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How journaling can help you in hard times, stressed and isolated try expressing your thoughts and feelings in writing..

On April 1, I had been quarantining in my downtown apartment for two weeks, and it was starting to become clear that this coronavirus thing wasn’t going away anytime soon.

As I often do in tough times, I turned to journaling. I decided I’d keep a record of my quarantine life through the month of April, a way to remember this crazy historical moment and process my feelings.

Now it’s August, and my daily journal continues. I’ve left my building about two dozen times since I started journaling, so its contents aren’t all that exciting—tidbits of everyday life, news about social distancing rules and reopening stages, moments of worry and loneliness and cabin fever and gratitude.

I know I’m not the only one with a pandemic journal. In fact, hundreds of people have written journal entries on the Pandemic Project website , a resource created by psychology researchers that offers writing prompts to help people explore their experiences and emotions around COVID-19.

At a time when the days blend into each other, journaling is helping people separate one from the next and clear out the distressing thoughts invading our heads (and our dreams ). Research also suggests it might be helping our health and immune systems, the very things many of us are worried about.

Although there are some pitfalls to journaling—ways of doing it that might backfire—it’s one of those rare and valuable mental health tools that doesn’t require you to leave your house or even see another human being.

The power of opening up

People had been keeping diaries long before scientists thought to put them under microscopes. But in the past 30 years, hundreds of studies have uncovered the benefits of putting pen to paper with your deepest thoughts and feelings.

According to that research, journaling may help ease our distress when we’re struggling. In a 2006 study , nearly 100 young adults were asked to spend 15 minutes journaling or drawing about a stressful event, or writing about their plans for the day, twice during one week. The people who journaled saw the biggest reduction in symptoms like depression, anxiety, and hostility, particularly if they were very distressed to begin with. This was true even though 80 percent had seldom journaled about their feelings and only 61 percent were comfortable doing so.

Why do we avoid journaling?

For one, it isn’t always pleasant; I know that I sometimes have to force myself to sit down and do it. Cathartic is probably a better word. In fact, some research suggests that we can feel more anxious , sad, or guilty right after we write.

But in the long term, we can expect to cultivate a greater sense of meaning as well as better health. Various studies have found that people who do a bout of journaling have fewer doctor visits in the following half year, and reduced symptoms of chronic disease like asthma and arthritis.

Can your diary keep you healthy?

Other research finds that writing specifically boosts our immune system, good news when the source of so much stress today is an infectious virus.

One older study even found that journaling could make vaccines more effective. In the experiment, some medical students wrote for four days in a row about their thoughts and feelings around some of the most traumatic experiences of their lives, from divorce to grief to abuse, while others simply wrote down their daily events and plans. Then, everyone received the hepatitis B vaccine and two booster shots.

According to blood tests, the group who journaled about upsetting experiences had higher antibodies right before the last dose and two months later. While the other group had a perfectly healthy response to the vaccine, the authors write, journaling could make an important difference for people who are immune-compromised or for vaccines that don’t stimulate the immune system as well. 

“Expression of emotions concerning stressful or traumatic events can produce measurable effects on human immune responses,” write the University of Auckland’s Keith J. Petrie and his colleagues.

Greater Good’s Guide to Well-Being During Coronavirus

Practices, resources, and articles for individuals, parents, and educators facing COVID-19

Journaling could also boost our immune system once we’ve been infected with a virus. In another study , researchers recruited undergraduate students who tested positive for the virus that causes mononucleosis, which persists in the body after infection and has the potential to flare up. Three times weekly for 20 minutes, some wrote about a stressful event—like a breakup or a death—while others wrote about their possessions.

Based on blood samples taken before and after, writing about stress increased people’s antibodies—an indication that the immune system has more control over the latent virus in the body—compared to more mundane writing. It also seemed to help them gain a deeper understanding of their stress and see more positives to it.

Why journaling works

What’s the secret to the humble diary? It turns out journaling works on two different levels, having to do with both our feelings and our thoughts.

First, it’s a way of disclosing emotions rather than stuffing them down, which is known to be harmful for our health. So many of us have secret pain or shame that we haven’t shared with others, swarming around our brains in images and emotions. Through writing, our pain gets translated into black-and-white words that exist outside of ourselves. 

“I’m able to organize thoughts and feelings on paper so they no longer take up room in my head,” says Allison Quatrini, an assistant professor at Eckerd College who has been journaling for years and started a COVID-19 journal in April. “If I get them out on the page and clear the mental decks, it sets up the rest of the day to not only be more productive but be more relaxed.”

On the thinking level, writing forces us to organize our experiences into a sequence, giving us a chance to examine cause and effect and form a coherent story. Through this process, we can also gain some distance from our experiences and begin to understand them in new ways, stumbling upon insights about ourselves and the world. While trauma can upset our beliefs about how life works, processing trauma through writing seems to give us a sense of control.

“Journaling is a tool to put our experiences, thoughts, beliefs, and desires into language, and in doing so it helps us understand and grow and make sense of them,” says Joshua Smyth, a distinguished professor of biobehavioral health and medicine at Penn State University, who coauthored the book Opening Up by Writing It Down with pioneering journaling researcher James Pennebaker.

How to start a journaling practice

While you can journal in many different ways, one of the most well-studied techniques is called Expressive Writing . To do this, you write continuously for 20 minutes about your deepest thoughts and emotions around an issue in your life. You can explore how it has affected you, or how it relates to your childhood or your parents, your relationships or your career.

Expressive Writing is traditionally done four days in a row, but there isn’t anything magical about this formula. Studies suggest you can journal a few days in a row, a couple times a week, or just once a week; you can write for 10 or 15 or 20 minutes; and you can keep journaling about the same topic or switch to different ones each time.

Expressive Writing

A simple, effective way to work through an emotional challenge

For example, the Pandemic Project offers several prompts to inspire your writing. You can write a basic entry about your general thoughts and feelings around COVID-19, or dig into more specific topics like the following:

• Social life: How is your social world changing, how does that make you feel, and how are you handling it?
• Work and money: How do you feel about your financial situation, and how has your job changed?
• Uncertainty: Where is your anxiety and sense of uncertainty coming from, and how can you cope with it?

“Many people often start writing about COVID-19 and then begin writing about other topics that are bothering them more than they thought,” notes the Pandemic Project website, which was created by Pennebaker and his research team. “This is what expressive writing is good for. Use it to try to understand those problems that are getting under your skin.”

In my journal, I’ve found myself exploring the issue of control . My constant instinct is to organize and plan out life, but that’s been impossible in the midst of a massive, unpredictable crisis. Journaling also let me ponder the lessons I want to take away from this experience around flexibility, acceptance, and letting go.

The do’s and don’ts of a diary

A 2002 study does suggest that journalers should beware of rehashing the same difficult feelings over and over in writing.

In the experiment, over 120 college students journaled about a stressful or traumatic event they were experiencing, like troubles at school, conflicts with their partner, or a death in the family. They were instructed to write for at least 10 minutes, twice a week, over the course of a month. Some students wrote about their deepest thoughts and feelings—including how they try to make sense of the stress and what they tell themselves to cope with it—while others wrote about their feelings only.

During the month, the group who wrote about feelings and thoughts experienced more growth from the trauma: better relationships with others and a greater sense of strength, appreciation for life, and new possibilities for the future. They seemed to be more aware of the silver linings of the experience, while the group who focused on emotions expressed more negative emotions over time and even got sick more often that month.

The point here is that the most effective journaling moves from emotions to thoughts over time. We start expressing our feelings, allowing ourselves to name them; after all, jumping to thoughts too quickly could mean we’re over-analyzing or avoiding. But eventually, we do start to make observations, notice patterns, or set goals for the future.

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This has been the case for Allison Quatrini, who usually writes for a half hour in the morning about whatever’s going through her mind—from the losses she’s experiencing during the pandemic to her work or romantic relationship. It allows her to put into words how much her life has been disrupted, normalize the range of emotions she’s been feeling, and brainstorm ways forward.

“It helps me make sense of the way that I’m feeling right now,” she says. “Why do I feel not very motivated, why do I feel bored, why do I feel sad? It’s also useful in admitting to myself what is going on [and] why it’s been very challenging to deal with this.”

In addition to writing, you might also consider adding drawings to your journal. In a 2003 study , people either journaled, made drawings, or journaled and drew about a negative experience from the past that still upset them, like relationship troubles or loss. According to surveys before and after, the group who wrote and drew saw the biggest improvements in their mood after three weekly, 20-minute sessions. Drawing without writing actually made people’s moods worse, though. The researchers speculate it may have dredged up difficult feelings without offering a way to process them.

If writing is challenging, speaking your feelings aloud may work just as well. In that mono study, there was another group of students who recorded themselves talking about their stress. This group ended up showing the strongest immune responses to the dormant virus in their bodies. They also seemed to be doing the best psychologically, gaining insight and a positive perspective on their stress, improving in self-esteem, and engaging in healthier coping strategies. The researchers suspect that talking—even to a voice recorder—may feel similar to sharing our feelings with a loved one.

Freedom of expression

Sharing with a trusted confidant might seem even better than writing down feelings, as it serves a similar purpose and offers us warmth and validation that a piece of paper can’t provide. And that’s probably true, write Pennebaker and Smyth in Opening Up by Writing It Down .

One study , for example, found that people who talked to a therapist for four short daily sessions showed more positive emotion and less negative emotion. They gained understanding and perspective, and they made healthy behavior changes similar to people who journaled.

Therapy also seemed to be less unpleasant than writing. In fact, when Pennebaker originally envisioned journaling as a mental health exercise, he was inspired by the benefits of therapy—but mindful that not everyone has the means or the inclination to talk to a professional about their problems.

Of course, confessing to friends or partners isn’t without its complications. Sometimes our loved ones are overloaded by their own stresses, or they can’t offer the right kind of support—and may even make us feel worse. Other times, our secrets feel too vulnerable to speak out loud.

No matter what, if we’re talking to another human, our brains will be doing a constant calculation about what to say or not say, how they might react, and how we will be perceived, says Smyth. Confiding on paper can be a valuable alternative and a way to express ourselves with absolute freedom. Journaling lets us process secrets before we reveal them to others.

For Quatrini, who researches and teaches about China, the stress of the pandemic has an extra layer: With the disruption to U.S.-China relations and travel, she’s concerned about the future of her research. The immensity of that loss and uncertainty—and how it was affecting her day-to-day feelings and relationships—only became clear to her when she wrote about it.

“My entire life has been turned upside down and I don’t know if it will ever right itself,” she says. “Without the journal, I think I would not have figured that out.”

About the Author

Kira M. Newman

Kira M. Newman is the managing editor of Greater Good . Her work has been published in outlets including the Washington Post , Mindful magazine, Social Media Monthly , and Tech.co, and she is the co-editor of The Gratitude Project . Follow her on Twitter!

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Vingt ans après.

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Le média a fêté son vingtième anniversaire mardi 15 mars 2022. Dernier rescapé de ce modèle économique, il a traversé de fortes turbulences, notamment avec la crise du Covid. Peut-il tenir encore longtemps ?

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The surprising benefits of journaling for 15 minutes a day—and 7 prompts to get you started

If you're like most people, you'll only write down what you absolutely need to, like to-do lists, meeting notes and reminders. But writing in your journal as a way to release and express your thoughts, feelings and emotions can be a life-changing habit.

Daily writing can be a challenge if you're new to it. Much like meditating, it requires patience and commitment. But if you stick to it, it can improve your life in significant ways.

The surprising benefits of journaling

1. It can help you clarify your thoughts and feelings

Keeping a journal allows you to track patterns, trends and improvements over time. When current circumstances appear insurmountable, you can look back on previous dilemmas that you have since resolved and learn from them.

You might also encounter moments where you feel confused and uncertain about your feelings. By writing them down, you're able to tap into your internal world and better make sense of things.

Anne Nelson, an acclaimed journalist and author of the forthcoming book, "Shadow Network: Media, Money and the Secret Hub of the Radical Right," says she's often asked whether she suffers when writing on fraught subjects. Her answer is always no.

"What I feel is a deep satisfaction when I get it right," she said. "It's the feeling when I've explained something in writing that I couldn't explain to myself before I started."

2. It can help your injuries heal faster

It may sound a little crazy, but a 2013 study found that 76% of adults who spend 50 to 20 minutes writing about their thoughts and feelings for three consecutive days two weeks before a medically necessary biopsy were fully healed 11 days after. Meanwhile, 58% of the control group had not fully recovered.

"We think writing about distressing events helped participants make sense of the events and reduce distress, thus helping the body to heal faster," Elizabeth Broadbent, professor of medicine at the University of Auckland in New Zealand and co-author of the study, said in an interview with Scientific American .

3. It can improve your problem-solving skills

When you encounter a difficult problem, removing the situation from your mind and putting it down on paper encourages you to look at things from different angles and brainstorm several solutions in a more organized manner.

A classic 1985 study from the School Science and Mathematics Association, for example, found that students who wrote about their math problems in a journal (e.g., describing the problem and writing about how they came up with the answer) had significantly improved test scores over time.

4. It can help you recover from traumatic experiences

There are no rules as to how or what you must write about. Creative writing, such as fiction or poetry, can also be a form of journaling — and it can help you move past traumatic experiences.

Writing creatively allows you to craft a coherent narrative and shifting perspective, according to Jessica Lourey, a tenured writing professor, sociologist and author of 15 books, including "Rewrite Your Life: Discover Your Truth Through the Healing Power of Fiction."

What I feel is a deep satisfaction when I get it right. It's the feeling when I've explained something in writing that I couldn't explain to myself before I started. Anne Nelson Journalist and author

After the loss of her husband, Lourey said she couldn't survive reliving the pain of the tragedy by writing down her thoughts and emotions. "I needed to convert it, package it and ship it off," she wrote in a column for Psychology Today . Rewriting her life to fit a fictional narrative helped her heal faster because it allowed her to become "a spectator to life's roughest seas."

Journalist and novelist Leila Cobo agrees. Writing fiction has helped her so much that it's now become a daily routine. "It allows me to say anything in any way that I wish. It's the most amazing feeling," she said. "I write either early in the morning or late at night. And once I'm in, I'm in."

How to get started

While some can write for hours at a time, researchers say that journaling for at least 15 minutes a day three to five times a week can significantly improve your physical and mental health.

If you're new to journaling, the easiest way to begin is to find a time and place where you won't be disturbed and just start writing. (Don't worry about spelling or grammar; you're writing for yourself and no one else.)

If you don't know what to write about, here are some ideas:

• Write about something (or someone) extremely important to you.
• Write about three things you're grateful for today — and why.
• Write about what advice you'd give to your younger self.
• Write about a current challenge you're struggling with and possible solutions.
• Write about 10 things you wish people knew about you.
• Write about one thing you did this year that you're proud of.
• Write about 10 things you'd say yes to and 10 things you'd say no to.

Deepak Chopra is the co-author of "The Healing Self," founder of The Chopra Foundation and co-founder of Jiyo and The Chopra Center for Wellbeing .

Kabir Sehgal is a New York Times best-selling author. He is a former vice president at JPMorgan Chase, multi-Grammy Award winner and U.S. Navy veteran. Chopra and Sehgal are the co-creators of Home: Where Everyone Is Welcome , inspired by American immigrants.

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Around 20 minutes of exercise a day may balance out the harms of sitting, study finds

People who have no choice but to sit at a desk for hours on end may have seen, in recent years, a slew of headlines about the scary consequences of sitting for long periods of time — and how even regular exercise couldn’t undo the damage.

Research published Tuesday in the British Journal of Sports Medicine , however, finds that about 22 minutes a day of moderate to vigorous activity may provide an antidote to the ills of prolonged sitting. What’s more, the researchers found that, as a person’s activity level increases, the risk of dying prematurely from any cause goes down. 

The study found that the current recommendation of 150 minutes per week of moderate to vigorous activity “is enough to counteract the detrimental health effect of prolonged sitting,” said the study’s lead author, Edvard Sagelv, a researcher at The Arctic University of Norway. “This is the beautiful part: we are talking about activities that make you breathe a little bit heavier, like brisk walking, or gardening or walking up a hill.”

While 150 minutes may seem like a lot, Sagelv broke it down into manageable terms.

“Think of it: only 20 minutes of this a day is enough, meaning, a small stroll of 10 minutes twice a day — like jumping off the bus one stop before your actual destination to work and then when taking the bus back home, jumping off one stop before,” he said in an email.

The new research appears to upend findings from earlier studies showing that regular exercise didn’t zero out the negative effects associated with extended periods of sitting. One of those studies, published in the Annals of Internal Medicine in 2017, found that working out regularly reduced some of the harms associated with hours of sitting, but didn’t completely eliminate them.

In the study, researchers looked at information from nearly 12,000 people ages 50 and older in four datasets from Norway, Sweden and the United States. In those datasets, the participants wore movement detection devices on their hips for 10 hours a day for at least four days. All of the individuals included in the new study were tracked for at least two years.

More on the benefits of exercise

• Morning workouts may be better for weight loss, study finds
• If you're sitting all day, science shows how to undo the health risks: "activity snacks"
• Short bursts of activity , totaling less than 10 minutes, linked to lower risk of death

In the new analysis, the researchers accounted for factors, including medical conditions, that could’ve affected risk of early death. 

About half of the participants spent 10 ½ hours or more sedentary each day.  

When the researchers linked the participants’ information with death registries in the different countries, they found that over an average of five years, 805 people, or 17%, had died. Of those who died, 357, or 6%, had spent less than 10 ½ hours a day seated, while 448 averaged 10 ½  hours or more sedentary.

Sitting for more than 12 hours a day, the researchers found, was associated with a 38% increased risk of death as compared to eight hours, but only among those who managed to get less than 22 minutes of moderate to vigorous activity a day.

The risk of death went down with increasing amounts of physical activity . An extra 10 minutes a day translated into a 15% lower risk of death among those spending fewer than 10 ½  hours seated and a 35% lower risk among those who spent more than 10 ½  hours sedentary each day.

Lower intensity activity only made a difference among participants who spent 12 or more hours sitting every day.   

Sagelv said he believes the new study is more accurate than previous research because he and his colleagues painstakingly adjusted data from the four datasets so that the individuals in them were more comparable to one another and thus their data could be treated as if they were all participating in a single study.

Prolonged sitting is becoming a bigger and bigger problem, said Benjamin Boudreaux, a research scientist in the division of behavioral cardiology at Columbia University Vagelos College of Physicians and Surgeons, who was not involved with the new research.

More activity can easily be incorporated into the schedules of even the busiest people, Boudreaux said. 

“I always tell people if they are pressed for time, when you go grocery shopping or running errands, park your car far away in the lot. If you have a meeting with co-workers, do a walking meeting.”

Dr. Howard Weintraub, clinical director of the Center for the Prevention of Cardiovascular Disease at NYU Langone Heart, said he worries that people will take the wrong message from the study and “think all they need is 22 minutes of activity, that it will make them bulletproof like Kevlar and after that they can plunk down in a chair.”

Instead, he said, “people should look at this and then speak to their physician or trainer about it.”

“Ask what they think about the strategy of 22 minutes of activity a day being an antidote to sitting ,” said Weintraud, who wasn’t involved with the new research. 

The good news from this study is that even a minimum amount of activity will help decrease the risk of premature death related to prolonged sitting , said Dr. Joseph Herrera, professor and chair of the department of rehabilitation and human performance at the Mount Sinai Health System in New York City.

“It says that 20 to 25 minutes of moderate to vigorous activity for those who are sedentary — walking briskly, pushing a lawn mower, riding a bicycle at a speed of 10 to 12 miles per hour — can make a difference,” said Herrera, who was not involved with the new study. “It doesn’t mean if you’re already active and exercising you can cut down to 20 minutes, the bare minimum.”

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Linda Carroll is a regular health contributor to NBC News. She is coauthor of "The Concussion Crisis: Anatomy of a Silent Epidemic" and "Out of the Clouds: The Unlikely Horseman and the Unwanted Colt Who Conquered the Sport of Kings." 

• Mental Health/Psychology

Spending Just 20 Minutes in a Park Makes You Happier. Here’s What Else Being Outside Can Do for Your Health

S pending time outdoors, especially in green spaces, is one of the fastest ways to improve your health and happiness. It’s been shown to lower stress, blood pressure and heart rate, while encouraging physical activity and buoying mood and mental health . Some research even suggests that green space is associated with a lower risk of developing psychiatric disorders — all findings that doctors are increasingly taking seriously and relaying to their patients.

Now, a new study published in the International Journal of Environmental Health Research adds to the evidence and shows just how little time it takes to get the benefits of being outside. Spending just 20 minutes in a park — even if you don’t exercise while you’re there — is enough to improve well-being, according to the research.

For the study, researchers surveyed 94 adults who visited one of three urban parks near Birmingham over the summer and fall. They were given fitness trackers to measure physical activity but were not told what to do in the park or how long to stay. Each person also answered questions about their life satisfaction and mood — which were used to calculate a subjective well-being score, with a maximum value of 55 — before and after their park visit.

The average park visit lasted 32 minutes, and 30% of people engaged in at least moderate-intensity physical activity while there. Well-being scores rose during the park visit in 60% of people, with an average increase of about 1.5 points (from about 37 to 39).

Physical activity was not necessary to increase well-being, the study authors found, even though plenty of research suggests that exercise is great for mental health , particularly when it’s done outside . For many people in the study, simply being in green space seemed to be enough to spark a change, says study co-author Hon Yuen, director of research in the occupational therapy department at the University of Alabama at Birmingham.

“Some people may go to the park and just enjoy nature. It’s not that they have to be rigorous in terms of exercise,” Yuen says. “You relax and reduce stress, and then you feel more happy.”

The medical community is increasingly viewing green space as a place for their patients to reap physical and mental health benefits. Some physicians, like Dr. Robert Zarr, a pediatrician in Washington, D.C., are even writing prescriptions for it.

These “nature prescriptions” — therapies that are redeemable only outdoors, in the fresh air of a local park — advise patients to spend an hour each week playing tennis, for instance, or to explore all the soccer fields near their home. The scripts are recorded in his patients’ electronic health records.

“There’s a paradigm shift in the way we think about parks: not just as a place to recreate, but literally as a prescription, a place to improve your health,” says Zarr, who writes up to 10 park prescriptions per day. In 2017 he founded Park Rx America to make it easier for health professionals to write park prescriptions for people of all ages, particularly those with obesity, mental-health issues or chronic conditions like hypertension and Type 2 diabetes .

By writing nature prescriptions — alongside pharmaceutical prescriptions, when necessary — physicians are encouraging their patients to get outdoors and take advantage of what many view to be free medicine. The specificity that comes with framing these recommendations as prescriptions, Zarr says, motivates his patients to actually do them. “It’s something to look forward to and to try to feel successful about,” he says.

In 2018, NHS Shetland, a government-run hospital system in Scotland, began allowing doctors at 10 medical practices to write nature prescriptions that promote outdoor activities as a routine part of patient care. And in recent years, organizations with the goal of getting people outside for their health have proliferated in the U.S. The National Park Service’s Healthy Parks Healthy People program promotes parks as a “powerful health prevention strategy” locally and nationally. Walk With a Doc , which sponsors free physician-led community walks, is now in 47 states, and Park Rx , which has studied and tracked park-prescription programs since 2013, says these are now in at least 33 states and Washington, D.C. Even mental-health professionals are going green. A growing number of “ecotherapy” counselors conduct sessions outdoors to combine the benefits of therapy and nature.

Plus, these unusual prescriptions are the prettiest you’ll ever fill — a fact that Betty Sun, program manager at the Institute at the Golden Gate, which runs Park Rx, says encourages people to actually do them. “With social media and Instagram, when you see your friends going out to beautiful places, you want to go too,” Sun says. “It’s about making a positive choice in your life, rather than a punitive choice — like ‘You’re sick, take a pill.’ It just seems so much more supportive.”

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Expert Consult

Journal Club: How to Build One and Why

By Michelle Sharp, MD; Hunter Young, MD, MHS

Published April 6, 2022

Journal clubs are a longstanding tradition in residency training, dating back to William Osler in 1875. The original goal of the journal club in Osler’s day was to share expensive texts and to review literature as a group. Over time, the goals of journal clubs have evolved to include discussion and review of current literature and development of skills for evaluating medical literature. The ultimate goal of a journal club is to improve patient care by incorporating evidence into practice.

Why are journal clubs important?

In 2004, Alper et al . reported that it would take more than 600 hours per month to stay current with the medical literature. That leaves residents with less than 5 hours a day to eat, sleep, and care for patients if they want to stay current, and it’s simply impossible. Journal clubs offer the opportunity for residents to review the literature and stay current. Furthermore, Lee et al . showed that journal clubs improve residents’ critical appraisal of the literature.

How do you get started?

The first step to starting a journal club is to decide on the initial goal. A good initial goal is to lay the foundation for critical thinking skills using literature that is interesting to residents. An introductory lecture series or primer on study design is a valuable way to start the journal club experience. The goal of the primer is not for each resident to become a statistician, but rather to lay the foundation for understanding basic study designs and the strengths and weaknesses of each design.

The next step is to decide on the time, frequency, and duration of the journal club. This depends on the size of your residency program and leadership support. Our journal club at Johns Hopkins is scheduled monthly during the lunch hour instead of a noon conference lecture. It is essential to pick a time when most residents in your program will be available to attend and a frequency that is sustainable.

How do you get residents to come?

Generally, if you feed them, they will come. In a cross-sectional analysis of journal clubs in U.S. internal medicine residencies, Sidorov found that providing food was associated with long-lasting journal clubs. Factors associated with higher resident attendance were fewer house staff, mandatory attendance, formal teaching, and an independent journal club (separate from faculty journal clubs).

The design or format of your journal club is also a key factor for attendance. Not all residents will have time during each rotation to read the assigned article, but you want to encourage these residents to attend nonetheless. One way to engage all residents is to assign one or two residents to lead each journal club, with the goal of assigning every resident at least one journal club during the year. If possible, pick residents who are on lighter rotations, so they have more time outside of clinical duties to dissect the article. To enhance engagement, allow the assigned residents to pick an article on a topic that they find interesting.

Faculty leadership should collaborate with residents on article selection and dissection and preparation of the presentation. Start each journal club with a 10- to 20-minute presentation by the assigned residents to describe the article (as detailed below) to help residents who did not have time to read the article to participate.

What are the nuts and bolts of a journal club?

To prepare a successful journal club presentation, it helps for the structure of the presentation to mirror the structure of the article as follows:

Background: Start by briefly describing the background of the study, prior literature, and the question the paper was intended to address.

Methods: Review the paper’s methods, emphasizing the study design, analysis, and other key points that address the validity and generalizability of the results (e.g., participant selection, treatment of potential confounders, and other issues that are specific to each study design).

Results: Discuss the results, focusing on the paper’s tables and figures.

Discussion: Restate the research question, summarize the key findings, and focus on factors that can affect the validity of the findings. What are potential biases, confounders, and other issues that affect the validity or generalizability of the findings to clinical practice? The study results should also be discussed in the context of prior literature and current clinical practice. Addressing the questions that remain unanswered and potential next steps can also be useful.

Faculty participation: At our institution, the faculty sponsor meets with the assigned residents to address their questions about the paper and guide the development of the presentation, ensuring that the key points are addressed. Faculty sponsors also attend the journal club to answer questions, emphasize key elements of the paper, and facilitate the open discussion after the resident’s presentation.

How do you measure impact?

One way to evaluate your journal club is to assess the evidence-based practice skills of the residents before and after the implementation of the journal club with a tool such as the Berlin questionnaire — a validated 15-question survey that assesses evidence-based practice skills. You can also conduct a resident satisfaction survey to evaluate the residents’ perception of the implementation of the journal club and areas for improvement. Finally, you can develop a rubric for evaluation of the resident presenters in each journal club session, and allow faculty to provide feedback on critical assessment of the literature and presentation skills.

Journal clubs are a great tradition in medical training and continue to be a valued educational resource. Set your goal. Consider starting with a primer on study design. Engage and empower residents to be part of the journal club. Enlist faculty involvement for guidance and mentorship. Measure the impact.

• Methodology
• Open access
• Published: 12 February 2022

Operationalising the 20-minute neighbourhood

• Lukar E. Thornton   ORCID: orcid.org/0000-0001-8759-8671 1 , 2 ,
• Ralf-Dieter Schroers 2 , 3 ,
• Karen E. Lamb 2 , 4 ,
• Mark Daniel 3 , 5 ,
• Kylie Ball 2 ,
• Basile Chaix 6 ,
• Yan Kestens 7 , 8 ,
• Keren Best 2 ,
• Laura Oostenbach 2 &
• Neil T. Coffee 3  

International Journal of Behavioral Nutrition and Physical Activity volume  19 , Article number:  15 ( 2022 ) Cite this article

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Recent rapid growth in urban areas and the desire to create liveable neighbourhoods has brought about a renewed interest in planning for compact cities, with concepts like the 20-minute neighbourhood (20MN) becoming more popular. A 20MN broadly reflects a neighbourhood that allows residents to meet their daily (non-work) needs within a short, non-motorised, trip from home. The 20MN concept underpins the key planning strategy of Australia’s second largest city, Melbourne, however the 20MN definition has not been operationalised. This study aimed to develop and operationalise a practical definition of the 20MN and apply this to two Australian state capital cities: Melbourne (Victoria) and Adelaide (South Australia).

Using the metropolitan boundaries for Melbourne and Adelaide, data were sourced for several layers related to five domains: 1) healthy food; 2) recreational resources; 3) community resources; 4) public open space; and 5) public transport. The number of layers and the access measures required for each domain differed. For example, the recreational resources domain only required a sport and fitness centre (gym) within a 1.5-km network path distance, whereas the public open space domain required a public open space within a 400-m distance along a pedestrian network and 8 ha of public open space area within a 1-km radius. Locations that met the access requirements for each of the five domains were defined as 20MNs.

In Melbourne 5.5% and in Adelaide 7.6% of the population were considered to reside in a 20MN. Within areas classified as residential, the median number of people per square kilometre with a 20MN in Melbourne was 6429 and the median number of dwellings per square kilometre was 3211. In Adelaide’s 20MNs, both population density (3062) and dwelling density (1440) were lower than in Melbourne.

Conclusions

The challenge of operationalising a practical definition of the 20MN has been addressed by this study and applied to two Australian cities. The approach can be adapted to other contexts as a first step to assessing the presence of existing 20MNs and monitoring further implementation of this concept.

Estimates suggest that in 2018, 4.2 billion people (55% of the world population) lived in cities and by 2050, 68% of the world’s population will live in urbanised areas [ 1 ]. Australia is witnessing a rapid population increase in its major cities [ 2 ]. Seventy-five percent of Australia’s population growth over the last 20 years occurred in state capital cities [ 2 , 3 ] and further significant population growth is forecast [ 4 ].

The global transition to urban living has occurred concomitant with increases in obesity and chronic diseases related to inappropriate diet and physical inactivity [ 5 , 6 ]. Understanding how urbanisation and urban design inhibit, or alternately, promote healthful lifestyles, is essential to preventing obesity and chronic disease [ 7 , 8 ]. Creating liveable urban environments that facilitate improved population health presents challenges and opportunities for governments, planners, and policy-makers responsible for employment, transport, housing, the environment, community engagement, urban sprawl, education and health [ 3 , 8 , 9 , 10 , 11 ], all of which are key indicators of liveability [ 12 , 13 ].

Compact city policies seek to ensure residents have access to important everyday amenities and services without travelling far from home and without resorting to motorised transport. In theory, neighbourhoods with a wide range of local amenities, services, and transport infrastructure, should encourage greater local interaction and support more healthful choices.

International adoption of compact city strategies

Many Asian cities are designed in a way that reflects compact cities and consequently this results in local and, especially, vertical living [ 14 , 15 ]. Portland, USA, initially promoted their compact city concept within the framework of a “20-minute neighbourhood” (20MN) [ 16 , 17 ]. A 20MN was defined as “a place with convenient, safe, and pedestrian-oriented access to the places people need to go to and the services people use nearly every day: transit, shopping, healthy food, school, parks, and social activities” (p.4, [ 16 ]) and noted that the 20MN term “is not intended to convey a specific metric ” (p.4 [ 16 ]). Recently, cities such as Paris, France [ 18 ], Edinburgh, UK [ 19 ], Seattle, USA [ 20 ], and the Flanders region of Belgium [ 21 ] have put forward similar concepts. In England, an emphasis is being placed on creating 20MNs with benefits stated to extend to the economy, environment, health, as well as social benefits such as safety and inclusiveness [ 22 ].

What is happening in Melbourne?

Increasingly, Australian city planners are examining opportunities to create compact localised environments [ 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 ]. In Melbourne, Australia’s second largest city, the most recent planning strategy, Plan Melbourne, proposed an agenda to manage urban growth and meet Melbourne’s future environmental, population, housing and employment needs [ 26 ]. A key component underpinning Plan Melbourne was the promotion of 20MNs that allowed people to access amenities and services near their home promoting and enabling healthful local living [ 24 , 26 ].

Table  1 presents an overview of the four key policy documents relating to Melbourne’s 20MN strategy with iterations published in 2014, 2015, 2017 and 2019. This table identifies how key aspects of the Melbourne 20MN have evolved and changed over this timeframe. When the 20MN concept was first introduced in the 2014 Plan Melbourne planning strategy, it ambitiously stated that “20-minute neighbourhoods are places where you have access to local shops, schools, parks, jobs and a range of community services within a 20-minute trip from your front door” [ 27 ] (page numbers for the quoted text throughout are provided in Table 1 ). The most recent version (2019) states “The 20-minute neighbourhood is all about ‘living locally’ – giving people the ability to meet most of their daily needs within a 20-minute walk from home, with access to safe cycling and local transport options” [ 24 ].

Apart from employment opportunities, amenities and services considered as constituting everyday needs have remained relatively stable across the various iterations of Plan Melbourne (Table 1 ). These have included amenities and services related to retail (with specific reference among others to food retail such as small supermarkets and cafés), education, open space, sports facilities, community services, health services, and public transport. Access to safe and well-connected pedestrian and cycling infrastructure has also been a common element.

Less consistent in Plan Melbourne has been the definition of what constitutes 20 minutes from the perspective of travel mode and what distance this equates to. Originally in 2014, this was posed as “within 20 minutes of where they live, travelling by foot, bicycle or public transport” [ 27 ], while the 2015 version refined this to “primarily within a 20-minute walk” with an estimated distance of 1 to 1.5 km [ 25 ]. The updated strategy that followed in 2017 stated “within a 20-minute journey from home by walking, cycling, riding or local public transport” [ 26 ], although it was unclear what “riding” referred to given “cycling” preceded it separately. It is perhaps not surprising that the 2019 update refined this once again to just include walking and this time acknowledged the benefit of access to other modes using the following statement: “ within a 20-minute walk from home with access to safe cycling and local transport options” [ 24 ]. Importantly, it is stated that “this 20-minute journey represents an 800m walk from home to a destination, and back again” [ 24 ]. Two interesting points are of note here. First, instead of features being within 20 minutes, the wording is suggestive that these are now effectively within 10 minutes from home factoring in a return journey. The second point of interest is the emphasis on walking noting that “while cycling and local transport provide people with alternative active travel options to walking, these modes do not extend neighbourhoods, or access to 20-minute neighbourhood features beyond walkable catchments of 800m” [ 24 ].

Problem statement and objective

Without a clear conceptualisation and operationalisation of a 20MN, it is impossible to properly implement a 20MN, much less evaluate the benefits. This study sought to develop and operationalise a practical definition of the 20MN concept. The method proposed can be utilised elsewhere and modified by adding/removing spatial data layers that represent amenities and services and altering the measures of access (e.g., by distance and mode of travel) assuming each decision rule is rationalised. Flexibility in allowing the approach to be tailored ensures it can remain relevant to different populations, contexts, and policy environments.

With the intense policy focus on 20MNs in Melbourne (state capital of Victoria, Australia), we chose this city as the basis for our 20MN measure. To demonstrate how the measure could be tailored and applied to a different setting, the Australian city of Adelaide (state capital of South Australia) was chosen for comparison purposes. Both the Victorian [ 24 , 25 , 26 , 27 ] and South Australian [ 29 ] state governments have neighbourhood design and urban renewal policies yet the two state capitals themselves differ substantially in terms of population, urban sprawl, and transportation infrastructure. The 30 Year Plan for Greater Adelaide [ 29 ], while not explicitly invoking the 20MN, refers to transit-oriented developments that support walkable and connected communities .

Spatial extent

The spatial extent of the metropolitan Melbourne and Adelaide regions is represented by the 2016 Australian Bureau of Statistics Greater Capital City Statistical Areas [ 36 ] (Fig.  1 , Melbourne, and Fig.  2 , Adelaide). The Greater Capital City Statistical Areas represent the functional extent of the Australian State and Territory capital cities, capturing most of the commuting population and the labour markets of each capital city. They are not a marker of the edge of the city, but instead include the population who regularly socialise, shop, or work within the city, and include small towns and rural areas surrounding the urban core of the city.

Areas in Melbourne with access to the healthy food, recreational resources, community resources, public open space, and public transport domains and a population density layer depicted by population density grid [ 37 ]

Areas in Adelaide with access to the healthy food, recreational resources, community resources, public open space, and public transport domains and a population density layer depicted by population density grid [ 37 ]

Defining the attributes of the 20-minute neighbourhood

Drawing on Plan Melbourne’s various definitions of the 20MN [ 24 , 25 , 26 , 27 ], the Portland Plan [ 16 , 17 ], literature related to urban liveability indices (e.g. [ 8 , 11 , 12 ]), and our collective knowledge of this field, we proposed five spatial data domains required for a 20MN: 1) healthy food; 2) recreational resources; 3) community resources; 4) public open space; and 5) public transport. Further details of the attributes used and the inclusion rationale for each are outlined in Table  2 and in the text below.

Defining the pedestrian network layer

A pedestrian network layer was created for each city which allowed for the calculation of pedestrian network distances. A pedestrian network distance differs from a road network distance by including paths that vehicles cannot use (e.g. pedestrian alleyways that link two streets) and excluding network paths accessible to cars but not pedestrians (e.g. freeways) [ 43 ]. Vehicle based one-way restrictions on streets were also removed to allow pedestrian movement in either direction, whilst tunnels and overpasses were included in the network model so as to distinguish them from crossroad intersections. For Melbourne, VicMap Transport data were used to create this layer and, in Adelaide, Statewide Road Network data.

Data sources

Data were sourced from a combination of government and commercial sources either publicly available or accessible upon request. Some datasets were available at a national level, meaning the same data sources could be used for both Melbourne and Adelaide (e.g., general practitioners (GPs) and pharmacies), whilst others were state or city specific (e.g., public open space). For full data source details see Additional File  1 .

A further comment on our featuring of both a primary city (Melbourne) and a comparison city (Adelaide) is that a great deal of spatial data representing natural and built environments in Australia is based at a state or even at more local levels rather than being available nationally in a consistent format. Thus, the use of a comparison city provides an opportunity to test the applicability of our 20MN concept in a different context where the data sources vary, further demonstrating the generalisability of the approach.

Defining accessibility for each layer

All layers were processed using ArcGIS v10.5 [ 44 ] and access to each was defined as per Table 2 . For most measures, a pedestrian network service area at a specified distance was created using the feature as the starting point noting that there were no one-way restrictions within our network layer. Address points within this service area were therefore considered to have access to this feature. For most features, a 1.5-km distance was used and is consistent with common definitions used in walkability studies which equate a 5-minute walk to 400 m [ 45 ]. For public transport, accessibility measures were informed by the literature and altered based on published estimates of usual distances that people walk to different transport modes [ 39 , 40 , 41 ].

The access measure used for open space considered both access to public open space within a 400-m network distance and at least 8 ha of public open space area within a 1-km radius. These access metrics were consistent with the Melbourne planning guideline recommendations for open space (see Table 2 ). The comprehensive Victorian Planning Authority Metropolitan Open Space Network walkable catchment layer [ 38 ] was used to determine if households were located within 400 m of open space in Melbourne with open space access points within this dataset specified by the provider at 30-m intervals. For Adelaide, data were sourced from a previous study [ 46 ] and 400-m pedestrian network service areas were created along park border points (50-m spacing). In both cities, the selected open space features outlined in Table 2 were rasterised to a 10-m × 10-m grid (cell defined as open space: 0 = no; 1 = yes). A count of open space cells within a 1-km radius (circular radius using focal statistics) around each individual cell was undertaken. A minimum count of 800 cells classified as open space was required to represent access to at least 8-ha open-space area within a 1-km radius. The method resulted in a continuous surface (10-m grid) representation of open space access across both Melbourne and Adelaide. This approach avoids some of the complex issues associated with measuring open space access [ 47 ].

Combining layers to create domains

As detailed in Table 2 , for each of the five 20MN domains (healthy food, recreational resources, community resources, public open space, public transport), several criteria had to be met for households to be defined as having access to this domain, with the exception of the recreational resources domain, which required access to a gym only. The healthy food domain required access to either a large supermarket or both a smaller supermarket and a greengrocer (greengrocers defined as fruit and vegetable stores). The community resources domain required access to each of the six layers (i.e., primary school, general practitioner, pharmacy, library, post office, and café). The public open space domain required access to public open space within 400 m and at least 8 ha of open space within 1 km. Finally, the public transport domain in Melbourne required access to any public transport mode for households located within a 5-km radius of the city centre (defined by the location of the General Post Office) or access to a train station and either a bus or tram for those beyond 5 km (see Table 2 for rationale). In Adelaide, the public transport domain required access to any of the three specified modes of transport.

Using the community resources domain as an example, determining if access to the domain criteria had been met involved overlaying the services areas of the six individual layers and extracting the intersection of the six layers. The spatial distribution of areas considered to meet the access criteria for each domain is presented in Fig. 1 for Melbourne and Fig. 2 for Adelaide.

Creating the final 20MN layer

Once the five domains were generated, they were overlayed, and the count of intersecting areas calculated (Fig.  3 ). Areas where all five domains intersected were considered as consistent with the 20MN concept as they met the access criteria for each domain (healthy food, recreational resources, community resources, public open space, and public transport). This approach allows features to be dispersed in different directions around address points rather than clustered in a single activity centre.

Intersecting areas of domain access

Areas with access to each of the five domains and therefore a 20MN are represented in Fig.  4 for Melbourne and Fig.  5 for Adelaide. As expected, more areas considered to be 20MNs were clustered nearer to the city centres whilst in Melbourne there was also a noticeable pattern of areas with 20MNs appearing around the train stations in the mid and outer suburbs. Figures  4 and 5 also show the intensity of domain access across the two cities.

Count of domain access within Greater Melbourne (left) and the inner-mid Melbourne region (right)

Count of domain access within Greater Adelaide (left) and the inner-mid Adelaide region (right)

Population and dwelling density by level of domain access

Population and dwelling counts were determined using data from the Australian Bureau of Statistics (ABS) 2016 census mesh block (the smallest geographical area defined by the ABS [ 48 ]). Mesh block centroids were used to determine how many domains that mesh block had access to. The ABS assign the dominant land use to each mesh block (e.g., residential, commercial, primary production, parkland). Over 95% of the population in both cities reside within mesh blocks categorised as residential. The total population with access to each domain was extracted (Table  3 ) in addition to the population density and dwelling densities of residential mesh blocks by the count of domains the mesh block had access to (Table  4 ).

When examining domains individually, over 50% of the population in each city met the access criteria for the healthy food domain whilst over 70% had access to open space (Table 3 ). In Melbourne, 45% met the access criteria for the recreational resources domain compared to 56% in Adelaide. The percentage meeting the access criteria for the community resources layer was much lower in both cities (20% Melbourne; 18% Adelaide) as this domain required access to six separate layers. The main difference between cities was in the percentage of the population meeting the access criteria for the public transport domain. This was to be expected given the different access criteria applied in the two cities (i.e., those further than 5 km from the General Post Office in Melbourne required access to a train station) with just 13% of the Melbourne population meeting the requirements of this domain compared to 64% in Adelaide.

Most of the Melbourne population (66%) had access to two or fewer domains compared to 45% in Adelaide which again likely reflects the differences in the public transport access criteria. In Melbourne, 5.5% of the population met the access criteria for each of the five domains and therefore were considered to have a 20MN. In Adelaide, this percentage was slightly higher at 7.6%.

Noticeably, there was a trend in the population density and dwelling density results with the lowest median density in areas without access to any of the domains and the highest median density in areas with access to all five domains (Table 4 ). The median number of people per square kilometre with access to all five domains (a 20MN) was 6429 in Melbourne and 3062 in Adelaide. The median number of dwellings per square kilometre with access to all five domains was also higher in Melbourne (3211) compared to Adelaide (1440).

The 20MN continues to be promoted as having many projected benefits [ 22 , 24 , 25 , 26 , 27 , 49 , 50 ]. However, without defining and operationalising the 20MN, it remains difficult to implement a 20MN, monitor the progress of 20MN initiatives, and quantify the benefits. There are various ways that a 20MN could be expressed differently to what is proposed here including, for example, the addition of further attributes deemed important for everyday living, altering the modes of travel and the corresponding distance of a 20-minute trip, and allowing for more refined gradations of access to attributes. We have presented the first steps to flexibly operationalise the 20MN concept without resorting to the typical approach of using predefined administrative units. This ensures access can be determined from individual address points. This is an advance over existing liveability indicators that utilise predefined administrative units that measure access to various attributes according to their presence, number, and distance from some referent (e.g. within the boundaries of the unit or the distance from the geographic centroid) [ 51 , 52 ]. We view pre-defined administrative units that specify arbitrary boundaries (e.g., statistical area 1, census tract) as having little, if any, inherently meaningful correspondence to a resident’s lived environment [ 53 ].

In support of our methodology, we examined variations in how the 20MN concept has been presented across various iterations of Melbourne’s planning strategies [ 24 , 25 , 26 , 27 ] (Table 1 ) but also internationally [ 16 , 17 , 19 , 22 ]. We concede the attributes and access definition can, and should, be debated and that no single prescriptive definition may suit all contexts. Yet, the simplistic definition conveyed in policy documents falls short of specifying which amenities and services should be located within 20-minutes. This lack of specificity prevents a clear capacity to evaluate targeted interventions to increase 20MNs in urban areas.

The attributes that we selected represent a broad range of everyday services and amenities that may be considered to promote environmental, social, economic and health benefits across various demographic groups. In defining these attributes, we note three issues. First, access to an attribute is defined by the presence of a single attribute within the specified distance rather than the concentration of that attribute, with the partial exception of open space where a minimum concentration of 8 ha was required. Second, the selection of attributes did not consider those that might be harmful for environmental, social, or health reasons (e.g., fast food chains, presence of major thoroughfares leading to greater traffic, congestion, and pollution) and thus we did not exclude areas where harmful features were co-located with the selected layers. Third, in the case of recreational resources, our measure was limited to gyms including municipal-run facilities that are sometimes termed leisure centres and are available to non-members. In the Australian context, gyms operate all year round and it is not unusual for gyms (especially municipal-run gyms) to include facilities such as swimming pools and classes for activities such as yoga, in addition to weights and cardio equipment. Gyms also cater to people of all levels of fitness and abilities. We avoided sport specific facilities such as tennis courts due to the more limited general appeal. Whilst the availability of gyms provides the opportunity for people to use them, we acknowledge we did not differentiate between municipal-run and commercially-operated gyms, with the latter restricted to members and thus only accessible to those that can afford the membership fees. A key benefit of our overall approach is that each of the domains can be modified through the addition or removal of attributes. They can also be tailored, such that there may be multiple ways to meet the domain criteria. For example, for the healthy food domain, access could be obtained from having access to either a large supermarket or a smaller supermarket and greengrocer whilst in Melbourne, we altered the public transport criteria for those further from the city.

Our measures of access for most layers (i.e., a 20-minute walk equating to ~ 1.5-km) was consistent with the 2015 Plan Melbourne Refresh [ 25 ], with the exception of public transport and public open space where the access measures were guided by the literature [ 39 , 40 , 41 ] and land use planning guidelines, as detailed in Table 2 . The recent suggestion that the 20MN relates to an 800-m walking distance [ 24 ] appears unfeasible given the current population density levels of Australian cities and the fact only a small percentage of the population were found to meet the 20MN criteria when our longer distance criterion was applied. The 1.5-km distance used represents the absolute maximum distance to which a number of attributes are considered accessible yet many of these may be closer. Additionally, our measure is based on a walking distance however the distance equating to a 20-minute trip would clearly vary based on the mode of travel and travel route used [ 54 , 55 , 56 , 57 ] in addition to other factors such as the slope of the land and the presence and quality of sidewalks. As the Portland Plan background report notes, the 20MN term is not intended to convey a specific metric but to reflect neighbourhoods where people can walk a relatively short distance from home to their daily destinations and services [ 16 ]. Thus, we believe the distance used combined with the five data domains adequately captured areas within a walkable distance to a range of services and amenities that meet daily needs.

Our final 20MN measure was based on all domain conditions being met. Future approaches may classify attributes by their level of relative importance (e.g., compulsory, very important, desirable but not essential) and modify the measure that way. This would also allow for a broader set of attributes to be included that may include, for example, secondary schools, banks, and playgrounds. In Figs.  4 and 5 , areas that meet the access criteria for fewer domains are identifiable and this type of information could be used as part of the monitoring and implementation process with regards to transitioning these areas to a 20MN. Perhaps more importantly, the combination of population density and the domain intensity maps allows for the identification of areas with relatively high populations and relatively low amenity and service provision as these are clearly more important priority areas from a neighbourhood renewal perspective.

The flexible approach can (and should) also be tailored to different contexts nationally and internationally. Context-specific measures are more important than standardised measures for understanding local influences where contexts may differ in many ways. Different locations and settings vary in terms of physical and social structures and consequently essential attributes relevant to local needs may be unaccounted for by applying a single consistent measure [ 12 ]. Indeed, Portland, USA [ 16 ] had previously defined a 20MN according to the concentration of grocery stores, other retailers (e.g., convenience stores, coffee shops, health and personal services), park access points, public elementary (primary) schools, and frequent public transport in addition to street connectivity, sidewalks and slope. In some cases, it may be desirable to add additional attributes (e.g., additional health and community services or childcare facilities), perhaps substituting at the expense of others that might be replaced, to ensure the area meets the everyday needs of the population of interest. Our Australian measure included access to health services such as general practitioners and pharmacies which, as Whitzman suggests [ 58 ], is important given Australia’s ageing population. In addition to the different contexts, there may be a desire to alter the attributes and distances and/or travel modes based on the population of interest (e.g., apply a shorter access distance in areas with a higher number of elderly people, or families with young children). An additional consideration related to travel, especially for the elderly and young children, could also include a safe walking environment indicator that consists of traffic calming features and safe crossing points, and perhaps even the slope of the land to avoid large hills.

Whilst Australia has a largely urban population, the population density in urban areas is often much lower than in other developed nations [ 59 ]. Increasing population density is seen as an important means of facilitating better access to amenities and services [ 7 , 49 , 60 ]. However, a recent report [ 61 ] forecasts significant challenges to the infrastructure of Australian cities (e.g., housing, traffic) and their ability to support rapid population growth whilst Neuman (2005) further discusses the potential negative implications of poorly managed density in his paper on the compact city fallacy [ 62 ]. In Adelaide, we found that 20MNs were achieved in neighbourhoods with lower population densities than in Melbourne. A likely explanation for this is that in Melbourne several high-rise apartment buildings have been approved in areas with high-service provision [ 34 , 35 , 63 , 64 ]. This potentially means the higher population density of 20MNs in Melbourne has been achieved through locating more people near services rather than locating services near people. Further explanation is warranted on the role of high population densities in achieving the projected benefits of the 20MN or whether such benefits also hold true in less population dense areas such as those observed in Adelaide.

Whilst potential benefits exist through the development of local 20MNs, it is important to acknowledge and highlight the challenges of this concept [ 54 , 58 , 65 , 66 ]. Although we were able to demonstrate the applicability of our approach across two cities, direct comparisons should be undertaken with care. This is, firstly, because we used a different public transport measure for areas further than five kilometres from the centre of the city in Melbourne. In this instance, we believe the criterion requiring train access outside of the inner Melbourne area is appropriate given the larger geographic size of this city and that commuters in Melbourne have a longer average commute distance [ 42 ]. An additional point of caution relates to the use of different data sources which was necessary in the absence of consistent national level data.

The need for an operationalised measure of the 20MN is clear from both an implementation and evaluation perspective. This challenge was addressed in this study, conceding there is clearly more than one way to define a 20MN. Our approach provides the flexibility to contextually tailor key attributes and access measures. It is hoped that modified versions of this measure can be applied to other cities nationally and internationally to determine the presence of and need for 20MNs. By applying our operationalised measure to two Australian cities, our analysis indicates that only a small percentage of the population live in what we would consider to be a 20MN. This measure can now be used to assess the projected benefits of the 20MN including whether they promote healthy and local living.

Availability of data and materials

The datasets used for the during the current study are available from the corresponding author on reasonable request.

Abbreviations

20 minute neighbourhood

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Acknowledgements

We would like to acknowledge the various contacts that assisted us with sourcing the relevant datasets for this study including the team at the Australian Urban Research Infrastructure Network (AURIN).

This work was supported by an Australian Research Council Discovery Project Grant [DP 170100751]. The funding agency had no role in conceptualising, designing or conducting this study.

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LT led the conceptualisation of this study and led the writing of the article. NTC, RDS, KEL, MD, KBa, BC, YK, and KBe provided input into the attribute selection and access definitions. LO assisted with the write up of the manuscript including the review of policy documents. RDS led the GIS work with assistance from NTC and LT. All authors contributed to the article draft and approved the final version for submission.

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Thornton, L.E., Schroers, RD., Lamb, K.E. et al. Operationalising the 20-minute neighbourhood. Int J Behav Nutr Phys Act 19 , 15 (2022). https://doi.org/10.1186/s12966-021-01243-3

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Published : 12 February 2022

DOI : https://doi.org/10.1186/s12966-021-01243-3

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20 minutes of vigorous exercise daily works wonders for teens

Exercising vigorously for 20 minutes a day may be the best way for teens to develop and maintain cardiorespiratory fitness , suggests a study published in the journal Pediatrics.

Cardiorespiratory fitness refers to how well the heart and lungs supply oxygen to the body’s muscles and organs during physical exertion. Good cardiorespiratory fitness has been shown to lower risks for obesity, diabetes, hypertension, cardiovascular disease, poor mental health and more.

Aerobic exercise may help teen athletes recover faster, better from concussions

Study participants included 339 teens, ages 13 and 14, who took part for two years in school-based exercise programs that focused on running, with wrist-worn trackers calculating the intensity of their workouts.

The researchers found that the teens maximized their cardiorespiratory fitness at 20 minutes of vigorous running. Exercising longer did not improve their fitness. Current guidelines call for youths to do at least 60 minutes a day of moderate to vigorous physical activity to maximize their fitness, but health and fitness experts have said many teens find the daily time commitment difficult to maintain.

What happened to P.E.? It’s losing ground in our push for academic improvement.

Just one-fourth of youths are physically active for an hour a day, according to the Centers for Disease Control and Prevention. The researchers say their findings show that, when exercising vigorously rather than moderately (running, for instance, instead of brisk walking), longer stints of physical activity are not needed to improve cardiorespiratory fitness. They note, however, that only cardiorespiratory fitness was assessed, and that other aspects of teens’ health may benefit from physical activity at a lower intensity.

This article is part of The Post’s “Big Number” series, which takes a brief look at the statistical aspect of health issues. Additional information and relevant research are available through the hyperlinks.

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The Five Minutes That Brought Down the Francis Scott Key Bridge

When a massive cargo ship lost power in Baltimore, crews scrambled to control the ship and to evacuate the bridge lying ahead. But it was too late.

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By Annie Correal ,  Nicholas Bogel-Burroughs ,  Campbell Robertson ,  Michael Forsythe and Mike Baker

Nicholas Bogel-Burroughs and Campbell Robertson reported from Baltimore, Annie Correal and Michael Forsythe from New York, and Mike Baker from Seattle.

Follow our live coverage of the Francis Scott Key Bridge collapse in Baltimore .

“Hold all traffic on the Key Bridge.”

The terse command from an officer in Baltimore’s busy commercial shipping port was one of the first warnings of a disaster that experts now predict will transform shipping on the Eastern Seaboard and change how ships and bridges function around the world. But after the cargo ship Dali lost power early Tuesday, there were precious few minutes to act.

In those minutes, many people — from the ship’s crew, who sent out a mayday signal, to the transportation authority police officers, who stopped traffic heading onto the Francis Scott Key Bridge — did what they could to avert catastrophe, most likely saving many lives.

And yet — no matter what anyone did — several factors made catastrophe all but inevitable. When a ship of this size loses engine power, there is little to be done to correct its course, even dropping an anchor down. And the Key Bridge was particularly vulnerable. As long ago as 1980, engineers had warned that the bridge, because of its design, would never be able to survive a direct hit from a container ship.

The collision and subsequent collapse of the bridge swallowed up seven road workers and an inspector who could not be alerted and pulled off the bridge in time; two were pulled alive out of the water, but four others are still missing and presumed dead. Two bodies were retrieved on Wednesday, authorities said.

Also caught up in the disaster were the ship’s 21 crew members, all from India, who had prepared for a long journey to Sri Lanka on the Dali. While none of them were hurt, they would be held on board for more than a day as the ship sat in the harbor, the ruins of the bridge tangled around it, as authorities began their investigation.

The accident, the deadliest bridge collapse in the United States in more than a decade, will have a lasting impact on the Port of Baltimore, with its 8,000 workers, and industries that rely on the port, which is the leading American hub for auto and other wheeled equipment, said Pete Buttigieg, the U.S. transportation secretary, on Wednesday.

“It’s difficult to overstate the impact of this collision,” Mr. Buttigieg said.

He compared the Dali, roughly as long a city block, to the size of an American aircraft carrier.

“A hundred thousand tons, all going into this pier all at once,” he said of the impact on the bridge support structure.

Officials from the National Transportation Safety Board, which is leading the investigation into the accident, boarded the Dali on Tuesday night to gather documentation. They obtained data from the voyage data recorder, the equivalent of an aircraft’s black box, hoping that it could help investigators determine what led to the accident.

Mr. Buttigieg said that any private party found liable in the accident “will be held responsible.”

The ship left the Port

of Baltimore around

1 a.m. on Tuesday.

Ship called for

tugboats to return

Francis Scott

Alarms sounded on ship

Traffic onto bridge was halted

The ship hit

at 1:28 a.m.

Alarms sounded

Traffic onto bridge

Sources: MarineTraffic, Google Earth

By Agnes Chang, Weiyi Cai, and Leanne Abraham

It was about half an hour past midnight on Tuesday when the Dali, loaded with cargo containers, departed its dock, guided by two tugboats, as is customary. On board was a local harbor pilot with more than 10 years of experience and deep familiarity with Baltimore’s port, as well as an apprentice pilot in training.

The sky above the Patapsco River was clear and still, lit by a full moon.

At 1:25 a.m., after the two tugboats detached and turned back, the Dali had accelerated to about 10 miles per hour as it approached the Key Bridge. But just then, according to a timeline released by the National Transportation Safety Board on Wednesday, “numerous audible alarms” started sounding on the ship.

For reasons still being investigated, the ship’s powerful propulsion system stopped. The lights flickered out.

The ship had a “complete blackout,” according to Clay Diamond, head of the American Pilots’ Association, who was briefed on the account of the pilot of the Dali. (The chair of the N.T.S.B., Jennifer Homendy, said officials were still trying to determine whether the power failure was complete.)

The harbor pilot noticed the ship starting to swing right, in the direction of one of the piers holding up the Key Bridge. At 1:26, he called for the tugs to return; he urged the captain to try to get the engine back up and directed the crew to steer hard left. As a last ditch measure, at 1:27, he ordered the crew to throw down the port anchor.

One of the tugboats, the Eric McAllister, turned around and raced back toward the ship.

But the failures onboard were cascading. The emergency generator had kicked on, sending a puff of thick smoke belching from the ship’s exhaust stack and briefly restoring the lights, radar and steering. It did not help. With no effective propulsion, the 95,000-ton ship had become an unstoppable object, drifting toward one of the most heavily traveled bridges in Baltimore.

On land, officers with the Maryland Transportation Authority moved swiftly into action. “I need one of you guys on the South side, one of you guys on the North side, hold all traffic on the Key Bridge,” someone is heard saying on the audio recording of emergency radio traffic that night. “There’s a ship approaching that just lost their steering. So until they get that under control, we’ve got to stop all traffic.”

Vehicles were held on either side of the bridge as the ship continued its inexorable drift toward the 1.6-mile-long span.

A minute later, the officers turned their attention to several workers, some of them immigrants from Guatemala, Honduras, El Salvador and Mexico, who were still laboring on the bridge in the chilly darkness, taking advantage of the light traffic at night to fix potholes.

“There’s a crew up there,” one officer is heard saying on the audio recording of the radio exchange between officers. “You might want to notify whoever the foreman is, see if we could get them off the bridge temporarily.”

But even then, the ship was striking the bridge. Almost at once, the pier buckled and collapsed, twisting over the ship, with its cargo containers stacked high on the deck. Then the rest of the bridge went, breaking into sections as it plummeted and splashed into the dark river waters below.

“The size and weight of these ships make them really difficult, even with propulsion, to stop them,” said Stash Pelkowski, a professor at State University of New York Maritime College and a retired Coast Guard rear admiral. With no power, he said, “There was very little the pilot or the crew on the Dali could do.”

The collapse had happened in seconds. Except for the stumps of the piers, the central span of the bridge had plunged into the frigid river — where divers would spend the whole day searching amid twisted metal for survivors — by 1:29 a.m.

“Dispatch, the whole bridge just fell down!” an officer called out. “Whoever, everybody, the whole bridge just collapsed.”

Stray ships had long been seen as a risk to the Key Bridge. Just a few years after the Baltimore structure was constructed in 1977, a vessel crash knocked down the Sunshine Skyway Bridge in Tampa Bay, Fla., killing 35 people.

Officials acknowledged that the Key Bridge would not be able to withstand that kind of direct hit from a heavy cargo vessel. “I would have to say if that ship hit the Bay Bridge or the Key Bridge — I’m talking about the main supports, a direct hit — it would knock it down,” John Snyder, the director of engineering for the state Toll Facilities Administration told the Baltimore Sun at the time.

But building a bridge that could withstand such an impact was simply not economically feasible, he said. When the bridge was built, cargo ships were not the size they are today. A much smaller freighter did hit the bridge in 1980 , but the bridge stood strong.

Minutes after the bridge collapsed on Tuesday, both tugboats that had accompanied the Dali arrived on scene, followed soon by the Coast Guard and the Baltimore City Fire Department.

Two of the workers who had been on the bridge were rescued from the water. The others could not be found.

Jack Murphy, who owns Brawner Builders, the company whose workers had been on the bridge, got a phone call about the collapse and raced to the area, about a 30-minute drive away. He stayed by the bridge all night, and eventually began making calls to the men’s families.

Two workers’ bodies were discovered in a red pickup truck found near the bridge debris, police said Wednesday. They were identified as Alejandro Hernandez Fuentes, 35, an immigrant from Mexico, and Dorlian Ronial Castillo Cabrera, 26, a native of Guatemala.

About two miles from the bridge, Andrew Middleton had been lying awake when he heard the crash. He first thought it was thunder, maybe a low-flying jet.

It was only when he awoke a few hours later that he saw the news of the collapsed bridge. “I thought to myself, I was just with those guys yesterday,” he said.

Mr. Middleton, who runs Apostleship of the Sea, a program that ministers to sailors coming through the port, had driven the ship’s captain and a few crew members to Walmart on Monday to stock up on goods for the 28-day voyage ahead — toothpaste, snacks, clothes, Bluetooth speakers.

He recalled the captain telling him their next port was Sri Lanka, but that they were taking a longer route, down around South Africa, in order to avoid recent Houthi attacks on cargo ships in the Red Sea.

Mr. Middleton immediately messaged the crew on WhatsApp after hearing the news on Tuesday, he said, and “they responded within a few minutes saying that everyone was OK,” he said.

Around the site of the bridge collapse, firefighters and rescuers in diving gear were swarming around the shore, followed by news crews. John McAvoy, who owns a nearby restaurant, had driven over with hot meals — chicken, crab balls and pretzel bites — to hand out to the crews.

But by nightfall on Tuesday, officials had called off the rescue efforts and said they would switch to searching for bodies. “The water’s deep, visibility’s low, it’s cold as I-don’t-know-what,” said Kevin Cartwright, a spokesman for the Fire Department.

The signs of all that had changed were only starting to become clear on Wednesday. The U.S. Army Corps of Engineers said it was mobilizing more than 1,100 specialists to clear the wreckage of the bridge and unblock the Port of Baltimore’s shipping lane. In the meantime, Mr. Buttigieg, the secretary of transportation, said the East Coast would have to rely more heavily on ports outside Baltimore.

Mr. McAvoy said the tragedy would ripple over the port for years.

Fishing crews always have found their way home following the Key Bridge, he said. “It’s going to change a lot of things for a lot of people.”

Reporting was contributed by Daniel Victor , Jacey Fortin , Zach Montague , Eduardo Medina , Miriam Jordan and Judson Jones . Susan C. Beachy contributed research.

Annie Correal reports from the U.S. and Latin America for The Times. More about Annie Correal

Nicholas Bogel-Burroughs reports on national stories across the United States with a focus on criminal justice. He is from upstate New York. More about Nicholas Bogel-Burroughs

Campbell Robertson reports on Delaware, the District Columbia, Kentucky, Maryland, Ohio, Pennsylvania and Virginia, for The Times. More about Campbell Robertson

Michael Forsythe a reporter on the investigations team at The Times, based in New York. He has written extensively about, and from, China. More about Michael Forsythe

Mike Baker is a national reporter for The Times, based in Seattle. More about Mike Baker

Watch CBS News

5-year Havana Syndrome investigation finds new evidence of who might be responsible

By Will Croxton

March 31, 2024 / 7:43 PM EDT / CBS News

This week on 60 Minutes, Scott Pelley and a team of producers continued their five-year investigation into Havana Syndrome , the phenomenon of mysterious brain injuries to U.S. national security officials and diplomats, and their families, both abroad and at home, that in some cases have led to major health conditions, like blindness, memory loss, and vestibular damage.

This fourth installment brought major developments to the story: a suspected link between attacks in Tbilisi, Georgia and a top-secret Russian intelligence unit, and new evidence that a reliable source calls "a receipt" for acoustic weapons testing done by the same Russian intelligence unit.

A retired Army lieutenant colonel who led the Pentagon investigation into these incidents, Lt. Col. Greg Edgreen, told 60 Minutes he is confident that Russia is behind these attacks, and that they are part of a worldwide campaign to neutralize U.S. officials. 

• Statements of White House, FBI, Office of the Director of National Intelligence to 60 Minutes

"If my mother had seen what I saw, she would say, 'It's the Russians, stupid,'" Edgreen told 60 Minutes.

60 Minutes Overtime spoke to producers Oriana Zill de Granados and Michael Rey about the story's evolution over the course of their investigation, as they pulled back layers of government secrecy to speak with victims, identify a potential technology used to attack them, and examine a Russian intelligence unit that may have been behind some of the Havana Syndrome incidents.

"In the first story we said, 'Hmm. Is this Russia?' Second round of stories we felt, 'This is starting to look like Russia.' And in this story, our sources are telling us that it's Russia," producer Michael Rey told 60 Minutes Overtime. 

The investigation begins

In 2014, producer Oriana Zill de Granados worked on a 60 Minutes story about the opening of the U.S. embassy in Cuba under then-President Obama. After the embassy had opened in 2015, media outlets began reporting on a series of strange medical symptoms exhibited by U.S. embassy personnel working in Cuba: dizziness, fatigue, problems with memory, and impaired vision. 

"And we very early on started approaching people within the intelligence community and the Department of State, to find out what these incidents were. That led us to China, which really expanded the story beyond Havana, Cuba," Zill de Granados told 60 Minutes Overtime. 

The first installment of their series of investigative reports, called "Targeting Americans," focused on Commerce and State Department officials who reported hearing strange sounds in their homes while they were stationed overseas in China. The officials, and family members who lived with them, suffered from mysterious injuries afterward, with symptoms like headaches, nausea, memory problems and difficulty balancing.

Producers Zill de Granados and Rey interviewed Mark Lenzi, a State Department security officer who worked in the U.S. consulate in Guangzhou, China. He told 60 Minutes that both he and his wife began to suffer symptoms after hearing bizarre sounds in their apartment in 2017. 

"He told us a lot of things when we first met him that we kind of couldn't believe. And now, years later, we believe everything he told us," Rey told 60 Minutes Overtime.

Lenzi described the sound as a "marble" circling down a "metal funnel." He said he heard the sound four times, always in the same spot and at the same time of day: right above his son's crib when he put him to bed at night. He said the sound was like nothing he'd ever heard before and "fairly loud." Shortly after hearing the sounds, he and his wife began to feel ill.

• Havana Syndrome mystery continues as a lead military investigator says bar for proof was set impossibly high

"He suffered through migraines, dizziness, [and] memory issues. And his big concern was that nobody believed him. He had a very hard time convincing his superiors something was up and this needed to be addressed," Rey explained. 

Lenzi told 60 Minutes he believed he was targeted because of his work, using top-secret equipment to analyze electronic threats to diplomatic missions. 

"This was a directed standoff attack against my apartment…it was a weapon," he told Scott Pelley. "I believe it's RF, radio frequency energy, in the microwave range."

"Whether it was an intentional use of technology that could be adjusted to hurt people, or whether it was a device that was specifically designed to hurt people…we still don't know," Rey told 60 Minutes Overtime. 

"We learned to kind of trust what he was saying, that, in his experience, the capabilities exist in the world."

Domestic cases and microwave technology

In 2022, the second and third installment of the investigative series took a closer look at Havana Syndrome incidents that had happened on U.S. soil and had not been previously reported. It also examined microwave technology that could have been used as a potential weapon against these officials and their families.

One of these domestic incidents involved Olivia Troye , a former Homeland Security and counterterrorism adviser to then-Vice President Mike Pence, who said she was physically struck while descending the steps of the Eisenhower building, just a short distance away from the West Wing of the White House in Washington, D.C. 

"It was like this piercing feeling on the side of my head…and I got like, vertigo. I was unsteady. I felt nauseous. I was somewhat disoriented," she told Scott Pelley.

"I remember thinking like, 'OK…don't fall down the stairs. You've got to find your ground again and steady yourself,'" she told Pelley.

Another U.S. government official, Miles Taylor, who was deputy chief of staff for the Department of Homeland Security at the time, told 60 Minutes he woke up to a strange sound in his apartment near Capitol Hill in 2018. 

"I went to the window, opened up my window, looked down at the street… I see a white van, and the van's brake lights turned on. And it pulled off and it sped away."

Taylor said he felt "off" and "sick" the next day. About five weeks later, it happened again. He said he felt "concussion-like symptoms," like he'd been "knocked pretty hard in a sport." 

While reporting the story, producers Rey and Zill de Granados began hearing about other cases of U.S. officials who said they were attacked while overseas and then later attacked again after they had returned to the United States. 

Robyn Garfield, a Commerce Department official, and his wife Britta Garfield told 60 Minutes that they had heard strange sounds in the night when they were living overseas in Shanghai, China. This was followed by symptoms of memory loss, impaired vision, and difficulty with balance, for both them and their two children. 

In 2020, they spoke to 60 Minutes again, saying they had been attacked again, in the middle of the night, in Philadelphia, where they had been receiving treatment for the injuries they sustained in China. 

Late one night, Britta Garfield awoke suddenly, saying she had heard a loud, painful sound. They gathered their kids and booked a room at a hotel. But whatever had "hit" them in their apartment before had followed them to their hotel. 

"And we woke up, around, I believe, 2 a.m., with strange vibrations in our bodies, and a sound," Garfield told Pelley. 

Concerned, he ran to his children's bedside to check on them and saw an eerie scene. 

"Both were thrashing in their beds— asleep. But both kicking and moving aggressively. And I went over to my daughter, and I put my head down next to her head. And I heard a very distinct sound, just right there, sort of like water rushing," Garfield said. 

They reported the event to the FBI. The family continues to work on improving their balance, eyesight, and memory.

"This is the most difficult aspect of this whole issue for me are the children who've been impacted, both mine as well as many others. I personally know the parents of, I believe, eight other children. I can tell you I've personally seen balance issues in children that have never had that," Garfield told Pelley.

"One of the arguments that came out from researchers around the Havana Syndrome issue was that this is psychosomatic, that people are hearing of these symptoms, they're stressed, they're nervous. It's a normal reaction," Rey told 60 Minutes Overtime. 

"One of the things that dissuaded us of that was the fact that children were getting... bloody noses [and] bleeding from the ear. There were seizures happening in children. And then pets reacting to noises or pressures that people were feeling at the same time."

60 Minutes Overtime examined the case of two Canadian diplomats, who were also interviewed for "Targeting Americans," who said they were attacked in their homes while they were stationed in Havana, Cuba. They said their children suffered from symptoms like nosebleeds, fainting, vision problems, and dizziness afterward.

The 2022 installment of "Targeting Americans" also examined the possibility of microwave technology being used as a potential weapon against these officials and their families. 

"We haven't found the smoking gun, literally. But there is a lot of scientific research out there that is concrete on this type of technology," Zill de Granados told 60 Minutes Overtime.

In 2022, 60 Minutes spoke with James Benford, a physicist and leading authority on microwaves. In an interview with Scott Pelley, he discussed the existence of portable microwave transmitters that could damage the tissues of the brain. He said these transmitters have been studied for over 50 years. 

"There are many kinds, and they can go anywhere in size, from a suitcase all the way up to a large tractor trailer unit. And the bigger the device, the longer the range," he explained. 

He said the devices can transmit microwave energy through walls, glass, and brick. "Practically everything," he told Pelley. 

"It's been developed widely in, perhaps, a dozen countries. The primary countries are the United States, Russia, and China."

The latest installment of "Targeting Americans" brought a major development to the story with the help of a renowned investigative journalist, Christo Grozev.

Grozev famously identified the men behind the August 2020 poisoning of the late Russian dissident Alexey Navalny. He also identified other men who attempted to poison Sergei Skripal, a Russian military intelligence officer, who later became a double agent for the United Kingdom, and his daughter Yulia.

In 2018, Grozev was the first to identify the existence of a top-secret Russian intelligence unit, Unit 29155. He told 60 Minutes that this elite unit consists of assassins and saboteurs who use countersurveillance, explosives, poison, and technologically advanced equipment on their targets. 

Grozev believes he has found a document that can link the 29155 intelligence unit to an acoustic energy weapon.

Grozev worked with investigative partners, who collaborated with 60 Minutes on this report: a magazine called The Insider and German news publication Der Spiegel.

He tracked down an email that he says is for services provided to the Russian government by a member of Unit 29155 for "potential capabilities of non-lethal acoustic weapons."

"Which told us that this particular unit had been engaged with somewhere, somehow, empirical tests of a directed energy unit," he told Scott Pelley. 

60 Minutes sources said that a suspected member of Russia's 29155-unit, Albert Averyanov, who is also the son of the commander of the 29155 unit, is the subject of an investigation into Havana Syndrome incidents reported by Americans living in Tbilisi, Georgia.

Grozev found Albert Averyanov's phone was turned off during the Tbilisi incidents. But 60 Minutes sources say there's evidence someone in Tbilisi logged in to Averyanov's personal email during the time these incidents occurred. Grozev believes it was Averyanov himself— placing him in the city at that time.

"We believe members of Unit 29155 were there in order to facilitate, supervise, or maybe even personally implement attacks on American diplomats, on American government officials, using an acoustic weapon," Grozev told Pelley. 

Questions remain

Producers Rey and Zill de Granados told 60 Minutes Overtime that much remains unknown. Despite their recent findings, there is no clear answer as to who, or what country, was behind these incidents. There is also no "smoking gun" that confirms the victims' suspicions that the Havana Syndrome symptoms they experienced were the result of a deliberate attack.

In 2022, about a month before the second installment of their investigation aired on 60 Minutes, the CIA gave an interim assessment that said, "We assess it unlikely that a foreign actor, including Russia, is conducting a sustained, worldwide campaign harming U.S. personnel with a weapon or a mechanism."

Last year, in 2023, the Director of National Intelligence said that it's " very unlikely a foreign adversary is responsible ," but some intelligence agencies had only "low" or "moderate" confidence in that assessment. 

"This has never, for us, been an adversarial process. Because who are we to tell the intelligence community of the United States, 'We are right and you're wrong'? That's not our job," Rey explained.

"Our job is to ask questions and share information that we've learned that may counter the narrative that's out there…if you say there's no evidence of a foreign adversary involved, then what are we looking at?"

The video above was produced by Will Croxton. It was edited by Sarah Shafer. 

• Havana Syndrome

Will Croxton is a digital producer at 60 Minutes.

More from CBS News

Russian role in attack on American officials?

Statements of White House, FBI, ODNI to 60 Minutes

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• News Releases

Daily 20-25 mins of physical activity may offset death risk from prolonged sitting

But higher daily tallies linked to lower risk irrespective of time spent seated among over 50s

Clocking up just 20-25 minutes of physical activity every day may be enough to offset the heightened risk of death from a highly sedentary lifestyle, suggests research published online in the  British Journal of Sports Medicine.

But higher daily tallies of physical activity are linked to a lower risk, irrespective of the amount of time spent seated every day, the findings show.

In developed nations, adults spend an average of 9 to 10 hours every day sitting down—mostly during working hours. And a highly sedentary lifestyle is associated with a heightened risk of death, explain the researchers.

Much of the previously published research on the benefits of physical activity to counter prolonged sitting time have relied on aggregated data, which inevitably results in a broad brush approach, they suggest.

To try and overcome this, the researchers pooled individual participant data from four groups of people fitted with activity trackers to find out whether physical activity might modify the association between sedentary time and death, and vice versa, and what amount of physical activity and sitting time might influence risk. 

They included Individual participant data from collected between 2003 and 2019 from the Norwegian Tromsø Study 2015–16; the Swedish Healthy Ageing Initiative (HAI) 2012–19; the Norwegian National Physical Activity Survey (NNPAS) 2008– 09; and the US National Health and Nutrition Examination Survey (NHANES) 2003–06.

Just short of 12,000 people aged at least 50 were included in the analysis. They had a minimum of 4 days of 10 daily hours of activity tracker records, had been monitored for at least 2 years, and had provided details of potentially influential factors: their sex, educational level, weight, height, smoking history, alcohol intake, and whether they had current and/or previous cardiovascular disease, cancer and/or diabetes.

In all, 5943 people spent fewer than 10.5 hours sitting down every day; 6042 clocked up 10.5 or more sedentary hours.

Linkage with death registries showed that during an average period of 5 years, 805 (7%) people died, 357 (6%) of whom spent under 10.5 hours sitting down every day, and 448 of whom clocked up 10.5 hours or more.

The analysis of the activity tracker data showed that being sedentary for more than 12 hours a day was associated with a 38% heightened risk of death compared with a daily tally of 8 hours—but only among those totting up fewer than 22 daily minutes of moderate to vigorous physical activity.

More than 22 daily minutes of moderate to vigorous physical activity was associated with a lower risk of death.

While a higher amount of moderate to vigorous physical activity was associated with a lower risk of death, irrespective of the amount of sedentary time, the association between sedentary time and death was largely influenced by the amount of moderate to vigorous physical activity. 

For example, an extra 10 minutes a day was associated with a 15% lower risk of death in those spending fewer than 10.5 sedentary hours, and a 35% lower risk among those spending more than 10.5 sedentary hours, every day.

Light intensity physical activity was only associated with a lower risk of death among highly sedentary people (12+ daily hours).

This is an observational study, and as such, can’t establish cause and effect. And the researchers acknowledge that they weren’t able to repeat measures of physical activity and sedentary hours, so precluding any changes in either over time. 

Potentially influential factors, such as diet, mobility issues, and general health weren’t accounted for either. And activity trackers may not correctly classify all activity types and their corresponding intensity—cycling, resistance exercises, gardening, for example.

Nevertheless, the researchers conclude: “Small amounts of MVPA [moderate to vigorous physical activity] may be an effective strategy to ameliorate the mortality risk from high sedentary time, where accumulating more than 22 mins of MVPA eliminates the risk of high sedentary time.

“Efforts to promote physical activity may have substantial health benefits for individuals.”

British Journal of Sports Medicine

10.1136/bjsports-2022-106568

Method of Research

Observational study

Subject of Research

Article title.

Device-measured physical activity, sedentary time, and risk of all-cause mortality: an individual participant data analysis of four prospective cohort studies

Article Publication Date

24-Oct-2023

COI Statement

None declared

Disclaimer: AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert system.

Original Source

A trick to reduce stress? Spend 20 seconds a day doing this easy practice

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Eli Susman was a fairly experienced meditator when he attended a month-long retreat at Plum Village, a Buddhist monastery in Southern France in 2017.

The UC Berkeley PhD candidate in clinical science had been on other retreats where participants spent most of their time meditating. So he was surprised when he saw that the daily Plum Village retreat schedule included only 30 minutes of formal seated meditation a day.

Midway through the retreat he decided to extend one of his sessions, sitting beneath a tree for three hours. Later, he ran into a monk named Brother Treasure and told him about his practice. The monk’s response was not what he expected.

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“Three hours?” Susman remembers Brother Treasure telling him with a smile. “How about three breaths? That’s all it takes to step into the present moment.”

The words stuck with Susman. It led him to wonder whether an abbreviated practice that takes no more than a few breaths can make a difference in someone’s life.

Seven years later, he and his colleagues at Berkeley’s Golden Bear Sleep and Mood Research Clinic have evidence that it might. Earlier this year they published a paper online in the journal Behaviour Research and Therapy that describes how a simple 20-second self-compassion “micropractice” lowered stress levels and improved the mental health of undergraduate volunteers who did it every day for a month.

“Two of the biggest barriers people have for developing a meditation habit is having the time to do it and developing the habit of doing it regularly,” Susman said. “Micropactices are like tiny training sessions that are based on the most potent parts of therapeutic practices.”

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Below, Susman describes the practice he developed for the study and explains how anyone can use it to try to feel better in less than one minute a day.

This interview has been lightly edited and condensed for length and clarity.

How do you describe the 20-second self-compassion micropractice that you studied?

The instructions we gave were to close your eyes and call to mind something about yourself that has been bothering you and making you feel unworthy, unloved or not enough and notice what arises in the body.

Then we asked people to send kindness and warmth to themselves by placing one hand over the heart and another over the belly with the energy of giving themselves a hug and notice what arises in the body now.

Next, we invited them to ask themselves, “How can I be a friend to myself in this moment?”

Finally we told them to open their eyes when they were ready.

And doing this for 20 seconds a day really made a difference in the lives of study participants?

Yes, but it only worked for people who practiced it regularly. In our study we looked at the subset of people who practiced daily and at the whole sample of people who were given the instruction.

More frequent practice was associated with greater increase in self-compassion and a greater reduction in stress and mental health problems like symptoms of depression or anxiety compared to a control group.

What are some ways that people can send kindness and warmth to themselves?

The key phrase we used in the study was “How can I be a friend to myself in this moment?” What we meant by that is imagine you were seeing a friend or your younger self in a similar situation and you were being really caring to that friend. What would you tell them to do? How would you ask them to be?

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You can also imagine yourself receiving unconditional love from someone like a mentor, a parent or a close friend. How would they relate to you in this moment of suffering? Is there a way you can give that same compassion to yourself?

Does it matter where people do this practice?

We didn’t look at that, but that’s a great question.

Why is it helpful for people to touch their stomach and chest while doing the exercise?

There has been so much work on touch and how beneficial it can be for people to receive touch, but it had not been looked at as a standalone intervention for emotional well-being in terms of people offering self-compassionate touch to themselves. I was interested in the synergy between thinking self-compassionate thoughts and doing this embodied form of self-compassionate touch. It offers two potential ways of regulating yourself.

I should also say that we told participants they could choose other forms of touch like stroking yourself on the cheeks or giving yourself a hug. What’s most important is that the method of touch supports you in feeling compassionately toward yourself.

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I was surprised that the majority of students who participated in the study said they were too busy to do this 20-second practice everyday. What’s that about?

I was just joking with a friend about this, and she said that when people are stressed they can get wrapped up in feeling like they can’t take 20 seconds to pause. It might be more a mind-set than a reality, but there is more work to be done on how to help people feel like those 20 seconds are going to make a difference in their lives. We wash our hands for 20 seconds. We brush our teeth for two minutes. Why not take 20 seconds to do this?

Do you have any advice on how people can make this practice a habit?

It can be helpful to choose a cue. You can practice after morning coffee in the living room or whenever you’re feeling stressed if you can get yourself to do it then. The more specific you are in describing your cue and developing your plan the more likely you are to develop the practice into a habit.

Does this research suggest there is no reason to do a longer practice?

Most of the participants in our study were novice meditators or people who had never meditated before, so we don’t know how this would look with people who have a really dedicated meditation practice or are very experienced with meditation. Rigorous research is needed for whether shorter practices have advantages over longer practices, and for whom those advantages may be most pronounced.

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Also, just like brushing teeth is not a replacement for going to the dentist, this micropractice should not be a replacement for therapy or more intensive mental health care.

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Deborah Netburn covers faith, spirituality and joy for the Los Angeles Times. She started at The Times in 2006 and has worked across a wide range of sections including entertainment, home and garden, national news, technology and science.

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• Published: 24 November 2023

The effect of ten versus twenty minutes of mindfulness meditation on state mindfulness and affect

• Robert Palmer 1 ,
• Corey Roos 1 ,
• Nilofar Vafaie 1 , 2 &
• Hedy Kober 1  

Scientific Reports volume  13 , Article number:  20646 ( 2023 ) Cite this article

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We aimed to elucidate the effects of “dose” of a single-session of mindfulness meditation on state mindfulness and affect as well as moderators of effects. 372 adults recruited remotely via Amazon’s MTurk platform were randomly assigned to either a: 10-min mindfulness meditation, 20-min mindfulness meditation, 10-min control, or 20-min control. Control conditions were recordings of a National Geographic article. Primary outcomes were changes in state mindfulness, anxiety, and negative and positive affect. Moderator variables included neuroticism, trait mindfulness, and prior meditation experience. Collapsing across doses, participants in mindfulness conditions reported greater increases in state mindfulness than in control conditions. There was a greater increase in state mindfulness in the 10-min mindfulness condition versus 10-min control condition. There were no differences between 10- and 20-min mindfulness conditions. Exploratory moderation analyses indicated that meditation (10 or 20) versus control (10 or 20) predicted increased state mindfulness among participants with lower trait mindfulness. Additionally, 20-min versus 10-min meditation predicted greater decreases in state anxiety among individuals with high trait mindfulness. Dose–response relationships were minimal, suggesting that 10 and 20 min of meditation may improve state mindfulness comparably. Findings support the benefits of brief mindfulness meditation and suggest that trait mindfulness moderates certain outcomes.

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Introduction

While mindfulness meditation was an esoteric research topic in the US just two decades ago, such research has since grown at an exponential rate 1 , 2 . In parallel, the percentage of American adults practicing meditation increased three-fold between 2012 and 2017, and the US meditation industry was estimated to have a revenue of $2 billion in 2020 3 , 4 . Reassuringly, meta-analyses of mindfulness-based interventions (MBIs) have found that these interventions can yield meaningful improvements in a wide range of measures of wellbeing 5 , 6 , 7 , 8 , 9 . Further, numerous studies have found that people with higher levels of trait mindfulness report lower levels of stress, depression, and anxiety 5 , 6 , 7 .

Yet, despite mindfulness’ entry into mainstream consciousness, many important and pragmatic questions about it remain inadequately addressed. Such questions include whether the length of a single mindfulness meditation session (e.g., 10 vs. 20 min) leads to meaningfully different outcomes, and whether individual differences moderate interventions’ effects. Such questions are important especially within a precision medicine approach, which aims to individualize treatments for each patient, rather than adhere to a one-size-fits-all approach. However, “prescribers” of mindfulness meditation (e.g., therapists, physicians, etc.) have limited empirical evidence to draw upon when trying to answer these practical questions.

Prior research on dose–response relationships in mindfulness meditation and MBIs

MBIs have been shown to improve many indices of stress, cognition, and wellbeing 10 , 11 . In this context, it seems intuitive that “more is better,” such that people would experience greater benefits the more they practice mindfulness meditation. Indeed, a commonly-used metaphor in mindfulness teachings is that mindfulness is like a muscle that gets strengthened with practice 11 . However, research has not always supported this assumption. Several meta-analyses and a meta-regression of MBIs have reported conflicting findings regarding the moderating effects (or lack thereof) of several dose-related variables—including MBI duration, the cumulative duration of assigned or completed homework, and the number of sessions—on changes in various psychological measures 9 , 12 , 13 , 14 , 15 . Further, meta-analyses don’t allow for causal inferences regarding dose–response relationships, which is the purview of randomized controlled trials (RCTs).

To directly test the “more is better” hypothesis of the dose–response relationship, Strohmaier et al 16 conducted a small RCT (N = 71) comparing two doses of face-to-face mindfulness practice: four 20-min versus four 5-min mindfulness meditation sessions, both administered over the course of two weeks (both were also compared to a control condition). Surprisingly, participants who engaged in the 5-min sessions reported significantly greater improvements on trait mindfulness, state mindfulness, and stress compared to participants who engaged in the 20-min sessions (with a trend in the same direction for depression and anxiety). Notably, participants in this study had limited prior experience with mindfulness practices, and other researchers have speculated that longer practices may be difficult for novice meditators 17 .

In another small RCT (N = 77), Berghoff et al 18 randomized participants to complete two weeks of daily 10-min meditation sessions versus daily 20-min meditation sessions (the first session was in person, the rest were completed at home). The only between-group difference was greater improvement in self-compassion in the 20-min group versus the 10-min group. However, a major shortcoming of this study is that, due to low adherence, there were no significant between-group differences in the total time spent meditating, which severely limits the interpretation of results.

Taken together, these findings suggest an uncertain—and potentially counterintuitive—understanding of dose–response relationship. Further, we are unaware of any prior research that has assessed dose–response relationships for a single session of mindfulness meditation. Such an investigation may provide key insights into how to optimize the design of multi-session MBIs.

Prior research on individual-level moderators of MBIs

Studies and meta-analyses have tried to determine which participant characteristics moderate outcomes of MBIs, however, meta-analyses suggest that findings have been inconsistent 19 . Specifically, several studies have tested trait mindfulness and the Big Five personality traits as moderators, and results have been mixed. Whereas one study (N = 131) found that lower baseline levels of acceptance and decentering predicted greater decreases in stress from MBSR (potentially because there’s more “room for improvement”), the same study found that higher levels of awareness and lower decentering predicted greater reductions in negative affect 20 . Additionally, another study of MBSR (N = 30) found that high levels of trait mindfulness predicted better outcomes (e.g., greater subjective wellbeing and lower stress and depression) 21 . Conversely, another study (N = 322) found that trait mindfulness did not moderate the effects of MBSR 22 . Further, another study (N = 288) found that neuroticism and conscientiousness—but not trait mindfulness—moderated certain effects of MBSR, whereby higher levels of neuroticism predicted larger improvements in mental distress and subjective wellbeing, while higher conscientiousness predicted less study stress 23 .

Studies of single-session MBIs have also reported mixed results. For example, one study (N = 202) reported that higher levels of trait mindfulness predicted better stress regulation following an MBI 24 , while another study (N = 76) found that low levels of the describing and observing aspects of trait mindfulness predicted greater reductions in anxiety 25 . Concerning the Big Five personality traits, two studies (N = 37, N = 56) found that neuroticism moderated attention-related outcomes, such that participants lowest in neuroticism experienced the greatest improvement in attention-related outcomes following the MBI 26 .

Prior meditation experience is another potential moderator. Multiple studies have found that prior meditation experience moderates effects of MBIs, with one study (N = 299) finding that previous meditation experience predicted greater levels of state mindfulness following a single-session MBI . Another study (N = 203) found that changes in positive affect (but not negative affect) in response to a single-session MBI were moderated by prior meditation experience, such that meditation-naïve participants reported decreases in positive affect, while meditation-experienced participants reported no such decreases in positive affect 29 . Overall, these findings leave many important questions open to further investigation.

Current study & hypotheses

The current study aimed to help researchers and clinicians better apply the principles of precision medicine to the design of MBIs. Towards that end, we conducted a randomized controlled experiment to evaluate dose–response relationships and moderators of the effect of a single-session mindfulness meditation session. We specifically compared 10 versus 20 min of mindfulness meditation versus control conditions, and tested their effects on outcomes including state mindfulness, anxiety, negative affect, and positive affect. Participants were randomly assigned to either a: (1) 10-min mindfulness meditation, (2) 20-min mindfulness meditation, (3) 10-min control condition, or (4) 20-min control condition. Moderator variables included trait mindfulness, neuroticism, and prior meditation experience. By assessing acute changes in state mindfulness and affect, this study may help elucidate the proximal mechanisms by which MBIs with meditations of different lengths may exert their beneficial effects.

We hypothesized that both meditation conditions would yield significant improvements in state mindfulness, state anxiety, and negative affect relative to control conditions, with no effect on positive affect. We expected no difference in positive affect because prior research has shown that changes in positive affect in a single-session MBI were moderated by prior meditation experience. Given that we expected the sample to be comprised of meditation-naïve individuals as well as individuals with prior meditation experience, we expected that, at an aggregate level, we would not see significant changes in positive affect. We also hypothesized that participants in the 20-min meditation condition would report greater improvements in state mindfulness, state anxiety, and negative affect, but not positive affect, relative to participants in the 10-min meditation condition. Although this hypothesis may seem to contradict the aforementioned findings of Strohmaier et al., specifically that five minutes of meditation resulted in greater increases in state mindfulness than did twenty minutes, the sample from that study was comprised entirely of people with either no or limited prior meditation experience. We expected to recruit a more diverse sample with respect to prior meditation experience (i.e., more prior meditation experience at an aggregate level), and therefore hypothesized that there would be a dose–response relationship in favor of longer durations of meditation for all outcomes, except for positive affect. Relatedly, we hypothesized that participants’ prior meditation experience would interact with “dose,” such that people with prior meditation experience would experience greater improvements in state mindfulness, state anxiety, negative affect, and positive affect from the 20-min meditation compared to meditation-naïve individuals.

Participants

Eight hundred and sixty participants were recruited from the United States using Amazon’s Mechanical Turk (MTurk) survey platform. Participants were excluded from the study if they were younger than 18-years old or older than 56-years old. Of the 860 participants who signed the informed consent and began the study, only 641 participants completed the first survey and were randomized (see Fig.  1 for CONSORT diagram). Of these, 162 participants were randomized to listen to the 10-min mindfulness recording, 162 participants to the 20-min mindfulness recording, 161 participants to the 10-min control recording, and 156 participants to the 20-min control recording. Of those, only 426 participants completed the study. Of these 426 participants, 54 participants were removed for failing to meet pre-determined quality control checks (e.g., “approximately how long was the recording”), which made for a final sample of 372 participants (see Table 1 for participant demographics for the entire sample and each condition).

CONSORT diagram depicting participant recruitment, allocation, exclusion, and analysis.

The study was presented as an investigation of the effects of auditory attention on cognitive performance. Participants signed an online informed consent, after which each participant completed questions assessing demographic information, neuroticism, trait mindfulness, state mindfulness, positive and negative affect, and state anxiety, all using Likert scales (see below for additional details). Participants were then randomly assigned to one of the four conditions, which determined which audio recording they would listen to. Before listening to their assigned recording, participants were instructed to ensure that they were in a quiet environment with minimal distractions. To further encourage attentiveness, participants were told that they would need to answer questions based on the recording in order to be compensated for the study. Following the audio recording, which were delivered using Inquisit software, participants again answered questions assessing state mindfulness, positive and negative affect, and state anxiety, as well as multiple-choice questions and Likert scales to assess their comprehension of the recording, enjoyment of the recording, and prior meditation experience. Participants also answered open-response questions regarding their perception and understanding of the recording.

Experimental conditions

Participants were randomly assigned to listen to one of the four aforementioned audio recordings. Versions of both the mindfulness and control recordings have been used and described previously 27 . The mindfulness meditation recordings guided participants through a typical breath-focused mindfulness meditation, instructing participants to attend to the sensations of breathing, and to practice acceptance of the moment and of any distraction without judgment (modeled after typical mindfulness instructions delivered in MBSR). The control condition was a recording of a National Geographic article about the history of sequoia trees and Sequoia National Forest. Notably, both the mindfulness and control conditions were recorded by the same person, had similar rates of speech and word frequencies, included the same number of words, and had periods of silence at the same times and for the same duration. Additionally, all recordings began by instructing the listener to adopt a comfortable and upright posture. The only difference between the 10- and 20-min recordings was the addition of periods of silence at various points during the 20-min versions. Participants took an average of 30 min to complete the study and were paid $2 as compensation; participants in the 20 versus 10 min conditions (both control and mindfulness) took, on average, 10 min longer to complete the study. This study was approved by Yale University Institutional Review Board.

Immediately before the recording, participants completed measures of demographics, neuroticism, trait mindfulness, positive and negative affect, state mindfulness, and state anxiety (see below). Immediately after the recording, participants completed the same measures of positive and negative affect, state mindfulness, and state anxiety as well as measures assessing their perception of the recording, their attention to and comprehension of the recording, and prior meditation experience (see below).

Demographic survey

Before the intervention, participants were asked to report their date of birth, gender, race, ethnicity, educational attainment, and marital status.

Neuroticism

Neuroticism was assessed before the intervention using the neuroticism subscale of the Big Five Personality Inventory 30 . The neuroticism subscale consists of eight items (α = 0.90) and uses a five-point Likert scale (1 =  disagree strongly , 5 =  agree strongly ). Each item began with the phrase “I see myself as someone who…” Sample items for the neuroticism subscale include: “worries a lot” and “is emotionally stable, not easily upset,” with the latter item reverse-coded.

Trait mindfulness

Trait mindfulness was assessed using the Cognitive and Affective Mindfulness Scale-Revised (CAMS-R) 31 . The CAMS-R is a 12-item self-report measure (α = 0.66) that uses a four-point Likert scale (1 =  rarely/not at all , 4 =  almost always ). Sample items include: “It’s easy for me to keep track of my thoughts and feelings” and “I try to notice my thoughts without judging them.”

Positive and negative affect

Positive and negative affect were measured using the International Positive and Negative Affect Schedule Short Form (I-PANAS-SF) 32 . The I-PANAS-SF is a self-report measure comprised of 10 items, five of which refer to positive affect and five of which refer to negative affect. It uses a five-point Likert scale (1 =  not at all , 5 =  a great deal ). Participants were instructed to rate the extent to which they felt each emotion in the present moment. Sample items for positive affect include: “Attentive” and “Active.” Sample items for negative affect include: “Ashamed” and “Nervous.” For positive affect, Cronbach’s alphas were 0.83 and 0.87, pre- and post-intervention, respectively. For negative affect, Cronbach’s alphas were 0.82 and 0.89, pre- and post-intervention, respectively.

State mindfulness

State mindfulness was measured using the State Mindfulness Scale (SMS) 33 . The SMS is a self-report measure comprised of 21 items and uses a five-point Likert scale (1 =  not at all , 5 =  very well ). The measure assesses state mindfulness of body (e.g., “I noticed physical sensations come and go”; six items) and mind (e.g., “I was aware of what was going on in my mind”; fifteen items), though the subscales were summed in the present study. Participants were instructed to, “Please use the rating scale to indicate how well each statement describes your experiences in the past 10 min.” Cronbach’s alphas were 0.95 and 0.96, pre- and post-intervention, respectively.

State anxiety

State anxiety was measured using the five-item State scale of the Spielberger State-Trait Anxiety Inventory (STAI-S-5) 34 . The STAI-S-5 uses a four-point Likert scale (1 =  not at all , 4 =  very much so ). Participants were instructed to rate how well each item described how they felt in the present moment. Sample items included: “I feel nervous” and “I feel upset.” Cronbach’s alphas were 0.88 and 0.81, pre- and post-intervention, respectively.

Perception of the intervention

To assess participants’ perception of the interventions and their overall acceptability, participants answered two 5-point Likert scales assessing the extent to which they enjoyed the recording and to what extent they found listening to the recording to be a worthwhile experience.

Attention checks

To assess participants’ attentiveness and comprehension, participants were required to correctly provide a numerical code given at the end of the recording. Participants were then asked multiple-choice questions about the language of the speaker and the approximate duration of the recording. Additionally, participants were asked to write complete sentence answers to the following two open-ended questions: 1) “What was the recording about?” and 2) “What did you think of the recording?”.

Prior meditation experience

To assess participants’ prior experience with mindfulness meditation, participants were asked whether or not they had previously tried mindfulness meditation. If they answered that they did, we followed this with five additional questions to assess the extent of their experience.

Statistical analysis

The data were initially assessed to remove duplicate participants as well as participants who took over two hours to complete the study and those who incorrectly answered questions assessing attentiveness and comprehension. Data were analyzed using SPSS version 28. To assess within- and between-condition differences, we performed repeated-measures ANOVAs on state mindfulness, state anxiety, negative affect, and positive affect. Time (i.e., pre- vs. post-intervention) was entered as a within-subjects factor, while Condition (i.e., meditation vs. control) and Duration (i.e., 10 vs. 20 min, or “dose”) were entered as between-subjects factors. Individual within- and between-group differences were subsequently assessed with paired or independent-samples t-tests (note that we did not directly compare unmatched pairs of conditons, e.g., 20-min control vs. 10-min mindfulness).

To evaluate moderators, we conducted moderated regression analyses using the PROCESS 4.0 macro (Model 1) with 5,000 bootstrapped samples 35 . Moderator variables included trait mindfulness, neuroticism, and prior meditation experience. For the moderated regression analyses, we were primarily interested in moderators of the effect of mindfulness meditation (10- or 20-min) versus control (10- or 20-min) on outcomes, as well as the effect of the effect of meditation duration (20- vs. 10-min mindfulness meditation only) on outcomes. Hence, we created two dummy-coded variable to represent these specific comparisons. We first conducted a series of moderated regression models with mindfulness meditation (10- or 20-min) versus control (10- or 20-min) as the predictor variable. Subsequently, we conducted a series of regression models with 20- versus 10-min mindfulness meditation as the predictor variable.

To probe the nature of statistically significant moderation effects, we applied the Johnson-Neyman (JN) technique 36 in the PROCESS 4.0 macro in SPSS, as an exploratory analysis. The JN technique does not require the analyst to select specific values of the moderator variable to test varying effect of the predictor variable on the outcome. Rather, the JN techniques computes ‘transition points’ across continuum of values for the moderator variable in which the effect of the predictor variable transitions between statistically significant and nonsignificant. The JN technique can be applied to determine a “region of significance” or the specific range of values of the moderator variable in which the effect of the predictor variable on the outcome is statistically significant.

Ethical approval

Approval was obtained from the ethics committee of Yale University. The procedures used in this study adhere to the tenets of the Declaration of Helsinki.

Consent to participate

Informed consent was obtained from all individual participants included in the study.

Participant characteristics

Table 1 shows participant characteristics by group. We conducted ANOVAs and Chi Square tests and found no significant differences between groups on any of the baseline variables (all ps  > 0.06).

Interventions effects: state mindfulness

There was a significant main effect of Time ( F (1,368)  = 102.99, p  < 0.001, η 2 p  = 0.219), such that participants across all conditions reported an increase in state mindfulness post- compared to pre-intervention (see Table 2 for means and standard deviations for each condition as well as within- and between-group comparisons). Importantly, this main effect was qualified by a significant Time x Condition interaction ( F (1,368)  = 10.93, p  < 0.005, η 2 p  = 0.029). Specifically, participants in the mindfulness conditions reported a significantly greater increase in state mindfulness than did participants in the control conditions ( t (370)  = 3.33, p  < 0.001; See Fig.  2 ). Notably, post-hoc tests showed the change in state mindfulness in the 10-min meditation condition was greater than that of the 10-min control condition ( t (188)  = -3.18, p  < 0.005). There were no other significant main effects or interactions, including none of the predicted interactions with Duration (all ps  > 0.27).

Mean pre- and post-intervention values of state mindfulness for the collapsed control and meditation conditions. Error bars represent standard errors.

Interventions effects: state anxiety

There was a significant main effect of Time ( F (1,368)  = 17.94, p  < 0.001, η 2 p  = 0.046), such that participants across conditions exhibited decreases in state anxiety. There were no other significant main effects or interactions, including none of the predicted interactions with Duration (all ps  > 0.54). The change in state anxiety was not significantly different between any conditions (all ps  > 0.56; see Table 2 ).

Interventions effects: negative affect

There was a significant main effect of Time ( F (1,368)  = 10.97, p  = 0.001, η 2 p  = 0.029), such that participants across conditions exhibited a decrease in negative affect. There were no other significant main effects or interactions (all ps  > 0.16). The change in negative affect was not significantly different between any conditions (all ps  > 0.13; see Table 2 ).

Interventions effects: positive affect

There was a significant effect of Time ( F (1,368)  = 4.33, p  = 0.04, η 2 p  = 0.012), such that participants across all conditions exhibited a decrease in positive affect. There were no additional significant main effects or interactions (all ps  > 0.51; see Table 2 ).

Moderated regression analyses

Figure  3 presents a conceptual diagram of the moderation analyses. Trait mindfulness moderated the effect of meditation (10- or 20-min) versus control (10- or 20-min) on changes in state mindfulness ( p  = 0.004), such that meditation led to greater increases in state mindfulness only among participants with lower trait mindfulness (below 3.23; d  = 0.50; p  < 0.05; 73.1% of sample; Fig.  4 ). Additionally, trait mindfulness moderated the meditation duration effect (20-min vs. 10-min meditation) on changes in state anxiety ( p  = 0.03), such that 20 min of meditation led to greater decreases in state anxiety only among participants with higher trait mindfulness (above 3.48; d  = 0.35; p  < 0.05; 23.1% of sample; Fig.  5 ). There were no other significant moderation effects (i.e., no effects of meditation experience or neuroticism; see Tables 3 and 4 ).

Conceptual diagram of the moderation analyses. Intervention was the independent variable, neuroticism, prior meditation experience, and trait mindfulness were moderating variables, and state mindfulness, anxiety, and positive and negative affect were dependent variables.

Trait mindfulness moderated the effects of meditation (mindfulness conditions vs. control) on changes in state mindfulness. Dotted lines represent 95% Johnson-Neyman confidence intervals. Region of significance is where the confidence intervals do not cross zero and is below 3.23, such that mindfulness meditation versus control predicted significantly greater increases in state mindfulness when trait mindfulness was below 3.23.

Trait mindfulness moderated the effects of meditation duration (20- vs. 10-min mindfulness meditation) on changes in state anxiety. Dotted lines represent 95% Johnson-Neyman confidence intervals. Region of significance is where the confidence intervals do not cross zero and was above 3.48, such that the 20- versus 10-min mindfulness meditation predicted greater decreases in state anxiety when trait mindfulness was above 3.48.

Perception of interventions

Participants completed two Likert scales to assess how much they enjoyed listening to the recording and how worthwhile they found the experience. Responses were averaged to create an estimate of the participant’s overall positive perception of the recording. Mean positive perception did not differ between the two 10-min conditions ( t (188)  = − 1.26, p  = 0.22), nor between the two meditation conditions ( t (184)  = 0.15, p  = 0.88). There were significant differences between the two control conditions, with the 10-min control recording being rated more favorably ( t (184)  = 2.46, p  = 0.02), as well as between the two 20-min conditions, with the meditation recording being rated more favorably ( t (180)  = − 3.34, p  = 0.001).

Consistent with our hypotheses, mindfulness meditation led to a significantly greater increase in state mindfulness compared to the control conditions. Further, additional analyses revealed that this effect was moderated by trait mindfulness, such that meditation (relative to control) increased state mindfulness especially among participants with lower trait mindfulness. This finding suggests that individuals with relatively low trait mindfulness have more “room for improvement” with regards to state mindfulness, perhaps akin to how people beginning an exercise program for the first time can experience relatively fast changes in physical fitness with even modest effort 37 .

Notably, contrary to our hypotheses, we found no significant differences between meditation and control conditions on anxiety or negative affect. We were also surprised to find no differences between the 10- and 20-min meditation conditions, suggesting that a higher “dose” of meditation was not associated with overall greater changes in any of the outcomes measured in this study. However, exploratory moderation analyses found that meditating for 20 versus 10 min led to greater decreases in state anxiety for participants with higher trait mindfulness. Taken together, these findings suggest that 10-min of mindfulness meditation may be just as effective as 20-min in improving state mindfulness for the majority of people, which runs counter to the popular notion that “more is always better.” Indeed, given the often-used metaphor of mindfulness being a muscle that’s strengthened with practice, these findings may come as a surprise. Nevertheless, it is possible that typical-dose response relationships may exist at higher doses than measured in this study, and/or that 10 and 20 min of meditation are close to each other on the dose–response curve (at least for this sample). It is also possible that the dose–response relationship for MBIs follow an inverted U-shaped curve 38 . Thus, future research could test additional durations to better understand the nature of dose–response relationships in single sessions of meditation.

Another interpretation is suggested by the finding of Strohmaier et al 17 , who previously found that four 5-min meditation sessions over two weeks—as compared to four 20-min sessions over two weeks—resulted in greater increases in state and trait mindfulness and greater decreases in stress, with similar trends for depression and anxiety. Taken together with the current findings, Strohmaier’s findings may suggest that some dose–response relationships with MBIs require multiple meditation sessions to manifest to a statistically significant degree. This hypothesis is in line with the popular notion that MBIs cultivate new habits and qualities of mind that must be practiced repeatedly in order to be deeply learned and embodied, much like learning to play an instrument. As such, it may be that single-session MBIs induce a limited degree of consolidation of these new skills and that these changes are strengthened with repeated practice over multiple sessions.

Another important consideration is that the lack of differences between meditation and control may have been due in part to a floor effect, since 55% and 56.5% of participants reported the lowest possible level of state anxiety and negative affect, respectively, pre-intervention. Indeed, many studies of single-session mindfulness meditations have induced anxiety or rumination in participants before or after instructing them to practice mindfulness, thereby increasing the “room for improvement” 39 , 40 , 41 . Relatedly, it’s conceivable that dose–response relationships may have appeared had these sorts of provocations been incorporated.

The findings of the current study also suggest that the optimal duration of a single meditation session may vary according to an individual’s level of trait mindfulness. Moderation analyses indicated that meditating for 20 min (vs. 10 min) predicted greater decreases in state anxiety among individuals with relatively higher trait mindfulness. There could be several possible interpretations for this finding, including the possibility that individuals higher in trait mindfulness may benefit more from longer periods of practice relative to those low in trait mindfulness. Expressed another way, it may be beneficial to titrate the duration of a given session of meditation according to an individual’s level of trait mindfulness, in the same way that one might titrate the duration of a workout to an individual’s level of physical fitness. That said, moderation analyses did not reveal a similar trend for other outcomes, raising the possibility that this finding may be due to error. Additionally, it is notable that prior research that used a different measure for trait mindfulness found that high levels of certain facets of mindfulness and low levels of other facets were associated with better improvements in state anxiety in a single-session MBI 28 . However, given the use of different measures of trait mindfulness, it is difficult to compare these findings and draw conclusions. Thus, further research with multiple mindfulness measures and larger samples is warranted to replicate the current findings and to disambiguate these effects.

Contrary to our expectations, prior meditation experience did not moderate the effects of the interventions. This finding may be at odds with the results of a prior study that found that participants with prior meditation experience had higher levels of state mindfulness following an eight-minute, single-session MBI as compared to meditation-naïve participants 28 . One possible explanation for these differing findings is that the participants with prior meditation experience in the aforementioned study could have had a different amount of prior meditation experience than did participants in the current study. This possibility highlights the importance of developing a standardized way for assessing participants’ prior meditation experience, thereby enabling more precise and effective comparisons within and between studies. Nevertheless, our finding suggests that meditation-naïve participants can follow mindfulness instructions and experience meaningful improvements from a single meditation to a degree comparable to people with prior experience. Additionally, it seems that both 10 and 20 of minutes of meditation are reasonable durations of meditation for meditation-naïve individuals.

It is also noteworthy that neuroticism did not moderate the interventions’ effects. Prior research using the same ten-minute meditation and control scripts found that neuroticism moderated the interventions’ effects on measures of attention 27 , such that participants with lower neuroticism tended to perform better on various measures of attention following a ten-minute meditation than did participants with higher neuroticism. Additionally, other research has found that neuroticism moderated the effects of a four-session meditation training, such that participants with higher neuroticism experienced greater reductions in negative mood, perceived stress, state anxiety, and psychological distress 42 . It may be the case that neuroticism moderates the effects of single-session interventions only for certain outcomes (e.g., attention), whereas neuroticism’s moderation of multi-session interventions’ effects may include additional outcomes as well (e.g., mood and anxiety). Consequently, further research on the moderating effects of neuroticism on single- and multi-session mindfulness interventions is warranted.

Since the only significant difference between the meditation and control conditions in the current study was a greater increase in state mindfulness in the meditation conditions, it is possible that acute changes in state mindfulness, and not acute changes in affect, could be a proximal mechanism of action by which MBIs exert their beneficial effects on mental wellbeing, as other have previously suggested 43 , 44 , 45 . Indeed, while one study on MBIs did not support the mediating role of state mindfulness 17 , other studies have found that state mindfulness mediates a variety of positive outcomes of both single- and multi-session MBIs, including positive emotions, hope, gratitude, trait mindfulness, and psychological distress 46 , 47 , 48 .

Given the mainstream perception of mindfulness as a stress-relieving panacea, the large degree to which the effects of the control conditions resemble those of the meditation conditions in this study may be surprising. The control conditions’ anxiolytic and mindfulness-boosting effects may have been due to a combination of factors, including the speaker’s soothing voice, the potentially anxiolytic content of the audio recording (i.e., the history of sequoia trees), and the intermittent periods of silence. Further, these findings are fairly consistent with prior research comparing mindfulness meditation to sham meditation 49 , 50 , which supports the importance of using strong controls in mindfulness research and of identifying both specific and unique effects and mechanisms of action.

This study has multiple strengths, one of which is the diversity of the participants with respect to age, gender, and ethnicity. Many studies of MBIs have relied upon local university students or adults, which can limit the generalizability of the findings. Relatedly, the study’s sample size is larger than that of many single-session MBIs in the published literature, which further increases the generalizability of the current findings and increases the study’s power.

Another strength of this study is the use of active control conditions, specifically one that has been used in prior published research. A common criticism of mindfulness research has been the frequent use of passive control conditions, which has likely led to an inflated estimate of the effectiveness of MBIs 51 , 52 , 53 , 54 . Additionally, so as to help isolate the unique effects of the mindfulness components of the intervention, the control conditions in the current study were designed to match the mindfulness recordings in terms of word count, pace of speech, tone of voice, and periods of silence.

This study has several limitations. Perhaps most importantly, this study only sheds light on the effects of the duration of a single session of mindfulness meditation and may not generalize to multi-session MBIs. Further, as the outcomes were measured immediately before and after the intervention, further research would be needed to assess the longevity of any intervention’s effects. For example, although 10- and 20-min meditations may lead to comparable increases in state mindfulness immediately after the meditation, it may be that the increases persist longer in participants who completed the 20-min meditation (or vice versa).

Another limitation is that the setting in which participants completed the study was not standardized or directly supervised, as would be the case if the study were conducted in person. Indeed, although we used multiple methods to ensure participants’ attentiveness and comprehension (and excluded participants who endorsed or demonstrated poor adherence to or understanding of instructions), it is still possible that some participants who were included in the final analysis were minimally attentive. Thus, a possible explanation for the lack of a dose–response relationship is that the overall quality of meditation practice (i.e., the total time spent “actively meditating”) may not have differed between meditation conditions due to high rates of mind-wandering that may have occurred during the prolonged periods of silence in the 20-min condition. This phenomenon would be unsurprising, given that a high frequency of mind-wandering has been found in the general population 55 , 56 . Consequently, future studies could attempt to measure the frequency or duration of participants’ mind-wandering and on-task mindful awareness as well as meditation practice quality 57 , 58 .

Consistent with our hypotheses, mindfulness meditation led to a greater increase in state mindfulness compared to control conditions, an effect which was moderated by trait mindfulness. Moderation outcomes also revealed that trait mindfulness moderated the effect of meditation duration on changes in state anxiety. To our surprise, however, we found no other differences between the two durations of meditation, which raises important questions about the nature of dose–response relationships in MBIs. Additionally, neuroticism and prior meditation experience were not found to moderate effects of the interventions. The current findings provide a step towards understanding of dose–response relationships, and we hope that future research will further investigate such relationships and moderators of single- as well as multi-session MBIs.

Data availability

The datasets generated and analyzed during the current study are available in the Open Science Framework. https://osf.io/sw9bj/?view_only=37fd712d0c494f249c59d5ad51d962f5 .

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R.P., N.V., and H.K. contributed to the study conception and design; R.P. and N.V. collected the data; R.P., C.R., and H.K. performed the statistical analyses; R.P. wrote the first draft of the manuscript and all authors commented, provided critical revisions, and approved the final manuscript.

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Palmer, R., Roos, C., Vafaie, N. et al. The effect of ten versus twenty minutes of mindfulness meditation on state mindfulness and affect. Sci Rep 13 , 20646 (2023). https://doi.org/10.1038/s41598-023-46578-y

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Operationalising the 20-minute neighbourhood

Lukar e. thornton.

1 Department of Marketing, Faculty of Business and Economics, University of Antwerp, Antwerp, Belgium

2 Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria Australia

Ralf-Dieter Schroers

3 Health Research Institute, University of Canberra, Canberra, Australia

Karen E. Lamb

4 Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Australia

Mark Daniel

5 Department of Medicine, St Vincent’s Hospital, The University of Melbourne, Melbourne, Australia

Basile Chaix

6 INSERM, Institut Pierre Louis d’Épidémiologie et de Santé Publique, Sorbonne Universités, Paris, France

Yan Kestens

7 École de Santé Publique de l’Université de Montréal (ESPUM), Montreal, QC Canada

8 Centre de recherche du CHUM (CRCHUM), Université de Montréal, Montreal, QC Canada

Laura Oostenbach

Neil t. coffee, associated data.

The datasets used for the during the current study are available from the corresponding author on reasonable request.

Recent rapid growth in urban areas and the desire to create liveable neighbourhoods has brought about a renewed interest in planning for compact cities, with concepts like the 20-minute neighbourhood (20MN) becoming more popular. A 20MN broadly reflects a neighbourhood that allows residents to meet their daily (non-work) needs within a short, non-motorised, trip from home. The 20MN concept underpins the key planning strategy of Australia’s second largest city, Melbourne, however the 20MN definition has not been operationalised. This study aimed to develop and operationalise a practical definition of the 20MN and apply this to two Australian state capital cities: Melbourne (Victoria) and Adelaide (South Australia).

Using the metropolitan boundaries for Melbourne and Adelaide, data were sourced for several layers related to five domains: 1) healthy food; 2) recreational resources; 3) community resources; 4) public open space; and 5) public transport. The number of layers and the access measures required for each domain differed. For example, the recreational resources domain only required a sport and fitness centre (gym) within a 1.5-km network path distance, whereas the public open space domain required a public open space within a 400-m distance along a pedestrian network and 8 ha of public open space area within a 1-km radius. Locations that met the access requirements for each of the five domains were defined as 20MNs.

In Melbourne 5.5% and in Adelaide 7.6% of the population were considered to reside in a 20MN. Within areas classified as residential, the median number of people per square kilometre with a 20MN in Melbourne was 6429 and the median number of dwellings per square kilometre was 3211. In Adelaide’s 20MNs, both population density (3062) and dwelling density (1440) were lower than in Melbourne.

Conclusions

The challenge of operationalising a practical definition of the 20MN has been addressed by this study and applied to two Australian cities. The approach can be adapted to other contexts as a first step to assessing the presence of existing 20MNs and monitoring further implementation of this concept.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12966-021-01243-3.

Estimates suggest that in 2018, 4.2 billion people (55% of the world population) lived in cities and by 2050, 68% of the world’s population will live in urbanised areas [ 1 ]. Australia is witnessing a rapid population increase in its major cities [ 2 ]. Seventy-five percent of Australia’s population growth over the last 20 years occurred in state capital cities [ 2 , 3 ] and further significant population growth is forecast [ 4 ].

The global transition to urban living has occurred concomitant with increases in obesity and chronic diseases related to inappropriate diet and physical inactivity [ 5 , 6 ]. Understanding how urbanisation and urban design inhibit, or alternately, promote healthful lifestyles, is essential to preventing obesity and chronic disease [ 7 , 8 ]. Creating liveable urban environments that facilitate improved population health presents challenges and opportunities for governments, planners, and policy-makers responsible for employment, transport, housing, the environment, community engagement, urban sprawl, education and health [ 3 , 8 – 11 ], all of which are key indicators of liveability [ 12 , 13 ].

Compact city policies seek to ensure residents have access to important everyday amenities and services without travelling far from home and without resorting to motorised transport. In theory, neighbourhoods with a wide range of local amenities, services, and transport infrastructure, should encourage greater local interaction and support more healthful choices.

International adoption of compact city strategies

Many Asian cities are designed in a way that reflects compact cities and consequently this results in local and, especially, vertical living [ 14 , 15 ]. Portland, USA, initially promoted their compact city concept within the framework of a “20-minute neighbourhood” (20MN) [ 16 , 17 ]. A 20MN was defined as “a place with convenient, safe, and pedestrian-oriented access to the places people need to go to and the services people use nearly every day: transit, shopping, healthy food, school, parks, and social activities” (p.4, [ 16 ]) and noted that the 20MN term “is not intended to convey a specific metric ” (p.4 [ 16 ]). Recently, cities such as Paris, France [ 18 ], Edinburgh, UK [ 19 ], Seattle, USA [ 20 ], and the Flanders region of Belgium [ 21 ] have put forward similar concepts. In England, an emphasis is being placed on creating 20MNs with benefits stated to extend to the economy, environment, health, as well as social benefits such as safety and inclusiveness [ 22 ].

What is happening in Melbourne?

Increasingly, Australian city planners are examining opportunities to create compact localised environments [ 23 – 35 ]. In Melbourne, Australia’s second largest city, the most recent planning strategy, Plan Melbourne, proposed an agenda to manage urban growth and meet Melbourne’s future environmental, population, housing and employment needs [ 26 ]. A key component underpinning Plan Melbourne was the promotion of 20MNs that allowed people to access amenities and services near their home promoting and enabling healthful local living [ 24 , 26 ].

Table  1 presents an overview of the four key policy documents relating to Melbourne’s 20MN strategy with iterations published in 2014, 2015, 2017 and 2019. This table identifies how key aspects of the Melbourne 20MN have evolved and changed over this timeframe. When the 20MN concept was first introduced in the 2014 Plan Melbourne planning strategy, it ambitiously stated that “20-minute neighbourhoods are places where you have access to local shops, schools, parks, jobs and a range of community services within a 20-minute trip from your front door” [ 27 ] (page numbers for the quoted text throughout are provided in Table ​ Table1). 1 ). The most recent version (2019) states “The 20-minute neighbourhood is all about ‘living locally’ – giving people the ability to meet most of their daily needs within a 20-minute walk from home, with access to safe cycling and local transport options” [ 24 ].

The variations in the 20-minute neighbourhood concept across different iterations of Plan Melbourne

a This work is made available under the terms of the Creative Commons Attribution 3.0 Australia license

b This work is licensed under a Creative Commons Attribution 4.0 International license

Apart from employment opportunities, amenities and services considered as constituting everyday needs have remained relatively stable across the various iterations of Plan Melbourne (Table ​ (Table1). 1 ). These have included amenities and services related to retail (with specific reference among others to food retail such as small supermarkets and cafés), education, open space, sports facilities, community services, health services, and public transport. Access to safe and well-connected pedestrian and cycling infrastructure has also been a common element.

Less consistent in Plan Melbourne has been the definition of what constitutes 20 minutes from the perspective of travel mode and what distance this equates to. Originally in 2014, this was posed as “within 20 minutes of where they live, travelling by foot, bicycle or public transport” [ 27 ], while the 2015 version refined this to “primarily within a 20-minute walk” with an estimated distance of 1 to 1.5 km [ 25 ]. The updated strategy that followed in 2017 stated “within a 20-minute journey from home by walking, cycling, riding or local public transport” [ 26 ], although it was unclear what “riding” referred to given “cycling” preceded it separately. It is perhaps not surprising that the 2019 update refined this once again to just include walking and this time acknowledged the benefit of access to other modes using the following statement: “ within a 20-minute walk from home with access to safe cycling and local transport options” [ 24 ]. Importantly, it is stated that “this 20-minute journey represents an 800m walk from home to a destination, and back again” [ 24 ]. Two interesting points are of note here. First, instead of features being within 20 minutes, the wording is suggestive that these are now effectively within 10 minutes from home factoring in a return journey. The second point of interest is the emphasis on walking noting that “while cycling and local transport provide people with alternative active travel options to walking, these modes do not extend neighbourhoods, or access to 20-minute neighbourhood features beyond walkable catchments of 800m” [ 24 ].

Problem statement and objective

Without a clear conceptualisation and operationalisation of a 20MN, it is impossible to properly implement a 20MN, much less evaluate the benefits. This study sought to develop and operationalise a practical definition of the 20MN concept. The method proposed can be utilised elsewhere and modified by adding/removing spatial data layers that represent amenities and services and altering the measures of access (e.g., by distance and mode of travel) assuming each decision rule is rationalised. Flexibility in allowing the approach to be tailored ensures it can remain relevant to different populations, contexts, and policy environments.

With the intense policy focus on 20MNs in Melbourne (state capital of Victoria, Australia), we chose this city as the basis for our 20MN measure. To demonstrate how the measure could be tailored and applied to a different setting, the Australian city of Adelaide (state capital of South Australia) was chosen for comparison purposes. Both the Victorian [ 24 – 27 ] and South Australian [ 29 ] state governments have neighbourhood design and urban renewal policies yet the two state capitals themselves differ substantially in terms of population, urban sprawl, and transportation infrastructure. The 30 Year Plan for Greater Adelaide [ 29 ], while not explicitly invoking the 20MN, refers to transit-oriented developments that support walkable and connected communities .

Spatial extent

The spatial extent of the metropolitan Melbourne and Adelaide regions is represented by the 2016 Australian Bureau of Statistics Greater Capital City Statistical Areas [ 36 ] (Fig.  1 , Melbourne, and Fig.  2 , Adelaide). The Greater Capital City Statistical Areas represent the functional extent of the Australian State and Territory capital cities, capturing most of the commuting population and the labour markets of each capital city. They are not a marker of the edge of the city, but instead include the population who regularly socialise, shop, or work within the city, and include small towns and rural areas surrounding the urban core of the city.

Areas in Melbourne with access to the healthy food, recreational resources, community resources, public open space, and public transport domains and a population density layer depicted by population density grid [ 37 ]

Areas in Adelaide with access to the healthy food, recreational resources, community resources, public open space, and public transport domains and a population density layer depicted by population density grid [ 37 ]

Defining the attributes of the 20-minute neighbourhood

Drawing on Plan Melbourne’s various definitions of the 20MN [ 24 – 27 ], the Portland Plan [ 16 , 17 ], literature related to urban liveability indices (e.g. [ 8 , 11 , 12 ]), and our collective knowledge of this field, we proposed five spatial data domains required for a 20MN: 1) healthy food; 2) recreational resources; 3) community resources; 4) public open space; and 5) public transport. Further details of the attributes used and the inclusion rationale for each are outlined in Table  2 and in the text below.

The domains, attributes, rationale for inclusion and access measure definition for features of a 20MN

Defining the pedestrian network layer

A pedestrian network layer was created for each city which allowed for the calculation of pedestrian network distances. A pedestrian network distance differs from a road network distance by including paths that vehicles cannot use (e.g. pedestrian alleyways that link two streets) and excluding network paths accessible to cars but not pedestrians (e.g. freeways) [ 43 ]. Vehicle based one-way restrictions on streets were also removed to allow pedestrian movement in either direction, whilst tunnels and overpasses were included in the network model so as to distinguish them from crossroad intersections. For Melbourne, VicMap Transport data were used to create this layer and, in Adelaide, Statewide Road Network data.

Data sources

Data were sourced from a combination of government and commercial sources either publicly available or accessible upon request. Some datasets were available at a national level, meaning the same data sources could be used for both Melbourne and Adelaide (e.g., general practitioners (GPs) and pharmacies), whilst others were state or city specific (e.g., public open space). For full data source details see Additional File  1 .

A further comment on our featuring of both a primary city (Melbourne) and a comparison city (Adelaide) is that a great deal of spatial data representing natural and built environments in Australia is based at a state or even at more local levels rather than being available nationally in a consistent format. Thus, the use of a comparison city provides an opportunity to test the applicability of our 20MN concept in a different context where the data sources vary, further demonstrating the generalisability of the approach.

Defining accessibility for each layer

All layers were processed using ArcGIS v10.5 [ 44 ] and access to each was defined as per Table ​ Table2. 2 . For most measures, a pedestrian network service area at a specified distance was created using the feature as the starting point noting that there were no one-way restrictions within our network layer. Address points within this service area were therefore considered to have access to this feature. For most features, a 1.5-km distance was used and is consistent with common definitions used in walkability studies which equate a 5-minute walk to 400 m [ 45 ]. For public transport, accessibility measures were informed by the literature and altered based on published estimates of usual distances that people walk to different transport modes [ 39 – 41 ].

The access measure used for open space considered both access to public open space within a 400-m network distance and at least 8 ha of public open space area within a 1-km radius. These access metrics were consistent with the Melbourne planning guideline recommendations for open space (see Table ​ Table2). 2 ). The comprehensive Victorian Planning Authority Metropolitan Open Space Network walkable catchment layer [ 38 ] was used to determine if households were located within 400 m of open space in Melbourne with open space access points within this dataset specified by the provider at 30-m intervals. For Adelaide, data were sourced from a previous study [ 46 ] and 400-m pedestrian network service areas were created along park border points (50-m spacing). In both cities, the selected open space features outlined in Table ​ Table2 2 were rasterised to a 10-m × 10-m grid (cell defined as open space: 0 = no; 1 = yes). A count of open space cells within a 1-km radius (circular radius using focal statistics) around each individual cell was undertaken. A minimum count of 800 cells classified as open space was required to represent access to at least 8-ha open-space area within a 1-km radius. The method resulted in a continuous surface (10-m grid) representation of open space access across both Melbourne and Adelaide. This approach avoids some of the complex issues associated with measuring open space access [ 47 ].

Combining layers to create domains

As detailed in Table ​ Table2, 2 , for each of the five 20MN domains (healthy food, recreational resources, community resources, public open space, public transport), several criteria had to be met for households to be defined as having access to this domain, with the exception of the recreational resources domain, which required access to a gym only. The healthy food domain required access to either a large supermarket or both a smaller supermarket and a greengrocer (greengrocers defined as fruit and vegetable stores). The community resources domain required access to each of the six layers (i.e., primary school, general practitioner, pharmacy, library, post office, and café). The public open space domain required access to public open space within 400 m and at least 8 ha of open space within 1 km. Finally, the public transport domain in Melbourne required access to any public transport mode for households located within a 5-km radius of the city centre (defined by the location of the General Post Office) or access to a train station and either a bus or tram for those beyond 5 km (see Table ​ Table2 2 for rationale). In Adelaide, the public transport domain required access to any of the three specified modes of transport.

Using the community resources domain as an example, determining if access to the domain criteria had been met involved overlaying the services areas of the six individual layers and extracting the intersection of the six layers. The spatial distribution of areas considered to meet the access criteria for each domain is presented in Fig. ​ Fig.1 1 for Melbourne and Fig. ​ Fig.2 2 for Adelaide.

Creating the final 20MN layer

Once the five domains were generated, they were overlayed, and the count of intersecting areas calculated (Fig.  3 ). Areas where all five domains intersected were considered as consistent with the 20MN concept as they met the access criteria for each domain (healthy food, recreational resources, community resources, public open space, and public transport). This approach allows features to be dispersed in different directions around address points rather than clustered in a single activity centre.

Intersecting areas of domain access

Areas with access to each of the five domains and therefore a 20MN are represented in Fig.  4 for Melbourne and Fig.  5 for Adelaide. As expected, more areas considered to be 20MNs were clustered nearer to the city centres whilst in Melbourne there was also a noticeable pattern of areas with 20MNs appearing around the train stations in the mid and outer suburbs. Figures  4 and ​ and5 5 also show the intensity of domain access across the two cities.

Count of domain access within Greater Melbourne (left) and the inner-mid Melbourne region (right)

Count of domain access within Greater Adelaide (left) and the inner-mid Adelaide region (right)

Population and dwelling density by level of domain access

Population and dwelling counts were determined using data from the Australian Bureau of Statistics (ABS) 2016 census mesh block (the smallest geographical area defined by the ABS [ 48 ]). Mesh block centroids were used to determine how many domains that mesh block had access to. The ABS assign the dominant land use to each mesh block (e.g., residential, commercial, primary production, parkland). Over 95% of the population in both cities reside within mesh blocks categorised as residential. The total population with access to each domain was extracted (Table  3 ) in addition to the population density and dwelling densities of residential mesh blocks by the count of domains the mesh block had access to (Table  4 ).

Population at the 2016 Census with access to each domain and the 20-minute neighbourhood

Population and dwelling density at the 2016 Census within mesh blocks classified as residential by count of domain access

When examining domains individually, over 50% of the population in each city met the access criteria for the healthy food domain whilst over 70% had access to open space (Table ​ (Table3). 3 ). In Melbourne, 45% met the access criteria for the recreational resources domain compared to 56% in Adelaide. The percentage meeting the access criteria for the community resources layer was much lower in both cities (20% Melbourne; 18% Adelaide) as this domain required access to six separate layers. The main difference between cities was in the percentage of the population meeting the access criteria for the public transport domain. This was to be expected given the different access criteria applied in the two cities (i.e., those further than 5 km from the General Post Office in Melbourne required access to a train station) with just 13% of the Melbourne population meeting the requirements of this domain compared to 64% in Adelaide.

Most of the Melbourne population (66%) had access to two or fewer domains compared to 45% in Adelaide which again likely reflects the differences in the public transport access criteria. In Melbourne, 5.5% of the population met the access criteria for each of the five domains and therefore were considered to have a 20MN. In Adelaide, this percentage was slightly higher at 7.6%.

Noticeably, there was a trend in the population density and dwelling density results with the lowest median density in areas without access to any of the domains and the highest median density in areas with access to all five domains (Table ​ (Table4). 4 ). The median number of people per square kilometre with access to all five domains (a 20MN) was 6429 in Melbourne and 3062 in Adelaide. The median number of dwellings per square kilometre with access to all five domains was also higher in Melbourne (3211) compared to Adelaide (1440).

The 20MN continues to be promoted as having many projected benefits [ 22 , 24 – 27 , 49 , 50 ]. However, without defining and operationalising the 20MN, it remains difficult to implement a 20MN, monitor the progress of 20MN initiatives, and quantify the benefits. There are various ways that a 20MN could be expressed differently to what is proposed here including, for example, the addition of further attributes deemed important for everyday living, altering the modes of travel and the corresponding distance of a 20-minute trip, and allowing for more refined gradations of access to attributes. We have presented the first steps to flexibly operationalise the 20MN concept without resorting to the typical approach of using predefined administrative units. This ensures access can be determined from individual address points. This is an advance over existing liveability indicators that utilise predefined administrative units that measure access to various attributes according to their presence, number, and distance from some referent (e.g. within the boundaries of the unit or the distance from the geographic centroid) [ 51 , 52 ]. We view pre-defined administrative units that specify arbitrary boundaries (e.g., statistical area 1, census tract) as having little, if any, inherently meaningful correspondence to a resident’s lived environment [ 53 ].

In support of our methodology, we examined variations in how the 20MN concept has been presented across various iterations of Melbourne’s planning strategies [ 24 – 27 ] (Table ​ (Table1) 1 ) but also internationally [ 16 , 17 , 19 , 22 ]. We concede the attributes and access definition can, and should, be debated and that no single prescriptive definition may suit all contexts. Yet, the simplistic definition conveyed in policy documents falls short of specifying which amenities and services should be located within 20-minutes. This lack of specificity prevents a clear capacity to evaluate targeted interventions to increase 20MNs in urban areas.

The attributes that we selected represent a broad range of everyday services and amenities that may be considered to promote environmental, social, economic and health benefits across various demographic groups. In defining these attributes, we note three issues. First, access to an attribute is defined by the presence of a single attribute within the specified distance rather than the concentration of that attribute, with the partial exception of open space where a minimum concentration of 8 ha was required. Second, the selection of attributes did not consider those that might be harmful for environmental, social, or health reasons (e.g., fast food chains, presence of major thoroughfares leading to greater traffic, congestion, and pollution) and thus we did not exclude areas where harmful features were co-located with the selected layers. Third, in the case of recreational resources, our measure was limited to gyms including municipal-run facilities that are sometimes termed leisure centres and are available to non-members. In the Australian context, gyms operate all year round and it is not unusual for gyms (especially municipal-run gyms) to include facilities such as swimming pools and classes for activities such as yoga, in addition to weights and cardio equipment. Gyms also cater to people of all levels of fitness and abilities. We avoided sport specific facilities such as tennis courts due to the more limited general appeal. Whilst the availability of gyms provides the opportunity for people to use them, we acknowledge we did not differentiate between municipal-run and commercially-operated gyms, with the latter restricted to members and thus only accessible to those that can afford the membership fees. A key benefit of our overall approach is that each of the domains can be modified through the addition or removal of attributes. They can also be tailored, such that there may be multiple ways to meet the domain criteria. For example, for the healthy food domain, access could be obtained from having access to either a large supermarket or a smaller supermarket and greengrocer whilst in Melbourne, we altered the public transport criteria for those further from the city.

Our measures of access for most layers (i.e., a 20-minute walk equating to ~ 1.5-km) was consistent with the 2015 Plan Melbourne Refresh [ 25 ], with the exception of public transport and public open space where the access measures were guided by the literature [ 39 – 41 ] and land use planning guidelines, as detailed in Table ​ Table2. 2 . The recent suggestion that the 20MN relates to an 800-m walking distance [ 24 ] appears unfeasible given the current population density levels of Australian cities and the fact only a small percentage of the population were found to meet the 20MN criteria when our longer distance criterion was applied. The 1.5-km distance used represents the absolute maximum distance to which a number of attributes are considered accessible yet many of these may be closer. Additionally, our measure is based on a walking distance however the distance equating to a 20-minute trip would clearly vary based on the mode of travel and travel route used [ 54 – 57 ] in addition to other factors such as the slope of the land and the presence and quality of sidewalks. As the Portland Plan background report notes, the 20MN term is not intended to convey a specific metric but to reflect neighbourhoods where people can walk a relatively short distance from home to their daily destinations and services [ 16 ]. Thus, we believe the distance used combined with the five data domains adequately captured areas within a walkable distance to a range of services and amenities that meet daily needs.

Our final 20MN measure was based on all domain conditions being met. Future approaches may classify attributes by their level of relative importance (e.g., compulsory, very important, desirable but not essential) and modify the measure that way. This would also allow for a broader set of attributes to be included that may include, for example, secondary schools, banks, and playgrounds. In Figs.  4 and ​ and5, 5 , areas that meet the access criteria for fewer domains are identifiable and this type of information could be used as part of the monitoring and implementation process with regards to transitioning these areas to a 20MN. Perhaps more importantly, the combination of population density and the domain intensity maps allows for the identification of areas with relatively high populations and relatively low amenity and service provision as these are clearly more important priority areas from a neighbourhood renewal perspective.

The flexible approach can (and should) also be tailored to different contexts nationally and internationally. Context-specific measures are more important than standardised measures for understanding local influences where contexts may differ in many ways. Different locations and settings vary in terms of physical and social structures and consequently essential attributes relevant to local needs may be unaccounted for by applying a single consistent measure [ 12 ]. Indeed, Portland, USA [ 16 ] had previously defined a 20MN according to the concentration of grocery stores, other retailers (e.g., convenience stores, coffee shops, health and personal services), park access points, public elementary (primary) schools, and frequent public transport in addition to street connectivity, sidewalks and slope. In some cases, it may be desirable to add additional attributes (e.g., additional health and community services or childcare facilities), perhaps substituting at the expense of others that might be replaced, to ensure the area meets the everyday needs of the population of interest. Our Australian measure included access to health services such as general practitioners and pharmacies which, as Whitzman suggests [ 58 ], is important given Australia’s ageing population. In addition to the different contexts, there may be a desire to alter the attributes and distances and/or travel modes based on the population of interest (e.g., apply a shorter access distance in areas with a higher number of elderly people, or families with young children). An additional consideration related to travel, especially for the elderly and young children, could also include a safe walking environment indicator that consists of traffic calming features and safe crossing points, and perhaps even the slope of the land to avoid large hills.

Whilst Australia has a largely urban population, the population density in urban areas is often much lower than in other developed nations [ 59 ]. Increasing population density is seen as an important means of facilitating better access to amenities and services [ 7 , 49 , 60 ]. However, a recent report [ 61 ] forecasts significant challenges to the infrastructure of Australian cities (e.g., housing, traffic) and their ability to support rapid population growth whilst Neuman (2005) further discusses the potential negative implications of poorly managed density in his paper on the compact city fallacy [ 62 ]. In Adelaide, we found that 20MNs were achieved in neighbourhoods with lower population densities than in Melbourne. A likely explanation for this is that in Melbourne several high-rise apartment buildings have been approved in areas with high-service provision [ 34 , 35 , 63 , 64 ]. This potentially means the higher population density of 20MNs in Melbourne has been achieved through locating more people near services rather than locating services near people. Further explanation is warranted on the role of high population densities in achieving the projected benefits of the 20MN or whether such benefits also hold true in less population dense areas such as those observed in Adelaide.

Whilst potential benefits exist through the development of local 20MNs, it is important to acknowledge and highlight the challenges of this concept [ 54 , 58 , 65 , 66 ]. Although we were able to demonstrate the applicability of our approach across two cities, direct comparisons should be undertaken with care. This is, firstly, because we used a different public transport measure for areas further than five kilometres from the centre of the city in Melbourne. In this instance, we believe the criterion requiring train access outside of the inner Melbourne area is appropriate given the larger geographic size of this city and that commuters in Melbourne have a longer average commute distance [ 42 ]. An additional point of caution relates to the use of different data sources which was necessary in the absence of consistent national level data.

The need for an operationalised measure of the 20MN is clear from both an implementation and evaluation perspective. This challenge was addressed in this study, conceding there is clearly more than one way to define a 20MN. Our approach provides the flexibility to contextually tailor key attributes and access measures. It is hoped that modified versions of this measure can be applied to other cities nationally and internationally to determine the presence of and need for 20MNs. By applying our operationalised measure to two Australian cities, our analysis indicates that only a small percentage of the population live in what we would consider to be a 20MN. This measure can now be used to assess the projected benefits of the 20MN including whether they promote healthy and local living.

Acknowledgements

We would like to acknowledge the various contacts that assisted us with sourcing the relevant datasets for this study including the team at the Australian Urban Research Infrastructure Network (AURIN).

Abbreviation

Authors’ contributions.

LT led the conceptualisation of this study and led the writing of the article. NTC, RDS, KEL, MD, KBa, BC, YK, and KBe provided input into the attribute selection and access definitions. LO assisted with the write up of the manuscript including the review of policy documents. RDS led the GIS work with assistance from NTC and LT. All authors contributed to the article draft and approved the final version for submission.

This work was supported by an Australian Research Council Discovery Project Grant [DP 170100751]. The funding agency had no role in conceptualising, designing or conducting this study.

Availability of data and materials

Declarations.

Not applicable.

The authors declare that they have no competing interests.

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