The Natural Health Service in Action

Nature4Health was created to demonstrate how structured activities in green spaces can be provided to boost health and wellbeing.

Now, three years later, the programme has successfully demonstrated a significant increase in levels of physical activity and positive mental wellbeing. It has also boosted the profile of and the capacity to deliver nature-based wellbeing activities.

Nature4Health was a three year, £420,000 project funded by The Big Lottery’s Reaching Communities Programme to tackle health inequalities in targeted communities across The Mersey Forest.

Nature4Health provided five different evidence-based activities, from group walking to mindfulness, all taking place in a green, therapeutic environment. The activities were provided in twelve week blocks, with tailored sessions targeted at adults, children and young people. All activities were designed to be welcoming to complete beginners.

The Mersey Forest managed Nature4Health as part of its Natural Health Service programme, working with a range of partners to run the activities. 

Nature4Health also included academic partners with the University of Liverpool and Liverpool John Moores University working in close collaboration with The Mersey Forest in order to evaluate the initiative. 

THE five nature4health activity products

Health walks

Walking is the easiest form of outdoor exercise supporting the widest age and ability range.

Horticultural Therapy

Improving mental and physical wellbeing through gardening and growing food.

Mindful Contact with Nature

Applying the principles of mindfulness to the outdoors brings a walk in the woods to a new level of intensity. It’s all about submerging yourself in the sights, sounds and smells of the woods.

Forest School

Forest School allows children to play, explore and learn about the natural environment and do activities like shelter-building, outdoor cooking, growing plants, using tools and bug-hunting. It’s a hands-on approach to promote play in natural environments. We also adapted Forest School for adults, calling it ‘Bushcraft’.

Practical Conservation

Conservation Workout sessions such as Green Gym™ involve getting stuck in to do practical tasks to improve the environment, boosting health at the same time.

Some sessions were targeted at those with particular needs (e.g. young women) or health conditions (e.g. adults with dementia). The ‘Routes to Recovery’ project used horticultural therapy as part of the recovery plan for groups of adults in St Helens with a history of substance misuse…

Play Video

…while ‘Reading with Nature’ worked with adults with dementia, combining gentle exercise with reading in the stunning surroundings of Calderstones Park:

Participants and places

Nature4Health worked with 27 local partners across six local authorities to enable 1,936 participants to take part in activities during the three years of the programme.

A significant number of the participants had a pre-existing health condition (20%) or a disability (19%). 

19% have disability


19% have health condition



Employment status

Projects were targeted in locations of high health deprivation and sought to attract participants from the area. The map shows where participants live and the project locations.

The project sought to make full use of the different types of green spaces within the target areas. There was an objective to use assets that are maturing parts of the Mersey Forest, such as Colliers Moss and Northwich Woodlands, as well as traditional parks and outdoor community spaces. 

Impact on physical activity/fitness

All participants were asked to complete IPAQ* questionnaires which assessed levels of self-reported physical activity. Qualitative data was also gathered. 

The IPAQ* questionnaire was used to calculate the amount and intensity level of physical activity. Participants completed baseline questionnaires and this was followed up with a second after the 12 week course of activities was complete. The IPAQ results show an overall increase in ‘MET-minutes’ per week of 31.1% (from 357 to 468 minutes). The chart below shows the different levels of activity that make up that overall figure. 

physical activity results

Walking activity

+ 0 %

Moderate activity

+ 0 %

Vigorous activity

+ 0 %
Better management of health conditions

Participants with pre-existing physical health conditions have reported improvements indicating that Nature4Health has been useful in enabling better self-management of health conditions.

“We get energised and… it helps my oestoporosis. I look forward to meeting new friends and we are active whilst talking so time flies and you feel good”


“I have asthma and many other problems but since joining the group… my breathing is getting better”


“I’ve come off antibiotics after being on them for 20+ years due to a long term lung condition – the walking helps my breathing.”


Increased fitness levels

Participants have reported increased levels of physical fitness, such as increased endurance, improved flexibility, weight loss and easier breathing.

“I feel a lot healthier – I notice my knees feel a lot better. My breathing has improved- I am not panting or wheezing like I did when I first started.”


“I can notice the difference of the development of my muscles in the upper chest and this is due to using the poles effectively – I would never get this from normal walking”


“I love the walks, I have lost weight and feel better in myself and I feel much fitter.”


Impact on mental wellbeing

All participants were asked to complete WEMWBS* questionnaires which were used to measure changes in mental wellbeing. Qualitative data was also gathered. 

The WEMWBS set of 14 questions gives a wellbeing score of between 14 and 70. Participants completed baseline questionnaires and this was repeated after the 12 week course of activities had finished.

The results show a marked improvement in WEMWBS scores of over six points. Between three and eight points improvement is usually considered to be meaningful.

Mental wellbeing results

WEMWBS average scores

+ 0
points (13%)
Everyday wellbeing

Participants reported a boost to their everyday wellbeing and a greater ability to cope with everyday stress.

“I certainly feel more relaxed and able to cope with everyday stresses since the course. I also find I am far more patient especially when driving.”


“The group is good and i can now take on the world – bring it on.”


“The walk is something I look forward to – I would be depressed if I did not have my walk.”


Greater social interaction

The social aspect of the courses have been especially valued by participants, who report the benefits of meeting and socialising with new people. 

“Without the walks we would not have the social aspect of chatting together which helps us with our overall health and wellbeing as we are walking and talking and getting all the benefits of feeling happy.”


“You meet new people and it is great for mental health and social activity. The comradeship of the group is important to me and we have a good group.”


“Some people enjoy it so much they keep coming back even after their 12 weeks are up! Everyone is friendly and easy to get along with, making a very comfortable atmosphere.”


Impact on existing mental health conditions

People with pre-existing mental health conditions have reported improvements since attending Nature4Health activities. 

“Billy hasn’t needed to access his mental health support team since starting the course… He was usually stressed at the beginning but by the time he’d finished the meditation he went home all relaxed.”

Support worker

“I get anxiety so the gardening helps me have ‘me time’ for a few hours. It has helped with my confidence to mix with others”


“Since I have been on the course I feel much more relaxed and I am starting to appreciate life again. I still have a long journey ahead, but I am beginning to cope a lot more.”


Reduction in isolation

Many participants have reported that the activities have reduced isolation and given them a sense of purpose that had been lacking. 

“What would I do except sit in and do housework… I have a structure which helps me get moving. I am able to have a chat and meet new friends and it is local to me – I look forward to it every week”


“I don’t see anybody from one day to the next unless I go shopping . This is a social group and I enjoy coming.”


“It gets me out the house as I am quite isolated, I look forward to it and we have a nice way of exercising and it is making me feel better”


Impact: additional outcomes

Nature4Health has helped to achieve outcomes for individuals and organisations beyond those relating directly to health and wellbeing. The programme has also of helped to raise the profile of the link between nature, green spaces and health. Additional outcomes include:

Influencing policy

Throughout the programme The Mersey Forest has sought to engage local and national policy makers in conversations about the role of the natural environment in health and wellbeing. This has included meetings, a conference and visits from senior officials to see Nature4Health in action. Nature4Health was featured in the government’s new ‘25 Year Plan for the Environment’ which includes a commitment to help people improve their health and wellbeing by using green spaces including using environmental therapies for mental health conditions.

Skills development

The project worked with participants to help them find ways of continuing activities informally or signposting them towards other initiatives at the end of the 12 weeks. For 75 of the participants progression has meant joining the programme as a volunteer, helping to lead activities and guide a new cohort towards greater wellbeing.

Contributing to evidence base

Nature4Health has sought to build on existing best practice to ensure that the data collected is robust and will help to make the case for the value of providing activities and therapies in green spaces. The partnership with the University of Liverpool and Liverpool John Moores University will also provide new insight and research evidence. Two pieces of work are underway: one examining Forest School and another which is utilising observations from Mindful Contact with Nature.

Increasing community capacity

Nature4Health has helped to grow local community infrastructure and skills to improve health outcomes. For example, trainer Donna B was assisted to develop her offering and reach more people locally. Participants from her Mindful Movement sessions wanted to continue after the end of the 12 weeks and are now paying for the activity themselves. Word spread of the positive impact of the sessions and Donna was then asked by Retain Wellbeing to run Dementia Inclusive sessions at the Grosvenor Park in Chester.

Value for money

A Social Return on Investment study was conducted into an expanded Natural Health Service, working with around 6,000 people a year who are at high risk of developing a future need for expensive health services. This predicted a return on investment where for every £1.00 invested in the service, £6.75 social return will be generated.

Download the PDF

A longer version of this report is available in PDF format

Get in Touch

If you'd like to know more about Nature4Health, or are interested in working with The Mersey Forest on developing our Natural Health Service, please contact our team.


Clare Olver, The Mersey Forest, Ordnance Ave, Birchwood, Warrington WA3 6QX

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Clare Olver 
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