Effects of forest bathing on pre-hypertensive and hypertensive adults: a review of the literature

Scenting serenity: influence of essential-oil vaporization on dental anxiety - a cluster-randomized, controlled, single-blinded study (AROMA_dent)

Dental fear and anxiety (DFA) is known as an immense challenge in oral healthcare, which can result in compromised oral health, pain, and uncomfortable treatment. The objective of this study was to analyze the effect of essential-oil vaporization on acute anxiety of patients in dental practices. Four dental practices used five weekly cycles of vaporization with each scent: Orange (Citrus sinensis), Swiss Pine (Pinus cembra), Good Mood (blended essential oils: Citrus sinensis, Citrus aurantifolia, Citrus limon, Osmanthus fragrance (5%)), Forest Walk (blended essential oils: Abies grandis, Pinus cembra, Myrtus communis c. t. 1,8-cineol, Abies alba, Citrus paradisi, Abies sibirica, Pseudotsuga menziesii, Vetiveria zizanoides), and water. Acute anxiety was the primary outcome (state-trait-anxiety inventory (STAI-S)). Secondary outcomes were trait anxiety (STAI-T), dental anxiety (Kleinknecht dental fear survey), and pain perception in treatment (numeric rating scale). Across all patients (n = 486), STAI-S was slightly higher in the control group (40.7 ± 11.6) than in the intervention groups (38.4 ± 10.5). Post-hoc analyses revealed that the effect is only robust for the subgroup of female patients (n = 296, p = 0.044). We also conducted a post-hoc additional analysis on a subpopulation with an increased level of STAI-T ≥ 42 (n = 131 patients). For this group the difference in acute anxiety between the control group (51.1 ± 11.9, n = 30) vs. the intervention groups (46.8 ± 9.6, n = 118) was significant (T = 4.39, p = 0.0379). The results of the study indicate a promising potential of essential-oil vaporization to alleviate dental anxiety, particularly in the subgroups of patients with a high level of trait anxiety, and particularly in female patients. The calming effects of the essential-oil vaporization were also highlighted by the anecdotical statements of the dental-practice staff. The anxiety-reducing role of essential-oil vaporization alone and as one part of combined techniques to counter DFA should be further explored using multi-perspective methodological approaches in research.

Greenspaces And Cardiovascular Health

Accumulating evidence suggests that living in areas of high surrounding greenness or even brief exposures to areas of high greenery is conducive to cardiovascular health, which may be related to the environmental, social, psychological, and physiological benefits of greenspaces. Recent data from multiple cross-sectional, longitudinal, and cohort studies suggest that living in areas of high surrounding greenness is associated with a lower risk of all-cause and cardiovascular mortality. High levels of neighborhood greenery have been linked also to a decrease in the burden of cardiovascular disease risk factors as reflected by lower rates of hypertension, dyslipidemia, and diabetes. Those who live in greener environments report better mental health and more frequent social interactions, which can benefit cardiovascular health as well. In this narrative review, we discuss evidence linking greenspaces to cardiovascular health as well as the potential mechanisms underlying the beneficial effects of greenspaces, including the impact of vegetation on air, noise and light pollution, ambient temperature, physical activity, mental health, and biodiversity. We review literature on the beneficial effects of acute and chronic exposure to nature on cardiovascular disease risk factors, inflammation and immune function, and we highlight the potential cardiovascular effects of biogenic volatile organic compounds that are emitted by trees and shrubs. We identify current knowledge gaps in this area and underscore the need for additional population studies to understand more clearly and precisely the link between greenness and health. Such understanding is urgently needed to fully redeem the promise of greenspaces in preventing adverse environmental exposures, mitigating the effects of climate change, and creating healthier living environments.

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.

Exploring the effect of different typical plant community on human stress reduction: a field experiment

Research has demonstrated the positive effect of natural environment on human restoration and well-being. Time spent in nature can often alleviate both physiological and psychological stress. However, few studies have discussed the environmental health effects of the nature's components and characteristics. Sixty volunteers were recruited and one manufactured environment and five different natural environments were randomly assigned to them, including coniferous forests (pure coniferous forest-PC and mixed coniferous forest-MC), broad-leaved forests (pure broad-leaved forest-PB and mixed broad-leaved forest-MB), and mixed forest (mixed coniferous and broad-leaved forest-MCB). Each volunteer sat in a built or natural environment and looked around the environment for 15 min. Physiological (HR, HRV, BP, pulse rate and salivary cortisol) and psychological indicators (POMS and STAI) were used to evaluate the changes in their stress level. Results indicated a strong difference in HR, HRV, POMS and STAI between the built and natural environment, which showed that natural environment can lower the stress level. MC had the best effect on relieving physiological stress, whereas MCB is most successful in improving emotional state and reducing anxiety. Broad-leaved forest and mixed forest significantly affected the DBP and vigor level of the subjects, respectively. While coniferous forest did significantly increase the concentration of salivary cortisol in subjects. The study confirmed that compared to the built environment, the natural environment can relieve the human body's physical and psychological stress and negative emotions, while significantly increasing vitality. And different plant communities also have different effects on the physiological and psychological indicators of the subjects. These results will provide scientific basis for the construction and improvement of urban green space environment.

Nature and Mental Health in Urban Texas: A NatureScore-Based Study

In this cross-sectional study, we examined the impact of access to nature on mental health utilization in urban neighborhoods using Texas outpatient encounters data merged with NatureScoreTM (0-100; low to high nature levels) and US census data (household income, education, employment, poverty, and insurance coverage) at the zipcode level. Our sample size included 61 million outpatient encounters across 1169 zipcodes, with 63% women and 30% elderly. A total of 369,344 mental health encounters were identified, with anxiety/stress and depression encounters representing 68.3% and 23.6%, respectively. We found that neighborhoods with a NatureScore of 60+ had lower overall mental health utilization than those below 40 (RR 0.51, 95%CI 0.38-0.69). This relationship persisted for depression, bipolar disorder, and anxiety/stress and in neighborhoods with a NatureScore above 80 (p < 0.001). Compared to neighborhoods with a NatureScore below 40, those above 80 had significantly lower depression (aRR 0.68, 95%CI 0.49-0.95) and bipolar (aRR 0.59, 95%CI 0.36-0.99) health encounters after adjusting for demographic and socioeconomic factors. This novel approach, utilizing NatureScore as a proxy for urban greenness, demonstrates the correlation between a higher NatureScore and reduced mental health utilization. Our findings highlight the importance of integrating nature into our healthcare strategies to promote well-being and mental health.

Explore the effects of forest travel activities on university students' stress affection

This study aims to explore the effects of forest travel activities on university students' stress affection. Forty volunteer university students participated in this study. All participants were asked to complete physiological (Heart Rate Variability) and psychological (Brief Profile of Mood State and State-Trait Anxiety Inventory) tests before and after the travel activities. The results reported that students' heart rates were significantly lower after the forest travel activities than before. All domains of negative mood and anxiety decreased from the pre-test to the post-test. This study found that university students could feel less stressed if they went on forest travel activities.

Spending time in the forest or the field: qualitative semi-structured interviews in a randomized controlled cross-over trial with highly sensitive persons

Introduction

The effects of spending time in forests have been subject to investigations in various countries around the world. Qualitative comparisons have been rarely done so far.

Methods

Sixteen healthy highly sensitive persons (SV12 score ≥ 18) aged between 18 and 70 years were randomly assigned to groups spending 1 h in the forest and in the field at intervals of one week. Semi-structured interviews were conducted after each intervention and analyzed using a mixed-methods approach of content analysis and grounded theory.

Results

Both natural environments induced feelings of inner calmness, inner cleansing, joy, freedom, connectedness, strengthening qualities, and heightened body awareness. The forest environment additionally offered emotional shelter, and showed advantages in promoting inner strength and self-concentration.

Discussion

People with previous negative experiences in the forest may feel safer in fields because of the wider view and better overview. Important preconditions are enough time and the absence of a judgmental authority. The two environments induced in part different but also similar emotions which might be useful to promote psychological well-being differentially.

An exploratory investigation of human biofield responses to encountering a sacred object

CONTEXT

While advances in the Western sciences have increased our understanding of the human biofield, few studies have examined the potential effects of sacred objects on its functioning.

DESIGN AND STUDY PARTICIPANTS

This exploratory study examined the effects of a sacred object called the Sri Yantra / Durga Stone on the human biofield. Twelve women and five men were studied on three separate occasions using the Bio-Well device, which purportedly measures aspects of the biofield: baseline (the day before exposure to the sacred object), pre-exposure (immediately prior to exposure to the sacred object), and post-exposure (immediately following exposure to the sacred object). A set of a priori hypotheses examined outcome effects on a set of variables, including multiple physiological systems.

RESULTS

The overall Bio-Well energy state (Bio-Well variables are in units of joules) was significantly changed following exposure to the sacred object (p = 0.001). In addition, the cardiovascular, endocrine, musculoskeletal, digestive, urinogenital, and immune system readings showed significant changes (p's<0.003) while the nervous and respiratory system assessments were unchanged. Chakra (defined as a center of vital prana) energy was changed following exposure to the stone (p = 0.001), while chakra alignment was not (p = 0.145).

CONCLUSIONS

The findings from this exploratory study suggest that short-term human exposure to this particular sacred object had significant effects on aspects of the human biofield.

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.

Health education via "empowerment" digital marketing of consumer products and services: Promoting therapeutic benefits of self-care for depression and chronic pain

Increasing health care costs and high economic burden exemplify the impact of chronic diseases on public health. Multifaceted approaches to treating chronic diseases include pharmaceutical drugs, digital therapeutics, and lifestyle medicine. Chronic diseases are largely preventable, and health promotion yields positive outcomes. However, despite positive return on investment (ROI) and cost-to-benefit ratio (CBR) for health promotion (median ROI 2.2, median CBR 14.4), commercial marketing of healthy lifestyles and self-care is limited. The objective of this perspective article is to discuss how digital marketing of consumer goods and services that support therapeutic self-care can also bridge public health and for-profit interests. We describe how "empowerment" marketing campaigns can provide evidence-based associations between products/services and self-care benefits for people living with chronic pain and depression. Such a "health education as marketing" strategy is illustrated by educational ads describing how contact with nature, music, and yoga can improve chronic pain and reduce depressive symptoms. Creating associations between health-related benefits of these activities with products (outdoor and yoga apparel, audio equipment) and services (music streaming services, music mobile apps, eco-tourism, yoga studios) that support them expand their value proposition, thus incentivizing profit-driven companies to engage in public health campaigns. Long-term success of companies that incorporate evidence-based health education as marketing and branding strategies will depend on following ethical considerations and advertising guidelines defined by consumer protection regulatory agencies, such as the Federal Trade Commission (FTC). In conclusion, integration of health education about self-care and commercial marketing can support health care outcomes and disease prevention.

Cardiac and Mental Benefits of Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) Diet plus Forest Bathing (FB) versus MIND Diet among Older Chinese Adults: A Randomized Controlled Pilot Study

(1) Background: The Mediterranean-DASH intervention for neurodegenerative delay (MIND) diet and forest bathing (FB) are first-line therapies for controlling hypertension. This study aimed to investigate the combined effects of a MIND diet and FB and MIND diet alone among older Chinese patients with hypertension. (2) Methods: Seventy-two participants aged >50 with stages 1 or 2 hypertension were randomly assigned to the MIND group (n = 23), MIND-FB group (n = 25), or control group (n = 24). Systolic blood pressure (SBP) (primary outcome), point-of-care tests for blood lipid panel and glucose (Glu), anxiety levels, mood states, body mass index (BMI), waist-to-hip ratio (WHR), and body fat percentage (BFP) were measured. (3) Results: After a four-week intervention, the change in SBP revealed no significant differences between the intervention groups, and SBP tended to decrease in the MIND and MIND-FB groups. Total cholesterol, and low-density lipoprotein (LDL-C) were significantly decreased (p < 0.01), Triglycerides (TG) and Glu levels were significantly lower (p < 0.05) in the MIND-FB and MIND groups, and the mean differences for anxiety level and negative mood states were significantly lower (p < 0.00) in MIND-FB group. (4) Conclusions: The results provide preliminary evidence that the MIND diet and FB are good for promoting cardiac and mental health well-being in the Chinese population.

Does Forest Therapy Have Physio-Psychological Benefits? A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Forest therapy involves visiting forests or conducting forest-based treatment activities to improve one's health. Studies have investigated the health benefits of forests, but consensus has not been reached. This study comprised a systematic review and meta-analysis to determine how forest therapy affects the physiological and psychological health of adults. The Cumulative Index to Nursing and Allied Health Literature, Embase, and Medline databases were searched on 31 August 2021. Systematic review and meta-analysis, risk evaluation, GRADE evaluation, and advertisement effect evaluation were performed for each article. The effect size was calculated by dividing blood pressure as a physiological indicator and depression as a psychological indicator. Of the 16,980 retrieved studies, 17 were selected based on the inclusion criteria. Of these, eight studies were included in the meta-analysis. The effect size of forest therapy on improving systolic and diastolic blood pressure was not significant; however, it significantly reduced depression. While the results have limited generalizability due to the inclusion of few studies, the effects of forest therapy on reducing depression have been confirmed. Since the application of forest therapy was heterogeneous in these studies, a moderator effect analysis or subgroup analysis in meta-analysis should be performed in the future.

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.

An Investigation of Virtual Reality Nature Experiences in Patients With Metastatic Breast Cancer: Secondary Analysis of a Randomized Controlled Trial

BACKGROUND

Connection with nature has well-established physical and psychological benefits. However, women with metastatic breast cancer (MBC) are often unable to access nature because of physical limitations, psychological barriers, and treatment demands. Virtual reality (VR) nature experiences offer an alternative means of connecting with nature and may be of particular benefit to patients with cancer who are house- or hospital-bound.

OBJECTIVE

This study aims to explore whether VR nature experiences are associated with physical and psychological benefits for women with MBC who are disconnected with nature.

METHODS

This secondary analysis of a previous randomized controlled crossover trial recruited participants from the emailing lists of breast cancer support organizations. Participants were provided VR headsets for daily use in their homes for over 3 weeks. In the first week, participants used 1 of 2 VR nature experiences (Ripple or Happy Place) daily, followed by a 1-week washout period, before using the other VR experience every day for the final week. Outcomes assessed changes between baseline and postintervention scores in quality of life (EQ-5D-5L), pain (Brief Pain Inventory Short Form), fatigue (Functional Assessment of Chronic Illness Therapy-fatigue), depression (Depression, Anxiety, and Stress Scale-depression), anxiety (Depression, Anxiety, and Stress Scale-anxiety), and spiritual well-being (Functional Assessment of Chronic Illness Therapy- Spiritual Well-being) and investigated whether benefits were greater in participants who were not strongly connected with nature at baseline.

RESULTS

A total of 38 women with MBC completed the VR interventions and were included in the analyses. Participants reported significantly less fatigue (P=.001), less depression (P<.001), and greater quality of life (P=.02) following the interventions than at baseline. Women with a weaker connection to nature reported greater fatigue (P=.03), depression (P=.006), and anxiety (P=.001), and poorer spirituality (P=.004) than their strongly connected counterparts. Only those with a weaker baseline connection with nature showed improvements in depression following the intervention (P=.03), with similar trends observed in fatigue (P=.07) and quality of life (P=.10).

CONCLUSIONS

This study provides preliminary evidence that feeling connected with nature is associated with better physical and psychological status in patients with MBC and that VR nature interventions might be beneficial for this clinical population. Future studies should focus on activities that encourage connection with nature (rather than simply exposure to nature) and investigate the aspects of VR nature interventions that have the greatest therapeutic potential.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry ACTRN12619001480178; https://tinyurl.com/et6z3vac.

Context, classification and study methodologies in research into nature-based therapies: protocol for a scoping review

INTRODUCTION

Nature provides an array of health benefits, and recent decades have seen a resurgence in nature-based interventions (NBI). While NBI have shown promise in addressing health needs, the wide variety of intervention approaches create difficulty in understanding the efficacy of NBI as a whole. This scoping review will (1) identify the different nomenclature used to define NBI, (2) describe the interventions used and the contexts in which they occurred and (3) describe the methodologies and measurement tools used in NBI studies.

METHODS AND ANALYSIS

Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols Extension for Scoping Reviews, four databases will be searched (PubMed, Web of Science, Scopus, ProQuest Dissertations and Theses Global) as well as cross-referencing for published and unpublished (masters theses and dissertations) studies on NBI in humans. Eligible studies must employ intervention or observational designs, and an English-language abstract will be required. Database searches will occur from inception up to the date of the search. Animal-based therapies and virtual-reality therapies involving simulated nature will be excluded. Independent dual screening and data abstraction will be conducted. Results will be analysed qualitatively as well as with simple descriptive statistics (frequencies and percentages).

ETHICS AND DISSEMINATION

Since this is a scoping review of previously published summary data, ethical approval for this study is not needed. Findings will be published in a peer-reviewed journal. This protocol has been registered with Open Science Framework (https://osf.io/mtzc8).

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.

Effects of forest environment (Shinrin-yoku/Forest bathing) on health promotion and disease prevention -the Establishment of "Forest Medicine"

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 (Forest bathing/Shinrin-yoku) on human health. My research team has 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 studies the effects of forest environments (Forest bathing/Shinrin-yoku) on human health. It has been reported that Forest bathing/Shinrin-yoku has the following beneficial effects on human health:1 Shinrin-yoku increases 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 Shinrin-yoku reduces blood pressure and heart rate showing preventive effect on hypertension and heart diseases. 3 Shinrin-yoku reduces stress hormones, such as urinary adrenaline and noradrenaline and salivary/serum cortisol contributing to stress management. 4 Shinrin-yoku increases the activity of parasympathetic nerves and reduces the activity of sympathetic nerves to stabilize the balance of autonomic nervous system. 5 Shinrin-yoku improve sleep. 6 Shinrin-yoku increases the levels of serum adiponectin and dehydroepiandrosterone sulfate. 7 In the Profile of Mood States (POMS) test, Shinrin-yoku reduces the scores for anxiety, depression, anger, fatigue, and confusion, and increases the score for vigor, showing preventive effects on depression. 8 Shinrin-yoku may apply to rehabilitation medicine 9 Shinrin-yoku in city parks also has benefits on human health. 10 Shinrin-yoku may have preventive effect on COVID-19 by boosting immune function and by reducing mental stress.Taken together, these findings suggest that Shinrin-yoku may have potential preventive effects on non-communicable diseases.

Forest-bathing and physical activity as weapons against COVID-19: a review

Strengthening the immune system in order to better withstand the threat of COVID-19 is an important way to ensure the protection of our health against the current pandemic associated with SARS-CoV-2. There are many ways to achieve this, but with current circumstances, certain modalities stand out as being the most valid and are certainly worth greater consideration. Here we review the effects that particular immuno-strengthening activities can have on limiting the severity of COVID-19 disease as well as preventing virus infection. Physical activity, in particular, should not be discounted as an important method of prevention of viral diseases as it triggers many biological processes within the human body which in turn lead to heightened natural defences against viral infections. When exercise is performed in forested areas, these protective health benefits may be increased since many plant species emit biogenic volatile compounds (VOCs) which, when inhaled, have many protective properties. These VOCs have been shown in particular to have immunostimulatory effects on the human body and, thus, they could be of use in the prevention and/or treatment of COVID-19. Being amongst trees may also help to alleviate stress and anxiety, lowering cortisol levels and consequently helping the proper functioning of the immune system. In the following work, we have performed an analysis of the available scientific literature which looks at the effects of physical exercise as well as 'forest-bathing' on the immune system's ability to fight disease, especially of course as it relates to COVID-19. Our review aims at shedding light on the benefits of exercising outdoors in green areas and suggests reforestation as a protective measure against future outbreaks.

Green Exercise: Can Nature Video Benefit Isometric Exercise?

Green exercise is the combination of physical activity and nature exposure, which has been associated with positive effects on psychophysiological health. This study aimed to investigate the effects of nature video viewing on isometric exercise and find a useful practice for green exercise in urban living. In the current study, 18 male subjects were recruited in a randomized crossover trial and underwent a sequence of wall squat exercises. The whole experiment contained three periods of baseline (before exercise), exercise, and recovery (after exercise), and each period lasted for 2 min. A video of forest walking was played in the exercise and recovery periods as treatment, while a black screen was set as control. The Rate of Perceived Exertion Scale (RPE) and Feeling Scale (FS) were employed to measure perceived exertion and affective responses in the exercise period; heart rate (HR) and heart rate variability (HRV) including the standard deviation of normal-to-normal RR intervals (SDNN), the root mean square of successive differences (RMSSD), and the standard deviations of the Poincaré plot (SD1), were recorded in the three periods. Heart rate recovery (HRR) in the recovery period was further calculated based on 30 s and 60 s time frames. Results demonstrated that during the exercise period nature video viewing was associated with better affective responses (median of 1.00 and an interquartile (IQR) of 2.00, p = 0.017), lower perceived exertion (median = 6.00, IQR = 2.00, p = 0.021), and lower HR (median = 89.60, IQR = 20.94, p = 0.01), but the differences in HRV indices between the experimental settings were not statistically significant. In the recovery period, significantly higher values of RMSSD (median = 34.88, IQR = 24.52, p = 0.004), SD1 (median = 24.75, IQR = 17.41, p = 0.003), and HR (median = 84.18, IQR = 16.58, p = 0.001) were observed in the treatment setting, whereas no statistically significant difference was found for HRR. In general, our findings support that nature video viewing may help reduce perceived exertion, increase exercise pleasure, buffer heart rate, and improve cardiac autonomic recovery for wall squat exercising, which implies the potential of nature-based stimuli in green exercise. However, due to the limited research sample, further study may need to include female participants and focus on various populations to confirm the effectiveness of using virtual and environments depicting nature at home or in public exercise places to promote positive exercise experience.

Nature's Role in Supporting Health during the COVID-19 Pandemic: A Geospatial and Socioecological Study

The COVID-19 pandemic has brought about unprecedented changes to human lifestyles across the world. The virus and associated social restriction measures have been linked to an increase in mental health conditions. A considerable body of evidence shows that spending time in and engaging with nature can improve human health and wellbeing. Our study explores nature's role in supporting health during the COVID-19 pandemic. We created web-based questionnaires with validated health instruments and conducted spatial analyses in a geographic information system (GIS). We collected data (n = 1184) on people's patterns of nature exposure, associated health and wellbeing responses, and potential socioecological drivers such as relative deprivation, access to greenspaces, and land-cover greenness. The majority of responses came from England, UK (n = 993). We applied a range of statistical analyses including bootstrap-resampled correlations and binomial regression models, adjusting for several potential confounding factors. We found that respondents significantly changed their patterns of visiting nature as a result of the COVID-19 pandemic. People spent more time in nature and visited nature more often during the pandemic. People generally visited nature for a health and wellbeing benefit and felt that nature helped them cope during the pandemic. Greater land-cover greenness within a 250 m radius around a respondent's postcode was important in predicting higher levels of mental wellbeing. There were significantly more food-growing allotments within 100 and 250 m around respondents with high mental wellbeing scores. The need for a mutually-advantageous relationship between humans and the wider biotic community has never been more important. We must conserve, restore and design nature-centric environments to maintain resilient societies and promote planetary health.

The Psychological and Physical Effects of Forests on Human Health: A Systematic Review of Systematic Reviews and Meta-Analyses

BACKGROUND

The aim of this systematic review of systematic reviews was to identify, summarise, and synthesise the available evidence of systematic reviews (SRs) and meta-analyses (MAs) on the preventative and therapeutic psychological and physical effects of forest-based interventions. Methods: Both bibliographic databases and grey literature sources were searched for SRs and MAs published until May 2020. Eight databases were searched for relevant articles: MEDLINE, Embase, Web of Science, Cochrane Library, PsycInfo, CiNii, EBSCO, and Scopus. Grey literature was sourced from Google Scholar and other web-based search tools. SRs and MAs that included randomised controlled (RCT), non-randomised controlled (NRCT), and non-controlled trials (NCT) on health-related effects of forest-based interventions were eligible if they had searched at least two databases. The methodological quality of eligible reviews was assessed by AMSTAR-2. Results: We evaluated 11 systematic reviews covering 131 different primary intervention studies, mostly from Asian countries, three of which included supplementary meta-analyses. The quality assessment resulted in moderate confidence in the results of two reviews, low confidence in six, and critically low confidence in three. The results of the eight moderate and low-rated reviews indicated that forest-based interventions are beneficial to the cardiovascular system, immune system, and mental health (in the areas of stress, depression, anxiety, and negative emotions). Evidence for the effectiveness of forest-based interventions on metabolic parameters in adults, the severity of atopic dermatitis in children and adolescents, and social skills and sociality in healthy primary school children was weak. Discussion/Conclusions: Evidence suggests beneficial therapeutic effects of forest-based interventions on hypertension, stress, and mental-health disorders, such as depression and anxiety. Changes in immunological and inflammatory parameters after forest therapy should be verified in bio-geographically native forests. In the future, more attention should be paid to careful planning, implementation, and reporting of primary studies and to systematic reviews on the effects of forest-based interventions.

Mindfulness and Shinrin-Yoku: Potential for Physiological and Psychological Interventions during Uncertain Times

Mindfulness and Shinrin-yoku (SY) translated as forest bathing, is potentially effective to alleviate mental health issues related to the COVID-19 pandemic and beyond. The purpose of this article is to provide a translational and pragmatic approach to understanding mindfulness in the context of SY and psychological wellbeing through a rapid review of the literature. The background of mindfulness and SY practice are discussed and the emotional, neuroendocrine, and neurobiological responses are examined. Next, a rapid review of the literature examined six studies, published between 2010 and 2020 to determine what is known regarding the relationship between SY, mindfulness, and psychological wellbeing. The studies included 21-360 participants with a mean age of 20-55 years. The results demonstrated a significant positive correlation between nature, mindfulness, and measures of psychological wellbeing. During uncertain events, including COVID-19, weaving mindfulness with SY may be specifically important to at-risk groups, those experiencing depression, loneliness, and social isolation, and at-risk populations such as college students, veterans, and professionals with high levels of stress. The goal of this review is to provide a thorough background and support of this cost-effective modality to promote overall psychological wellbeing as a preventative measure to those at risk or experiencing psychological illnesses.

Radar Satellite Image Time Series Analysis for High-Resolution Mapping of Man-Made Forest Change in Chongming Eco-Island

Forests are important oxygen sources and carbon sinks. They provide a series of ecosystem services that are crucial to eco-island sustainability, such as the protection of soils, conservation of biodiversity, and development of the eco-tourism, etc. Interestingly, Chongming eco-island is located in the borderlands between fresh- and saltwater environments, where the Yangtze River meets the East China Sea. Most forests in Chongming island are therefore man-made and very vulnerable to the ecological environment mixing of freshwater streams and rivers with salty ocean tides, and are affected by climate and human activity. Estimating and monitoring forest change within an estuary is required for the sustainable management of forest resources and forest-based eco-tourism. Most optical satellites are unsuitable for continuous forest mapping due to cloud cover and their relatively low spatial and temporal resolution. Here, using Sentinel-1 satellite carrying an imaging C-band synthetic aperture radar, radar vegetation index was derived to detect the forest dynamics on the island. Furthermore we quantified forest area change in three well known and the most strictly protected and representative areas, namely Dongping National Forest Park, Dongtan National Wetland Park, and Xisha National Wetland Park, in the Chongming eco-island over the past five years at 10-metre resolution. We recorded the early and mid summers when the forest canopies grew to the peak in the study areas. The planted forest in Dongping National Forest Park grew an area of 7.38 hectares from 2015 to 2019, and disappeared from an area of almost 2.59 hectares in 2018. The man-made forest of Xisha National Wetland Park increased at an area of almost 20.19 hectares over the past five years. The forest in Dongtan National Wetland Park increased to an area of almost 2.12 hectares in the period of 2015–2017 and 2018–2019. However, from 2017 to 2018, the area of planted forests in Dongtan National Wetland Park decreased by 1.35 hectares. This study shows man-made forest change can be measured and that evidence can be collected to show how the forest is altered by human activities, and informs forest management decision-making for Chongming eco-island.