Psychological effects of forest environments on healthy adults: Shinrin-yoku (forest-air bathing, walking) as a possible method of stress reduction

How Does Nature Exposure Affect Adults With Symptoms of Mental Illness? A Meta-Analysis

Existing research on the effects of nature exposure on the mental health of adults indicates that spending time in nature reduces depressive symptoms and stress, increases quality of life and mood and improves mental health. This meta-analysis aimed to answer the question: what are the effects of nature exposure on the social, mental and physical health of adults with symptoms of mental illness? The meta-analysis included all studies relevant to the study research questions which collected quantitative data on nature exposure using validated instruments for at least two time points on each participant and which were published between 1990 and 2020. Regarding the impact of nature exposure on adults with symptoms of mental illness, analyses showed significant, moderate effect sizes for all studies and smaller, but significant, effect sizes for studies with control groups Analyses also yielded critical information regarding the effect size of the type of nature dosage, nature setting, nature-based activity, key mental health outcomes and other factors. These findings from the present study results have important implications regarding the potential benefits of nature exposure for adults and its role in healthcare.

Exercise in a natural environment increases program compliance in people with chronic migraine: A pilot cross-over randomized trial

Adverse side effects from pharmacological treatments cause people with migraine to delay or avoid taking medication. Exercise is effective, but the effect of environment is unknown. The purpose was to determine if a natural environment affects monthly migraine load. Sedentary individuals (8 female, 1 non-binary) who experienced migraines participated. Participants completed one month of exercise (3 x week, 30-min, 60-70% estimated HRmax) indoors as well as in a natural outdoor environment in a randomized counterbalanced order. Migraine load was determined using the Headache Impact Test (HIT-6) and Migraine Disability Assessment (MIDAS) at the beginning and end of each month. Data were analyzed using repeated measures ANOVA. No interactions were evident for HIT-6 (p = 0.80), MIDAS (p = 0.72), migraine days (p = 0.508), or pain intensity (p = 0.66). No main effects were noted. Compliance was greater in the outdoor environment, with more exercise sessions completed in nature (Indoor = 72%, Outdoor = 90%, p < 0.001). Exercise environment did not impact MIDAS or HIT-6 questionnaire results, number of migraine days, or pain intensity. While there was no reduction in migraine load, it is possible that other health benefits were experienced due to greater compliance in a natural environment.

The effect of forest-based health and wellness on the stress-relieve of middle-aged people

In order to explore the impact of experience in forest-based health and wellness (FHW) on the stress of middle-aged people, 12 participants aged 35-39 were selected to conduct a 3-day/2-night study on FHW experience in Wencheng, Wenzhou. Huawei bracelets were used to monitor participants' movement, pulse and blood pressure and their mood state was measured before and after the health care experience using the Profile of Mood States (POMS) scale. After the FHW experience, the lowest value of bracelet stress appeared on the second day of the experience for men and women. The total mood disturbance (TMD) decreased by 38.8 points on average, which significantly improved the positive mood and relieved the stress. The decompression effect of the FHW experience showed some variability among individuals. Furthermore, there were gender differences in alleviation of fatigue and puzzlement, which was greater for females than males.

Identifying multilevel predictors of behavioral outcomes like park use: A comparison of conditional and marginal modeling approaches

This study compared marginal and conditional modeling approaches for identifying individual, park and neighborhood park use predictors. Data were derived from the ParkIndex study, which occurred in 128 block groups in Brooklyn (New York), Seattle (Washington), Raleigh (North Carolina), and Greenville (South Carolina). Survey respondents (n = 320) indicated parks within one half-mile of their block group used within the past month. Parks (n = 263) were audited using the Community Park Audit Tool. Measures were collected at the individual (park visitation, physical activity, sociodemographic characteristics), park (distance, quality, size), and block group (park count, population density, age structure, racial composition, walkability) levels. Generalized linear mixed models and generalized estimating equations were used. Ten-fold cross validation compared predictive performance of models. Conditional and marginal models identified common park use predictors: participant race, participant education, distance to parks, park quality, and population >65yrs. Additionally, the conditional mode identified park size as a park use predictor. The conditional model exhibited superior predictive value compared to the marginal model, and they exhibited similar generalizability. Future research should consider conditional and marginal approaches for analyzing health behavior data and employ cross-validation techniques to identify instances where marginal models display superior or comparable performance.

Effects of forest walking on physical and mental health in elderly populations: a systematic review

There is a growing awareness that spending time in nature is associated with improvement of well-being; nevertheless, the prescription of forest bathing is still limited. The aim of this systematic review was to explore the physiological and psychological benefits of different forest therapies on healthy and pathological elderly populations (>60 years) to identify the most-effective type, duration, and frequency of these interventions. A search for literature was carried out in December 2021 using PubMed, EMBASE, ResearchGate, Google Scholar and Web of Science. Grey literature was searched as well. After removal of the duplicates, within the 214 articles identified, ten met the inclusion criteria. The methodological quality of the selected studies was rated. Forest walking, alone and in combination with other activities is the most effective intervention. The selected studies reported a positive impact on physical components, including reduction in blood pressure and heart rate and improvements in cardiopulmonary and neurochemical parameters. Favorable modifications have also been noted in the psychological field, with improvements in depression, stress levels and in quality of life perception. In conclusion, forest walking may play an important role in promoting physical and mental health in healthy and pathological elderly populations. However, the lack of high-quality studies limits the strength of the results, calling for more trials.

The Inverse Association between the Frequency of Forest Walking (Shinrin-yoku) and the Prevalence of Insomnia Symptoms in the General Japanese Population: A Japan Multi-Institutional Collaborative Cohort Daiko Study

Since a single forest walk (Shinrin-yoku or forest bathing) session is reported to improve sleep temporarily, occasional forest walks may have a positive effect on daily sleep. Therefore, this study aimed to examine whether more frequent forest walking is associated with better daily sleep conditions. Data from the second survey of the Japan Multi-Institutional Collaborative Cohort (J-MICC) Daiko Study conducted among residents of Nagoya City, Japan, were used. The study design was a cross-sectional study. In total, 2044 participants (529 men and 1515 women; age, mean ± standard deviation: 58.8 ± 9.9 years) were included in the analysis. Frequent forest walks were associated with a low percentage of insomnia symptoms (Insomnia Severity Index ≥10) in women, but not in men. The adjusted odds ratio for the group that rarely took forest walks with reference to the group that engaged in the activity once a month or more often was 2.04 (95% confidence interval: 1.29-3.23) in women. Forest walk frequency was not significantly associated with sleep duration or sleep efficiency as measured by actigraphy in either men or women. In conclusion, the results suggested that increasing the frequency of forest walks or Shinrin-yoku may be effective in preventing insomnia in women.

How can plant-enriched natural environments benefit human health: a narrative review of relevant theories

Plant-enriched environments, the most common terrestrial landscapes, are usually coded as "green space" in urban studies. To understand how these natural environments can benefit human health, many theories have been developed, such as the well-known Attention Restoration Theory. Nowadays, more theories are emerging with regard to various and complex health dimensions. In this context, we searched online databases (from 2000 to 2022) and conducted a narrative review aiming to introduce relevant theories concerning psychological (e.g. Perceptual Fluency Account and Conditioned Restoration Theory), physiological (e.g. volatile organic compounds and environmental microbiomes), and behavioural (e.g. physical activity and social contact) perspectives. We also slightly mentioned some limitations and directions to be considered when using these theories. These results may offer general readers insights into the value of nature exposure and also help relevant researchers with study design and result interpretation.

Effects of an Integrative Day Care Clinic Program with a Focus on Nature Therapy in a Hospital Park Setting on Quality of Life in Oncological Patients-A Non-Randomized Controlled Study

Cancer often causes long-term physical and psychological impairments. Lifestyle modification and nature-based interventions (NBIs) can have a positive impact on patients' quality of life (QOL). This participants-blinded, non-randomized controlled study assessed parameters at weeks 0, 12, and 24, including, as a primary endpoint, QOL in cancer patients on the Functional Assessment of Cancer Therapy-General (FACT-G) at week 12. QOL in breast cancer patients, fatigue, well-being, stress, anxiety/depression, socio-psychological well-being, benefits of nature interaction, insomnia, self-efficacy, mindfulness, and self-compassion were assessed as secondary endpoints. N = 107 cancer patients (96.3% women; 52.5 ± 9.3 years, 80.4% breast cancer) were assigned to either a 12-week nature-based (NDC; n = 56) or conventional (DC; n = 51) oncology day care clinic program, whereby the assignment group was not known to the participants. There was no significant group difference for the primary endpoint. At week 24, QOL, fatigue, mindfulness and self-compassion scores were significantly higher, and at weeks 12 and 24, the insomnia score was significantly lower in NDC compared to DC. In conclusion, this study indicates positive and clinically relevant effects of the program on QOL, fatigue, and psychological parameters. NBIs seem to have a more pronounced effect.

Impact of Environmental Factors on Hypertension and Associated Cardiovascular Disease

Hypertension is the primary cause of cardiovascular diseases and is responsible for nearly 9 million deaths worldwide annually. Increasing evidence indicates that in addition to pathophysiologic processes, numerous environmental factors, such as geographic location, lifestyle choices, socioeconomic status, and cultural practices, influence the risk, progression, and severity of hypertension, even in the absence of genetic risk factors. In this review, we discuss the impact of some environmental determinants on hypertension. We focus on clinical data from large population studies and discuss some potential molecular and cellular mechanisms. We highlight how these environmental determinants are interconnected, as small changes in one factor might affect others, and further affect cardiovascular health. In addition, we discuss the crucial impact of socioeconomic factors and how these determinants influence diverse communities with economic disparities. Finally, we address opportunities and challenges for new research to address gaps in knowledge on understanding molecular mechanisms whereby environmental factors influence development of hypertension and associated cardiovascular disease.

Seasonal Forest Changes of Color and Temperature: Effects on the Mood and Physiological State of University Students

In this study, we attempted to analyze the effect of color and temperature changes in the forest environment over time on the mood and physiological state of university students. The survey was conducted four times considering forest changes such as new leaf appearance and growth, autumn leaf changes, and fallen leaves. The participants' moods and physiological states were first evaluated in an indoor environment; a second evaluation was conducted after contact with the forest. The color visual information of the forest environment was analyzed through color extraction from photographs taken each survey day. The participants' moods and physiological states were measured using the Korean Profile of Mood States-Brief and a heart rate variability measuring device, respectively. Changes in the forest experience according to the season had an effect on university students' mood states. In particular, the effects of the spring forest experience included the relaxation of tension and the activation of vigor. This result is considered to be influenced by factors such as the season's temperature and the green color, which is predominant in the spring forest. However, no physiological changes were found in the participants according to each season. The results of this study can lead to greater consideration of the role of color in urban forest planning for universities and other public spaces.

A systematic review of the anxiety-alleviation benefits of exposure to the natural environment

Research suggests that exposure to natural environments can be beneficial for health, such as reducing physical illness and improving mood and cognitive ability. The potential benefits of nature have come into focus at a time when mental health issues are growing globally. Here, we have selected 24 studies from four databases for meta-analysis to explore the effects of exposure to the natural environment on the anxiety of the human body and summarize the influencing factors on the anxiety relief effect. A random-effect meta-analysis of anxiety state changes before and after exposure to natural environment shows that natural exposure effectively alleviated human anxiety (SMD -1.28, 95% CI: -1.65 to -0.92). The overall quality of the included papers, assessed using the PEDro scale, is considered to vary considerably, but most of the papers are rated between 4 and 7 which is considered fair or good. In addition, we have also investigated the potential moderators of anxiety-relieving effects of the nature. Our results shows that the age and exposure time of the subjects are related to the effect of anxiety relief. The results of the subgroup analysis of moderators prove that compared with the middle-aged people (SMD -0.63, 95% CI: -1.13 to -0.12), young people (SMD -1.50, 95% CI: -1.90 to -1.10) get better anxiety alleviation effect in the natural environment. In terms of exposure time, compared with 0.5-2 h (SMD -0.18, 95% CI: -0.59 to -0.23) and >2 h (SMD -0.84, 95% CI: -1.40 to -0.27) exposure periods, subjects get the maximum anxiety relief benefit when they spent <0.5 h (SMD -1.60, 95% CI: -1.93 to -1.27) in the natural environment. However, the quality of the included studies varies greatly and there is a significant heterogeneity in the meta-analysis. Study location, natural environment type and other moderator factors have no obvious correlation with anxiety-alleviation effect of the nature. A higher quality and more comprehensive study needs to be carried out to find out more moderators about the effects of the natural environment on anxiety alleviation. Further experimental studies should also be conducted to determine the mechanism by which natural exposure reduces anxiety so as to provide strong support for the construction and improvement of healthy natural environment.

Psychological and functional outcomes following a randomized controlled trial of surf and hike therapy for U.S. service members

Introduction

Exercise-based interventions have established benefits for the treatment of depression and other psychological outcomes; however, limited data exist evaluating psychological, social, and functional outcomes for exercise outdoors.

Methods

The current study sought to expand knowledge about the breadth of effects following outdoor exercise interventions by using data from a randomized control trial comparing Surf and Hike Therapy among 96 U.S. active duty service members with major depressive disorder (MDD). Assessments examining psychological symptoms and functioning were completed before and after the 6-week programs, and 3 months following program completion. Participants also completed assessments before and after each exercise session. Multilevel modeling was used to determine whether psychological and functional outcomes (anxiety, positive and negative affect, resilience, pain, and physical and social functioning) improved for service members receiving Surf or Hike Therapy, and whether improvements differed by intervention.

Results

Study findings showed improved anxiety (p < 0.001), negative affect (p < 0.001), psychological resilience (p = 0.013), and social functioning (p < 0.001) following program participation, with no differences by intervention. Positive affect, pain, and physical functioning did not significantly improve after the program. Within sessions, positive affect (p < 0.001) and pain (p = 0.036) changed, and to a greater extent for those in the Surf Therapy condition.

Conclusion

Study results suggest that both Surf Therapy and Hike Therapy can improve psychological symptoms and social functioning impairments that commonly co-occur among service members with MDD, but Surf Therapy may provide enhanced immediate effects on positive affect and pain.

Clinical trial registration

ClinicalTrials.gov, NCT03302611.

Potential pathways of association from green space to smartphone addiction

Green space is increasingly known to improve physical and mental health. Based on these benefits, green space might also be expected to help mitigate related harmful behavioral patterns, such as obsessive Internet use and relevant addictions. In response, we conducted a study on smartphone addiction, a new form of Internet addiction. We carried out a cross-sectional investigation in August 2022. We recruited 1011 smartphone users across China, measured the Normalized Difference Vegetation Index (NDVI) in their residential neighborhoods (in 1, 2, and 3 km buffers), and captured data on smartphone addiction via the Smartphone Addiction Scale - Short version (SAS-SV). Potential mediators between green space and smartphone addiction, including physical activity, stress, and loneliness, were also reported by participants using the Physical Activity Rating Scale-3 (PRS-3), Depression, Anxiety and Stress Scale-21 Items (DASS-21), and 8-items UCLA Loneliness Scale scales (ULS-8). Multiple linear regression was employed to examine the relationships between green space and smartphone addiction. Structural equation modeling was performed to examine the potential pathways between these variables. Unexpectedly, NDVI in 1 km buffers was positively associated with smartphone addiction. By contrast, population density, an indicator of urbanization, was associated with lower levels of smartphone addiction levels in all NDVI buffer sizes. Meanwhile, we found NDVI was strongly associated with population density as well as other indicators of urbanization. Generally, our findings are unexpected and suggest that greenness may serve as an indicator of urbanization at national levels and that urbanization may buffer against smartphone addiction. During the hot summer, green space and indoor facilities may have competitive land uses, so future research should examine whether this association exists in other seasons and scenarios. We also recommend alternative models to systematically evaluate the effects of different components of residential environments.

Associations of greenspace use and proximity with self-reported physical and mental health outcomes during the COVID-19 pandemic

Research has shown that the COVID-19 pandemic affected individual's mental and physical health. The aim of this study was to estimate associations between greenspace use and proximity with perceived mental and physical health during the COVID-19 pandemic. We surveyed metropolitan Philadelphia residents, October 20-December 1, 2020, about walking time to the nearest greenspace from their home, frequency of greenspace use in the past 30 days, change in frequency of greenspace use during the COVID-19 pandemic, and perceived physical and mental health outcomes. We ran unadjusted and adjusted log-binomial regression models to derive Risk Ratio (RR) and 95% Confidence Intervals (CI) estimates of associations of loneliness, physical and mental health outcomes with: (1) self-reported walking time to nearest greenspace; (2) reported greenspace use frequency; and (3) changes in greenspace use frequency. Of 485 survey participants, 244 (51.4%) reported feeling lonelier, 147 (31.37%) reported higher perceived stress, 261 (54.9%) reported worsened mental health, and 137 (28.7%) reported worsened physical health during vs. before the start of pandemic-restrictions in mid-March of 2020. After adjustment for gender, age, and change in financial status, RR estimates suggested modest protective associations between visiting greenspaces more frequently during vs. before the pandemic and worsened mental (RR: 0.84, 95% CI: 0.70-1.00), and physical health (RR 0.77, 95% CI: 0.56-1.10), and loneliness (RR: 0.91, 95% CI: 0.75-1.1) and perceived stress (RR 0.83, 95% CI: 0.61-1.13). Shorter walking distances to the nearest greenspace were associated with reduced risk of reporting worsened physical health and higher perceived stress; however, living shorter walking distances from greenspace were not associated with protection against worsened mental health or loneliness. These results suggest that active greenspace use may provide mental and physical health protection, particularly during a stressful public health crisis.

A randomized controlled trial of surf and hike therapy for U.S. active duty service members with major depressive disorder

BACKGROUND

Major depressive disorder (MDD) is the most prevalent mental health disorder worldwide, including among U.S. service members. In addition to evidence-based treatments, activity-based approaches have been shown to effectively treat depressive symptoms, particularly when they occur in the natural environment.

METHODS

This study compared two activity-based interventions, Surf Therapy and Hike Therapy, on depression outcomes among 96 active duty service members with MDD. Participants were randomized to 6 weeks of Surf or Hike Therapy. Clinician-administered and self-report measures were completed at preprogram, postprogram, and 3-month follow-up. A brief depression/anxiety measure was completed before and after each activity session.

RESULTS

Multilevel modeling results showed that continuous depression outcomes changed significantly over time (ps < .001). Although service members in Hike Therapy reported higher average depression scores than those in Surf Therapy, the trajectory of symptom improvement did not significantly differ between groups. Regarding MDD diagnostic status, there were no significant differences between the groups at postprogram (p = .401), but Surf Therapy participants were more likely to remit from MDD than were those in Hike Therapy at the 3-month follow-up (p = .015).

LIMITATIONS

The sample consisted of service members, so results may not generalize to other populations. Most participants received concurrent psychotherapy or pharmacotherapy, and, although statistically accounted for, results should be interpreted in this context.

CONCLUSIONS

Both Surf and Hike Therapies appear to be effective adjunctive interventions for service members with MDD. Research is needed to examine the effectiveness of these therapies as standalone interventions.

TRIAL REGISTRATION

Clinical trials registration number NCT03302611; First registered on 05/10/2017.

Onsite restorative effect of a rural ecological farm versus an urban public greenery space

Accessible urban greenery allows short breaks and leisure activities while experiencing nature. Studies have shown that contact with nature elicits psychological and physical health benefits. However, the immediate impact and influence of exposure to artificial versus rural ecological nature have yet to be examined. This study investigates their psychophysiological restorative effects onsite, specifically when individuals view a ubiquitous urban public greenery space or a more indigenous ecological forest-like nature area, to compare levels of restorativeness and relaxation. Participants were asked to sit and view a scene onsite for 6 min while their facial muscle tension was recorded. The data were used to evaluate the degree of facial relaxation for both scenes. In addition, participant self-reports measured perceived restorativeness after the 6-min period. The self-reported data showed that the ecological farm scene was rated significantly higher for perceived restorativeness (t [49.136] = 9.094, p < .001) after 6 min of viewing. The muscle tension analysis showed that facial tension significantly declined when participants viewed the farm scene compared to the urban greenery space. These results, especially those on the farm, show that nature with more forest-like and rural elements elicited more powerful restorative effects and significantly lowered facial muscle tension (t [65] =  − 2.785, p < .05), thus verifying that a more ecological nature landscape provides immediate, significant health benefits through attention recovery and reduced facial muscle stress.

Forest bathing and hiking benefits for mental health during the COVID-19 pandemic in Mediterranean regions

Forest bathing (FB) has evidenced positive effects on individuals' mental health and well-being, but its benefits have mainly been studied in Asian biomes. The present study aimed to evaluate whether its benefits are also generalisable to other forests and biomes of the world, such as the Mediterranean. Eighty-six healthy adults of the general population were assessed before and after a FB near Barcelona (Spain) during the COVID-19 pandemic. A control-hiking group of participants was also analysed to contrast the FB effects on anxiety, affect, mood states and mindfulness. Results show that the guided practice of FB in Mediterranean-Catalan forests increases mindfulness states and positive affect and reduces anxiety and negative affect, with effect sizes being large to very large. Hiking also induced significant changes in all variables tested, but FB showed higher effect sizes. An exploratory analysis also revealed a different profile of the FB participants compared to the hiking practitioners, being highly educated women living in urban areas and with lower basal levels of psychological well-being. Accordingly, it is concluded that both Mediterranean FB and hiking (to a lesser degree) might be cost-effective strategies to promote and restore psychological well-being after the COVID-19 pandemic and to promote sustainable tourism in Mediterranean biomes of the European forested and protected areas.

Using Heart Rate Variability Methods for Health-Related Outcomes in Outdoor Contexts: A Scoping Review of Empirical Studies

Heart rate variability (HRV) is a psychophysiological variable that is often used in applied analysis techniques to indicate health status because it provides a window into the intrinsic regulation of the autonomic nervous system. However, HRV data analysis methods are varied and complex, which has led to different approaches to data collection, analysis, and interpretation of results. Our scoping review aimed to explore the diverse use of HRV methods in studies designed to assess health outcomes in outdoor free-living contexts. Four database indexes were searched, which resulted in the identification of 17,505 candidate studies. There were 34 studies and eight systematic reviews that met the inclusion criteria. Just over half of the papers referenced the 1996 task force paper that outlined the standards of measurement and physiological interpretation of HRV data, with even fewer adhering to recommended HRV recording and analysis procedures. Most authors reported an increase in parasympathetic (n = 23) and a decrease in systematic nervous system activity (n = 20). Few studies mentioned methods-related limitations and challenges, despite a wide diversity of recording devices and analysis software used. We conclude our review with five recommendations for future research using HRV methods in outdoor and health-related contexts.

Restorative effect of audio and visual elements in urban waterfront spaces

Introduction

Urban waterfront spaces are often composed of built infrastructures and nature elements. Though citizens could take advantage of these public spaces to relax from daily work, its restorative potential has not been paid enough attention. In this study, the restorative effect and mechanism of different audio and visual elements in urban waterfront spaces was systematically studied.

Methods

At the first stage, restorative potential of waterfront spaces was investigated and different elements with restorative effects were identified through an on-site survey, in which visual and auditory forms of environmental-nature, animal-nature, on-water human activities and on-shore human activities were identified. At the second stage, a series of laboratory experiments were conducted to explore the restorative function of the audio and visual elements.

Results and discussion

It is found that the degree of artificiality of waterfront space was a crucial factor influencing the restoration level of the space, and higher artificiality level of waterfront space resulted in lower level of perceived restoration. However it was available by adding visual and audio elements to the scene to facilitate the restorative effect in waterfront spaces with high-level artificiality. The effects of adding visual and auditory elements on psychophysiological restoration were explored, and elements that should be recommended and restrained were discussed.

Prospects

These findings would provide applicable suggestions for future design and rebuilding of urban waterfront spaces.

Effects of Urban Forest Therapy Program on Depression Patients

Depression is a common serious mental health condition that can have negative personal and social consequences, and managing it is critical for treating depression patients. Forest therapy is emerging as a promising non-pharmacological intervention to improve mental health. However, although the effectiveness of forest therapy programs using forests far from the city has been proven, it is not well known that urban forests can be easily accessed in daily life. Therefore, this study aimed to examine the effects of an urban forest therapy program on depression symptoms, sleep quality, and somatization symptoms of depression patients. To evaluate this, a randomized controlled trial (RCT) design was employed. A total of 47 depression patients participated in this study (22 in the urban forest therapy program group and 25 in the control group). The Beck Depression Inventory (BDI), the Hamilton Rating Scale for Depression (HRSD), the Pittsburgh Sleep Quality Index (PSQI), and the Patient Health Questionnaire-15 (PHQ-15) were administered to each participant to assess the effects of the urban forest therapy program. The results of this study revealed that depression patients in the urban forest therapy program had significantly alleviated depression symptoms and improved sleep quality and somatization symptoms compared to the control group. In conclusion, this study demonstrates the possibility that the urban forest therapy program could be used as an effective non-pharmacological treatment to alleviate depression disorder.

Is altitude a determinant of the health benefits of nature exposure? A systematic review and meta-analysis

Introduction

Nature exposure is a widely accepted option for promoting public health owing to the recent surge of scientific evidence. However, the actual settings to facilitate this initiative is yet to be extensively reviewed. In this systematic review, we have aimed to provide an up-to-date summary of interventional studies investigating the psycho-physiological effects of forests and urban forests, including details on their physical settings, and investigate an effect-modifying role of altitude and summarize data on the magnitude and shape of the association.

Methods

A keyword search using five electronic academic databases (PubMed, Embase, PsycINFO, Web of Science, and Scopus) was conducted to identify relevant articles published in English from the inception year to the end of February 2022. The methodological quality was evaluated using the ROBINS-I or ROB2 tool, depending on the study design. Meta-regression and random effects model were jointly used to examine the relationship between altitude and health outcomes.

Results

We included 27 eligible studies and 31 cases extracted from 19 studies were used for the meta-analysis. In the meta-regression, we observed a non-linear association between altitude and psycho-physiological effects. Altitude had a positive quadratic association with anxiety (p < 0.000, adjusted R ² = 96.79%), depression (p < 0.000, adjusted R ² = 98.78%), and fatigue (p < 0.000, adjusted R ² = 64.74%) alleviating effects. Conversely, altitude demonstrated a negative non-linear association with the blood pressure-lowering effect (p = 0.009, adjusted R ² = 32.83%). Additionally, the thermal index (THI) and illuminance (lx) levels were significantly associated with effect sizes of psychological restoration.

Discussion

This review provides moderate-certainty evidence for an effect-modifying role of altitude. The meta-regression results suggested the optimal and minimal altitude ranges for psychological restoration and physiological relaxation, respectively. Despite some limitations, the study findings provide a significant basis for utilizing altitude, which is easily accessible and simple, to promote the health benefits of nature-based initiatives.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022310894, identifier: CRD42022310894.

Influence of Comprehensive Lifestyle Intervention (LSI) Program on Health, Fatigue, and Quality of Life in Middle-Aged Women

Background

Middle age is one of the most important times in a woman's life, and it is a time when multiple changes occur that affect the body and health. The study aimed to investigate the efficacy of a comprehensive lifestyle intervention (LSI) program, including stress management, on middle-aged women's physical, physiological, and mental health.

Methods

A total of 40 middle-aged women participated in a short-term LSI program, nutrition, exercise, and mental and physical management with various experiential activities. Physical measurements, biochemical indicators, stress hormones, chronic fatigue, and quality of life indicators were evaluated to interpret the clinical efficacy of the program.

Results

LSI program significantly improved satisfaction and quality of life in participants. Total chronic fatigue scores reduced significantly compared to scores before the start of the program. Moreover, fat mass and body fat were reduced without loss of muscle mass. Further, blood pressure and triglyceride levels significantly decreased after completing the LSI program. However, changes in stress hormone levels remained insignificant.

Conclusion

Adoption of LSI in middle-aged women demonstrated positive implications of the program. LSI efficiently regulates body fat, fat mass, fatigue, hypertension, and triglyceride levels which play a critical role in determining the quality of life. Thus, the LSI program could spread healthy lifestyles among middle-aged women.

Urban greenspace and anxiety symptoms during the COVID-19 pandemic: A 20-month follow up of 19,848 participants in England

This study examined the association between greenspace and the growth trajectories of anxiety symptoms during the COVID-19 pandemic. Using data from 19,848 urban residents in England who were followed for 20 months between March 2020 and October 2021, we found that living in an area with higher greenspace coverage (exposure) was associated with fewer anxiety symptoms independent of population density, area deprivation levels, socio-demographics, and health profiles. There was limited evidence that greenspace was related to the change of anxiety symptoms over time. No association with anxiety trajectories was found when considering distance to nearest greenspace (proximity), highlighting potentially differential mental health effects of simply having access to local parks and recreation areas versus living in areas of greater natural environment land cover. These findings have important implications for mental health intervention and policymaking.

Designing Multifunctional Urban Green Spaces: An Inclusive Public Health Framework

Evidence of the wide range of health benefits associated with the use of urban green space (UGS) continues to grow. Despite this evidence, many UGS designs do not adopt a community-inclusive approach that utilizes evidence-based public health strategies to maximize potential health benefits. This research focused on testing a multidisciplinary, community-involved public health framework to drive the UGS design process. The aim of this study was to use community feedback and evidence-based public health practices to promote physical health, psychological wellbeing, and social cohesion by creating a multifunctional UGS that enhances nature therapy, natural play, and sports and recreation. Community health assessment data (236 survey responses), community forum and survey feedback (157 survey responses), local urban green space inventory assessment, and environmental assessment and impact data were analyzed to develop a design plan that maximize the greatest potential health benefits for the greatest proportion of the population. Community health data indicated a strong relationship between the availability of places to be physically active in the community and higher ratings of mental (aOR = 1.80) and physical (aOR = 1.49) health. The creation and utilization of the proposed community-inclusive and public health-focused framework resulted in a UGS design that prioritized the needs of the community and provided evidence-informed strategies to improve the health of local residents. This paper provides unique insight into the application of a framework that promotes a more health-focused and functional approach to UGS design.

Effects of forest bathing (shinrin-yoku) on individual well-being: an umbrella review

The aim of this review was to outline the most relevant benefits of forest bathing for well-being promotion. This study was designed as an umbrella literature review. Medline (via PubMed), EMBASE, Web of Science, Cochrane Library, Google Scholar, Scopus, PsycINFO, CINAHL and the DOAJ were systematically searched for relevant reviews up to February 2021. After article selection, 16 systematic reviews met inclusion criteria. Overall, the best available evidence supports the use of forest bathing as a complementary practice for the promotion of psychophysical well-being, whereas evidence for its use as a therapeutic practice for the improvement of organic diseases needs to grow before clear and specific clinical indications can be formulated. The positive impact of forest bathing on individual quality of life, along with its favorable cost-effectiveness profile, may justify its possible adoption for public health strategies of well-being promotion. Further investigations on the topic are advised.

Impact of Contact With Nature on the Wellbeing and Nature Connectedness Indicators After a Desertic Outdoor Experience on Isla Del Tiburon

Nature connectedness is determined by the representation individuals have about themselves within nature. This concept is often studied in relation to the direct contact individuals have with natural environment, which according to some studies have demonstrated to generate positive effects by fostering a feeling of connecting and bonding with nature, as well as improving their wellbeing. The main focus of this study was to calculate and assess the relation between Nature Connectedness and wellbeing of participants. The methodological approach of this research reaches quantitative data comparing results obtained from both samples, as well as correlations between the variables. The sample for this study was composed by two groups of university students (M = 25 years old). Both contrast group (n = 32) and experience group (n = 29) filled the questionnaire in two separate moments and in different environments. First data collection moment for both groups was held inside a university classroom. A second moment of data collection was carried out after a month from the first application, having the contrast group answer the questionnaire on a classroom again whilst the experience group responded it during an excursion to Isla Del Tiburon in Northwestern Mexico after performing some recreational activities being totally immersed in a local desertic environment. Questionnaire was composed by a 6 point Likert type scale measuring Nature Connectedness through concepts such as Nature relatedness and Love and care for the natural, as well as Subjective and Psychological Wellbeing of participants. Results show that both wellbeing and Nature Connectedness are positively influenced by performing activities out in the natural environment. This work was also conducted in response to the need to understand the full extent of Contact and Connectedness to nature, carrying out an exploratory study in desertic settings when much of the early work centers around the study of these variables in green nature environments.

Effect of Indoor Forest Bathing on Reducing Feelings of Fatigue Using Cerebral Activity as an Indicator

We created an indoor forest bathing environment in a sunlight-type environmentally controlled chamber and both physiological and psychological measurements were conducted for the evaluation of mental fatigue reduction. At first, a working memory load experiment was performed among 10 participants in a space without plants to identify an indicator correlating with feelings of fatigue, using the cerebral activity of the prefrontal cortex. Then, the indicator was used to evaluate whether a 20-min exposure to an indoor forest bathing environment reduced the level of the feeling of fatigue. The working memory load experiment demonstrated that, when mental fatigue increased, the amount of oxygenated hemoglobin (oxy-Hb) in the right prefrontal cortex and the right-left difference in oxy-Hb (ΔRL oxy-Hb) in the prefrontal cortex increased. These were proposed as indicators of mental fatigue. In the indoor forest bathing experiment, staying in an indoor green space showed that the subjective values of feeling of fatigue decreased and ΔRL oxy-Hb decreased. Since these results demonstrated an opposite effect to the increase in ΔRL oxy-Hb related to the feeling of fatigue, it was inferred that the decrease in ΔRL oxy-Hb reflected the fatigue reduction in the indoor forest bathing environment.

Multi-Dimensional Evaluation Framework for the Sustainable Development of Forest Health Bases and Site Selection for Application in China

In the context of global aging, people’s awareness of health is deepening, and the rapid economic development has drawn widespread attention to the health tourism industry. As a way of experiencing health, forest health tourism is becoming increasingly favored, and the site selection and construction of forest health bases (FHBs) have also developed accordingly. To ensure sustainability in the process of the site selection and construction of FHBs, the suitability of regional development and the relative coordination of the market, environment, and resource levels should be considered. Although there have been numerous studies on sustainable forestry management, a comprehensive sustainability assessment framework based on development suitability and coordination in three dimensions is needed to guide the site selection and the construction of FHBs. The following tasks were carried out in this study: (1) based on market sustainability goals, environmental optimization goals, and ecological resource sustainability goals, a comprehensive sustainability evaluation framework for development suitability indicators and coordination indicators in three dimensions was established; (2) via the use of this framework, the construction potential of FHBs in 41,636 towns in China was evaluated; the evaluation results show that the towns in Anhui, Jiangxi, Guangdong, Guangxi, Fujian, Zhejiang, Hunan, Hubei, Guizhou, and other provinces of China generally have superior conditions for the development of FHBs; (3) a multi-dimensional comprehensive analysis of FHB site selection sustainability based on development suitability and coordination was carried out for four batches of approved pilots. The comprehensive analysis results demonstrate the worsening evaluation results of the four batches. The proposed framework can provide a reference for FHB development policies for countries worldwide.

The impact of restorative green environment on mental health of big cities and the role of mental health professionals

PURPOSE OF REVIEW

To provide an update on insights into the effectiveness of the green environment and forest on the mental health of city dwellers; and the role of mental health professionals in advocating green restorative therapies.

RECENT FINDINGS

The studies reviewed in this paper confirmed the mental health benefits on individuals who engaged in the green environment and forest. Results of studies showed that the participants reported significantly higher positive effects. However, it is difficult to compare studies because of marked differences in methodology and often lack of biological markers. With the recent global concern about climate warming, mental health professionals have a critical role to influence city planners on the importance of the green environment and the forest. In Singapore, the 'Therapeutic Garden' project and 'Therapeutic Rainforest' program are examples of mental health professionals working with government agencies for a 'city in nature'.

SUMMARY

The benefits of the green environment and forest are emphasized especially on the psychological well being. In the light of the danger of climate warming, this review highlights the need for city planners to collaborate with mental health professionals to incorporate high-quality green spaces when planning the city of the future. There is an urgent need for better consultation between health agencies and local city government to create an appealing and diverse green environment within the city.

Forest Bathing Is Better than Walking in Urban Park: Comparison of Cardiac and Vascular Function between Urban and Forest Parks

Forest bathing is beneficial for human health. To investigate whether walking in forest or urban parks affects cardiovascular functions (CVFs), the present study was conducted in five forest trails in the Xitou Experimental Forest and in five urban parks in Taipei city. We recruited 25 adult volunteers for an observational pilot study in forest parks (n = 14) and urban parks (n = 11). CVFs were assessed by measuring the arterial pressure waveform using an oscillometric blood pressure (BP) device. The baseline and paired differences of systolic BP (SBP), central end SBP, heart rate, left ventricle (LV) dP/dt max and cardiac output in participants were lower before and after walking in a forest park than those in an urban park. In addition, the systemic vascular compliance and brachial artery compliance of those who walked in a forest park were significantly higher compared with those in an urban park. Linear mixed models demonstrated lower levels of SBP by 5.22 mmHg, heart rate by 2.46 beats/min, and cardiac output by 0.52 L/min, and LV dP/dt max by 146.91 mmHg/s among those who walked in forest compared to those in an urban park after controlling covariates. This study provides evidence of the potential beneficial effects of walking exercise in forest parks on CVFs.

Workplace greenspace exposure and the change in dimensions of mood states: an experimental study in Taiwan

Changes in the dimensions of psychological health in relation to workplace greenspace exposure and its relationship with job stress was not yet fully revealed. A neighboring park of the workplace and a forest were chosen to represent experimental stimuli and the control, respectively. The experiment was conducted in March 2021 in Taiwan, using a virtual reality. Results show that negative emotions decreased in the post-test in both environment settings. However, positive emotion increased only after exposure to the forest (t=-3.88, p < .001). After virtually visiting the workplace greenspace, depression in the high stress group decreased significantly (t = 3.48 , p < .01) while the counterpart did not exhibit any significant change. Based on the interviews, participants only indicated stressful elements of the workplace greenspace video, despite the video also contained natural elements. Topics related to work decreased feelings of being away. Greenspace in a work context should be carefully designed to avoid the stressful elements.

A tranquil virtual reality experience to reduce subjective stress among COVID-19 frontline healthcare workers

OBJECTIVE

The novel coronavirus-19 (COVID-19) has taken an immense physical, social, and emotional toll on frontline healthcare workers. Research has documented higher levels of anxiety, depression, and burnout among healthcare workers during the pandemic. Thus, creative interventions are needed now more than ever to provide brief, accessible support to frontline workers. Virtual reality is a rapidly growing technology with potential psychological applications. In this study, we piloted a three-minute Tranquil Cinematic-VR simulation of a nature scene to lower subjective stress among frontline healthcare workers in COVID-19 treatment units. We chose to film a nature scene because of the extensive empirical literature documenting the benefits of nature exposure and health.

METHODS

A convenience sample of frontline healthcare workers, including direct care providers, indirect care providers, and support or administrative services, were recruited from three COVID-19 units located in the United States. Inclusion criteria for participation included adults aged 18 years and older who could read and speak in English and were currently employed by the healthcare system. Participants viewed a 360-degree video capture of a lush, green nature preserve in an Oculus Go or Pico G2 4K head-mounted display. Prior to viewing the simulation, participants completed a brief demographic questionnaire and the visual analogue scale to rate their subjective stress on a 10-point scale, with 1 = 'Not at all stressed' to 10 = 'Extremely stressed.' We conducted paired t-tests to examine pre- and post-simulation changes in subjective stress as well as Kruskal-Wallis tests and Mann-Whitney U tests to examine differences by demographic variables. All analyses were conducted in SPSS statistical software version 28.0. We defined statistical significance as a p-value less than .05.

RESULTS

A total of 102 individuals consented to participate in the study. Eighty-four (82.4%) participants reported providing direct patient care, 73 (71.6%) identified as women, 49 (48.0%) were between the ages of 25-34 years old, and 35 (34.3%) had prior experience with VR. The pre-simulation mean stress score was 5.5±2.2, with a range of 1 to 10. Thirty-three (32.4%) participants met the 6.8 cutoff for high stress pre-simulation. Pre-simulation stress scores did not differ by any demographic variables. Post-simulation, we observed a significant reduction in subjective stress scores from pre- to post-simulation (mean change = -2.2±1.7, t = 12.749, p < .001), with a Cohen's d of 1.08, indicating a very large effect. Further, only four (3.9%) participants met the cutoff for high stress after the simulation. Post-simulations scores did not differ by provider type, age range, gender, or prior experience with virtual reality.

CONCLUSIONS

Findings from this pilot study suggest that the application of this Tranquil Cinematic-VR simulation was effective in reducing subjective stress among frontline healthcare workers in the short-term. More research is needed to compare the Tranquil Cinematic-VR simulation to a control condition and assess subjective and objective measures of stress over time.

Environmental heterogeneity in human health studies. A compositional methodology for Land Use and Land cover data

The use of Land use and Land cover (LULC) data is gradually becoming more widely spread in studies relating the environment to human health. However, little research has acknowledged the compositional nature of these data. The goal of the present study is to explore, for the first time, the independent effect of eight LULC categories (agricultural land, bare land, coniferous forest, broad-leaved forest, sclerophyll forest, grassland and shrubs, urban areas, and waterbodies) on three selected common health conditions: type 2 diabetes mellitus (T2DM), asthma and anxiety, using a compositional methodological approach and leveraging observational health data of Catalonia (Spain) at area level. We fixed the risk exposure scenario using three covariates (socioeconomic status, age group, and sex). Then, we assessed the independent effect of the eight LULC categories on each health condition. Our results show that each LULC category has a distinctive effect on the three health conditions and that the three covariates clearly modify this effect. This compositional approach has yielded plausible results supported by the existing literature, highlighting the relevance of environmental heterogeneity in health studies. In this sense, we argue that different types of environment possess exclusive biotic and abiotic elements affecting distinctively on human health. We believe our contribution might help researchers approach the environment in a more multidimensional manner integrating environmental heterogeneity in the analysis.

Sociodemographic Determinants of Poles' Attitudes towards the Forest during the COVID-19 Pandemic

Attitudes towards forest ecosystems have been changing together with human needs, which is amplified with society's increasing need to spend recreation time in the forest. The phenomenon has been particularly visible during the COVID-19 pandemic. The aim of this study was to determine the attitude of Poles to forests during the COVID-19 pandemic. The research was based on (1) a sociodemographic background questionnaire that consisted of questions about the independent variables and (2) the LAS scale-an independently prepared tool for measuring attitudes towards the forest. In the survey, 1025 people participated (673 women). The age of the subjects was between 19 and 68. The attitude towards the forest was analysed in three dimensions: Benefits, Involvement, and Fears. The Mann-Whitney U test and Kruskal-Wallis one-way analysis of variance by ranks were used for statistical analysis. Women and people with primary education expressed the most fears connected with going to the forest. Men and people living in the countryside and in small towns, as well as respondents who were professionally active and performing work connected with forests were the most involved in exploring the forest and working for its benefit. Concerning the forest, concerned women, people from the highest age group, respondents with university education, and white-collar workers notice the most benefits from recreational activities in the forest.

Assessing the Effects of Nature on Physiological States Using Wearable Technologies

Nature therapy and forest bathing (FB) have been shown to have quantifiable positive effects on human health, but the physiological effects of a guided interactive nature activity remain unexplored. Autonomic nervous system responses to a guided nature walk (Nature Break) were assessed through the continuous measurement of the electrodermal activity (EDA), fingertip temperature, and heart rate (HR) of n = 48 participants, using a wearable sensor. Psychological distress was assessed before and after the activity using the Profile of Mood States (POMS) for n = 38 (24 females, 14 males, mean age = 43.55 ± 11.61 years) participants. The negative dimensions of POMS decreased and the positive (vigor) dimensions increased following a Nature Break. Significant differences were found across all of the physiological features, with some differences occurring between the morning and afternoon groups and between different days. The participants' mean HR decreased throughout the Nature Break. Our results suggest that interactive nature activities have positive psychological benefits and demonstrate the feasibility of using wearable sensors to monitor physiological responses in a naturalistic forest bathing activity.

Exploring the Physiological and Psychological Effects of Digital Shinrin-Yoku and Its Characteristics as a Restorative Environment

This study investigated the physiological and psychological therapeutic effects of a digital Shinrin-yoku environment constructed indoors in an urban facility as well as the characteristics of the environment that contribute to restorativeness (restorative traits). We measured the fluctuations in the physical and mental states of 25 subjects by obtaining both before–after measurements and continuous measurements while exposed to a digital Shinrin-yoku environment that reproduced visual, auditory, and olfactory elements. The results demonstrated that the parasympathetic nerve activity was significantly increased and that the heart rate was significantly decreased during the exposure compared with that during the resting state. As for mood, five of the six Profile of Mood States (POMS) scales (“Tension–Anxiety,” “Depression,” “Anger–Hostility,” “Fatigue,” and “Confusion”) were significantly decreased after the experience. In addition, psychological restorative effects were also confirmed, with a significant decrease in “negative affect” (measured using the Positive and Negative Affect Schedule (PANAS)) and a significant increase in the sense of restorativeness (Restorative Outcome Scale (ROS)) after the experience. In contrast, comparing the digital Shinrin-yoku environment with the actual forest environment and the urban environment using POMS, PANAS, ROS, and Perceived Restorativeness Scale (PRS), the psychological effects and environmental traits of the digital Shinrin-yoku were found to be considerably similar to those of the actual forest environment.

The role of campus greenspace and meditation on college students' mood disturbance

Objective To determine whether students who engage in a sedentary task in an urban park-like setting experience improved mood and whether this effect is moderated by mindfulness meditation. Participants: 234 (133 females) undergraduate students, who either engaged in outdoor recreation frequently or infrequently. Methods: Participants engaged in 20 minutes of mindfulness meditation or a control task, either in a campus park-like setting or in a quiet room indoors. Before and after the activity, total mood disturbance (TMD) was assessed with the Profile of Mood States Questionnaire. Results: Being outside or meditating reduced TMD for those who frequently recreated outside. Those who infrequently recreated outside experienced decreased TMD if they meditated inside and increased TMD if they did not. When outside, TMD decreased regardless of activity. Conclusions: Spending time outside and practicing meditation may be effective approaches for improving college students' mental health, particularly for students who infrequently go outside.

Market Segmentation by Motivations of Urban Forest Users and Differences in Perceived Effects

The purpose of this study aims at segmenting the urban forest users' market by motivation and analyzing the difference in perceived effects of urban forests. Based on a literature review, the study selected seven motivating factors of urban forest users: experiential activity, relaxatin/healing, health management, escape from everday life, daily leisure, affinity toward nature. Data were collected online from 21 to 29 Sepember 2020 with urban forest visitors. We analyzed 878 questionnaires received from those with experience of visiting an urban forest within the previous 24 months. We performed a cluster analysis to classify the subjects according to the characteristics of urban forest utilization, and assigned them to four clusters (rest in nature, family leisure, passive participation, and multiple pursuit). An additional analysis was performed to determine intergroup differences, which revealed differences in perceived benefits and healing effects of urban forests as well as satisfaction. The results of this study provide implications for urban forest operation and strategy setup.

Effect of Forest Therapy on Depression and Anxiety: A Systematic Review and Meta-Analysis

This systematic review and meta-analysis aimed to summarize the effects of forest therapy on depression and anxiety using data obtained from randomized controlled trials (RCTs) and quasi-experimental studies. We searched SCOPUS, PubMed, MEDLINE(EBSCO), Web of science, Embase, Korean Studies Information Service System, Research Information Sharing Service, and DBpia to identify relevant studies published from January 1990 to December 2020 and identified 20 relevant studies for the synthesis. The methodological quality of eligible primary studies was assessed by ROB 2.0 and ROBINS-I. Most primary studies were conducted in the Republic of Korea except for one study in Poland. Overall, forest therapy significantly improved depression (Hedges’s g = 1.133; 95% confidence interval (CI): −1.491 to −0.775) and anxiety (Hedges’s g = 1.715; 95% CI: −2.519 to −0.912). The quality assessment resulted in five RCTs that raised potential concerns in three and high risk in two. Fifteen quasi-experimental studies raised high for nine quasi-experimental studies and moderate for six studies. In conclusion, forest therapy is preventive management and non-pharmacologic treatment to improve depression and anxiety. However, the included studies lacked methodological rigor and required more comprehensive geographic application. Future research needs to determine optimal forest characteristics and systematic activities that can maximize the improvement of depression and anxiety.

Association between forest and greenspace walking and stress-coping skills among workers of Tsukuba Science City, Japan: A cross-sectional study

Objectives

Study design

Methods

Results

Conclusions

•

“Sense of coherence” (SOC) as a concept of stress-coping, has been gaining attention.

•

There is little evidence about the associations between SOC and habits that are easy to perform in everyday life.

•

Forests occupy 67% of the landmass and greenspace has been increasing every year in Japan.

•

Forest/greenspace walking may enhance stress-coping skills.

Evidence-Based Status of Forest Healing Program in South Korea

Various effects of forest healing on health have been reported, but a certification system to assess the effectiveness of forest healing programs does not exist. In this study, a systematic review (SR) on the "health benefits of forests" and "meta-analysis of forest therapy" was conducted after analyzing the status and level of evidence of 75 forest healing programs that were conducted post-certification in South Korea. The SR for "health benefits of forests" distinguished between activities and time, resulting in 90.9% of walking activities for more than an hour under psychological health, and 100.0% of exercise activities for less than an hour under physiological health. However, the effect of indirect activities performed for more than an hour was unknown. Thus, we confirmed that many indoor activities in the field had low effect size or no established basis regarding the feasibility of its operation. The SR on "meta-analysis of forest therapy" to check whether the program was effective. The highest number of healing effects were obtained for blood pressure (32), followed by psychological depression (24). The findings of this can serve as baseline data to facilitate future development and dissemination of evidence-based forest healing programs.

The Role of Social Context in Physiological and Psychological Restoration in a Forest: Case Study of a Guided Forest Therapy Program in Taiwan

Existing studies have demonstrated the restorative benefits of being in forests. However, most studies have designed participants to engage individually in forest walking and viewing, which neglects the social aspect of conversation. Researchers suggested that social context should be studied in order to have a better understanding how forests foster human health. To this end, we examined the role of social context using three types of forest therapy programs: a guided program, a self-guided program, and a walk alone program. A between-subject, pretest–posttest field experimental design was employed to evaluate restorative effects by measuring the physiological responses and mood states incurred in different forest therapy programs. Our findings showed, that the walk alone group exhibited a significant systolic blood pressure decrease and a significant increase in sympathetic nervous activity; the self-guided group showed a significant increase in heart rate values and significant decreases in systolic blood pressure and diastolic blood pressure; and the guided group revealed a significant decrease in systolic blood pressure. Further, the three forest therapy programs had positive effects on improving mood states, except a nonsignificant vigor–activity increase in the walk alone group. The three programs did not exhibit significant differences in changes of restorative benefits in physiological and psychological measures except for a significant difference in changes in sympathetic nervous activity between the walk alone group and guided group. The results showed the restorative benefits of forest therapy are apparent regardless of the program type. The management team should continue promoting forest therapy for public health by providing different types of forest therapy programs and experiences.

Non-Pharmacological Measures in the Prevention and Treatment of COVID-19 Infection

BACKGROUND

Previous pandemic and catastrophic events significantly changed the life of every human being, bringing him/her into a state of stress and the need to quickly adapt to new ways of daily activity. COVID-19 has a negative impact on all elements of health: social, physical and mental. Pharmacotherapy, as well as protective measures (isolation, wearing masks and maintaining physical distance) did not give the expected results. Vaccination has not yet led to herd immunity, so it is still jeopardizing every aspect of human health (1, 2). Non-pharmacological methods, such as stress and sleep control, physical activity and contact with nature are of great importance since they can significantly contribute to staying healthy during a pandemic.

OBJECTIVES

The aim of this paper is to evaluate the impact of non-pharmacological measures such as stress and sleep control (with different measures against the negative effects of anxiety and depression on mental state) and the possible positive impact of "forest bathing" on improving the immune response to the virus and its consequences.

METHODS

Available evidence-based studies on ways to com- bat stress and the effect of the proposed measures on human mental health and the im- mune system were analyzed. From the mentioned studies, recommended measures have been registered, which refer to stress and sleep control, diet and eating habits, contact with nature ("forest bathing", gardening), virtual communication and meditation (mindfulness practice).

RESULTS AND DISCUSSION

The combined results of these studies indicate that COVID-19 has a chronic course and complications that significantly affect the physical, mental and emotional state of the patient. Proven positive effects of non-pharmacological measures can be applied in the daily practice of primary health care in the comprehensive fight against the COVID-19 pandemic.

CONCLUSION

Non-pharmacological measures such as stress and sleep control, spending time in nature, healthy diet, and physical activity may improve the immune response to COVID-19. These measures, with their positive effects on all aspects of health, can make a major contribution to controlling and improving the quality of life during the COVID-19 pandemic.

Forest Therapy Alone or with a Guide: Is There a Difference between Self-Guided Forest Therapy and Guided Forest Therapy Programs?

There are generally two types of forest therapy. One is to walk or view the forest alone without a guide, and the other is to be accompanied by a guide. This study aimed to investigate the healing factors and health benefits of self-guided forest therapy and guided forest therapy programs and examine the differences in characteristics between interventions. Thirty-seven undergraduate students participated in a randomized experiment (19 in the self-guided forest therapy and 18 in the guided forest therapy program). Data were collected from 111 self-reported essays after each intervention (three essays per person). Results revealed that the forest healing factors contained four categories in common: auditory element, visual element, tactile element, and olfaction element. Forest therapy's health benefits included five categories in common: change of mind and body, introspection, change of emotion, cognitive change, and social interaction. Among the typical differences, the self-guided forest therapy group mentioned more keywords related to introspection than the guided forest therapy program group. On the other hand, the guided forest therapy program group mentioned more keywords associated with the change of emotion and social interaction than the self-guided forest therapy. Our findings show that self-guided forest therapy provides an opportunity for self-reflection to focus on and think about one's inner self. On the other hand, guided forest therapy programs provide positive emotional changes and promoting social bonds through interaction with others. Therefore, because the effects that can be obtained vary depending on the type of forest therapy, participants can utilize forest healing to suit the desired outcomes.

Influence of Forest Visitors' Perceived Restorativeness on Social-Psychological Stress

This study was conducted to verify the perceived restorativeness of citizens visiting forests on social-psychological stress and psychological resilience according to forest space type. The study involved a questionnaire survey conducted on citizens who visited forests between 1 May and 15 July 2020, when social distancing in daily life was being implemented. Three types of forest spaces (urban forest, national park, and natural recreation forest) were selected for the survey. They used the survey results of 1196 people as analysis data for this study. In this study, the PRS (Perceived Restorativeness Scale) and the PWI-SF (Psychosocial Well-being Index Short Form) were used to evaluate perceived restorativeness and social-psychological stress of citizens visiting forests. In the study, the average score of visitors' perceived restorativeness was 5.31 ± 0.77. Social-psychological stress was found in the healthy group, potential stress group, and high-risk group. These groups made up 8.0%, 82.5%, and 9.5% of the respondents, respectively. Pearson's correlation analysis between perceived restorativeness and social-psychological stress revealed that the higher the perceived restorativeness, the lower the social-psychological stress. "Diversion Mood", "Not bored", and "Coherence", which are the sub-factors of perceived restorativeness according to the forest space type, were found to have meaningful results for psychological resilience. However, there was no significant difference in the forest space type between "Compatibility" and social-psychological stress, which are sub-factors of perceived restorativeness. In conclusion, the forest space type affects the psychological resilience of those who visit the forest. Urban forests, national parks, and natural recreation forests are places to reduce stress.

Forest Manners Exchange: Forest as a Place to Remedy Risky Behaviour of Adolescents: Mixed Methods Approach

This paper evaluates the impact of the forest environment on aggressive manifestations in adolescents. A remedial educative programme was performed with 68 teenagers from institutions with substitute social care with diagnoses F 30.0 (affective disorders) and F 91.0 (family-related behavioural disorders), aged 12–16 years. Adolescents observed patterns of prosocial behaviour in forest animals (wolves, wild boars, deer, bees, ants, squirrels and birds), based on the fact that processes and interactions in nature are analogous to proceedings and bonds in human society. The methodology is based on qualitative and quantitative research. Projective tests (Rorschach Test, Hand Test, Thematic Apperception Test) were used as a diagnostic tool for aggressive manifestations before and after forest therapies based on Shinrin-yoku, wilderness therapy, observational learning and forest pedagogy. Probands underwent 16 therapies lasting for two hours each. The experimental intervention has a statistically significant effect on the decreased final values relating to psychopathology, irritability, restlessness, emotional instability, egocentrism, relativity, and negativism. Forest animals demonstrated to these adolescents ways of communication, cooperation, adaptability, and care for others, i.e., characteristics without which no community can work.

Associations between Nature Exposure and Health: A Review of the Evidence

There is extensive empirical literature on the association between exposure to nature and health. In this narrative review, we discuss the strength of evidence from recent (i.e., the last decade) experimental and observational studies on nature exposure and health, highlighting research on children and youth where possible. We found evidence for associations between nature exposure and improved cognitive function, brain activity, blood pressure, mental health, physical activity, and sleep. Results from experimental studies provide evidence of protective effects of exposure to natural environments on mental health outcomes and cognitive function. Cross-sectional observational studies provide evidence of positive associations between nature exposure and increased levels of physical activity and decreased risk of cardiovascular disease, and longitudinal observational studies are beginning to assess long-term effects of nature exposure on depression, anxiety, cognitive function, and chronic disease. Limitations of current knowledge include inconsistent measures of exposure to nature, the impacts of the type and quality of green space, and health effects of duration and frequency of exposure. Future directions include incorporation of more rigorous study designs, investigation of the underlying mechanisms of the association between green space and health, advancement of exposure assessment, and evaluation of sensitive periods in the early life-course.

The Influence of Forest Activities in a University Campus Forest on Student's Psychological Effects

This study aimed to examine the psychological effects of forest activities in a campus forest. A pre-test and post-test control group design was employed to evaluate the psychological effect of forest activities in a campus forest. A total of 38 participants participated in this study (19 in the forest activities group; 19 in the control group). The Profile of Mood State (POMS) questionnaire, the Concise Measure of Subjective Well-Being (COMOSWB), and the modified form of the Stress Response Inventory (SRI-MF) were administered to each participant to assess psychological effects. This study revealed that participants in the forest activities intervention group had significantly positive increases in their mood, stress response, and subjective well-being, comparing with those of control group participants who did not partake in any forest activities. In conclusion, the implementation of forest activities in a campus forest is an efficient strategy to provide psychological well-being benefits to college students.

Effect of exercise in a desert environment on physiological and subjective measures

Green exercise is beneficial to emotional and physiological measures, however, the US has large desert areas. We aimed to determine if exercise in a desert (brown) environment extends similar benefits to green. Participants (N = 10) completed baseline measures (PRE), 30-min seated rest (SIT), and 30-min self-paced walking (WALK) in: indoor, outdoor urban, green, and two brown environments. Heart rate (HR), blood pressure (BP), and measures of stress, comfort, and calm were obtained. After SIT, HR was elevated in urban vs green (p = 0.05). Systolic BP was lower after SIT compared to PRE and WALK (p = 0.05). Brown and green returned greater comfort and calm scores (p = 0.001). Stress was lower following WALK than PRE and SIT (p < 0.01). Comfort and calm were greatest in natural environments, and exercise significantly reduced perceived stress. Taken together, these data provide evidence that exercise in a desert environment is just a beneficial as the exercise performed in a green environment. Abbreviations: ANCOVA: analysis of covariance; ANOVA: analysis of variance; AU: arbitrary units; BP: blood pressure; BSL: below sea level; DBP: diastolic blood pressure; HR: heart rate; PRE: baseline measurement; PS: perceived stress; SBP: systolic blood pressure; SIT: measurement following 30-min seated rest; WALK: measurement following 30-min self-paced walking.