking as a promising additional means to strengthen self-compassion that could be integrated into compassion training programs. Future research should replicate the observed change across settings and related constructs, determine its causes, and investigate the interdependence of walking and meditation practices in stimulating self-compassion. Preregistration This study was not preregistered.
... The MWP was based on our previous study in patients with stress symptoms, 27 with an adjustment toward more physically active exercise. Over the course of 8 weeks, the patients allocated to the MWP group participated in eight group sessions, each restricted to 15 participants and lasting 50 to 60 min. ...
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Aim: The objective of this study was to investigate the effectiveness of a mindful walking program (MWP) in patients with chronic low back pain (CLBP). Methods: The trial was a two-armed, randomized, controlled single-center open clinical trial. The study was performed in the Outpatient Clinic for Integrative Medicine of the Charité-Universitätsmedizin Berlin. The participants were adults aged 18-65 years with CLBP (≥3 months) and an average low back pain within the past 7 days measured on a visual analog scale (VAS, 0 = no pain, 100 = worst imaginable pain) of at least 40 mm. The patients received either eight weekly MWP sessions or no intervention (control). The primary outcome was the perceived pain intensity assessed with a VAS (0-100 mm) after 8 weeks. The secondary outcomes included back function assessed by the Hannover Functional Questionnaire Backache (FFbH-R) and perceived stress assessed by the 14-item Cohen's Perceived Stress Scale (PSS-14). The results were obtained by analysis of covariance adjusted for the respective baseline values. Results: In total, 55 patients were randomized (MWP: n = 29, 82.8% female, mean (±standard deviation) age: 52.5 ± 8.6 years, pain: 56.4 ± 14.1 mm; control: n = 26, 84.6% female, 54.8 ± 7.5 years, pain: 55.4 ± 13.1 mm). After 8 weeks, compared with the control conditions, the MWP was not associated with a statistically significant benefit for pain (VAS), adjusted mean - 9.6 [-22.3 to 3.1], p = 0.136, clinical benefits for back function (FFbH-R), adjusted mean 2.2 [-4.2 to 8.6], p = 0.493, or stress (PSS-14), adjusted mean - 1.6 [-4.8 to 1.6], p = 0.326. Conclusion: In conclusion, compared with no intervention, mindful walking did not significantly improve pain, back function, or perceived stress in patients with CLBP. Trial registration: ClinicalTrials.gov (NCT01893073).
... It is viable to integrate mindfulness practice with walking as an intervention strategy (i.e., mindful walking) (Kabat-Zinn, 2017). This "active form" of mindfulness practice has been implemented as part of the standard mindfulness-based programs (i.e., Mindfulness-Based Stress Reduction program) to enhance psychological well-being (Gotink et al., 2016;Teut et al., 2013). However, mindful walking has not been used as a major strategy to study cognitive outcomes. ...
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Mindfulness practice and walking have been linked individually to sustain cognition in older adults. This early-phase study aimed to establish proof-of-concept by evaluating whether an intervention that integrates light-intensity walking with mindfulness practices shows promising signs of improving cognition in older adults. Participants (N= 25, Mage= 72.4±6.45) were community-dwelling older adults who engaged in a supervised mindful walking program over one month (8 sessions total, 2 sessions per week, 30-minute walking containing mindfulness skills). They completed performance-based and subjective ratings of cognitive measures in field before and after two mindful walking bouts using a smartphone app. They also completed in-lab performance-based and self-report cognitive measures at baseline and after the entire program. Controlling for demographics, potential covariates, and time trends, short-term improvements in perceived cognition and processing speed were observed from pre- to post-mindful walking sessions (i.e., 30 minutes) across multiple ambulatory cognitive measures (Cohen’s ds range=0.46-0.66). Longer-term improvements in processing speed and executive function were observed between baseline and end of the program (i.e., one month) across various performance-based cognitive measures (ds range=0.43-1.28). No significant changes were observed for other cognitive domains. This early-phase study (Phase IIa) provides preliminary support that mindful walking activity is promising for sustaining cognition in older adults. Our promising findings form the building blocks of evidence needed to advance this intervention to a fully powered randomized controlled trial that examines program efficacy with a comparator. Favorable outcomes will inform the development of this lifestyle behavioral strategy for promoting healthy brain aging in late adulthood.
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The purpose of this study was to test mindful motorcycling interventions to raise awareness of driving on motorcyclists. Mixed method research is conducted with qualitative research followed by quantitative experiment research. Both of these methods result in increased awareness in motorcyclists.
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