The effects of nature walk therapy on post-traumatic growth in breast cancer survivors: A comparative study

Eur J Oncol Nurs. 2025 Oct 1;79:102994. doi: 10.1016/j.ejon.2025.102994. Online ahead of print.

ABSTRACT

PURPOSE: This study evaluated the effectiveness of nature walk therapy in enhancing post-traumatic growth (PTG) among breast cancer survivors.

METHODS: A quasi-experimental design was applied with an eight-week intervention at Safari Park, Karachi. Participants were randomly assigned to a Nature Walk Therapy group (guided walks with mindfulness) or a Standard Physical Activity group. PTG was measured using the Post-Traumatic Growth Inventory (PTGI), while mental health was assessed using the Depression, Anxiety, and Stress Scale (DASS-21).

RESULTS: Both groups improved in PTG, though gains were greater in the Nature Walk Therapy group (14.9 points, 95 % CI [13.7-16.1]) than in the Standard Physical Activity group (6.8 points, 95 % CI [5.9-7.7]; p < 0.001, partial η² = 0.26). Subscale analyses showed larger increases with Nature Walk Therapy in personal strength, appreciation for life, spiritual change, relating to others, and new possibilities (all p < 0.001). DASS-21 scores improved in both groups (all p < 0.001), with Nature Walk Therapy producing greater stress reduction (-1.44 points, 95 % CI [-2.68, -0.20], p = 0.027; η² = 0.04). Anxiety and depression differences were not significant. Time in nature correlated positively with PTG change (R² = 0.569). Regression confirmed therapy type as a significant predictor (β = 8.5, 95 % CI [6.1-10.9], p < 0.001), and mediation analysis showed psychological well-being mediated this effect (β = 0.46, p < 0.001).

CONCLUSION: Nature walk therapy is a promising, non-clinical intervention that fosters post-traumatic growth, emotional recovery, and personal development in breast cancer survivors.

PMID:41092524 | DOI:10.1016/j.ejon.2025.102994