PANDA Trial - Physical activity in Nature for Cardiometabolic Diseases in People Aged 45y+
University of New South Wales
254 participants
Oct 10, 2025
Interventional
Conditions
Summary
The PANDA study aims to explore whether a personalised nature prescription can encourage physically inactive adults aged 45 and older, who have cardiometabolic diseases, to increase their physical activity over 12 months. The study compares two groups: one that receives standard advice on physical activity, and another that gets tailored encouragement to spend time in nature through personalised text messages. We hypothesise that participants who receive the nature prescription will engage in more physical activity compared to those who only receive standard guidance. By examining changes in activity levels and health outcomes, we hope to determine if spending more time in natural environments can lead to improved health and well-being in this population. Additionally, we will evaluate the cost-effectiveness of the intervention and its impact on various psychological and social factors.
Eligibility
Inclusion Criteria25
- Physically inactive (defined as less than 150 minutes of moderate-intensity activity per week, or equivalent)
- Fewer than 2 hours spent in nature per week
- Stable weight for previous 3 months (defined as stable weight +/- 4kgs)
- Presence of a cardiometabolic disease, diagnosed by a doctor or health professional including at least one of the following:
- Doctor diagnosed:
- a) hypertension (Blood pressure: greater than or equal to 130mm/Hg systolic or greater than or equal to 85mm/Hg diastolic)
- b) hypercholesterolemia (Fasting plasma triglycerides:greater than or equal to 1.7mmol/L Fasting plasma HDL-C: less than 1.0mmol/L in males, less than 1.3mmol/L in females)
- c) diabetes mellitus (Fasting blood glucose: greater than 5.5 mmol/L, HbA1C: greater than or equal to 6% and/or oral antidiabetic medications) mellitus
- d) stable coronary artery disease (greater than 3 months since revascularization or myocardial infarction)
- e) stable cerebrovascular disease (greater than 3 months since stroke)
- f) congestive cardiac failure (NYHA class I, II)
- g) moderate valvular heart disease
- h) paroxysmal atrial fibrillation
- Self-measured (or by health professional):
- i) Waist circumference: greater than or equal to 94cm in males, greater than or equal to 80cm in females
- j) Obesity (body mass index greater than or equal to 30 kg/m squared)
- Willing to receive and respond to text messages throughout the study
- Willing to use equipment to measure physical activity, blood pressure and location as per instruction manuals including:
- a) a ‘wrist worn’ device to record physical activity for 10 days.
- b) a wrist worn device to record Blood Pressure for 10 days.
- c) carry a GPS tracker throughout the day for 10 days.
- Speak, read and understand English, as consent and introductory phone call translators are not available.
- Willing to travel to one of the study sites (Blacktown Hospital or Wollongong University) to perform the assessments in accordance with the assessment schedule.
- Currently live in Blacktown or surrounding areas, or Wollongong/Shellharbour or surrounding areas, (NSW, Australia).
- Access to a smartphone (IOS version 15 or newer) or android device (android 8.0 or newer, Bluetooth 4.2 or higher) with an internet connection and feel comfortable using it to download an App.
Exclusion Criteria8
- A health professional-diagnosed debilitating or terminal medical condition (e.g. end stage cancer)
- Current significant alcohol or drug abuse (classify significant alcohol intake as drinking more than 2 standard measures of alcohol each day for more than 5 days a week).
- Severe/untreated mental illnesses (including eating disorders)
- Advanced cardiac, liver or renal disease (eGFR less than 15 mL/min/1.73 m squared)
- Active proliferative diabetic retinopathy
- Unable to give written informed consent
- Unwilling to use the accelerometer (for measuring physical activity), or refuses to follow the protocol
- Upper arm circumference of greater than 64cm (BP device size limit) or a wrist circumference of greater than 22 cm (BP device size limit)
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Interventions
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.
Locations(1)
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ACTRN12624001450505