Walking and Nordic walking programmes

1. Introduction

Version followed: four published strands, used together. (1) Walk-and-talk (outdoor) psychotherapy as framed by British Psychological Society guidance on talking therapy outdoors (Cooley and Robertson, 2020), applied in an NHS Talking Therapies pilot (Davies, 2024) and an inpatient feasibility study (James, Kidd, Cooley and Fenton, 2021). (2) Walking used inside behavioural activation, following the BAcPAc self-help materials (Farrand, Taylor, Greaves and Pentecost, Get Active, Feel Good!, 2013). (3) Community health walks run to the Ramblers Walking for Health standards (England). (4) Nordic walking as taught through the International Nordic Walking Association (INWA) and its 10 Step Method. [source: Davies 2024; James et al. 2021; Farrand et al. 2013; Ramblers; INWA]

This is a family of programmes and formats, not a single therapy. The psychotherapist can deliver strands 1 and 2 directly within their existing competence and contract. Strand 3 is delivered by trained volunteer walk leaders, and strand 4 by INWA-certified instructors. For those two, the therapist signposts, prepares and integrates, unless they hold the relevant training themselves. [source: Ramblers; INWA education overview]

Core idea of change. Walk-and-talk sessions move therapy side by side into a natural or public space. Clients in the Davies pilot reported less pressure to talk, less need for constant eye contact and more presence with their surroundings. Davies links these effects to the Kaplans' attention restoration theory. [source: Davies 2024] In behavioural activation, walking is one of the most accessible ways to rebuild structure, mastery and pleasure. It is added gradually once mood begins to lift, and it builds on movement already in the client's life rather than on formal exercise. [source: Farrand et al. 2013] Nordic walking adds poles: INWA describes pushing down and back through the poles to pull the body forwards and up, engaging the upper body. [source: INWA research page] For the evidence summary, see the end of section 2.

2. Framework

Strand 1: walk-and-talk psychotherapy

Phase A: suitability assessment (before any outdoor session). Davies used a telephone assessment of about an hour. It covered presenting issues and goals, expectations and what working outdoors would mean, health conditions affecting the client's ability to move through the space, familiarity with the location (including whether they expected to meet people they know), and positive or negative associations with green spaces. In James et al., suitability rested on risk, formulation and preference; clients whose clinical risk or acute illness made outdoor work unsafe were excluded. [source: Davies 2024; James et al. 2021]
Phase B: contracting. Agree a written or verbal outdoor contract before the first outdoor session, covering the limits of confidentiality in public and the weather policy. The client agrees to say if they feel uncomfortable, and the contract is reviewed as sessions progress. [source: Davies 2024; James et al. 2021]
Phase C: outdoor sessions. Use a regular meeting place and route for predictability (Davies, citing BPS guidance). Choose walking or sitting by risk, formulation and preference. Move indoors when conditions make sessions unsafe or unsuitable. [source: Davies 2024; James et al. 2021]
Phase D: review and re-contract. Review sessions as they progress, re-contract if needed, and keep monitoring outcomes. Davies used PHQ-9 and GAD-7 because the service required them. [source: James et al. 2021; Davies 2024]
Session count and format. The cited sources give no fixed outdoor session count; the outdoor format sits inside whatever course the service already offers (for example an NHS Talking Therapies episode). [uncertain]
Moving between phases. Go outdoors only after the assessment and contract are in place. Return indoors, or to phone or video, when risk rises, weather is unsafe or the client withdraws consent. [source: Davies 2024; James et al. 2021]

Strand 2: walking within behavioural activation (BAcPAc)

The case study follows a sequence: rationale and psychoeducation, then a starting-point activity diary, goals, sorting activities into routine, pleasurable and necessary, and a graded difficulty hierarchy. Activities are then scheduled across the week, with weekly review and mood questionnaires. Physical activity is introduced after mood begins to lift: listing options, anticipating barriers and planning solutions. Weekly activity goals with explicit plans and self-monitoring follow (a pedometer appears in the case study). The sequence ends with a relapse toolkit and a follow-up call about a month later. Support came from a Psychological Wellbeing Practitioner. [source: Farrand et al. 2013] Moving on depends on review: in the case study, a week-four setback after too many activities were added at once led to pacing back. [source: Farrand et al. 2013]

Strand 3: community health walks (Walking for Health)

The Ramblers runs Walking for Health with Sport England funding; local organisations such as councils, charities, leisure providers or NHS bodies lead each scheme. The first scheme was set up by Dr William Bird in 1996. The programme's standards, stated as facts and not as targets for clients: walks are regular, easy, free and led by trained volunteers; each lasts 90 minutes or less, and at least one walk a week is around 30 minutes. Ideally a scheme holds a short walk weekly at the same time and place. All leaders complete Ramblers walk leader training. In 2020 the gov.uk case study reported 361 schemes, about 1,800 walks a week, about 80,000 walkers and about 5,000 volunteer leaders; about 85% of walkers were over 55. [source: Ramblers set-up page; gov.uk case study]

Strand 4: Nordic walking (INWA)

INWA was founded in Finland in 2000 and describes itself as the sport's global governing body. Its flagship course is the Nordic Walking Instructor Course built on the INWA 10 Step Method, supported by the online INWA Academy. The roles are National Trainer (trains instructors and leaders in a country), Nordic Walking Instructor (teaches technique and runs groups) and Activity Guide (leads group walks but does not teach technique). National associations and affiliates are licensed to deliver INWA programmes. INWA's cited pages do not state course length, prerequisites, step names or renewal rules. [source: INWA home; INWA education overview] [uncertain: not verified]

Guideline figures (attributed facts, not client instructions)

The WHO 2020 guidelines state that all adults should undertake 150–300 minutes of moderate-intensity or 75–150 minutes of vigorous-intensity aerobic activity a week, or an equivalent mix. They also say "some physical activity is better than none" and add a recommendation to reduce sedentary behaviour. Separate recommendations cover older adults, people with chronic conditions or disability, and pregnancy and postpartum. [source: Bull et al. 2020, BJSM] Treat these as population public-health figures. Set individual activity levels with the client and, where needed, their medical team. [synthesis]

Evidence status

Aerobic exercise for depression. Morres et al. (2019) pooled 11 RCTs (455 adults recruited through mental health services) and found a moderate-to-large reduction in depression scores (SMD −0.79). Walking was grouped with other aerobic exercise rather than reported separately. About a third of eligible people declined to take part, and the 2013 Cochrane review had found less robust results. [source: NIHR Evidence alert, 2019]
NICE. NICE CG90 (2009) listed a structured group physical activity programme among low-intensity interventions for depression, and a later update was then expected. [source: NIHR Evidence alert] The current guideline, NG222 (2022), lists group exercise among the treatment options in its tables for a new episode of less severe depression (table 1, recommendation 1.5.2) and of more severe depression (table 2). It describes this as a group physical activity programme designed for people with depression and run by a trained practitioner; it notes that it may need adapting for physical health problems or for anxiety or shame, and that it takes a considerable time commitment. Recommendation 1.4.40 says to advise people that regular physical activity of any kind, walking included, could help their sense of wellbeing, and that the benefits can be greater outdoors. [source: NICE NG222]
Walk-and-talk. The evidence is mostly qualitative and feasibility work (Davies 2024; James et al. 2021; the Cooley et al. 2020 meta-synthesis cited by Davies). [source: Davies 2024; James et al. 2021]
Nordic walking. INWA claims benefits for mood, anxiety and depression, heart and metabolic health, joints, Parkinson's disease, COPD, cancer recovery and more. It cites systematic reviews (Tschentscher et al. 2013; Mathieson and Lin 2014; Liu, Xie and Ossowski 2022) and a depression study (Ginoux et al. 2023). These are the developer's claims. Tschentscher et al. (2013) concluded that Nordic walking had beneficial effects on resting heart rate, blood pressure and exercise capacity across various patient groups [source: Tschentscher et al. 2013, PEDro record]; Mathieson and Lin (2014) is a short British Journal of Sports Medicine summary of that review [source: Mathieson and Lin 2014]. Liu, Xie and Ossowski (2022) and Ginoux et al. (2023) are named as INWA cites them. INWA's figures for muscle use and calorie burn are not tied to a specific study on its page. Nordic walking is not a treatment for any physical disease. [source: INWA research page] [uncertain: secondary, unverified]
Walking for Health. Reported outcomes (less inhaler use, weight loss, better blood pressure, less isolation, eased anxiety) are programme-reported, with methods not described. [source: gov.uk case study]

3. Guiding principles

Assess before you go outdoors. Practical meaning: no first session outside without the suitability assessment and a contract. [source: Davies 2024; James et al. 2021]
Consent is informed and revisited. Practical meaning: explain the limits of confidentiality in public, written or verbal; re-contract as sessions develop. [source: Davies 2024; James et al. 2021]
Client controls exposure. Practical meaning: ask how much the client minds being overheard, and agree to pause when others are within earshot. [source: James et al. 2021]
Boundaries hold outside the room. Practical meaning: the informal setting can drift toward friendship; keep the session frame (time, purpose, ending, fees) as indoors. [source: James et al. 2021; BACP 2018 para 33; UKCP 2019 item 8]
Predictability. Practical meaning: same meeting point and route where possible. [source: Davies 2024, citing BPS guidance]
Safety is planned, not improvised. Practical meaning: risk assessment throughout therapy, lone-working check-in and check-out, a weather rule, and an indoor or remote fallback. [source: Davies 2024; James et al. 2021]
Inclusion. Practical meaning: choose accessible, even paths with seating, transport links and toilets. Offer sitting or non-walking outdoor options, and remember that green spaces are less accessible to some groups. [source: Davies 2024]
Some is better than none; build gradually. Practical meaning: start from movement already in the client's day, add one small step at a time, and pace back after setbacks. [source: Bull et al. 2020; Farrand et al. 2013]
Activity follows mood, not willpower. Practical meaning: in BA, introduce physical activity once mood starts to lift and frame it as enjoyable, not as formal exercise. [source: Farrand et al. 2013]
Stay within competence. Practical meaning: deliver walk-and-talk and BA within your training. Refer to Walking for Health leaders and to INWA-certified instructors for Nordic walking technique. [source: UKCP 2019 items 23–24; BACP 2018 para 13; INWA education overview]
No touch as a technique. Practical meaning: the psychotherapist does not physically guide, steady or correct the client. Any physical help (for example after a fall) is offered verbally first, and the client may refuse. Sexual contact is prohibited under every professional code. [source: USABP Code VIII.2, VIII.5; UKCP 2019 item 4; BACP 2018 para 34] [synthesis for the walking context]
Medical decisions stay medical. Practical meaning: never advise starting or stopping medical treatment. Seek medical clearance where the client has a health condition that affects exercise. [synthesis]
Watch the function of exercise. Practical meaning: monitor for compulsive exercise, weight-driven or punitive walking, and body-image distress, especially with eating-disorder histories. [synthesis]
Attribute claims. Practical meaning: present Nordic walking and health-walk benefits as the organisations' claims, with their evidence status. [source: INWA research page]

4. Intervention inventory

4.1 Physical-safety screening and medical clearance (all strands)

Purpose: decide whether walking or Nordic walking is safe for this client now, and under what conditions. Use it before walk-and-talk, before adding walking to a BA plan, and before referring to a group or Nordic walking course.
Steps: (1) Ask about health conditions that affect moving through the space, as in the Davies assessment: mobility, balance or falls, pain, and heart, breathing or metabolic conditions. [source: Davies 2024] (2) Ask about medication side effects that affect walking (dizziness, sedation), allergies such as hay fever, and sun or cold sensitivity. [source: James et al. 2021, which lists pollen, sun and cold as factors; synthesis for the medication item] (3) Ask about pregnancy and the postpartum period, chronic conditions and disability; WHO has separate recommendations for these groups. [source: Bull et al. 2020] (4) If any significant condition is present, or the client is unsure, ask them to discuss the plan with their GP or treating clinician before increasing activity. A standard pre-participation questionnaire may be used (for example PAR-Q+). [synthesis] [uncertain: not verified] (5) Agree warning signs that end a walk at once and lead to seeking medical help: chest pain or pressure, unusual breathlessness, faintness, palpitations, or new pain. [synthesis] (6) Record the screening and any clearance. [synthesis]
Example language (illustrative): "Before we walk, I need a picture of your health. Is there anything that makes walking harder or riskier for you, such as your heart, breathing, joints, balance or a medication? If there is, I'd like you to check the plan with your GP first. We'll still have plenty to work on in the meantime."
Watch for: minimising symptoms in order to get outdoors; distress or shame when disclosing health problems; a pattern of over-exercising (see 4.16). It is working when the client can name their own warning signs and agrees the stop rule.

4.2 Walk-and-talk suitability assessment

Purpose: decide whether outdoor work fits this client and formulation, and whether to walk or sit.
Steps: cover the five Davies areas: presenting issues and goals; expectations and the implications of working outdoors; health conditions affecting movement; familiarity with the location, personal connections and the chance of meeting acquaintances; and associations with green spaces. [source: Davies 2024] Add current risk and acute illness. In inpatient or detained settings, add leave status under mental health law and an MDT risk view. [source: James et al. 2021] Decide walking versus sitting, or indoors, from risk, formulation and preference. [source: James et al. 2021]
Example language (illustrative): "Some people find it easier to talk side by side while walking, and others find it exposing. What comes up for you when you picture having our sessions in the park? Is there anywhere you'd rather avoid, or anyone you might bump into?"
Watch for: outdoor work chosen to avoid the relationship or difficult material; negative associations with nature (for example an assault in a park); paranoid or socially anxious fears about being seen. Outdoor work may still help with planned exposure. [source: James et al. 2021] It is working when the decision is a shared, reasoned choice that is recorded.

4.3 Outdoor contract and informed consent

Purpose: informed consent to a format with different confidentiality, safety and boundary conditions.
Steps: (1) Agree a written or verbal contract before the first outdoor session. Davies based his on BPS informed-consent guidance. [source: Davies 2024; James et al. 2021] (2) Explain the limits of confidentiality in a public space. [source: Davies 2024] (3) Agree a pause rule: talk stops when others are within earshot. Ask how much the client minds being overheard. [source: James et al. 2021] (4) Agree what happens if either of you meets someone you know. For example, the client decides whether to acknowledge them, and the therapist takes the client's lead and does not introduce themselves as their therapist. [synthesis] (5) State the weather rule and the fallback (see 4.6). [source: Davies 2024] (6) Agree that the client will say when they feel uncomfortable, and that either of you can move the session indoors or end the walk. [source: James et al. 2021] (7) Cover fees, timing, cancellation, the meeting point and what happens if one of you is late or cannot be found. [synthesis] (8) Review and re-contract as therapy progresses. [source: James et al. 2021]
Example language (illustrative): "Outdoors I can't promise the privacy of a closed room. If someone comes close, we'll pause. If we meet someone you know, you decide what happens and I'll follow your lead. And you can stop the walk or ask to go back inside at any point; that's always fine."
Watch for: consent given to please the therapist; clients who later feel overheard or exposed. It is working when the client uses the pause and stop rules without prompting.

4.4 Location and route selection

Purpose: a space that protects confidentiality, safety and access.
Steps: look for even, well-paved paths suitable for walking and wheelchairs; benches; toilets; a sheltered spot; transport links or parking. Davies judged larger central parks best because they are busy enough for personal safety and large enough for privacy. [source: Davies 2024] Keep a regular meeting place and route. [source: Davies 2024, citing BPS] Plan road crossings and allow for differing walking speeds. [source: James et al. 2021] Walk the route yourself first and note quiet stretches, benches, shelter and exits. [synthesis]
Example language (illustrative): "I'd suggest we meet at the café entrance and follow the lake loop. It's flat, there are benches all the way round, and there's a quieter stretch on the far side."
Watch for: isolated spots that feel unsafe to either person; slippery, muddy or uneven ground; places tied to the client's history. [source: James et al. 2021; Davies 2024] It is working when the client arrives oriented and settles quickly.

4.5 Lone-working and risk management

Purpose: practitioner and client safety away from the clinic.
Steps: use a check-in and check-out system. Davies' service used a private messaging group that at least one practitioner always monitored, with a post at the start and end of each session. [source: Davies 2024] Map the service against a recognised framework; Davies used the Institute for Outdoor Learning's Statement of Good Practice (Zone 1, where the main purpose is counselling). [source: Davies 2024] Repeat risk assessment throughout therapy, with the MDT where relevant. [source: James et al. 2021] Carry a phone and agree what happens if a client discloses acute risk outdoors, for example sitting down somewhere quieter, a crisis plan, and how to get back indoors or to emergency help. [synthesis] Check that your professional indemnity insurance covers outdoor sessions. [synthesis] [uncertain: not verified]
Example language (illustrative): "I always let a colleague know when we start and finish. That's routine for outdoor sessions and nothing about what we discuss."
Watch for: missed check-outs; sessions that drift off the agreed route; rising risk that the setting makes harder to manage. It is working when every session is logged and the escalation plan has been agreed in advance.

4.6 Weather and environment protocol

Purpose: predictable decisions about conditions.
Steps: (1) Choose a rule and state it in the contract. Davies' pilot went ahead in all weather unless the Met Office issued an alert; the practitioner then contacted the client quickly to offer phone, video or a new time. [source: Davies 2024] James et al. moved sessions indoors for rain, low temperatures or inadequate clothing, and kept sun protection, waterproofs and gloves on the ward. [source: James et al. 2021] (2) Consider pollen, sun exposure and the practitioner's own health in the cold. [source: James et al. 2021] (3) Remind clients to bring suitable footwear, clothing and water. [synthesis]
Example language (illustrative): "If there's a weather warning, I'll message you by 9am and we'll switch to video at the same time."
Watch for: clients pushing on in unsafe conditions to avoid cancelling. It is working when switching format happens without a rupture.

4.7 Conducting the walking session

Purpose: use side-by-side movement and the setting therapeutically while keeping the frame.
Steps: (1) Meet at the agreed point. Briefly check in on how the client is physically and emotionally, and confirm the pause and stop rules. [synthesis] (2) Let the client set the pace. Walk alongside rather than in front, slow or stop for intense material, and use benches. [synthesis; side-by-side stance from Davies 2024] (3) Allow silences. Clients reported less pressure to talk outdoors, and less continuous eye contact helped some. [source: Davies 2024] (4) Adjust the wording of questions when others are nearby. [source: James et al. 2021] (5) Notice the environment as material when it fits your model, for example something the client stops to look at, or the route as a metaphor. Present this as your own technique, not as a protocol from the sources. [synthesis] (6) Keep to time and loop back to the start point for the ending (see 4.9). [synthesis]
Example language (illustrative): "We can keep walking, or sit for a bit. Whatever suits what you're talking about." / "You went quiet by the water. What was happening for you just then?"
Watch for: the walk becoming a chat between friends (a boundary drift); the client tiring or struggling with pace; dissociation, which is harder to notice when you are side by side. [source: James et al. 2021 for the boundary risk; synthesis for the rest] It is working when the client reports less pressure and material deepens, and outcome scores move.

4.8 Documentation and outcome monitoring

Purpose: an accountable record and evidence of benefit.
Steps: record the suitability assessment, the contract, any consent changes, the route, conditions and any incidents, as well as the usual clinical notes. [synthesis] Use your service's outcome measures; Davies used PHQ-9 and GAD-7. [source: Davies 2024] Session feedback measures and reflective notes were used in the James et al. study. [source: James et al. 2021] Do not take notes while walking in public. Write them afterwards, and do not carry identifiable papers. [synthesis]
Example language (illustrative): "I'll make my notes once we're back, as usual. Before we finish, can you give me your quick rating of today's session?"
Watch for: gaps in records of outdoor-specific decisions. It is working when a colleague could reconstruct why each outdoor choice was made.

4.9 Ending the outdoor session

Purpose: contain material before the client leaves a public place alone.
Steps: signal the ending ahead of time; slow down or sit for the last part; summarise; check how the client is getting home; post your check-out. [synthesis; check-out from Davies 2024]
Example language (illustrative): "We've got about ten minutes left, so let's head back toward the gate. What do you want to take with you from today?"
Watch for: strong material surfacing during the walk back. Allow extra settling time on a bench rather than parting mid-flow. [synthesis]

4.10 Behavioural activation rationale including walking

Purpose: a shared model linking inactivity, withdrawal and low mood, with activity as the route back. Use it at the start of BA.
Steps: explain depression and BA as an NHS-recommended approach that rebuilds structure through gradual activity. Introduce the idea that physical activity can help, but need not mean formal exercise and can grow out of movement already in daily life. [source: Farrand et al. 2013] Link to the wider health benefits only where relevant and without weight goals. [source: Farrand et al. 2013; synthesis for the caution]
Example language (illustrative): "When we're low we do less, and doing less tends to keep us low. We'll start small, with things you already do, and build from there. Walking can be part of it, but it doesn't have to be 'exercise'."
Watch for: "exercise isn't for me". In the case study the client felt this, and was reassured that activity could be gradual and enjoyable. [source: Farrand et al. 2013] It is working when the client can state the model in their own words.

4.11 Starting-point activity diary

Purpose: a baseline of what the client does, where and with whom, and how they feel.
Steps: the client records activities and mood across a week (the BAcPAc "starting point" diary). Review it together and note walking that already happens, such as school runs, shopping or a dog walk. [source: Farrand et al. 2013] Use your own or your service's diary format; do not copy the published worksheet. [synthesis]
Example language (illustrative): "Looking at your week, the walk to the bus stop and the evening with the dog stand out. How did you feel on those?"
Watch for: blank or perfectionist diaries. Accept a partial one. It is working when patterns linking activity and mood become visible.

4.12 Sorting, grading and scheduling activities

Purpose: a balanced, achievable weekly plan.
Steps: sort activities into routine, pleasurable and necessary. Rank them from least to most difficult, break big tasks into smaller steps, and spread easier ones across the week at set times. Review weekly with mood questionnaires. [source: Farrand et al. 2013] In the case study, a big task was reduced to walking a child to school on two days instead of every day. [source: Farrand et al. 2013]
Example language (illustrative): "Rather than every day, which days would be realistic to start with?"
Watch for: adding too much at once. The case study shows a week-four setback from exactly this, followed by pacing back. [source: Farrand et al. 2013] It is working when planned activities are mostly completed and mood ratings start to shift.

4.13 Physical activity options and barrier problem-solving

Purpose: choose walking-based activity that fits the client, and plan for obstacles. Introduce it once mood has begun to lift. [source: Farrand et al. 2013]
Steps: list physical activity options, name the likely difficulties, and brainstorm solutions. In the case study, walking was chosen, while jogging and football training were judged too big a step for now. [source: Farrand et al. 2013] Include social options such as a Walking for Health group (4.17) or a Nordic walking course (4.19). [synthesis]
Example language (illustrative): "What kinds of moving have you enjoyed before? What usually gets in the way, and what could we do about that?"
Watch for: choices driven by shame or by others' expectations. It is working when the client picks an option they want, with a concrete plan for the main barrier.

4.14 Weekly walking plans and self-monitoring

Purpose: turn intentions into specific, reviewable plans.
Steps: set weekly physical activity goals with an explicit plan for each (when, where, with whom) and record what happened. [source: Farrand et al. 2013] The case study used a pedometer and the F.I.T.T. principles (frequency, intensity, time, type); when time was short, the client chose a hillier route instead of a longer walk. [source: Farrand et al. 2013] Any step count or amount is the client's own choice, reviewed against their health and mood. This guide sets no targets. Where asked, quote the WHO figures only as public-health guidance (section 2). [synthesis]
Example language (illustrative): "Which walk this week, on what day, and starting from where? Afterwards, jot down how it went and how you felt."
Watch for: fixation on numbers; guilt over missed walks; injury or pain. It is working when walks happen as planned and the client links them to mood or mastery.

4.15 Relapse toolkit and follow-up

Purpose: keep the gains going.
Steps: build a personal plan of early-warning signs of low mood and the activities, walking among them, that help. The case study calls this a low-mood "alarm" and activity toolkit. Arrange a follow-up contact; the case study used a call after about a month. [source: Farrand et al. 2013]
Example language (illustrative): "What will tell you your mood is slipping, and which walks or activities will you go back to first?"
Watch for: all-or-nothing relapse beliefs. It is working when the client can describe the plan and has used it at least once.

4.16 Monitoring the function of walking (compulsive exercise and body image)

Purpose: catch walking used compulsively, punitively or for weight control, and catch body-image distress.
Steps: at screening and review, ask what walking is for and how the client feels when they miss it. Look for rigid rules, walking through pain or injury, compensating for food, and secrecy. If eating-disorder features are present, assess and coordinate with eating-disorder services. Remove numeric targets and pedometer tracking, and refocus on mood, connection and enjoyment. [synthesis]
Example language (illustrative): "How do you feel on a day you don't walk? Does it ever feel like something you have to do, rather than something you choose?"
Watch for: anxiety or guilt on rest days; walking escalating as eating reduces. It is working when walking stays flexible and is chosen for its own sake.

4.17 Signposting to community health walks (Walking for Health / Ramblers)

Purpose: social, low-cost, sustained walking with a trained leader. This suits inactive, older or isolated clients, and those with long-term conditions. [source: gov.uk case study]
Steps: (1) Find the local scheme together; schemes are run locally by councils, charities, leisure providers or NHS bodies. [source: gov.uk case study] (2) Explain the format: free, regular, easy walks led by trained volunteers, each 90 minutes or less, often at the same time and place each week. [source: Ramblers; gov.uk] (3) Rehearse the first visit: arriving, introductions, what to wear, telling the leader about relevant health needs. [synthesis] (4) Review the experience in the next session. [synthesis] Any scheme registration or health form is the scheme's own; ask the local scheme. [uncertain: not verified]
Example language (illustrative): "There's a free group walk from the library on Tuesdays. It's short, flat and led by a trained volunteer. Would you like to look it up together and plan how you'd get there?"
Watch for: social anxiety stopping attendance. Grade the steps: look at the start point, go once with a friend, and so on. [synthesis] It is working when attendance becomes regular and is linked to mood or connection.

4.18 Running or leading a health walk (for therapists or services)

Purpose: offer group walks within a service.
Steps: contact the local group coordinator or the Ramblers. Every leader must complete Ramblers walk leader training, and the group can then be accredited. Keep to the standards: short, easy, accessible routes at a steady pace, 90 minutes or less, ideally weekly at the same time and place. [source: Ramblers set-up page] Keep the therapy and walk-leader roles separate. A therapy group run as a walk needs its own contract and confidentiality agreement (see 4.3). [synthesis]
Example language (illustrative): "This is a social walk, not a therapy group. If something comes up you'd like to talk about, we can arrange a time."
Watch for: clients disclosing clinical material to the group; dual-role confusion. It is working when walkers keep attending and roles stay clear.

4.19 Referral to INWA-certified Nordic walking instruction

Purpose: learn safe, effective pole technique from a qualified instructor. This suits clients who want more structure or an upper-body element, or who like a learnable skill.
Steps: (1) Find an INWA-certified Nordic Walking Instructor through the national association or INWA affiliate; these are licensed to deliver INWA programmes. [source: INWA education overview] (2) Explain that instructors teach technique through the INWA 10 Step Method, and that Activity Guides lead walks but do not teach technique. [source: INWA education overview] (3) Prepare the client to tell the instructor about relevant health conditions, and get medical clearance first where needed (4.1). [synthesis] (4) Review the experience in therapy. [synthesis] The number and length of course sessions vary by provider. [uncertain: not verified]
Example language (illustrative): "Nordic walking uses poles and is usually taught over a short course by a certified instructor. If you're interested, let's find someone local, and you can tell them about your knee before you start."
Watch for: buying poles and self-teaching without instruction; pain in the shoulders, wrists or joints. Refer pain back to the instructor or a clinician. [synthesis] It is working when the client completes instruction and keeps walking.

4.20 Understanding Nordic walking technique (for supporting the client, not teaching it)

Purpose: enough knowledge to discuss the client's experience. Teaching technique is the instructor's role.
Steps (as described qualitatively): INWA says pushing down and back through the poles pulls the body forwards and up. Its convention material describes the 10 Steps as a closed kinetic chain linking lower-body stability with upper-body propulsion, including a subtle lean from the ankle, and says the technique "remains unchanged". [source: INWA research page; INWA convention page] Pole maker LEKI's beginner guidance describes an upright posture with a slight forward lean, relaxed shoulders and an open chest. Opposite arm and leg move together. The pole is planted angled backward, not vertically; the step rolls from heel to toe; and the hand opens fully at the end of the push. Common errors are stiff arms, tense shoulders, overstriding, planting too far forward or upright, and looking down. LEKI suggests a pace at which you can still talk. [source: LEKI] The full content of the INWA 10 Step Method is taught on INWA courses and is not published openly. [uncertain: not verified]
Example language (illustrative): "What did the instructor have you focus on this week? What did it feel like when the rhythm came together?"
Watch for: the therapist drifting into coaching technique; frustration over coordination, which may echo the client's self-critical themes (see 4.21). It is working when technique questions go to the instructor and the experience is explored in therapy.

4.21 Integrating walking experiences into psychotherapy

Purpose: use what happens on walks (mood shifts, mastery, social contact, nature, frustration) as therapeutic material.
Steps: ask for a brief account of each walk: what was done, what was noticed, thoughts, feelings and body sensations. Link it to the formulation, for example avoidance, self-criticism or connection. Reinforce what the client noticed about mood change. Pass any adverse physical effects (falls, pain, cardiac or breathing symptoms) to the client's GP or instructor, and record them. [synthesis]
Example language (illustrative): "You said you nearly turned back, then didn't. What made the difference?"
Watch for: walking reports replacing harder therapeutic work. It is working when walking experiences feed insight and behaviour change.

5. Handling problems

Most of this section is [synthesis]. Items drawn from the sources are tagged.

Meeting someone the client knows. Follow the pre-agreed plan (4.3): the client leads, and the therapist does not identify their role. Afterwards, check how exposed the client felt and whether to change the route or go indoors. [synthesis; pre-assessment of this risk from Davies 2024]
Being overheard, or a sensitive disclosure in public. Use the pause rule, move to a bench away from passers-by, or postpone the material to an indoor or remote session. [source: James et al. 2021 for pausing and adjusting wording; synthesis for the rest]
Boundary drift toward friendship (coffee stops, personal chat, running over time). Name it kindly and return to the contract. Discuss the pattern in supervision. [source: James et al. 2021 for the risk; synthesis for the response]
Overwhelm or acute distress mid-walk. Stop and sit; slow the pace; ground the client in the immediate surroundings; use your usual risk assessment. Do not walk back while the client is flooded. Follow the agreed escalation plan if risk is acute. [synthesis]
Dissociation or panic outdoors. Prefer predictable routes and seated options, keep in steady verbal contact, and agree an exit. If exposure is the planned purpose, grade it, agree it in advance and obtain consent. [source: James et al. 2021 notes outdoor work may suit exposure-related discomfort; synthesis for the steps]
Physical symptoms (chest pain, faintness, unusual breathlessness, fall or injury). End the walk. Do not touch without asking, unless it is an emergency. Seek medical help and record and report the incident. Resume only after medical review. [synthesis]
Bad weather and repeated cancellations. Apply the contract rule and switch to phone or video quickly. If the outdoor format keeps failing, review whether it still fits. [source: Davies 2024; synthesis]
Mobility limits, pain or fatigue. Offer seated outdoor sessions, routes with benches, or non-walking outdoor options. [source: Davies 2024; James et al. 2021]
Non-adherence to walking plans in BA. Review the diary without blame; shrink the step; problem-solve the barrier; check whether too much was added at once. [source: Farrand et al. 2013] Check for anhedonia, low energy from medication or physical illness, and safety concerns about the area. [synthesis]
"Exercise isn't me" (resistance). Reframe walking as everyday movement and choose something the client enjoys, often social or with a pet. [source: Farrand et al. 2013]
Social anxiety stopping group attendance. Grade exposure to the group. Prepare by rehearsing the first visit or meeting the leader first. [synthesis]
Compulsive or weight-driven walking. Drop numeric tracking and assess for an eating disorder (4.16). [synthesis]
Nordic walking frustration, or pain from poles. Send technique and pain questions to the INWA instructor or a clinician. Explore the self-critical meaning of struggling to learn in therapy. [synthesis]
Client wants the therapist to teach Nordic walking. Decline unless you hold INWA instructor certification, and refer instead. [source: INWA education overview for roles; synthesis]
Rupture over the format (for example the client felt exposed, or the therapist cancelled outdoor work). Acknowledge it, explore it, and offer a choice of format. The format serves the therapy and is never a test of commitment. [synthesis]
Inpatient or detained clients. Check leave status and the MDT risk assessment before every outdoor session. Note that escorts reduce privacy. [source: James et al. 2021]
Inequity of access to green spaces. Be aware that people who are not white, people who are not middle class and disabled people often find green spaces harder to access. Discuss this openly, and choose locations with the client. [source: Davies 2024]

Sources

Cited via the above (secondary citations) [uncertain]:

Cooley S, Robertson N (2020). The use of talking therapy outdoors. British Psychological Society, Covid-19 resources hub (authors as named in the BPS news item above).
Richards K, Hardie A, Anderson N (2020). Outdoor mental health interventions and outdoor therapy: a statement of good practice. Institute for Outdoor Learning.
Cooley SJ et al. (2020). "Into the wild": a meta-synthesis of talking therapy in natural outdoor spaces. Clinical Psychology Review.
Newman E, Gabriel L (2023). Investigating clients' experiences of walk and talk counselling. Counselling and Psychotherapy Research.
Kaplan R, Kaplan S (1989). The Experience of Nature. Cambridge University Press.
Nordic walking studies cited by INWA: Liu, Xie and Ossowski (2022); Ginoux et al. (2023).

Web sources (professional codes)

← Previous · X-100Schroth scoliosis exercises Next · X-102 →Running and exercise for depression