Comprehensive Evaluation of Healthcare Benefits of Different Forest Types: A Case Study in Shimen National Forest Park, China

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 Plant-Emitted Monoterpenes on Anxiety Symptoms: A Propensity-Matched Observational Cohort Study

Immersive experiences in green areas, particularly in forests, have long been known to produce beneficial effects for human health. However, the exact determinants and mechanisms leading to healthy outcomes remain to be elucidated. The purpose of this observational cohort study was to investigate whether inhaling plant-emitted biogenic volatile compounds, namely monoterpenes (MTs), can produce specific effects on anxiety symptoms. Data from 505 subjects participating in 39 structured forest therapy sessions at different Italian sites were collected. The air concentration of monoterpenes was measured at each site. STAI state questionnaires were administered before and after the sessions as a measure of anxiety. A propensity score matching analysis was then performed, considering an above-average exposure to inhalable air MTs as the treatment. The estimated effect was -1.28 STAI-S points (95% C.I. -2.51 to -0.06, p = 0.04), indicating that the average effect of exposure to high MT air concentrations during forest therapy sessions was to decrease anxiety symptoms.

Exurban and suburban forests have superior healthcare benefits beyond downtown forests

Forests in urban areas provide great healthcare benefits to citizens, but it is less well known whether this benefit is related to different geographical spaces. We selected exurban forest, suburban forest, downtown forest, and urban control in Guangzhou, China to analyze the change characteristics of negative air ion concentration (NAIC), air oxygen content (AOC), and human comfort index (HCI). Based on Criteria Importance Through Intercriteria Correlation (CRITIC) method, the urban forest comprehensive healthcare index (UFCHI) was established. Finally, the evaluation criteria for UFCHI were identified by cluster analysis. The results demonstrated that (1) The NAIC in exurban forest (2,713 ± 1,573 ions/cm3) and suburban forest (2,147 ± 923 ions/cm3) was evidently better than downtown forest (1,130 ± 255 ions/cm3) and urban control (531 ± 162 ions/cm3). (2) The AOC was in the order of exurban forest (21.17 ± 0.38%) > suburban forest (21.13 ± 0.30%) > downtown forest (21.10 ± 0.16%) > urban control (20.98 ± 0.12%). (3) The HCI in urban control (5.56 ± 2.32) and downtown forest (5.15 ± 1.80) is higher than suburban forest (4.02 ± 1.53) and exurban forest (3.71 ± 1.48). (4) The UFCHI in exurban forest (1.000), suburban forest (0.790), and downtown forest (0.378) were beneficial to human health to some extent, while urban control (0.000) was at Level IV, having no healthcare benefit. Except in winter, the UFCHI in exurban forest and suburban forest were all at Level II and above; while downtown forest and urban control were all at Level III and below at all seasons. Overall, urban forests in the exurbs and suburbs have better healthcare benefits than those in the downtowns. Furthermore, it is recommended that urban residents visit exurban and suburban forests for forest therapy in spring, summer, and autumn.

The Effects of Forest Therapy on the Blood Pressure and Salivary Cortisol Levels of Urban Residents: A Meta-Analysis

Urban residents have a higher risk of hypertension and psychological stress than rural residents. Aside from medical interventions, understanding how to control hypertension and alleviate the stress of urban populations has become a public concern. As an alternative medical measure, forest therapy has shown the effects of normalizing blood pressure (BP) and reducing stress increasingly in recent literature, but this is still inconclusive. In order to systematically verify forest therapy’s effects on the BP and mental stress of urban residents, we conducted meta-analyses to assess the changes in systolic blood pressure (SBP), diastolic blood pressure (DBP), and salivary cortisol concentration (SCC; a stress biomarker) between the forest therapy group and urban control group. We searched 4 online databases, and 21 studies on BP involving 2270 participants and 13 studies on SCC involving 1786 participants were included. Through the meta-analysis, the mean difference and confidence interval (CI) estimates indicated that forest therapy significantly reduced participants’ SBP −3.44 (95% CI −5.74, −1.14), DBP −3.07 (95% CI −5.59, −0.54), and SCC −0.07 (95% CI −0.10, −0.04), as compared with urban control. Yet, there was substantial heterogeneity (I2 = 72.87−88.59%) among these studies. We also found that each prediction interval (PI) for SBP (95% PI −13.30, 6.42), DBP (95% PI −15.54, 9.41), and SCC (95% PI −0.18, 0.05) were all much wider than the CIs and contained values above 0. This means that forest therapy may reduce SBP, DBP, and SCC on average, but may not exclude adverse results. Meta-regression analyses showed that participants’ age and baseline SBP levels determined the heterogeneity among SBP studies. After forest therapy, older participants and those with higher baseline SBP levels had greater SBP-lowering effects. Among DBP studies, the primary source of heterogeneity was participants’ baseline DBP levels; participants with higher baseline DBP levels had greater DBP reduction. In subgroup analyses, we discovered that longer-term forest therapy programs (≥20 min) resulted in a greater reduction in BP and SCC than shorter-term forest therapy programs (<20 min). Additionally, seated viewing, walking, or multi-session programs in forests were observed to have similar effects on reducing BP and SCC. Despite extensive analyses, the study did not identify any sources of heterogeneity among forest therapy programs for lowering SCC levels. Overall, we conclude that forest therapy programs have beneficial therapeutic effects on urban residents’ physio-psychological health through lowering BP and relieving stress (reducing SCC). This finding provides solid evidence of the contribution of forest therapy to urban residents’ health and wellbeing.

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.

Effects of Altitude, Plant Communities, and Canopies on the Thermal Comfort, Negative Air Ions, and Airborne Particles of Mountain Forests in Summer

Forest bathing is considered an economical, feasible, and sustainable way to solve human sub-health problems caused by urban environmental degradation and to promote physical and mental health. Mountain forests are ideal for providing forest baths because of their large area and ecological environment. The regulatory mechanism of a mountain forest plant community in a microenvironment conducive to forest bathing is the theoretical basis for promoting physical and mental health through forest bathing in mountain forests. Based on field investigations and measurements, differences in the daily universal thermal climate index (UTCI), negative air ion (NAI), and airborne particulate matter (PM2.5 and PM10) levels in nine elevation gradients, six plant community types, and six plant community canopy parameter gradients were quantitatively analyzed. In addition, the correlations between these variables and various canopy parameters were further established. The results showed the following: (1) Altitude had a significant influence on the daily UTCI, NAI, PM2.5, and PM10 levels in the summer. The daily UTCI, NAI, PM2.5, and PM10 levels gradually decreased with the increase in altitude. For every 100 m increase in altitude, the daily UTCI decreased by 0.62 °C, the daily NAI concentration decreased by 108 ions/cm3, and the daily PM2.5 and PM10 concentrations decreased by 0.60 and 3.45 µg/m3, respectively. (2) There were significant differences in the daily UTCI, NAI, PM2.5, and PM10 levels among different plant communities in the summer. Among the six plant communities, the Quercus variabilis forest (QVF) had the lowest daily UTCI and the best thermal comfort evaluation. The QVF and Pinus tabuliformis forest (PTF) had a higher daily NAI concentration and lower daily PM2.5 and PM10 concentrations. (3) The characteristics of the plant community canopy, canopy density (CD), canopy porosity (CP), leaf area index (LAI), and sky view factor (SVF), had significant effects on the daily UTCI and NAI concentration, but had no significant effects on the daily PM2.5 and PM10 concentrations in the summer. The plant community with higher CD and LAI, but lower CP and SVF, showed a higher daily UTCI and a higher daily NAI concentration. In conclusion, the QVF and PTF plant communities with higher CD and LAI but lower CP and SVF at lower elevations are more suitable for forest bathing in the summer in mountainous forests at lower altitudes. The results of this study provide an economical, feasible, and sustainable guide for the location of forest bathing activities and urban greening planning to promote people’s physical and mental health.

What Activities in Forests Are Beneficial for Human Health? A Systematic Review

Over the past decade, clinical trials of forest-based interventions have increased, leading to their recognition as preventive medicine. However, little is known about the differences in health effects according to the activity characteristics of interventions. This study aimed to understand the types of activities and their associated health effects to identify differences in health effects between activities. PubMed, PsycINFO, Web of Science, and Scopus databases were searched, and methodological quality was assessed using Cochrane ROB2. A total of 32 randomized controlled trials (RCTs) met the eligibility criteria. Health outcomes were collected from 6264 participants aged 6-98 years, and the sample size was 12-585. The Interventions were walking (n = 21), staying (n = 7), exercise (n = 4), indirect exposure (n = 4), and the activity time was between 10 and 240 min. Overall, walking showed consistent positive health effects, and there were differences in effects on anxiety and depression, cognitive function, stress hormone, and inflammation according to the activity. However, most of the included studies had a high risk of bias, and interventions were limited to specific activities, durations, and frequencies. Although a few limitations remain, the findings in this study are of great significance in providing the basis for the design of forest-based interventions.

Study of the Vertical Structures, Thermal Comfort, Negative Air Ions, and Human Physiological Stress of Forest Walking Spaces in Summer

Forest walking is a popular, healthy, and light outdoor activity. The potential comprehensive relationships between the vertical structures, thermal comfort, negative air ions (NAI), and human physiological stress in forest walking spaces have not been determined. We performed an experiment in the Baishuihe National Nature Reserve, Sichuan Province, China. Thirty-two college students recruited as subjects completed a forest walk (approximately one kilometer) on the same trail divided into three vertical structure type subsections, namely: A (dense herb and shrub layers with a sparse tree layer), B (dense tree, herb and shrub layers), and C (dense tree and herb layers with a sparse shrub layer). When the subjects passed preset environmental measurement points, staff measured climatic indexes (air temperature, relative humidity, wind velocity, surface temperature and global radiation) and NAI levels, and these data were input into the Rayman model to form a comprehensive thermal comfort index, the physiologically equivalent temperature (PET). PET and NAI differences and dynamic data among the subsections were analyzed. The subjects’ brain waves, heart rates (HRs), and walking speed (S) were digitally recorded. We selected brain wave θ, γ and β-high/α rates, neuroemotional indexes (stress and relaxation) and HR as physiological indicators, and S as an auxiliary indicator. The correlations between PET and NAI with physiological and auxiliary indexes were analyzed. Forest type C showed the lowest PETs and highest NAIs along with the most stable dynamic changes. PET was negatively correlated with HR and positively correlated with γ (12 channels). NAI was positively correlated with S and relaxation and negatively correlated with γ (two channels) and the β-high/α ratio (five channels). These comprehensive relationships suggest that dense tree, sparse shrub, and high-coverage herb layers combined with optimal temporal conditions (before noon or after a light rain) form the best thermal comfort and NAI conditions conducive to reducing human physiological pressures during summer daytime forest walking. These results provide theoretical references for forest walking and spatial regulation.

Can Different Forest Structures Lead to Different Levels of Therapeutic Effects? A Systematic Review and Meta-Analysis

In recent decades, forests have expanded from natural resources for conservation and production to health-promoting resources. With the growing body of evidence supporting the therapeutic effects of forests, the number of investigations on the relationship between forest characteristics and therapeutic effects have increased. However, quantitative synthesis of primary studies has rarely been conducted due to a limited number of health studies including forest description and high heterogeneity of forest variables. In this study, we conducted a systematic review and meta-analysis to evaluate the relationship between the forest structure and the therapeutic effect. We systematically searched the studies examining the therapeutic effects of forests with different stand density and canopy density and synthesized the results. As a result of subgroup analysis, we found that stand density modifies the therapeutic effects. Emotional and cognitive restoration showed greatest improvement in low-density forests with a stand density of less than 500/ha and the therapeutic effects diminish as the stand density increases. The impact of canopy density was not found due to a lack of studies reporting canopy density. Although some limitations remain, the findings in this study have great significance in providing the basis for establishing management strategies of forests for therapeutic use.

PM2.5 Pollutant Concentrations in Greenspaces of Nanjing Are High but Can Be Lowered with Environmental Planning

Small-scale greenspaces in high-density central urban districts serve as important outdoor activity spaces for the surrounding residents, especially the elderly. This study selects six small-scale, popular greenspaces with distinct characteristics that are jointly situated along the same main urban artery in a high-density central urban district. Field investigations and questionnaires are conducted and combined with statistical analyses, to explore the spatial-temporal distribution and influencing factors of PM2.5 concentrations in these greenspaces. The study finds that the air quality conditions in the sites are non-ideal, and this has potential negative impacts on the health of the elderly visitors. Moreover, the difference values of PM2.5 concentrations' spatial-temporal distributions are significantly affected by vehicle-related emissions, which have significant temporal characteristics. PM2.5 concentration is strongly correlated with percentage of green coverage (R = 0.82, p < 0.05), degree of airflow (R = -0.83, p < 0.05), humidity and comfort level (R = 0.54, p < 0.01 and R = -0.40, p < 0.01 respectively). Meanwhile, the sites' "sky view factor" is strongly correlated with degree of airflow (R = 0.82, p < 0.05), and the comfort level plays an indirect role in the process of PM2.5 affecting crowd activities. Based on this analysis, an optimal set of index ranges for greenspace elements which are correlated with the best reduction in PM2.5 concentrations is derived. As such, this research reveals the technical methods to best reduce their concentrations and provides a basis and reference for improving the quality of small-scale greenspaces in high-density urban districts for the benefit of healthy aging.