Trends in research related to "Shinrin-yoku" (taking in the forest atmosphere or forest bathing) in Japan

A Pragmatic Controlled Trial of Forest Bathing Compared with Compassionate Mind Training in the UK: Impacts on Self-Reported Wellbeing and Heart Rate Variability

Forest Bathing, where individuals use mindfulness to engage with nature, has been reported to increase heart rate variability and benefit wellbeing. To date, most Forest Bathing studies have been conducted in Asia. Accordingly, this paper reports the first pragmatic controlled trial of Forest Bathing in the United Kingdom, comparing Forest Bathing with a control comprising an established wellbeing intervention also known to increase heart rate variability called Compassionate Mind Training. Sixty-one university staff and students (50 females, 11 males) were allocated to (i) Forest Bathing, (ii) Compassionate Mind Training or (iii) Forest Bathing combined with Compassionate Mind Training. Wellbeing and heart rate variability were measured at baseline, post-intervention and three-months follow-up. There were improvements in positive emotions, mood disturbance, rumination, nature connection and compassion and 57% of participants showed an increase in heart rate variability. There were no significant differences between conditions, showing that Forest Bathing had equivalence with an established wellbeing intervention. The findings will help healthcare providers and policy makers to understand the effects of Forest Bathing and implement it as a feasible social prescription to improve wellbeing. Future research needs to involve clinical populations and to assess the effects of Forest Bathing in a fully powered randomised controlled trial.

The effects of viewing a winter forest landscape with the ground and trees covered in snow on the psychological relaxation of young Finnish adults: A pilot study

Forest bathing is an outdoor activity, and it might be a promising preventive treatment for social problems involving stress. A vast number of studies confirm the positive effects of this activity on people's health. Nevertheless, little is known about the influence of winter forest bathing when conducted in an environment with snow cover on the ground and trees. Thus, a crossover experiment was designed in this study, with the participation of twenty-two healthy university students from Finland. During the experiment, a short exposition by a forest environment or landscape with buildings (as a control) was applied. Participants self-reported their psychological relaxation before and after the exposition, and the results were analyzed and compared. The mood, emotions, restorativeness, and subjective vitality were recorded as indices reflecting the psychological relaxation effect. The negative mood indices decreased significantly after exposition by the snow-covered environment, but the positive 'vigor' indices did not increase or decrease significantly. The level of negative emotions increased after the exposition with the control environment. Likewise, positive emotions decreased after the interaction with the control. Restorativeness was significantly increased after the exposition by the experimental forest but decreased after the viewing of the control buildings. The size of the effect in terms of restorativeness was the highest in this experiment. The subjective vitality was lowered as affected by the control, but it did not increase or decrease after the exposition with the experimental forest. There is probably an effect from the slight interruption in the process from the influence of the forest greens on participants because their vigor and vitality did not increase after the exposition with this environment in the study. However, snow might influence the participants as a calming and emotion-lowering component of the environment, but this idea needs to be further explored with the involvement of participants from other countries who would be viewing forest environments with snow cover and whose psychological relaxation could be measured.

A scoping review to map the concept, content, and outcome of wilderness programs for childhood cancer survivors

OBJECTIVES

Systematic mapping of the concept, content, and outcome of wilderness programs for childhood cancer survivors.

DESIGN

Scoping review.

SEARCH STRATEGY

Searches were performed in 13 databases and the grey literature. Included studies describe participation of childhood cancer survivors in wilderness programs where the role of nature had a contextual and therapeutic premise. At least two authors independently performed screening, data extraction and analysis.

RESULTS

Database searches yielded 1848 articles, of which 15 met the inclusion criteria. The majority of programs (73%) employed adventure therapy. Five activity categories were identified as components of wilderness programs: challenge/risk, free time/leisure, experiential learning, physical activity and psychotherapeutic activities. A majority of the participating childhood cancer survivors were female, white, aged 8-40 years, with a wide range of cancer diagnoses. Reported outcomes included increased social involvement, self-esteem, self-confidence, self-efficacy, social support, and physical activity. Key gaps identified included the absence of randomized controlled trials (RCTs), lack of studies on long-term effects, lack of information on the multicultural aspects of programs, and missing information on engagement in nature activities after the program ended.

CONCLUSIONS

This scoping review guides childhood cancer survivors, their families, practitioners, clinicians and researchers in the development and optimization of wilderness programs for childhood cancer survivors. In addition, it informs the utilization of these programs, and identifies gaps in the evidence base of wilderness programs. It is recommended that future study reporting on wilderness programs include more detail and explicitly address the role of nature in the program. Performing RCTs on wilderness programs is challenging, as they occur in real-life contexts in which participants cannot be blinded. Creative solutions in the design of pragmatic trials and mixed method studies are thus needed for further investigation of the effectiveness and safety of wilderness programs in childhood cancer survivors.

Harnessing the Spatial Foundation of Mind in Breaking Vicious Cycles in Anxiety, Insomnia, and Depression: The Future of Virtual Reality Therapy Applications

Mental Illnesses, particularly anxiety, insomnia, and depression often involve vicious cycles which are self-perpetuating and can trap one into a more chronic state. For example in the case of insomnia, sympathetic overactivity, intrusive thoughts, and emotional instability due to sleep loss can perpetuate further sleep loss the next night and so on. In this article, we put forward a perspective on breaking these vicious cycles based on preeminent theories in global and spatial cognition, that the foundation of the conscious mind is a spatial coordinate system. Based on this we discuss the potential and future of virtual reality therapeutic applications which utilize massive virtual spaces along with biofeedback designed to help break perpetual cycles in depression, anxiety, and insomnia. "Massive spaces" are those which are truly expansive such as when looking to the clear night sky. These virtual realities may take the form of a night sky, fantastical cosmic scenes, or other scenes such as mountain tops. We also hope to inspire research into such a spatial foundation of mind, use of perceived massive spaces for therapy, and the integration of biofeedback into virtual therapies.

Possibilities for Harmonisation between Recreation Services and Their Production within the Forest Sector—A Case Study of Municipal Forest Enterprise Hradec Králové (CZ)

This paper deals with the possibility of harmonising the needs of society and the possibilities of the forest property manager. The Municipal forest enterprise of the city of Hradec Králové (MLHK) in the Czech Republic (CZ) is an example of this principle, which proves that the intensive development of a recreational service is possible without limiting this principle. The forest enterprise manages 3707 ha of forest in the immediate vicinity of the city with 92,000 inhabitants. The forest enterprise pays the city rent and makes a profit. The data were obtained by analysing the economic data of the surveyed company, the annual observation of the forest attendance, the surveys of the characteristics of the forest visitors and the surveys of selected 16 companies (from seven countries) managing the forests of some European cities. The main results concerning MLHK are as follows: the share of recreational service costs in the total costs of the forestry activities is 19.7%. The recreational services of the forest are financed from 71.5% from revenues from the sale of raw wood, 17.5% from revenues from the sale of sand from its own quarry, 3.9% from revenues from the recreational services and 7.1% from subsidies. The operation of the gravel quarry contributes to the economic result of the forest enterprise roughly by an amount corresponding to the costs of the recreational services. An average annual forest attendance is 243 people/ha. The inhabitants of the city account for 61.5% of the visitors, 20.4% of the visitors live within a distance of up to 30 km, and 18.1% of the visitors live at a distance of more than 30 km. The main results of the survey among the forest enterprises managing the forests of the selected European cities are as follows: the share of costs for the recreational services in the total costs of the forestry activities is 21–72% for cities with a population of over 100,000, and 3–14% for cities with less than 100,000 inhabitants. As a source of financing recreational services, the forest enterprises from mentioned cities with over 100,000 inhabitants, the money especially came from the city budget (70–100%). Forest enterprises from cities under 100,000 inhabitants stated that they fund a recreational service with 95–100% of the revenues from the sale of raw wood. Data on the MLHK show that it is possible to finance a recreational forest service from its own resources if this is the owner’s priority. However, this only applies under certain conditions, such as that, in addition to the income from forest management, there are other sources of income (in this case, sand mining or subsidies from public programmes). If the forest owner did not have these resources, they would have to pay for the recreational service from their own other resources (e.g., from the city budget).

Integrative medicine considerations for convalescence from mild-to-moderate COVID-19 disease

The majority of individuals infected with SARS-CoV-2 have mild-to-moderate COVID-19 disease. Convalescence from mild-to-moderate (MtoM) COVID-19 disease may be supported by integrative medicine strategies. Integrative Medicine (IM) is defined as healing-oriented medicine that takes account of the whole person, including all aspects of lifestyle. Integrative medicine strategies that may support recovery from MtoM COVID-19 are proposed given their clinically studied effects in related conditions. Adoption of an anti-inflammatory diet, supplementation with vitamin D, glutathione, melatonin, Cordyceps, Astragalus and garlic have potential utility. Osteopathic manipulation, Qigong, breathing exercises and aerobic exercise may support pulmonary recovery. Stress reduction, environmental optimization, creative expression and aromatherapy can provide healing support and minimize enduring trauma. These modalities would benefit from clinical trials in people recovering from COVID-19 infection.

Reports on the mental health of children during the current pandemic

Emeritus Professor Alan Glasper, from the University of Southampton, discusses polices and reports designed to alert health professionals to deteriorating mental health among children and young people.

Comparative Study of the Restorative Effects of Forest and Urban Videos during COVID-19 Lockdown: Intrinsic and Benchmark Values

The prolonged lockdown imposed to contain the COrona VIrus Disease 19 COVID-19 pandemic prevented many people from direct contact with nature and greenspaces, raising alarms for a possible worsening of mental health. This study investigated the effectiveness of a simple and affordable remedy for improving psychological well-being, based on audio-visual stimuli brought by a short computer video showing forest environments, with an urban video as a control. Randomly selected participants were assigned the forest or urban video, to look at and listen to early in the morning, and questionnaires to fill out. In particular, the State-Trait Anxiety Inventory (STAI) Form Y collected in baseline condition and at the end of the study and the Part II of the Sheehan Patient Rated Anxiety Scale (SPRAS) collected every day immediately before and after watching the video. The virtual exposure to forest environments showed effective to reduce perceived anxiety levels in people forced by lockdown in limited spaces and environmental deprivation. Although significant, the effects were observed only in the short term, highlighting the limitation of the virtual experiences. The reported effects might also represent a benchmark to disentangle the determinants of health effects due to real forest experiences, for example, the inhalation of biogenic volatile organic compounds (BVOC).

Forest and Wellbeing: Bridging Medical and Forest Research for Effective Forest-Based Initiatives

Research Highlights: This review gives an overview of existing literature on the emerging topic of human wellbeing-forest contact nexus and provides a preliminary framework linking forests to wellbeing by highlighting key variables affecting this relationship. Background and Objectives: Existing literature reveals the psychological, physiological and social wellbeing benefits of contact with forest ecosystems; however, the role of forests in this relationship remains largely unexplored. The objectives of this review are twofold: (i) to provide an overview of the contributions of forest experiences to human wellbeing and the related interplay with forest ecosystems and (ii) to identify knowledge gaps to inform future research and systematize information available for forest managers and planners to support the development of effective forest-based initiatives. Materials and Methods: A scoping review was performed with a five-phase method integrating a systematic approach on Scopus, Web of Science and PubMed databases and snowball search. Studies were analyzed using a descriptive-analytical method. Results: Overall, 93 papers were included in the review. These are mainly from health-related sciences providing limited information for forest managers, planners and practitioners. Four main underlying variables of the forest-wellbeing relationship are identified: interaction, forest features, sensorial dimension of the forest and individual traits and reactions. Conclusions: Forest-based initiatives provide good opportunities for supporting public health and time spent in contact with forests seems to have a “health-bonus”. Whether and to what extent forest management can contribute to this is still poorly investigated. There is the need to better study causal relationships between specific forest features, type of interactions, frequency and “dose” of experiences, individual reactions and needs and wellbeing effects to maximize benefits from forest-based initiatives.

Conceptualizing the Human Health Outcomes of Acting in Natural Environments: An Ecological Perspective

Human-nature interactions have been presented as important for promoting and sustaining wellbeing and health benefits. Research has shown that pictures of nature, interacting with nature, physical activity in nature, immersion in nature and even feeling connected to nature can improve health. While considerable research supports this notion that nature can have positive health impact, theoretical and conceptual frameworks that help explain how the natural environment provides benefits to human health and wellbeing have proved limited. In extreme cases, theoretical approaches reinforce a problematic notion where nature is viewed as a separate entity, as a treatment to be taken as prescribed to remediate health problems that arise. Such approaches are limited as they fail to address how beneficial person-nature relations may be captured in interventions. There is a need for a deeper understanding of the processes underlying the observed benefits of the person-nature link in order to design effective research and interventions. It is especially important to consider the implications of research on person-nature relations for people living in urban contexts. In this paper, we present an ecological perspective building on James Gibson's conceptualization of human behavior. Specifically, we outline a framework that emphasizes the person-environment system as the most appropriate scale of analysis. We present three relevant concepts from the ecological approach: form of life, affordances and niche construction, as helpful for appreciating how acting in natural environments might benefit human health and wellbeing. This approach urges policy makers and urban designers to rethink environmental designs to provide and support a landscape of affordances that makes use of the richness of natural environments.

Association between Surrounding Greenness and Mortality: An Ecological Study in Taiwan

Exposure to surrounding greenness is associated with reduced mortality in Caucasian populations. Little is known however about the relationship between green vegetation and the risk of death in Asian populations. Therefore, we opted to evaluate the association of greenness with mortality in Taiwan. Death information was retrieved from the Taiwan Death Certificate database between 2006 to 2014 (3287 days). Exposure to green vegetation was based on the normalized difference vegetation index (NDVI) collected by the Moderate Resolution Imagine Spectroradiometer (MODIS). A generalized additive mixed model was utilized to assess the association between NDVI exposure and mortality. A total of 1,173,773 deaths were identified from 2006 to 2014. We found one unit increment on NDVI was associated with a reduced mortality due to all-cause (risk ratio [RR] = 0.901; 95% confidence interval = 0.862-0.941), cardiovascular diseases (RR = 0.892; 95% CI = 0.817-0.975), respiratory diseases (RR = 0.721; 95% CI = 0.632-0.824), and lung cancer (RR = 0.871; 95% CI = 0.735-1.032). Using the green land cover as the alternative green index showed the protective relationship on all-cause mortality. Exposure to surrounding greenness was negatively associated with mortality in Taiwan. Further research is needed to uncover the underlying mechanism.

Human Breathable Air in a Mediterranean Forest: Characterization of Monoterpene Concentrations under the Canopy

Monoterpenes have been identified as potential determinants of the human health effects induced by forest exposure. The present study characterizes the total monoterpene concentrations at nose height in a Mediterranean Holm oak forest located in North-East Iberian Peninsula during the annual emission peak (summer and autumn: June to November) using a Proton Transfer Reaction-Mass Spectrometry (PTR-MS). Results show a strong variability of the total monoterpene concentrations in season and daytime. The concentration peak appears during July and August. These two months displayed two average maxima in their diel cycles: One during early morning (from 6:00 to 8:00, 0.30 ppbv for July and 0.41 ppbv for August) and another one at early afternoon (from 13:00 to 15:00, 0.27 ppbv during July and 0.32 ppbv during August). Monoterpene concentrations were strongly related with the temperature (exponentially) and solar radiation (rectangular hyperbolic relationship). The concentrations registered here are similar or higher than in previous ex situ studies showcasing the effects of forests on human health. These findings provide relevant data for the scientific and healthcare community by improving the understanding of monoterpene dynamics at nose height and suggesting further research on the effects of forests on human health, particularly in the Mediterranean region.

The Psychological Effects of a Campus Forest Therapy Program

This study aimed to examine the psychological effects of a campus forest therapy program. To evaluate these, pre-test and post-test control group design was employed. A total of 38 participants participated in this study (19 in the campus forest therapy program group, and 19 in control). The Profile of Mood State (POMS) questionnaire and Modified form of the Stress Response Inventory (SRI-MF) were administered to each participant to assess psychological effects. The results of this study revealed that participants in the campus forest therapy program group had significantly positive increases in their mood and stress response compared with those of control group participants. In conclusion, the campus forest therapy program is an efficient strategy to provide psychological health benefits to university students and our study can inform decision-makers on the priority of the campus forest program in societal efforts to promote psychological well-being among university students.

Measures to Promote Rural Healthcare Tourism with a Scientific Evidence-Based Approach

The present study aimed to evaluate the effects of physical activities on human health in forests in countryside and rural areas. The test experiment was conducted in a countryside forest, whereas the controlled experiment was conducted in an urban area where the study participants resided. A total of 22 participants (aged 20.9 ± 1.3 years) were evaluated in this study. Heart rate variability and salivary cortisol level were used as indices of physiological conditions, and semantic differential method, profile of mood states (POMS), and state-trait anxiety inventory (STAI) were used to evaluate the participants' emotional states. The participants were asked to walk around forest and urban areas for 15 min. The results were as follows. As compared to the urban area, in the forest area, (1) the power of the high-frequency (HF) component of the heart rate variability (HRV) was significantly higher; (2) low-frequency (LF)/(LF + HF) was significantly lower; (3) salivary cortisol level was significantly lower; (4) the participants felt more comfortable, natural, relaxed, and less anxious and showed higher levels of positive emotions and lower levels of negative emotions. Consequently, walking in the forest area induces relaxing short-term physiological and psychological effects on young people living in urban areas.

Benefits of a Three-Day Bamboo Forest Therapy Session on the Physiological Responses of University Students

Studies have indicated that natural environments have the potential to improve the relationship between a stressful life and psychological well-being and physical health. Forest therapy has recently received widespread attention as a novel solution for stress recovery and health promotion. Bamboo is an important forest type in many countries, especially in East and Southeast Asia and in African countries. Bamboo is widespread throughout southwestern China. Empirical field research on the physiological effects of bamboo forest therapy is currently lacking. To explore the benefits of bamboo forest therapy on the physiological responses of university students, 120 university volunteers between the ages of 19 and 24 participated in this study (60 males and 60 females) and were randomly divided into four groups of equal size (15 males and 15 females in each). Four sites were selected for the experiment, including two natural bamboo forests (YA and YB), a bamboo forest park (DJY), and an urban environment (CS). During the testing period, all participants were asked to view the landscape for 15 min in the morning and then walk in the testing area for 15 min in the afternoon. Blood pressure (BP), heart rate (HR), and peripheral oxygen saturation (SpO2) were measured as the physiological indexes, and the semantic differential method (SDM) questionnaire was completed for the environmental satisfaction evaluation. The SDM for the subjective environmental evaluation differed significantly among the university students; they obtained a better environmental experience, in terms of sensory perception, atmosphere, climate, place, and space, in the bamboo forest sites. The three-day bamboo forest therapy session improved the physiological well-being of university students. First, the blood pressure and heart rate of the university students decreased, and the SpO2 increased, after the three-day viewing and walking activities of the three-day bamboo forest therapy session. The viewing activities had a more pronounced effect on decreased heart rate in university students. Additionally, three-day bamboo forest therapy had a positive impact on decreased systolic blood pressure and heart rate in the university students, and it was significantly decreased in females, while peripheral oxygen saturation (SpO2) remained relatively low. Finally, compared with the urban site (CS), the bamboo forest sites effectively improved the university students’ physiological state of health, decreased their physical pressure, and stabilized their physiological indicators. These findings provide scientific evidence that a three-day bamboo forest therapy session can increase positive physiological responses. The potential for a longer-term effect on human physiological health requires further investigation.

Horticultural Activity: Its Contribution to Stress Recovery and Wellbeing for Children

In recent years, children’s use of mobile phones has grown rapidly, which might lead to an increase in mental stress and negatively affect their health. Despite increasing evidence that horticultural activity can provide significant health benefits, few scientific evidence-based studies are currently available regarding these benefits to children’s health and wellbeing in schools. Therefore, this study aims to determine the potential benefits of horticultural activity for children from both psychological and physiological perspectives. Twenty-six elementary school students (mean age, 8.12 ± 0.21 years) were asked to perform a plant-related task and a mobile game task for 5 min. During both tasks, physiological sensors were used to measure the participants’ heart rate variability, skin conductance, and skin temperature. Additionally, the participants’ emotional responses were assessed using semantic differential and State–Trait Anxiety Inventory tests immediately after each task. Results revealed that, compared with the mobile game task, participants’ health statuses were positively correlated with the horticultural task, including a considerable decrease in skin conductance and sympathetic nervous activity, together with a marginal increase in parasympathetic nervous activity. Such responses suggested that horticultural activity increased relaxation and decreased feelings of stress. Furthermore, the horticultural activity was associated with a substantial increment in comfort, naturalness, relaxation, and cheerfulness feelings, as well as a significant reduction in depression and a reduction in total anxiety levels. Given these positive benefits, horticultural activity may provide a great contribution to children’s healthy life at school, prompt psychological relaxation and minimize mental stress relative to smartphone games.

How Should Forests Be Characterized in Regard to Human Health? Evidence from Existing Literature

The potential of forests as a source of health has been addressed by the scientific community and is now being considered in national forest strategies, management plans and policies. Studies identifying the mechanisms by which forest characteristics may induce these effects on human health are nevertheless scarce. This systematic review of literature on forests and human health with real-life human exposure was conducted to assess the extent to which forests have been studied and described in detail and the extent to which relationships between forest variables and health effects have been reported. The analysis underlines the lack of forest descriptions in 19.35% of the 62 studies selected for review as well as the high heterogeneity of forest variables’ description. Patterns among the articles could not be identified correlating the broader forest variable (forest type) and the most studied health variables identified (blood pressure, pulse rate or/and cortisol levels). These findings, together with previous ex situ researches, suggest the need to ameliorate and incorporate more accurate descriptions of forest variables within human health studies to provide data for forest management and the potential use of these habitats for preventive medicine and clinical practice guidelines.

Psychophysiological and cognitive effects of strawberry plants on people in isolated environments

In manned deep-space exploration, extremely isolated environments may adversely affect the mood and cognition of astronauts. Horticultural plants and activities have been proven to be effective in improving their physical, psychological, and cognitive states. To assess the effects of applying horticultural plants and activities in isolated environments, this study investigated the influence of viewing strawberry plants on the mood of people in a laboratory experiment as indicated by heart rate, salivary cortisol, and psychological scales. The results showed that heart rate and salivary cortisol were significantly decreased after viewing strawberry plants for 15 min. "Tension" and "confusion" scored using the Profile of Mood States negative mood subscales, and anxiety levels measured using the State-Trait Anxiety Inventory scale were also significantly reduced. This study further explored the impact of viewing strawberry plants on cognition. A notable reduction of the subjects' reaction time after 15-min plant viewing was observed. Based on these findings, a long-duration isolated experiment in a bioregenerative life support system-"Lunar Palace I"-was conducted. A similar trend was obtained that crew members' mood states were improved by viewing the strawberry plants, but no significant change was observed. This study provided some experimental evidence for the benefits of interacting with strawberry plants in isolated environments.

A Fragrant Environment Containing α-Pinene Suppresses Tumor Growth in Mice by Modulating the Hypothalamus/Sympathetic Nerve/Leptin Axis and Immune System

The environment is thought to affect outcomes in patients with cancer; however, this relationship has not been proven directly. Recently, an enriched environment, as a model of a positive environment, has been shown to suppress tumor growth by lowering leptin production through a pathway involving the hypothalamus/sympathetic nerve/leptin axis. We previously reported that a fragrant environment (FE) containing α-pinene suppressed tumor growth in mice; however, the underlying mechanism has not been elucidated. Accordingly, in this study, we investigated changes in the neuroendocrine and immune systems following exposure to an FE. Mice were exposed to α-pinene (5 h/day) for 4 weeks prior to tumor implantation with murine melanoma cells and 3 weeks after transplantation. In addition to the evaluation of tumor growth, the blood, spleen, and hypothalamus were collected 3 weeks after transplantation, and neuroendocrinological and immunological parameters were measured. Tumor size was ~40% smaller in mice exposed to FE. Moreover, plasma noradrenaline concentrations, which reflected sympathetic nervous activity, tended to increase, and leptin levels were significantly decreased in FE-exposed mice. Levels of stress hormones, such as plasma corticosterone and adrenaline, did not change in the 2 groups. In the hypothalamus, brain-derived neurotrophic factor protein levels and glucose-1-phosphate concentrations were decreased in the FE group. Additionally, numbers of B cells, CD4⁺ T cells, CD8⁺ T cells, and natural killer cells increased in the FE-exposed mice. These neurohormonal and immunological changes in the FE-exposed mice suggested that the FE may activate the hypothalamus/sympathetic nerve/leptin axis and immune system, thereby retarding tumor growth.

Benefits of A Three-Day Bamboo Forest Therapy Session on the Psychophysiology and Immune System Responses of Male College Students

Forest therapy is a fast-growing treatment approach, as it has the potential to alleviate stressful life events and to improve psychological well-being and physical health. Bamboo forests are widespread in southwestern China. Nevertheless, a knowledge gap on the specific health benefits of bamboo forest (BF) therapy still exists. To explore the psycho-physiologic responses of participants to the effects of BF therapy, 60 male adults aged between 19 and 24, with similar healthy conditions, were selected to participate in this study. A one-group pretest–posttest design was used for the BF sites and the city site (CS) to compare the difference in the psycho-physiologic responses of participants before and after the test. Participants at the BF sites participated in a three-day bamboo forest therapy session, and those at the CS participated in a three-day urban program. Blood pressure, heart rate, and peripheral oxygen saturation were measured as the physical signs, and the profile of mood state (POMS) questionnaire was completed by the participants for the psychological evaluation. Blood was sampled, and natural killer (NK) activity, the number of NK cells, and the levels of corticosterone, granulysin, perforin, and granzyme A/B in peripheral blood lymphocytes (PBLs) were measured. All the measurements mentioned above were performed at 08:00 on the first and fourth days within the test. Results indicated that the three-day BF therapy was capable of enhancing positive mood states and also reducing negative mood states in the male participants. The blood pressure and heart rates of the male participants decreased, while the peripheral oxygen saturation increased after the three-day BF therapy session. Furthermore, BF therapy significantly increased NK activity and the number of NK cells and perforin-, granulysin-, and granzyme A/B-expressing cells and significantly decreased the corticosterone level in PBLs in the male participants. The three-day BF therapy session improved the psychological and physiological well-being and enhanced the immune functions of the male college students.

Medical empirical research on forest bathing (Shinrin-yoku): a systematic review

Aims

This study focused on the newest evidence of the relationship between forest environmental exposure and human health and assessed the health efficacy of forest bathing on the human body as well as the methodological quality of a single study, aiming to provide scientific guidance for interdisciplinary integration of forestry and medicine.

Method

Through PubMed, Embase, and Cochrane Library, 210 papers from January 1, 2015, to April 1, 2019, were retrieved, and the final 28 papers meeting the inclusion criteria were included in the study.

Result

The methodological quality of papers included in the study was assessed quantitatively with the Downs and Black checklist. The methodological quality of papers using randomized controlled trials is significantly higher than that of papers using non-randomized controlled trials (p < 0.05). Papers included in the study were analyzed qualitatively. The results demonstrated that forest bathing activities might have the following merits: remarkably improving cardiovascular function, hemodynamic indexes, neuroendocrine indexes, metabolic indexes, immunity and inflammatory indexes, antioxidant indexes, and electrophysiological indexes; significantly enhancing people’s emotional state, attitude, and feelings towards things, physical and psychological recovery, and adaptive behaviors; and obvious alleviation of anxiety and depression.

Conclusion

Forest bathing activities may significantly improve people’s physical and psychological health. In the future, medical empirical studies of forest bathing should reinforce basic studies and interdisciplinary exchange to enhance the methodological quality of papers while decreasing the risk of bias, thereby raising the grade of paper evidence.

Physiological Benefits of Viewing Nature: A Systematic Review of Indoor Experiments

Contact with nature has been proposed as a solution to achieve physiological relaxation and stress recovery, and a number of scientific verification outcomes have been shown. Compared with studies of the other senses, studies investigating the visual effects of nature have been at the forefront of this research field. A variety of physiological indicators adopted for use in indoor experiments have shown the benefits of viewing nature. In this systematic review, we examined current peer-reviewed articles regarding the physiological effects of visual stimulation from elements or representations of nature in an indoor setting. The articles were analyzed for their stimulation method, physiological measures applied, groups of participants, and outcomes. Thirty-seven articles presenting evidence of the physiological effects of viewing nature were selected. The majority of the studies that used display stimuli, such as photos, 3D images, virtual reality, and videos of natural landscapes, confirmed that viewing natural scenery led to more relaxed body responses than viewing the control. Studies that used real nature stimuli reported that visual contact with flowers, green plants, and wooden materials had positive effects on cerebral and autonomic nervous activities compared with the control. Accumulation of scientific evidence of the physiological relaxation associated with viewing elements of nature would be useful for preventive medicine, specifically nature therapy.

Physiological and Psychological Effects of Viewing Urban Parks in Different Seasons in Adults

Although the health benefits of urban parks have gained significant attention, the effects of viewing park landscape on older adult residents have not commanded much research. This study aimed to investigate the physiological and psychological effects of viewing cherry blossoms in spring and fresh greenery in early summer at urban parks. The experiments were conducted in two viewing spots in the same park in Japan during different seasons, and included 12 participants in both spring (mean age, 66.4 ± 10.5 years) and summer (mean age, 65.75 ± 10.1 years). Participants sat and viewed an urban park and city landscape for 11-15 min. Blood pressure was measured before and after the seated viewing while heart rate was measured continuously. Then, they evaluated the psychological responses using the Profile of Mood States and State-Trait Anxiety Inventory. Viewing cherry blossoms and fresh greenery in urban parks led to lower blood pressure in spring and early summer than viewing city areas in spring and early summer. Moreover, the score of vigor-activity was significantly higher; tension-anxiety was significantly lower in spring; and the state-anxiety level was significantly lower in early summer. The results of this study suggest that viewing urban parks results in physiological and psychological relaxation.

The Potential Benefits of Therapeutic Treatment Using Gaseous Terpenes at Ambient Low Levels

Biological volatile organic compounds (BVOCs) are emitted abundantly from the flora. Among BVOCs, monoterpenes (MTs) have been used for aromatherapy (e.g., forest bathing) to treat human physiological and psychological conditions. However, relatively little is known about the therapeutic effects of MTs at low part per billion by volume (ppbv) levels. The effects of artificial MTs on human subjects were assessed by both olfactory and therapeutic parameters (brain alpha waves and stress index). Gaseous standards of three monoterpenes (i.e., α-pinene, β-pinene, and d-limonene) prepared at low ppbv levels were used individually and as mixtures. Fifty-nine healthy and non-asthmatics volunteer university students were selected for the test. All human subjects inhaled low ppbv levels of monoterpene in the testing room. Brain alpha waves and stress index were investigated during the inhalation time. Questionnaires were also used after testing. It was found that the detection threshold of MTs was close to 5 ppbv. When the MT levels increased from 0 to 20 ppbv, the mean values of brain alpha waves derived from all participants increased from 9.8 to 15.1. In contrast, the stress index values declined from 46.2 to 34.7. The overall results suggest that MTs have great potential to positively affect the relaxation state of subjects in a manner similar to forest bathing in terms of short-term effect. They can thus be applied as potential therapeutic media for mental health care.

The Voice and Speech Quality Correlates of Psychological Observations in Jungian Active Imagination Experiment

Jungian active imagination is a well known and valuable method in analytical psychology and psychotherapy. The present study assessed, for the first time, psychological and psycho-acoustical (voice and speech quality) effects of active imagination experiment in outdoor, forest, ambient. In order to analyse the voice and speech quality, participants' verbal expressions were recorded before and after the experiment. Psychological observations were based on the thirteen features and were rated according to the bipolar Comparison Mean Opinion Score scale. The results showed a noticeable positive participants' experiences after the experiment, connected with themselves, others, their behaviour, other verbal and non-verbal expressions and relations towards nature. Voice and speech quality analysis, based on the speech signal processing approach, was done based on the fourteen acoustic features. The results showed a statistically significantly better voice and speech quality of the participants at the end of the experiment (p < 0.05). Applying the averaging model from the Information Integration Theory, we obtained integral evaluative ratings in active imagination for psychological observations E_AI and voice and speech quality observations E_VQ, for each participant. The value of Pearson's correlation coefficient R = 0.6385 (p < 0.05) has shown a significant correlation between these two ratings. Overall results highlight starting hypothesis that exist some strong voice and speech correlates of psychological observations in Jungian active imagination experiment.

Physiological and Psychological Effects of Forest and Urban Sounds Using High-Resolution Sound Sources

Exposure to natural sounds is known to induce feelings of relaxation; however, only few studies have provided scientific evidence on its physiological effects. This study examined prefrontal cortex and autonomic nervous activities in response to forest sound. A total of 29 female university students (mean age 22.3 ± 2.1 years) were exposed to high-resolution sounds of a forest or city for 60 s, using headphones. Oxyhemoglobin (oxy-Hb) concentrations in the prefrontal cortex were determined by near-infrared spectroscopy. Heart rate, the high-frequency component of heart rate variability (which reflects parasympathetic nervous activity), and the ratio of low-frequency to high-frequency (LF/HF) components (which reflects sympathetic nervous activity) were measured. Subjective evaluation was performed using the modified semantic differential method and profiles of mood states. Exposure to the forest sound resulted in the following significant differences compared with exposure to city sound: decreased oxy-Hb concentrations in the right prefrontal cortex; decreased ln(LF/HF); decreased heart rate; improved feelings described as "comfortable,'' "relaxed," and "natural"; and improved mood states. The findings of this study demonstrated that forest-derived auditory stimulation induced physiological and psychological relaxation effects.

[Effect of forest bathing (shinrin-yoku) on human health: A review of the literature]

Humans have enjoyed forest environments for ages because of the quiet atmosphere, beautiful scenery, mild climate, pleasant aromas, and fresh, clean air. In Japan, since 2004, serial studies have been conducted to investigate the effects of forest environments on human health. We have established a new medical science called Forest Medicine. The Forest Medicine is a new interdisciplinary science, belonging to the categories of alternative medicine, environmental medicine and preventive medicine, which encompasses the effects of forest environments on human health. It has been reported that forest environments have the following beneficial effects on human health:1. Increase human natural killer (NK) activity, the number of NK cells, and the intracellular levels of anti-cancer proteins, suggesting a preventive effect on cancers.2. Reduce blood pressure, heart rate, and stress hormones, such as urinary adrenaline and noradrenaline and salivary cortisol.3. Increase the activity of parasympathetic nerves and reduce the activity of sympathetic nerves.4. Increase the levels of serum adiponectin and dehydroepiandrosterone sulfate.5. In the Profile of Mood States (POMS) test, reduce the scores for anxiety, depression, anger, fatigue, and confusion, and increase the score for vigor, showing psychological effects as well.These findings suggest that forest environments may have preventive effects on lifestyle-related diseases.

[Reviewing the psychological and physical health effects of forests]

Civilization illnesses today impact, and will impact in the future, everyday life of people, particularly in high-income countries. Consequences are loss in life expectancy, reduction of quality of life as well as rising economic loads. The positive effects of stays and visits in natural environments on human well-being are known for a long time. Particularly, there are many indications that forest stays have health-promoting effects. This narrative review of the literature presents the current state of the research on health-promoting effects of forest exposure. Forest exposure has positive health effects on the cardiovascular system, the immune system and on mood. Especially in the context of stress reduction, forest exposure seems to have positive influences. However, little can be concluded about the extent of these positive effects, as most studies work without control environment or control groups. Moreover forest exposure is often associated with physical activity which is also known to have health benefits. Against the background of the positive health promoting trend further research should be carried out.

A comparative study of the physiological and psychological effects of forest bathing (Shinrin-yoku) on working age people with and without depressive tendencies

BACKGROUND

In recent years, many of Japanese workers have complained of fatigue and stress, considering them as risk factors for depression. Studies have found that "forest bathing" (Shinrin-yoku) has positive physiological effects, such as blood pressure reduction, improvement of autonomic and immune functions, as well as psychological effects of alleviating depression and improving mental health. In this study, we investigate the physiological and psychological effects of "forest bathing" on people of a working age with and without depressive tendencies.

METHODS

We conducted physiological measurements and psychological surveys before and after forest bathing with subjects who participated in day-long sessions of forest bathing, at a forest therapy base located in Hiroshima Prefecture. After excluding severely depressed individuals, the participants were classified into two groups: those with depressive tendencies (5 ≤ K6 ≤ 12) and those without depressive tendencies (K6 < 5) for comparative study. The evaluation indices measured were systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse rate (PR), autonomic functions, and profile of mood states (POMS).

RESULTS

Of the 155 participants, 37% had depressive tendencies, without any differences observed between males and females. All participants showed significant decrease in SBP, DBP, and in negative POMS items after a forest bathing session. Before the session, those with depressive tendencies scored significantly higher on the POMS negative items than those without depressive tendencies. After forest bathing, those with depressive tendencies demonstrated significantly greater improvement in many of POMS items than those without depressive tendencies, and many of them no longer differed between those with and without depressive tendencies.

CONCLUSIONS

Examining the physiological and psychological effects of a day-long session of forest bathing on a working age group demonstrated significant positive effects on mental health, especially in those with depressive tendencies. Not applicable; this is not a report of intervention trial.

Nature-Based Interventions for Improving Health and Wellbeing: The Purpose, the People and the Outcomes

Engagement with nature is an important part of many people's lives, and the health and wellbeing benefits of nature-based activities are becoming increasingly recognised across disciplines from city planning to medicine. Despite this, urbanisation, challenges of modern life and environmental degradation are leading to a reduction in both the quantity and the quality of nature experiences. Nature-based health interventions (NBIs) can facilitate behavioural change through a somewhat structured promotion of nature-based experiences and, in doing so, promote improved physical, mental and social health and wellbeing. We conducted a Delphi expert elicitation process with 19 experts from seven countries (all named authors on this paper) to identify the different forms that such interventions take, the potential health outcomes and the target beneficiaries. In total, 27 NBIs were identified, aiming to prevent illness, promote wellbeing and treat specific physical, mental or social health and wellbeing conditions. These interventions were broadly categorized into those that change the environment in which people live, work, learn, recreate or heal (for example, the provision of gardens in hospitals or parks in cities) and those that change behaviour (for example, engaging people through organized programmes or other activities). We also noted the range of factors (such as socioeconomic variation) that will inevitably influence the extent to which these interventions succeed. We conclude with a call for research to identify the drivers influencing the effectiveness of NBIs in enhancing health and wellbeing.

[Relevance of green, shaded environments in the prevention of adverse effects on health from heat and air pollution in urban areas]

Adaptation to a warmer world is a priority, especially in large urban centers where the concentration of the population and the urban heat island increase heat-related risks. Cities are also willing to improve their air quality. This paper summarizes and discusses the current knowledge on how green spaces may be used to reduce heat-related health impacts, and on the potential co-benefits, especially through air quality. The literature shows that vegetation contributes to the creation of cool islands in cities, and to locally decrease temperature and air pollutant concentrations. Few epidemiological studies have investigated the associated health impacts, but they indicate that vegetation is probably a protective factor that reduces mortality and morbidity during heat waves. Green spaces can also contribute to the restoration and the building of resilience capacities, thus reducing the health impacts of heat and pollution. Current knowledge allows to develop green space strategies adapted to optimize the benefits in terms of urban heat island, thermal comfort and air quality, with potentially large health benefits. Only a part of those benefits can be quantified with the current health impact assessment tools.

[Forests and trees: A public health perspective]

Forests have historically supplied humans with timber, fuel, and forage. They have also provided goods and services associated with human physical, mental, social, and spiritual health. Given competing priorities for funding in healthcare, research on forests and health is important from a health economics perspective. Engagement with forests (including wilderness areas, managed production forests, and urban forests) for enhanced human health and wellbeing, and perhaps for illness prevention at a fraction of the cost of medical interventions, is a major opportunity for forest management in the 21st century. Despite this general recognition, there is a lack of information regarding public health policies and approaches that exist in relation to forests and trees. The available literature suggests that the majority in the field of public health view the natural environment with ambivalence. However, a paradigm shift is underway and there is an emerging field working with the positive impacts that trees and forests have on human health and wellbeing. While the value of forests has been noted by many health practitioners in Europe and Japan, health practitioners and the associated health industry in North America remain largely focused on treatment rather than preventative approaches. Largely as a result of advocacy from forestry and recreational organizations, this view is beginning to change, but the focus in the healthcare industry on treatment rather than prevention remains deeply entrenched.

Moving to an "Active" Biophilic Designed Office Workplace: A Pilot Study about the Effects on Sitting Time and Sitting Habits of Office-Based Workers

Promising initial insights show that offices designed to permit physical activity (PA) may reduce workplace sitting time. Biophilic approaches are intended to introduce natural surroundings into the workplace, and preliminary data show positive effects on stress reduction and elevated productivity within the workplace. The primary aim of this pilot study was to analyze changes in workplace sitting time and self-reported habit strength concerning uninterrupted sitting and PA during work, when relocating from a traditional office setting to “active” biophilic-designed surroundings. The secondary aim was to assess possible changes in work-associated factors such as satisfaction with the office environment, work engagement, and work performance, among office staff. In a pre-post designed field study, we collected data through an online survey on health behavior at work. Twelve participants completed the survey before (one-month pre-relocation, T₁) and twice after the office relocation (three months (T₂) and seven months post-relocation (T₃)). Standing time per day during office hours increased from T₁ to T₃ by about 40 min per day (p < 0.01). Other outcomes remained unaltered. The results suggest that changing office surroundings to an active-permissive biophilic design increased standing time during working hours. Future larger-scale controlled studies are warranted to investigate the influence of office design on sitting time and work-associated factors during working hours in depth.

Immersive Nature-Experiences as Health Promotion Interventions for Healthy, Vulnerable, and Sick Populations? A Systematic Review and Appraisal of Controlled Studies

In this systematic review, we summarized and evaluated the evidence for effects of, and associations between, immersive nature-experience on mental, physical, and social health promotion outcomes. Immersive nature-experience was operationalized as non-competitive activities, both sedentary and active, occurring in natural environments removed from everyday environments. We defined health according to the World Health Organization's holistic and positive definition of health and included steady-state, intermediate, and health promotion outcomes. An electronic search was performed for Danish, English, German, Norwegian, and Swedish articles published between January 2004 and May 2017. Manual approaches, e.g., bibliographies from experts, supplemented the literature search. Data were extracted from 461 publications that met the inclusion criteria. To assess the status and quality of the evidence for health promotion effects of immersive nature-experience, we focused on the subset of studies based on controlled designs (n = 133). Outcome level quality of the evidence was assessed narratively. Interventions most often involved adventure-based activities, short-termed walking, and seated relaxation in natural environments. We found positive effects on a range of health promotion outcomes grouped under psychological wellbeing (n = 97; ≈55% positive; ≈13% mixed; ≈29% non-significant; 2% negative); psychosocial function (n = 67; ≈61% positive; ≈9% mixed; ≈30% non-significant); psychophysiological stress response (n = 50; ≈58% positive; ≈18% mixed; ≈24% non-significant), and cognitive performance (n = 36; ≈58% positive; ≈6% mixed; ≈33% non-significant; 3% negative); and social skills and relationships (n = 34; ≈70% positive; ≈7% mixed; ≈22% non-significant). Findings related to outcomes categorized under physical health, e.g., risk of cardiovascular disease, were less consistent (n = 51; ≈37% positive; ≈28% mixed; ≈35% non-significant). Across the types of interventions and outcomes, the quality of the evidence was deemed low and occasionally moderate. In the review, we identify, discuss, and present possible solutions to four core methodological challenges associated with investigating immersive nature-experience and health outcomes: (1) intervention and program complexity; (2) feasibility and desirability of randomization; (3) blinding of participants and researchers; and (4) transferability and generalizability. The results of the review have been published as a popular-scientific report and a scientific research overview, both in Danish language.

Relation between Psychological Restorativeness and Lifestyle, Quality of Life, Resilience, and Stress-Coping in Forest Settings

Previous research has mainly dealt with the physiological and psychological restorative effects of the forest environment. However, comparatively few studies have focused on how the traits and attributes of individuals (individual traits) affect the restorative effects of the forest environment. In this study, we examined the relationships between the psychological restorative effects offered by perceived restorativeness of outdoor settings and the individual traits. Then, we investigated the relationships between the restorative indicators that are useful in examining the restorative properties (i.e., the Perceived Restorativeness Scale (PRS); seven indicators in total), the psychological restorative effect (Profile of Mood States (POMS), Restorative Outcome Scale (ROS), positive and negative affect schedule (PANAS), and Subjective Vitality Scale (SVS); 10 indicators in total), and the individual trait indicators that could be used to investigate individual traits (Development of Health and Life Habit Inventory for lifestyle, Lazarus-type Stress Coping Inventory for stress coping, World Health Organization Quality of Life Assessment 26 for quality of life (QOL), and Sukemune-Hiew Resilience test for resilience; 28 indicators in total) in forest and urban settings. Respondents consisted of 46 male students in their twenties. A short-term experiment was conducted using the same method in both environmental settings. We then analyzed the intrinsic restorative properties and the restorative effects of the settings and referred to prior research to determine the restorative effects. Furthermore, we analyzed the relationship between the restorative indicators and the individual trait indicators by correlation analysis and multiple regression (step-wise) analysis. These new findings were obtained: (1) the forest setting was a restorative environment with a higher restorative effect than the urban setting; (2) although the forest setting had a higher restorative effect than the urban setting, and the influence of individual traits was small; (3) in the forest setting, the relationship between the restorative indicators and individual traits indicators were arranged; (4) distancing (Stress coping), psychological health (QOL), and satisfaction with living environment (QOL) were likely important indicators that are related to the restorative effects in the forest setting.

Urban Nature Experiences Reduce Stress in the Context of Daily Life Based on Salivary Biomarkers

Stress reduction through contact with nature is well established, but far less is known about the contribution of contact parameters - duration, frequency, and nature quality. This study describes the relationship between duration of a nature experience (NE), and changes in two physiological biomarkers of stress - salivary cortisol and alpha-amylase. It is the first study to employ long-term, repeated-measure assessment and the first evaluation wherein study participants are free to choose the time of day, duration, and the place of a NE in response to personal preference and changing daily schedules. During an 8-week study period, 36 urban dwellers were asked to have a NE, defined as spending time in an outdoor place that brings a sense of contact with nature, at least three times a week for a duration of 10 min or more. Their goal was compliance within the context of unpredictable opportunity for taking a nature pill. Participants provided saliva samples before and after a NE at four points over the study period. Before-NE samples established the diurnal trajectory of each stress indicator and these were in line with published outcomes of more closely controlled experiments. For salivary cortisol, an NE produced a 21.3%/hour drop beyond that of the hormone's 11.7% diurnal drop. The efficiency of a nature pill per time expended was greatest between 20 and 30 min, after which benefits continued to accrue, but at a reduced rate. For salivary alpha-amylase, there was a 28.1%/h drop after adjusting for its diurnal rise of 3.5%/h, but only for participants that were least active sitting or sitting with some walking. Activity type did not influence cortisol response. The methods for this adaptive management study of nature-based restoration break new ground in addressing some complexities of measuring an effective nature dose in the context of normal daily life, while bypassing the limitations of a clinical pharmacology dose-response study. The results provide a validated starting point for healthcare practitioners prescribing a nature pill to those in their care. This line of inquiry is timely in light of expanding urbanization and rising healthcare costs.

Health impacts of environmental and social interventions designed to increase deprived communities’ access to urban woodlands: a mixed-methods study

Background

Contact with natural environments can bring health benefits, but research is lacking on how changes in access to natural environments might improve health, especially for deprived populations.

Objective

To evaluate the health impacts of woodland environment interventions intended to increase communities’ engagement with these woodlands.

Design

A prospective study of Forestry Commission Scotland’s Woods In and Around Towns (WIAT) programme in deprived communities to enhance public access to natural environments. The study investigated the impact that WIAT had on community-level mental health over time.

Setting

Three intervention and three control woodland sites, and associated communities within 1.5 km of the woodlands, located in central Scotland and eligible for WIAT support.

Participants

A core community survey was administered at each site in three waves, at baseline and after each phase of intervention (n = 5460, panel A). The completed survey contained a nested longitudinal cohort (n = 609, panel B). Community members also undertook 6-monthly environmental audits at all sites (n = 256) and participated in post-intervention focus groups (n = 34).

Interventions

Phase 1 involved physical changes to the woodlands, including footpaths, entrances and vegetation. Phase 2 involved community engagement events promoting woodland use.

Main outcome measures

The primary outcome was the Perceived Stress Scale (PSS). Other health measures included health-related quality of life (HRQoL) EuroQol-5 Dimensions (EQ-5D), physical activity (PA) [International Physical Activity Questionnaire (IPAQ)], connectedness to nature [Inclusion of Nature in Self (INS) scale] and social cohesion.

Results

The PSS scores significantly increased in the intervention group and marginally decreased in the control group. Multilevel regression models showed a differential impact between the intervention and the control at survey wave 3 in panel A [B(unstandardised coefficient) 3.58, 95% confidence interval (CI) 2.85 to 4.31;p < 0.001] and in panel B [B3.03, 95% CI 1.54 to 4.52;p < 0.001]. Using the same analytical approach, no significant change in HRQoL was associated with the intervention. Economic assessment included an illustrative cost–utility analysis and a cost–consequences analysis. The differential in stress between the intervention group and the control group was lower or non-significant in those who visited ‘nature’ in the previous year [panel A,B1.9, 95% CI 0.8 to 3.0;p < 0.001; panel B,B0.64, 95% CI –1.60 to 2.88;p = 0.57]. The IPAQ score showed a positive association with the intervention for moderate levels of PA [panel B,B559.3, 95% CI 211.3 to 907.2;p = 0.002] and overall PA [panel B,B861.5, 95% CI 106.5 to 1616.4;p = 0.025]. The intervention was also associated with increased nature connectedness and social cohesion by wave 3 – significant for panel A only. Qualitative and quantitative evidence showed that interventions increased the perceived quality of the woodland environment and enhanced its enjoyment for different activities, but the increase in use of natural environments post intervention was only 6% (panel B).

Limitations

This study was limited to three intervention sites. External factors may be the primary influence on health outcomes.

Conclusions

The WIAT interventions did not improve community-level health within 6 months of completion, and hence there was no basis for demonstrating cost-effectiveness. However, the WIAT interventions are low cost (average £11.80 per person in the eligible population) and have potential for cost-effectiveness, if health benefits were found in the longer term.

Future work

Using routinely collected data to consider a whole-programme evaluation is recommended.

Funding

The National Institute for Health Research Public Health Research programme.

A comparison of the effects of selected mono-ethnic urban environments on the autonomic functions of Muslim and Jewish women in Israel

Few previous studies evaluated ethnic differences in the effects of urban environments on the autonomic balance in intra-ethnic environments and the mediation effects of environmental exposures (air pollution, noise, and thermal load). In a field experimental study, we exposed 48 Muslim and 24 Jewish women to park, town center, and residential street in Israeli mono-ethnic small towns. Heart rate variability (HRV), noise, thermal load, and carbon monoxide (CO) were measured by portable devices while visiting the environments and were analyzed using mixed models. The results highlight the restorative effect of parks on both ethnic groups with stronger effect for Jewish women compared to Muslim women (β coefficient (95% confidence interval (CI)): - 6.45(- 6.70, - 6.20); - 4.99 (- 5.15, - 4.83), respectively). However, significant differences were recorded in Muslim and Jewish coping with the environments and the environmental exposures as measured by HRV.

The health benefits of the great outdoors: A systematic review and meta-analysis of greenspace exposure and health outcomes

BACKGROUND

The health benefits of greenspaces have demanded the attention of policymakers since the 1800s. Although much evidence suggests greenspace exposure is beneficial for health, there exists no systematic review and meta-analysis to synthesise and quantify the impact of greenspace on a wide range of health outcomes.

OBJECTIVE

To quantify evidence of the impact of greenspace on a wide range of health outcomes.

METHODS

We searched five online databases and reference lists up to January 2017. Studies satisfying a priori eligibility criteria were evaluated independently by two authors.

RESULTS

We included 103 observational and 40 interventional studies investigating ~100 health outcomes. Meta-analysis results showed increased greenspace exposure was associated with decreased salivary cortisol -0.05 (95% CI -0.07, -0.04), heart rate -2.57 (95% CI -4.30, -0.83), diastolic blood pressure -1.97 (95% CI -3.45, -0.19), HDL cholesterol -0.03 (95% CI -0.05, <-0.01), low frequency heart rate variability (HRV) -0.06 (95% CI -0.08, -0.03) and increased high frequency HRV 91.87 (95% CI 50.92, 132.82), as well as decreased risk of preterm birth 0.87 (95% CI 0.80, 0.94), type II diabetes 0.72 (95% CI 0.61, 0.85), all-cause mortality 0.69 (95% CI 0.55, 0.87), small size for gestational age 0.81 (95% CI 0.76, 0.86), cardiovascular mortality 0.84 (95% CI 0.76, 0.93), and an increased incidence of good self-reported health 1.12 (95% CI 1.05, 1.19). Incidence of stroke, hypertension, dyslipidaemia, asthma, and coronary heart disease were reduced. For several non-pooled health outcomes, between 66.7% and 100% of studies showed health-denoting associations with increased greenspace exposure including neurological and cancer-related outcomes, and respiratory mortality.

CONCLUSIONS

Greenspace exposure is associated with numerous health benefits in intervention and observational studies. These results are indicative of a beneficial influence of greenspace on a wide range of health outcomes. However several meta-analyses results are limited by poor study quality and high levels of heterogeneity. Green prescriptions involving greenspace use may have substantial benefits. Our findings should encourage practitioners and policymakers to give due regard to how they can create, maintain, and improve existing accessible greenspaces in deprived areas. Furthermore the development of strategies and interventions for the utilisation of such greenspaces by those who stand to benefit the most.

Physiological Effects of Touching the Wood of Hinoki Cypress (Chamaecyparis obtusa) with the Soles of the Feet

We clarified the physiological effects of tactile stimulation of the soles of the feet with the wood of the Hinoki cypress (Chamaecyparis obtusa) based on measurements of prefrontal cortex and autonomic nervous activities. Nineteen female university-attending students (age: 21.2 ± 0.3 years) were included. Oxy-hemoglobin (oxy-Hb) concentrations in the prefrontal cortex were determined by using near-infrared time-resolved spectroscopy. The high frequency (HF) indicating parasympathetic nervous activity and the ratio of low frequency (LF)/HF indicating sympathetic nervous activity were measured using heart rate variability. To evaluate the psychological effects caused by contact with the materials, the modified semantic differential method was used. The soles of the participants' feet were touched to a 600 × 600-mm plate made of Hinoki, which was finished in non-coating and brushing for 90 s. A marble plate served as the control. Next, subjective evaluation tests were administered to the participants. Compared with touching marble, touching Hinoki significantly (1) decreased the oxy-Hb concentrations in the left and right prefrontal cortices, which indicates decreased prefrontal cortex activity, (2) increased ln(HF), which indicates increased parasympathetic nervous activity, (3) decreased ln(LF/HF) ratio, which indicates decreased sympathetic nervous activity. Additionally, (4) according to subjective evaluations, the participants perceived themselves as being more "comfortable," "relaxed," "natural," "warm," "uneven," "dry," and "soft" after touching Hinoki. Thus, our cumulative findings indicate that touching Hinoki with the soles of the feet induces physiological relaxation.

Fifty Shades of Green: Pathway to Healthy Urban Living

Currently half the world population lives in cities, and this proportion is expected to increase rapidly to 70% over the next years. Over the years, we have created large, mostly grey cities with many high-rise buildings and little green space. Disease rates tend to be higher in urban areas than in rural areas. More green space in cities could reduce these rates. Here, we describe the importance of green space for health, and make recommendations for further research. Green space has been associated with many beneficial health effects, including reduced all-cause and cardiovascular mortality and improved mental health, possibly through mediators, such as reduced air pollution, temperature and stress, and increased physical activity, social contacts, and restoration. Additional studies are needed to strengthen the evidence base and provide further guidelines to transport planners, urban planners, and landscape architects. We need more longitudinal studies and intervention studies, further understanding of the contribution of various mechanisms toward health, and more information on susceptible populations and on where, when, how much, and what type of green space is needed. Also needed are standardized methods for green space quality assessments and evaluations of effectiveness of green prescriptions in clinical practice. Many questions are ideally suited for environmental epidemiologists, who should work with other stakeholders to address the right questions and translate knowledge into action. In conclusion, a growing evidence base supports the hypothesis that greener cities are healthier cities.

Effects of Walking in Bamboo Forest and City Environments on Brainwave Activity in Young Adults

Background. In Japan, “Shinrin-yoku” or forest bathing (spending time in forests) is a major practice used for relaxation. However, its effects on promoting human mental health are still under consideration. The objective of this study was to investigate the physiological and psychological relaxation effects of forest walking on adults. Sixty participants (50% males; 50% females) were trained to walk 15-minute predetermined courses in a bamboo forest and a city area (control). The length of the courses was the same to allow comparison of the effects of both environments. Blood pressure and EEG results were measured to assess the physiological responses and the semantic differential method (SDM) and STAI were used to study the psychological responses. Blood pressure was significantly decreased and variation in brain activity was observed in both environments. The results of the two questionnaires indicated that walking in the bamboo forest improves mood and reduces anxiety. Moreover, the mean meditation and attention scores were significantly increased after walking in a bamboo forest. The results of the physiological and psychological measurements indicate the relaxing effects of walking in a bamboo forest on adults.

For the Love of Nature: Exploring the Importance of Species Diversity and Micro-Variables Associated with Favorite Outdoor Places

Although the restorative benefits of nature are widely acknowledged, there is a limited understanding of the attributes of natural environments that are fundamental to restorative experiences. Faced with growing human populations and a greater awareness of the wellbeing benefits natural environments provide, park agencies and planners are increasingly challenged with balancing human and ecological outcomes in natural areas. This study examines the physical and experiential qualities of natural environments people referred to when describing their connection to their most valued natural environments in an online questionnaire. Recruited primarily via a public radio program, respondents were asked to identify their favorite places and explain what they loved about those places. Favorite places are considered exemplars of restorative environments and were classified based on an existing park typology. Reasons people liked particular sites were classified into three domains: setting, activity, or benefit. Content analysis was used to identify the attributes most commonly associated with favorite places. These attributes were then related to the four components of restorative environments according to Attention Restoration Theory. In contrast to previous research, we found that "fascination" was the most important component of favorite places. Possible reasons for this contrast, namely, respondents' median age, and the likelihood of a high degree of ecological literacy amongst the study population are discussed. South Australians' favorite environments comprise primarily hilly, wooded nature parks, and botanical gardens, in stark contrast to the vast arid areas that dominate the state. Micro-variables such as birds, plants, wildlife, native species, and biodiversity appear particularly important elements used to explain people's love of these sites. We discuss the implications of these findings and their potential value as an anchor for marketing campaigns seeking to encourage contact with nature, as well as education programs designed to improve people's understanding of important but intangible concepts such as biodiversity. The findings have clear, practical implications for park managers given the modifiable nature of many of the attributes identified as being most important to our respondents, and we believe attention to such elements has the potential to simultaneously enhance people's nature experiences, optimize restorative outcomes, and improve environmental stewardship.

Climatotherapy in Japan: a pilot study

Twenty-nine urban inhabitants participated in a half-day climatotherapy programme at the moderate mountain area and lowland area in the northwest part of the main island of Japan. The current study was aimed to investigate physically and mentally the objective and subjective influence of our short programme, which was a prospective pilot study of single intervention. Blood pressure was significantly descended during terrain cure at the uphill mountain path and returned after fresh-air rest cure, while there was no significant change throughout the programme at lowland flat path. Heart rate was significantly ascended and descended at both area, and more clearly changed at the mountain path. Profile of Mood Status brief form Japanese version administered before and after our half-day programme. Age adjusted T score of negative subscales, 'tension-anxiety', 'depression', 'anger-hostility', 'fatigue' and 'confusion' were significantly lower after climatotherapy at both sites. Whereas, there was no significant change concerning 'vigour' score. This short-version climatotherapy programme has been designed for people without enough time for long stay at health resort. It turned out our half-day climatotherapy programme contribute to mood status improvement. In addition, repeated practice of our short-version programme including endurance exercise with cool body shell using uphill path can be expected that blood pressure will go toward the normal range and heart rate will decrease both in usual time and during exercise. Therefore, health benefits can be expected of this climatotherapy programme.