PANDA Trial - Physical activity in Nature for Cardiometabolic Diseases in People Aged 45y+

In the PANDA study, adults in the Intervention group will receive a personalised nature prescription consisting of four text messages per week for 12 months from DigiCuris, an AI enabled text messaging platform created by the University of Sydney and Western Sydney Local Health District. Digicuris offers interactive and user-friendly digital tools that enhance participant understanding of the study’s procedures, risks, and benefits. The messages are personalised by Digicuris based on the surveys that participants complete to ensure they are relevant and sustainable for the participants lifestyle. Participants will only receive text messages between the hours of 8am and 6pm. These four messages are designed to: (a) encourage participants to spend time in nature, customised to their baseline data on motivations, barriers, etc; (b) suggest local opportunities to spend time in nature based on where they live (e.g., Landcare, Parkrun, gardens, parks); (c) provide education on the health benefits of spending time in nature, based on their health at baseline (e.g., mental health, loneliness). The participants will also receive a single, one-to-one MS Teams call from a trained Researcher/nurse to inform them of national physical activity guidelines and some suggestions on how that goal might be achieved, based on standard advice that may typically be provided by a General Practitioner (GP) and/or an Accredited Exercise Physiologist (AEP). This duration of this call is approximately 30 minutes. Participants be required to attend face to face clinic visits with trained researchers/nurses at either Blacktown hospital or Wollongong University Clinics at Baseline, 6 months, 12 months and 18 months during the study to collect the following data: Fasting Bloods via a finger-prick (HbA1c and Lipids) *Blood Pressure *Weight *Height *Waist Circumference *Change in medications or study related injuries since the last visit *Online demographic and physical activity surveys. They will be given the following equipment and instruction sheets to take home: *AX3, 3-Axis Logging Accelerometer *GPS QStarz BL-1000ST Activity Tracker * Blood Pressure Cuff Aktiia bracelet (non-sleep measurements only). Participants will leave the study visit wearing the equipment and will receive a short follow-up call within 2 days to check they are using the equipment correctly. Each of the participant clinic visits at baseline, 6, 12 and 18 months will take approximately 90 minutes. The participants will also receive monthly a text message and a short phone call and survey at 3 months post baseline visit to check they are okay and ask them if they are following the advice they have been given. They will receive text messages at months 6, 12 and 18 with links to online surveys, to provide reminders for the return of the accelerometers, BP bracelets and GPS equipment, and to provider reminders for when they are to go to have their blood tests on site. At the 12 and18-month study visit participants will be asked to complete a short process evaluation questionnaire and at 18 months 10–20-minute telephone interview with the research nurse consisting of 10 questions. These surveys will include participants self-report around their adherence to the intervention.