Effect of forest bathing trips on human immune function

Is forest bathing a panacea for mental health problems? A narrative review

Background

The fast pace of modem life brings great pressure, which lead to physical and mental health issues. Researches have demonstrated that forest bathing can considerably alleviate symptoms of depression and anxiety, eliminate negative emotions and promote mental wellbeing. We presented evidences of the positive impact of forest bathing on mental health in the context rapid urbanization and surging health needs in the post-pandemic era, and outlined the current insights into the related factors affecting the effect of forest bathing, as to provide directions for future interventions or research.

Method

The electronic databases PubMed, Cochrane Library, Embase, Web of Science Core Collections and the China Academic Journals (CAJ) offered through the Full-text Database (CNKI) were searched for relevant studies published from the inception of the databases to December 2024. The initial search strategy was performed using keywords, MeSH terms, and free text words such as "forest bathing", "forest medicine", "mental health pressure", "anxiety", "depression", "cortisol", etc.

Results

The synthesis of the findings in the included studies revealed that forest bathing interventions might improve mental and physical health, reduce blood pressure, improve sleep quality and boost immunity, as well as alleviate depression, anxiety, and stress. Furthermore, the effect of forest bathing on mental health indicators and the differences in these results among different populations varied. Forest environment, tree species, exposure duration, season, composition and concentration of volatile organic compounds have an impact on the effect of forest bathing.

Conclusions

Forest bathing were effective in lowering cortisol levels, reducing sympathetic nerve activity, as well as improving negative mood, which could serve as a non-pharmacological treatment for mental health in the general population.

Understanding immune system dysfunction and its context in mood disorders: psychoneuroimmunoendocrinology and clinical interventions

Mood disorders include a set of psychiatric manifestations of increasing prevalence in our society, being mainly represented by major depressive disorder (MDD) and bipolar disorder (BD). The etiopathogenesis of mood disorders is extremely complex, with a wide spectrum of biological, psychological, and sociocultural factors being responsible for their appearance and development. In this sense, immune system dysfunction represents a key mechanism in the onset and pathophysiology of mood disorders, worsening mainly the central nervous system (neuroinflammation) and the periphery of the body (systemic inflammation). However, these alterations cannot be understood separately, but as part of a complex picture in which different factors and systems interact with each other. Psychoneuroimmunoendocrinology (PNIE) is the area responsible for studying the relationship between these elements and the impact of mind-body integration, placing the immune system as part of a whole. Thus, the dysfunction of the immune system is capable of influencing and activating different mechanisms that promote disruption of the psyche, damage to the nervous system, alterations to the endocrine and metabolic systems, and disruption of the microbiota and intestinal ecosystem, as well as of other organs and, in turn, all these mechanisms are responsible for inducing and enhancing the immune dysfunction. Similarly, the clinical approach to these patients is usually multidisciplinary, and the therapeutic arsenal includes different pharmacological (for example, antidepressants, antipsychotics, and lithium) and non-pharmacological (i.e., psychotherapy, lifestyle, and electroconvulsive therapy) treatments. These interventions also modulate the immune system and other elements of the PNIE in these patients, which may be interesting to understand the therapeutic success or failure of these approaches. In this sense, this review aims to delve into the relationship between immune dysfunction and mood disorders and their integration in the complex context of PNIE. Likewise, an attempt will be made to explore the effects on the immune system of different strategies available in the clinical approach to these patients, in order to identify the mechanisms described and their possible uses as biomarkers.

Comprehensive snapshots of natural killer cells functions, signaling, molecular mechanisms and clinical utilization

Natural killer (NK) cells, initially identified for their rapid virus-infected and leukemia cell killing and tumor destruction, are pivotal in immunity. They exhibit multifaceted roles in cancer, viral infections, autoimmunity, pregnancy, wound healing, and more. Derived from a common lymphoid progenitor, they lack CD3, B-cell, or T-cell receptors but wield high cytotoxicity via perforin and granzymes. NK cells orchestrate immune responses, secreting inflammatory IFNγ or immunosuppressive TGFβ and IL-10. CD56dim and CD56bright NK cells execute cytotoxicity, while CD56bright cells also regulate immunity. However, beyond the CD56 dichotomy, detailed phenotypic diversity reveals many functional subsets that may not be optimal for cancer immunotherapy. In this review, we provide comprehensive and detailed snapshots of NK cells' functions and states of activation and inhibitions in cancer, autoimmunity, angiogenesis, wound healing, pregnancy and fertility, aging, and senescence mediated by complex signaling and ligand-receptor interactions, including the impact of the environment. As the use of engineered NK cells for cancer immunotherapy accelerates, often in the footsteps of T-cell-derived engineering, we examine the interactions of NK cells with other immune effectors and relevant signaling and the limitations in the tumor microenvironment, intending to understand how to enhance their cytolytic activities specifically for cancer immunotherapy.

An exploration of ecoacoustics and its applications in conservation ecology

Our planet is facing unprecedented adversity due to the global impacts of climate change and an emerging sixth mass extinction. These impacts are exacerbated by population and industrial growth, where increased resource extraction is required to meet our insatiable demands. Yet, the tangible elements of our lone inhabited planet in the solar system are not the only things disappearing or being modified. The sounds of Earth are being altered in ways that may never be recovered. Indeed, we occupy a noisier world in this age of machines that comes at a great expense in the form of sonic extinctions. It is profoundly apparent, yet not widely recognized, that conservation efforts must consider the importance of the sonic environment (i.e., sonosphere). Although sound has been integral to life for millions of years, our understanding of its ecological role has only just begun. Sounds are one of the most important extensions of the organismic inner world, becoming testimonials of environmental complexity, integration, and relationships between apparently separated parts. From a semiotic perspective, sounds are signals utilized by many organisms to save energy in patrolling, defending, exploring, and navigating their surroundings. Sounds are tools that establish dynamic biological and ecological competencies through refined partitioning in the natural selection process of evolution. Ecoacoustics is a recent scientific discipline that aims to investigate the role of sound in ecological processes. Despite its youth, Ecoacoustics has had rapid theoretical and applied growth, consolidating a diverse array of research on the ecology of sounds across many disciplines. Here, we present how Ecoacoustics plays a significant role in conservation ecology by exploring the discipline's theoretical framework, new descriptors of sonic complexity, and innovative methods for supporting conservation efforts from singular species to entire landscapes across local and global scales. The combination of automated recording units and ecoacoustic indices present a very promising approach to the study of remote areas, rare species, and data rich analyses. While Ecoacoustics scientists continue to explore this new scientific horizon, we encourage others to consider Ecoacoustics in their conservation agendas because of its application to the study and management of terrestrial, marine, and freshwater habitats.

Modifying effects of green space on the relationships between air pollution and ischemic cerebrovascular event recurrence in Tianjin, China

This study aimed to explore how air pollution and green space influence ICE recurrence and whether they might interact with each other. A case-cross design was used in this study, which was carried out in Tianjin, China. A total of 8306 patients with recurrent ICE were collected from 2019 to 2020. The maximum effects of PM2.5, PM10, SO2, NO2, CO were 1.012 (95%CI: 1.004, 1.019), 1.010 (95%CI: 1.004, 1.016), 1.035 (95%CI: 0.982, 1.091), 1.067 (95%CI: 1.043, 1.091) and 1.012 (95%CI: 1.004, 1.021)  , respectively, and the risk was higher in males and in the 50-60 age group. In the stratification of greening, it was found that air pollution except O3 had the highest risk of ICE recurrence for those with lower green space. Our study found that air pollution (except O3) can increase the risk of ICE recurrence, and this risk can be reduced by increasing green space.

Exercise, Dialysis, and Environment: A Narrative Review in an Ecological Perspective

BACKGROUND

Patient empowerment and environmental sustainability may contribute to creating efficient and resilient healthcare models. Chronic kidney diseases call for a sustainable approach aimed at improving physical function and mental health of patients and possibly contributing to the slowing down of the evolution toward the end stage of renal disease (ESRD) with a reduction of the environmental and economic impact.

SUMMARY

Multidisciplinary interventions should be implemented particularly, at the final stages when patients are exposed to sedentariness, reduced health-related quality of life (HR-QoL), high cardiovascular morbidity and mortality, and the healthcare services to high costs, and participation in environmental pollution. Ecological strategies based on specific nutritional approaches, exercise, and environment should be designed and tested. In particular, the introduction to physical exercise represents a useful replacement therapy to counteract the hazards derived from the sedentary behavior of ESRD patients, with low physical function associated with poor clinical outcomes. A more active and healthy lifestyle, particularly in the natural environment, could impact HR-QoL, mental and physical well-being but also on socialization, with lower anxiety and fatigue stress levels. Otherwise, combining sustainable exercise models into the patient's daily routine can be enhanced by the biophilic design called to reproduce a natural environment in the dialysis center. Finally, the involvement of the personnel and the health professionals in properly managing the exercise interventions and the related factors (location, modality, dose, intensity, and duration) might improve the patients' participation. In particular, ecological programs should be broadly inclusive and aimed to target the lowest performing populations through minimal feasible doses of exercise.

KEY MESSAGES

Moving toward an ecological framework of lifestyle change in the very advanced stages of kidney disease, the potential synergies between environment, diet, and exercise may improve the physical and mental health of the patients and reduce the impact of dialysis.

Associations between residential environments and late-onset schizophrenia in UK Biobank: Interaction with genetic risk factor

BACKGROUND

Environment and genes both contribute to schizophrenia. However, the impact of different natural environments surrounding residential addresses on schizophrenia in urban settings remains unknown. This study aimed to investigate the association of urbanisation, measured by residential environments, with late-onset schizophrenia and explore whether genetic risk for schizophrenia modified the associations.

METHODS

We examined the associations between residential environments and late-onset schizophrenia and its interaction with genetic risk factors in UK Biobank, followed from 2006 to 2010 (baseline) to Dec 2021. Residential environments, including greenspace, domestic garden, blue space, and total natural environment, were evaluated using land use coverage percentage. The polygenic risk score (PRS) of schizophrenia was derived using a Bayesian approach and adjusted it against ancestry. Cox proportional hazard regression model was used to assess the associations between per interquartile (IQR) increase of each type of residential environments and late-onset schizophrenia. Interactive effects of PRS and residential environments on late-onset schizophrenia were assessed on both additive and multiplicative scales.

RESULTS

A total of 393,680 participants were included in the analysis, with 844 cases of late-onset schizophrenia being observed after 12.8 years of follow-up. Within 300 m buffer surrounding the residential addresses, per interquartile increase in greenspace (31.5 %) and total natural environment (34.4 %) were both associated with an 11 % (HR = 0.89, 95 % CI 0.80, 0.99) lower risk of late-onset schizophrenia. Domestic garden and blue space did not show significant protective effects on late-onset schizophrenia. A strong dose-response relationship between schizophrenia PRS and schizophrenia was found, while no additive or multiplicative interaction effects were present between residential environments and PRS on late-onset schizophrenia.

CONCLUSION

Residential greenspace and total natural environment may protect against late-onset schizophrenia in older people regardless of genetic risk. These findings shed light on the prevention of schizophrenia and urban planning to optimise ecosystem benefits linked to schizophrenia.

A survey exploring the nexus of psychological traits, nature connection, and quality of life among patients with rheumatoid arthritis

Background

As the recognition of psychological factors in chronic illness management grows, this study examined the interplay of psychological traits - grit, self-efficacy, resilience, and nature-relatedness - and their collective impact on the Quality of Life (QoL) among patients with rheumatoid arthritis (RA) in Malaysia.

Methods

A cross-sectional study was conducted among 222 patients with RA at a private hospital in Malaysia. Utilizing validated scales, including the Connor-Davidson Resilience Scale, Short Grit Scale, Nature Relatedness Scale, and Arthritis Self Efficacy Scale, data were collected. Pearson Product-moment Correlation analyses assessed the relationships between variables, and a multiple mediation analysis explored the mediating effects of resilience, grit, and self-efficacy on the relationship between nature-relatedness and QoL.

Findings

Of the 222 participants (86% female, mean age = 56.03, S.D. = 13.42), the analysis revealed a significant mediating role of resilience in the relationship between nature-relatedness and QoL among RA patients (b = -.117, SE = .042, 95% BCa CI [-.208, -.046]). Although grit and self-efficacy positively correlated with QoL, they did not serve as significant mediators in the nature-relatedness - QoL relationship. This highlights the pivotal role of building a sense of resiliency among patients with RA.

Interpretation

Individuals with RA are not only resilient in terms of their psychological traits such as grit, self-efficacy, and general resilience but also exhibit resilience in their connection and interaction with the natural environment (nature-relatedness). This holistic concept recognizes that fostering resilience in both psychological aspects and the context of one's environment is crucial for promoting overall well-being, particularly in the management of chronic illnesses like RA. It emphasizes the interconnectedness of psychological factors and environmental engagement in contributing to an individual's ability to cope and thrive despite health challenges.

Effect of Therapeutic Gardening Program in Urban Gardens on the Mental Health of Children and Their Caregivers with Atopic Dermatitis

This study was conducted to identify the physical and psychological difficulties of children with atopic dermatitis and their caregivers, and to investigate the effects of participation in a novel therapeutic gardening program based on psychological intervention on their physical and mental health. The program, consisting of 15 sessions, was conducted for approximately 4 months in urban gardens in Seoul and involved 30 children with atopic dermatitis and their caregivers. Additionally, a control group of 30 non-participating caregivers was recruited for comparative analysis. The psychological and emotional changes in caregivers were assessed using six self-report scales (depression, anxiety, stress, vitality, life satisfaction, parenting efficacy) before and after participation in the program. Additionally, the depression index (CDI) and atopic dermatitis index (SCORAD, TEWL) were measured for the children with atopic dermatitis. The research results indicate that the therapeutic gardening program utilizing psychological intervention had a positive impact on the physiological and psychological health of participants. These results are significant as they demonstrate the clinical application of the professionally developed therapeutic gardening program through active intervention and operation. This study suggests that this program can serve as an effective intervention in improving the mental health of both children with atopic dermatitis and their caregivers.

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.

Public nature and health for homeless populations: Professionals' perceptions of contingent human benefits and harms

This article investigates relationships between public nature and health for unsheltered homeless populations. It examines perceptions of health benefits and harms for people living in public natural areas including local, state, and national forests and parks in the Seattle metropolitan area (USA). Interviews with environmental, social service, and law enforcement professionals who regularly interact with this vulnerable population were conducted and thematically analyzed to understand perceptions of physical and mental health outcomes. Results show professionals' perspectives on the health benefits and detriments of time spent in natural environments and the contextual factors perceived to influence health. Interviewees' observations about the variability of personal circumstances and biophysical, social, and weather conditions encourage the nuanced consideration of how contingent therapeutic landscapes provide deeply needed benefits, but for a population with a diminished capacity to adapt when conditions change. We conclude with insights for future research that directly assesses homeless populations' exposures and health outcomes of living in public natural areas.

Evaluating the impact of aerobic and resistance green exercises on the fitness, aerobic and intrinsic capacity of older individuals

OBJECTIVE

Our study determined the impact of 12-week aerobic exercise (AE) and aerobic + resistance exercises (AE + RE) within the green exercise concept, on senior fitness, aerobic capacity, and intrinsic capacity (IC).

METHODS

The study was a multicenter, randomized controlled study conducted at two senior living facilities with individuals aged 65 and above whose cardiorespiratory and musculoskeletal conditions are suitable for moderate exercise and who have normal cognition levels. Block randomization was applied to 96 participants in a ratio of 1:1:1 to be assigned to AE, AE + RE, and control (C) groups. Intervention groups received exercise sessions led by physiotherapists within the senior living facilitiy gardens, with a frequency of once a week for 50 min, for 12 weeks. Also, they were prescribed additional exercise sessions on two additional days of the week. At the commencement of the study and 12th week, shuttle walking test, senior fitness test (SFT), intrinsic capacity assessment (with Timed Up and Go test, Mini Mental State Examination, Geriatric Depression Scale-15, Mini Nutritional Assessment, handgrip strength test) was conducted of all participants. The primary outcome was the Z score of IC, secondary outcomes were VO2max and SFT subparameters. The study was registered in the Protocol Registry and Results System (Clinicaltrials.gov PRS) with the registration number NCT05958745.

RESULTS

90 participants successfully completed the study, with 30 individuals in each of the AE, AE + RE, and C groups. By the end of the 12th week, the arm curl score was significantly higher in the AE + RE compared to the C (mean difference: 3.96, 95 % CI= 2.47 to 5.46, p = 0.01). There were significant differences in chair stand, two-minute step, 8-foot up-and-go, chair sit and reach, and back scratch tests in both AE and AE + RE compared to C. AE and AE + RE exhibited significantly higher shuttle test distances and VO2max values compared to the C (p < 0.0001). AE + RE achieved a significantly higher total IC score than the C (mean difference: 0.59, %95 CI= -0.07 to 1.26, p = 0.025).

CONCLUSION

In this study within the green exercise concept, both AE and AE + RE led to similar improvements in strength, flexibility, mobility, endurance, and aerobic capacity. Notably, AE + RE demonstrated an additional benefit by increasing the total IC, while AE alone did not exhibit the same effect.

Aula Verde (tree room) as a link between art and science to raise public awareness of nature-based solutions

Nature-based solutions inherently require a multifaceted perspective that encompasses diverse fields. The aim of this project is to develop more effective nature-based solutions, climate action and environmental awareness by breaking down boundaries between disciplines and fostering a co-creative process. Concepts of ecology and urban forestry were combined with the research on political ecology, environmental humanities, land art, regenerative art, performing art, participatory art, and more-than-human art. This process resulted in the creation of Aula Verde Aniene. It is located in an urban park in Rome and consists of a stand of trees arranged in circles with a specific design to give the perception of being in an outdoor vegetated room. The project activities involved community participation through art performances and citizen science initiatives. Regulating and cultural ecosystem services of Aula Verde were assessed using i-Tree Eco software and citizens' surveys. Beyond numerical descriptions of ecosystem services, the manuscript introduces shinrin-yoku as a practice to raise awareness of nature. The distinctive approach here described contributed to convey a sense of belonging to the ecosystem to citizens. The project framework and study findings have been developed to formulate policy recommendations and disseminate a format that can be adapted to diverse locations.

Shinrin-Yoku (Forest Bathing): A Scoping Review of the Global Research on the Effects of Spending Time in Nature

Background

This Scoping review (ScR) builds upon the 2017 review conducted by Hansen et al which contributed to evidence base shinrin-yoku (SY), also known as forest bathing (FB), has many positive health effects and is becoming a prescribed dose (specific time spent in nature) by health care providers. Practice and research regarding SY, has been historically based in Asian countries with a recent increase in Europe. The need and call for more research worldwide continues to further the evidence of SY as a health promotion modality. Through this ScR the authors identified programmatic components, health information monitored and screened, time spent in nature, geographical regions, trends, and themes in SY research worldwide.

Methods

Following PRISMA-ScR guidelines we searched across 7 electronic databases for SY or FB research articles from 2017 through 2022. PubMed, CINAHL, PsycInfo, ScienceDirect, SCOPUS, Embase, JSTOR were included due to the interdisciplinary nature of SY or FB research. Each database provided unique strengths ensuring a capture of a wide range of articles. The resulting articles were screened and extracted through Covidence.

Results

Database searches returned 241 results, with 110 references removed during the deduplication process, 131 were initially screened in the title and abstract review stage. Resulting in 82 unique results deemed relevant and screened in full text. During the final stage of the review, 63 articles met all inclusion criteria and were extracted for data.

Conclusions

The practice of SY has physiological (PHYS) and psychological (PSYCH) benefits across age groups. Research findings indicate either the natural or the virtual environment (VW) has significant health benefits. Continued research is encouraged globally for short- and long-term health outcomes for all individuals. The connection with nature benefits the mind, body and soul and is supported by Henry David Thoreau's philosophy: "Our livesneed the relief of where the pine flourishes and the jay still scream."

Evaluation of a Guided Nature and Forest Therapy Walk for Internal Medical Residents - A Brief Report

Background

Medical residents commonly face compassion fatigue, burnout, anxiety, and depression. Studies of nature-based interventions show improved mental and physical health; few focus on healthcare providers.

Objective

To explore potential benefits of forest bathing for medical residents' wellbeing.

Methods

Using the Association of Nature and Forest Therapy's framework, we piloted a forest bathing intervention among medical residents with pre/post-participation surveys assessing perceptions of mindfulness and psychological wellbeing. Responses were analyzed using a Fisher's exact test and Student's t-test for independent samples.

Results

Fourteen of fifteen participants completed both surveys. We observed significantly improved mindfulness scores and expressions of feeling calm, vital, or creative, as well as a decreased sense of anxiety and depression. Nonsignificant trends towards decreased burnout and irritability were seen.

Conclusion

This quality improvement pilot demonstrates trends that forest bathing can improve medical residents' psychological wellbeing and mindfulness. Further exploration of this intervention for healthcare providers is warranted.

Forest Bathing Increases Adolescents' Mental Well-Being: A Mixed-Methods Study

Previous research has demonstrated that practicing forest bathing has significant positive effects on adult psychological well-being. Considering the ongoing adolescents' mental health crisis of increasing anxiety and depression, determining whether forest bathing has similar effects on adolescents is an important expansion of forest bathing research. This study investigated the possibility that forest bathing could improve adolescents' mental well-being and sought to determine participants' experiences of forest bathing. It used a convergent, parallel, mixed-methods design that was partially co-created with 24 participants aged 16-18 as part of a youth participatory action research (YPAR) project in which participants practiced forest bathing three times over 3 weeks. As measured using the Warwick-Edinburgh Mental Well-Being Survey, the mean participant mental well-being increased significantly after forest bathing, with moderate to large effect sizes. Participants described reduced stress and increased feelings of relaxation, peace, and happiness. These findings correlate with previous forest bathing research involving adult participants. It is recommended that educators and others who work with adolescents consider forest bathing as a simple, low-cost way to improve adolescents' mental well-being.

The complex role of air pollution on the association between greenness and respiratory mortality: Insight from a large cohort, 2009-2020

BACKGROUND

Although emerging studies have illuminated the protective association between greenness and respiratory mortality, efforts to quantify the potentially complex role of air pollution in the causal pathway are still limited. We aimed to examine the potential roles of air pollution in the causal pathway between greenness and respiratory mortality in China.

METHODS

We used data from a community-based prospective cohort of 654,115 participants in southern China (Jan 2009-Dec 2020). We evaluated the greenness exposure as a three-year moving average Normalized Difference Vegetation Index (NDVI) within the 500 m buffer around the residence. Cox proportional hazards model was applied to estimate the association between greenness and respiratory mortality. Causal mediation analysis combined with a four-way dimensional decomposition method was utilized to simultaneously quantify the interaction and mediation role of air pollution including PM2.5, PM10, or NO2 on the greenness-respiratory mortality relationship.

FINDINGS

We observed 6954 respiratory deaths during 12 years of follow-up. Increasing NDVI level from the lowest to the highest quartile is associated with a 19 % (95%CI: 13-25 %) reduction in the respiratory mortality risk. For the total protective effect, the proportion attributable to the overall negative interaction between greenness and air pollution (PM2.5, PM10, or NO2) was 2.2 % (1.7-3.2 %), 3.5 % (0.4-3.7 %), or 25.0 % (22.8-27.1 %), respectively. Simultaneously, we estimated 25.5 % (20.1-32.0 %), 49.5 % (32.5-71.9 %), or 1.0 % (0.8-1.2 %) of the total protective association was mediated through a reduction in PM2.5, PM10, or NO2, respectively.

INTERPRETATION

Increased greenness exposure mitigated respiratory mortality through both the antagonistic interaction and mediation pathway of air pollution (PM2.5, PM10, or NO2).

Nature-based biopsychosocial resilience: An integrative theoretical framework for research on nature and health

Nature-based solutions including urban forests and wetlands can help communities cope better with climate change and other environmental stressors by enhancing social-ecological resilience. Natural ecosystems, settings, elements and affordances can also help individuals become more personally resilient to a variety of stressors, although the mechanisms underpinning individual-level nature-based resilience, and their relations to social-ecological resilience, are not well articulated. We propose 'nature-based biopsychosocial resilience theory' (NBRT) to address these gaps. Our framework begins by suggesting that individual-level resilience can refer to both: a) a person's set of adaptive resources; and b) the processes by which these resources are deployed. Drawing on existing nature-health perspectives, we argue that nature contact can support individuals build and maintain biological, psychological, and social (i.e. biopsychosocial) resilience-related resources. Together with nature-based social-ecological resilience, these biopsychosocial resilience resources can: i) reduce the risk of various stressors (preventive resilience); ii) enhance adaptive reactions to stressful circumstances (response resilience), and/or iii) facilitate more rapid and/or complete recovery from stress (recovery resilience). Reference to these three resilience processes supports integration across more familiar pathways involving harm reduction, capacity building, and restoration. Evidence in support of the theory, potential interventions to promote nature-based biopsychosocial resilience, and issues that require further consideration are discussed.

Is COPD mortality in South China causally linked to the long-term PM1 exposure? Evidence from a large community-based cohort

BACKGROUND

Long-term ambient particulate matter (PM) exposure has been found associated with chronic obstructive pulmonary disease (COPD) mortality in an increasing body of research. However, limited evidence was available on the potential causal links between PM1 and COPD mortality, especially in highly exposed areas.

OBJECTIVES

To examine the COPD mortality risk following long-term ambient PM1 exposure in south China.

METHODS

The cohort included 580,757 participants recruited during 2009-2015. Satellite-based annual concentrations of PM1 were estimated at a spatial resolution of 1 km × 1 km and assigned to each participant based on their residential addresses. We analyzed the potential causal links between time-varying PM1 exposure and COPD mortality using marginal structural cox models within causal frameworks. Stratified analyses were also performed to identify the potential susceptible groups.

RESULTS

The annual average PM1 concentration continuously decreased over time. After adjusting for confounders, each 1 μg/m3 increase in PM1 concentration corresponded to an 8.1 % (95% confidence interval: 6.4-9.9 %) increment in the risk of COPD mortality. The impact of PM1 was more pronounced among the elderly and those with low exercise frequency, with a 1.9-6.9 % higher risk than their counterparts. We further observed a 0.1-9.7 % greater risk among those who lived in lower greenness settings. Additionally, we observed higher effect estimates in participants with long-term low PM1 exposure compared to the general population.

CONCLUSIONS

COPD mortality risk significantly increased following long term ambient PM1 exposure, particularly among groups with certain demographics or long-term low exposure.

The Patterns of Intraspecific Variations in Mass of Nectar Sugar along a Phylogeny Distinguish Native from Non-Native Plants in Urban Greenspaces in Southern England

To serve human needs, non-native species are selected based on an array of functional traits, which generally confer competitive advantages to these species in their recipient environments. Identifying non-obvious functional traits that indirectly inform human selection of non-natives to introduce into urban greenspaces is not yet part of common discussions in invasion biology. We tested whether functional traits integrated within a phylogenetic framework, may reveal those subtle criteria underlying the introduction of non-native plants into urban greenspaces. We found no differences in terms of functional traits between natives and non-natives. We also found no evidence that functional traits predict nectar production, irrespective of how nectar production was measured. Finally, we found that the mean sugar concentration of nectar per flower is evolutionarily shared both within closely related non-native plants as well as within close native plants. However, phylogenetically close species share similar intraspecific variation in mass of nectar sugar per flower, but this is true only for non-native plants, thus revealing a non-obvious selection criteria of non-native plants for urban greenspaces. Our results indicate that the phylogenetic patterns of intraspecific variation in mass of nectar sugar per flower is the major criterion distinguishing non-natives from native plants in urban greenspaces in Southern England.

Nature As Medicine: The 7th (Unofficial) Pillar of Lifestyle Medicine

There are 6 Official Pillars of Lifestyle Medicine, and now mounting evidence supports daily exposure to nature and fresh air as vital to optimizing overall physical and mental health. Time spent in nature has been shown to help lower blood pressure, reduce nervous system arousal, enhance immune system function, reduce anxiety and increase self-esteem. The positive effects of time spent in nature span different occupations, ethnic groups, financial status and individuals with a variety of chronic illnesses and disabilities. "Forest Bathing" is the term coined by Japanese researchers for walking in the woods. It is suspected that aerosols from trees, when inhaled during a forest walk, are one factor responsible for elevated immune system Natural Killer (NK) cells, which help fight off infections and tumor growth. In a culture of ever-increasing technology and screen time, now more than ever it is crucial to educate and empower individuals to incorporate nature into therapeutic treatment regimens. This article will demonstrate the potential benefits of nature, share evidence supporting nature as medicine and provide tools to help engage individuals to spend more time outdoors.

Impact of forestry on environment and human health: an evidence-based investigation

There is an increasing interest in the health effects of the forest. Without active participation in forestry, conflicts between the various stakeholders are foreseeable. The impact of forests on human life is unforgettable, and everyone gets enormous benefits from trees and greenery. COVID-19 has caused many changes in human behavior, which needs much attention. Environmental change's impact is considered a better solution and influences human behavior. Scientists around the globe are conducting research experiments on trees and the effect of forestry on human health, which is increasing in terms of social, ecological, and economic services. Trees provide full support to enhance the quality of life and minimize air pollution. Forests must be noticed to get benefits (e.g., carbon storage, fruits, human health considerations, economic benefits, and biodiversity). This research aims to explain the area of forest and health from the perspective of Saudi Arabian forestry and develop strategic measures for the proactive design of this topic. The research entailed expert interviews with forestry representatives and a quantitative survey of medical students. Our findings show that implementing strategic measures, such as establishing a forest and health, improves health and eliminates air pollution. It shows many other establishment and planning strategies, such as the use of professional visitor monitoring, the development of product innovations, the use of digitalization, and the development of integrated forest management.

What is Nature-Based Medicine and What Does It Do?

One's personal health and well-being can improve with activity in natural environments or decline without it. Many chronic illnesses to which personal nature deficiency contributes-including anxiety, depression, attention deficit, diabetes, hypertension, myopia, and obesity-have been exacerbated with the pandemic. That those illnesses may be preventable, treatable, and even reversible with an added nature-based approach may seem novel, but it is not. Though the field of nature-based medicine is just emerging in the U.S., it has been taught and practiced in Asia and the EU for decades. As the prescriptive, evidence-based use of natural settings and nature-based interventions, it aims to prevent and treat disease and improve well-being. Nature-based medicine blends particular activity in nature with the science of medicine to attempt to empower self-care safely, effectively, and happily. Its vision is to be readily available to all, regardless of proximity to blue (water-related) or green (land-related) space. The common sense of nature-based medicine belies its scientific evidence base, which is growing but not well-known, so it may seem unfamiliar to prescribe nature to patients. It will take education, training and practice to help patients access nature-based medicine and to help clinicians prescribe it.

An integrative review of the evidence for Shinrin-Yoku (Forest Bathing) in the management of depression and its potential clinical application in evidence-based osteopathy

There is growing interest in the idea of integrating Nature Therapies into the multidisciplinary management of complex conditions such as depression. Shinrin-Yoku (Forest Bathing), a practice involving spending time in a forested environment while paying attention to multi-sensory stimuli has been proposed as one such modality. The objectives of this review were to critically analyse the current evidence base on the efficacy of Shinrin-Yoku for the treatment of depression, and to examine how the findings may reflect and/or inform osteopathic principles and clinical practice. An integrative review of the evidence for Shinrin-Yoku in the management of depression published between 2009 and 2019 was conducted resulting in n = 13 peer-reviewed studies meeting inclusion criteria. Two themes emerged from the literature, the positive effect of Shinrin-Yoku on self-reported mood scores, and physiological changes arising from forest exposure. However, the methodological quality of the evidence is poor and experiments may not be generalisable. Suggestions were made for improving the research base via mixed-method studies in a biopsychosocial framework, and aspects of the research which may be applicable to evidence-based osteopathy were noted.

Effects of phytoncide on immune cells and psychological stress of gynecological cancer survivors: randomized controlled trials

This study aimed to identify neuroendocrine substances and natural killer (NK) cells, including their subsets and receptors, to determine whether phytoncides scented in an urban hospital could help improve stress in cancer survivors. Fifty-five gynecological cancer survivors were assigned to either the control group (CG, n=28) or phytoncide group (PTG, n=27). The PTG meditated by lying down in a space scented with phytoncide for 1 hr a day, 5 days a week for 8 weeks. Stress levels in both groups were high prior to the experiment and decreased by 9.31%±45.98% (P=0.003) only in the PTG after the experiment. Although the parasympathetic nerve activity of the PTG increased, the epinephrine and cortisol levels were significantly (P<0.001) decreased by 5.29%±25.5% and by 24.94%±11.62%. Moreover, the PTG showed a significant increase in the levels of NK cell subsets after 8 weeks, whereas there was no improvement in the CG. In conclusion, phytoncide fragrance reduces stress, increases the number of NK cells and their family even in a nonforest environment, and improves innate immunocytes in gynecological cancer survivors; parasympathetic nerve activity and cortisol hormones play critical roles in this process. That is, a phytoncide essential oil helps to stimulate changes in immunocytes' mobility by affecting the human nervous and endocrine systems, thereby providing relief for psychological stress among cancer survivors who previously had cancer cells.

Family stress during the COVID-19 pandemic: a qualitative analysis

OBJECTIVE

This study aimed to understand experiences with stress and coping strategies used among families in the COVID-19 pandemic.

DESIGN/SETTING

This qualitative study took place in the paediatric outpatient clinics of a large academic medical centre in the USA between March and July of 2021.

PARTICIPANTS

Parents (over the age of 18 years) of children under the age of 18 years were invited to complete a 30-minute semistructured interview.

PRIMARY AND SECONDARY OUTCOME MEASURES

Participants were asked about types of stressors experienced during the COVID-19 pandemic and coping strategies used. All interviews were audio recorded and transcribed. In the grounded theory tradition, transcripts underwent thematic analysis.

RESULTS

A total of 26 participants completed interviews, including 88% (n=23) women, 85% (n=22) reported having children under the age of 10 years and 65% (n=17) were 30-50 years of age. Themes that emerged included the compounding effect of COVID-19 stressors, in which participants described multiple, intersecting sources of stress. One parent noted, "I worked two different jobs, since the other job I had counted on working, I lost because of COVID. And so, working from home, also with the kids, was stressful." The second theme reflected the challenges for children with virtual schooling due to decreased educational support. The third theme was the need for parental self-care. The fourth theme was finding the silver lining in which parents noted unforeseen opportunities for resilience by spending time in nature and activities promoting family bonding.

CONCLUSIONS

Parents indicated need for self-care, connecting with their child(ren) and spending time in nature. Future work should develop approaches to support families in these areas when facing complex stressors, especially during a pandemic or other times of crisis.

Can natural environments enhance acute effects of rehabilitation exercise for older adults? A pilot randomized controlled trial

The added value of natural environments in rehabilitation exercise is unclear. This study aimed to investigate whether there are more acute health benefits for older adults after a single rehabilitation exercise session performed in an outdoor natural environment compared with an indoor environment. Twenty-two nursing home residents were randomly assigned to the outdoor (n = 11, 79.5 ± 2.1 years) or indoor group (n = 11, 78.8 ± 5.2 years). Performance test outcomes were measured pre- and post-training session. The indoor group had a significantly higher blood pressure, greater increase in heart rate, higher perceived exercise intensity and physiological fatigue than the outdoor group. The combination of rehabilitation exercise with an outdoor natural environment may reduce exercise fatigue and improve cardiovascular health in older adults, with greater acute health benefits compared with an indoor environment. Rehabilitation exercise in the natural environments may be a highly valued environmental intervention for physiotherapy in older adults.

Effects of Forest Bath (Shinrin-Yoku) and Forest Therapy (Shinrin-Ryoho) on Women's Health

Forest bathing is an approach that uses the healing effects of forests to improve people's health and prevent disease through forest walks. Although the terms forest therapy and forest bath are used in the same sense, they are different applications. While the forest therapy application is carried out in the company of a professional trained in this subject, the therapist in the forest bath is the forest itself. Considering the positive effects of forest bathing on the cardiovascular system, nervous system, endocrine system, immune system and mental health, it is thought that it can be used as an approach to protect and improve women's health. In this context, the aim of the study is to examine the physiological and psychological effects of forest bathing and forest therapy on women's health. In this study, which was revealed by literature review, the results of national and international studies on the subject were compiled. Many positive effects of forest bathing and forest therapy on the protection of human health have been reported in the literature. There are limited studies on the effects of forest therapy and forest bathing on human health, and no scientific research has been found in the field of health in our country. It is thought that these practices can be used in our country, which is rich in forests, and that scientific studies on this subject can provide benefits for women's health.

Exercise interventions for adults with cancer receiving radiation therapy alone

BACKGROUND

Radiation therapy (RT) is given to about half of all people with cancer. RT alone is used to treat various cancers at different stages. Although it is a local treatment, systemic symptoms may occur. Cancer- or treatment-related side effects can lead to a reduction in physical activity, physical performance, and quality of life (QoL). The literature suggests that physical exercise can reduce the risk of various side effects of cancer and cancer treatments, cancer-specific mortality, recurrence of cancer, and all-cause mortality.

OBJECTIVES

To evaluate the benefits and harms of exercise plus standard care compared with standard care alone in adults with cancer receiving RT alone.

SEARCH METHODS

We searched CENTRAL, MEDLINE (Ovid), Embase (Ovid), CINAHL, conference proceedings and trial registries up to 26 October 2022.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) that enrolled people who were receiving RT without adjuvant systemic treatment for any type or stage of cancer. We considered any type of exercise intervention, defined as a planned, structured, repetitive, objective-oriented physical activity programme in addition to standard care. We excluded exercise interventions that involved physiotherapy alone, relaxation programmes, and multimodal approaches that combined exercise with other non-standard interventions such as nutritional restriction.

DATA COLLECTION AND ANALYSIS

We used standard Cochrane methodology and the GRADE approach for assessing the certainty of the evidence. Our primary outcome was fatigue and the secondary outcomes were QoL, physical performance, psychosocial effects, overall survival, return to work, anthropometric measurements, and adverse events.

MAIN RESULTS

Database searching identified 5875 records, of which 430 were duplicates. We excluded 5324 records and the remaining 121 references were assessed for eligibility. We included three two-arm RCTs with 130 participants. Cancer types were breast and prostate cancer. Both treatment groups received the same standard care, but the exercise groups also participated in supervised exercise programmes several times per week while undergoing RT. Exercise interventions included warm-up, treadmill walking (in addition to cycling and stretching and strengthening exercises in one study), and cool-down. In some analysed endpoints (fatigue, physical performance, QoL), there were baseline differences between exercise and control groups. We were unable to pool the results of the different studies owing to substantial clinical heterogeneity. All three studies measured fatigue. Our analyses, presented below, showed that exercise may reduce fatigue (positive SMD values signify less fatigue; low certainty). • Standardised mean difference (SMD) 0.96, 95% confidence interval (CI) 0.27 to 1.64; 37 participants (fatigue measured with Brief Fatigue Inventory (BFI)) • SMD 2.42, 95% CI 1.71 to 3.13; 54 participants (fatigue measured with BFI) • SMD 1.44, 95% CI 0.46 to 2.42; 21 participants (fatigue measured with revised Piper Fatigue Scale) All three studies measured QoL, although one provided insufficient data for analysis. Our analyses, presented below, showed that exercise may have little or no effect on QoL (positive SMD values signify better QoL; low certainty). • SMD 0.40, 95% CI -0.26 to 1.05; 37 participants (QoL measured with Functional Assessment of Cancer Therapy-Prostate) • SMD 0.47, 95% CI -0.40 to 1.34; 21 participants (QoL measured with World Health Organization QoL questionnaire (WHOQOL-BREF)) All three studies measured physical performance. Our analyses of two studies, presented below, showed that exercise may improve physical performance, but we are very unsure about the results (positive SMD values signify better physical performance; very low certainty) • SMD 1.25, 95% CI 0.54 to 1.97; 37 participants (shoulder mobility and pain measured on a visual analogue scale) • SMD⁠⁠⁠⁠⁠⁠ 3.13 (95% CI 2.32 to 3.95; 54 participants (physical performance measured with the six-minute walk test) Our analyses of data from the third study showed that exercise may have little or no effect on physical performance measured with the stand-and-sit test, but we are very unsure about the results (SMD 0.00, 95% CI -0.86 to 0.86, positive SMD values signify better physical performance; 21 participants; very low certainty). Two studies measured psychosocial effects. Our analyses (presented below) showed that exercise may have little or no effect on psychosocial effects, but we are very unsure about the results (positive SMD values signify better psychosocial well-being; very low certainty). • SMD 0.48, 95% CI -0.18 to 1.13; 37 participants (psychosocial effects measured on the WHOQOL-BREF social subscale) • SMD 0.29, 95% CI -0.57 to 1.15; 21 participants (psychosocial effects measured with the Beck Depression Inventory) Two studies recorded adverse events related to the exercise programmes and reported no events. We estimated the certainty of the evidence as very low. No studies reported adverse events unrelated to exercise. No studies reported the other outcomes we intended to analyse (overall survival, anthropometric measurements, return to work).

AUTHORS' CONCLUSIONS

There is little evidence on the effects of exercise interventions in people with cancer who are receiving RT alone. While all included studies reported benefits for the exercise intervention groups in all assessed outcomes, our analyses did not consistently support this evidence. There was low-certainty evidence that exercise improved fatigue in all three studies. Regarding physical performance, our analysis showed very low-certainty evidence of a difference favouring exercise in two studies, and very low-certainty evidence of no difference in one study. We found very low-certainty evidence of little or no difference between the effects of exercise and no exercise on quality of life or psychosocial effects. We downgraded the certainty of the evidence for possible outcome reporting bias, imprecision due to small sample sizes in a small number of studies, and indirectness of outcomes. In summary, exercise may have some beneficial outcomes in people with cancer who are receiving RT alone, but the evidence supporting this statement is of low certainty. There is a need for high-quality research on this topic.

Effect of the Marine Exercise Retreat Program on Thyroid-Related Hormones in Middle-Aged Euthyroid Women

This study aimed to investigate the effects of a marine exercise retreat program on thyroid-related hormone levels. A total of 62 middle-aged euthyroid women participated in a 6-day marine exercise retreat program. Using thyroid-stimulating hormone (TSH) and free thyroxine (fT4) hormone levels, the participants were divided into high and low-hormone-level groups. Despite decreased TSH and fT4 levels after the program, the factors influencing changes in each group were different. TSH levels were influenced by changes in the normalized low frequency (nLF) of heart rate variability and carbon monoxide (CO) from all the participants, and changes in body fat percentage, nLF, and nitrogen dioxide (NO2) exposure level in the high TSH group. fT4 levels were influenced by changes in body mass index (BMI), NO2 exposure, and particulate matter diameter of 10 µm or less (PM10) exposure in all participants. Changes in BMI and CO exposure influenced the low fT4 group. Lastly, changes in the exercise stress test affected the high fT4 group. Thus, the marine exercise retreat program affected euthyroid thyroid-related hormone levels, and influencing factors differ depending on the initial value of the hormone.

Nature, smells, and human wellbeing

The link between nature and human wellbeing is well established. However, few studies go beyond considering the visual and auditory underpinnings of this relationship, even though engaging with nature is a multisensory experience. While research linking smell to wellbeing exists, it focuses predominantly on smells as a source of nuisance/offence. Smells clearly have a prominent influence, but a significant knowledge gap remains in the nexus of nature, smell, and wellbeing. Here, we examine how smells experienced in woodlands contribute to wellbeing across four seasons. We show that smells are associated with multiple wellbeing domains, both positively and negatively. They are linked to memories, and specific ecological characteristics and processes over space/time. By making the link between the spatiotemporal variability in biodiversity and wellbeing explicit, we unearth a new line of enquiry. Overall, the multisensory experience must be considered by researchers, practitioners, policy-makers and planners looking to improve wellbeing through nature.

COVID-19: Reducing the risk via diet and lifestyle

This review shows that relatively simple changes to diet and lifestyle can significantly, and rapidly, reduce the risks associated with coronavirus disease 2019 (COVID-19) in terms of infection risk, severity of disease, and even disease-related mortality. A wide range of interventions including regular exercise, adequate sleep, plant-based diets, maintenance of healthy weight, dietary supplementation, and time in nature have each been shown to have beneficial effects for supporting more positive health outcomes with COVID-19, in addition to promoting better overall health. This paper brings together literature from these areas and presents the argument that non-pharmaceutical approaches should not be overlooked in our response to COVID-19. It is noted that, in several cases, interventions discussed result in risk reductions equivalent to, or even greater than, those associated with currently available vaccines. Where the balance of evidence suggests benefits, and the risk is minimal to none, it is suggested that communicating the power of individual actions to the public becomes morally imperative. Further, many lives could be saved, and many harms from the vaccine mandates avoided, if we were willing to embrace this lifestyle-centred approach in our efforts to deal with COVID-19.

The Role of Nutrition and Forest-Bathing in the Physical Rehabilitation of Physically Inactive Patients: From the Molecular Aspects to New Nature-Inspired Techniques

Physical rehabilitation plays a fundamental role in the management of individuals with disabilities associated with age-related muscle loss or affected by catastrophic conditions such as trauma, surgery, cancer or other severe pathologies. These events have in common an extended period of physical inactivity. Patients who undergo prolonged bed rest often present with a number of complications; for example, muscle loss that can exacerbate existing conditions determined by sarcopenia, which in turn greatly limits physical functions. The main scope of this work is to summarize certain key strategies for the physiotherapeutic management of physically inactive patients, regardless of the reason behind their prolonged bed rest, with a particular focus on physical rehabilitation, nutrition and forest-bathing. The importance of correct nutrition in counter-acting the loss of muscle mass and consequent function is explored alongside a description of the main nutrients that are needed for muscle regeneration. From a biomolecular perspective, some specific molecular mechanisms associated with physical rehabilitation are also reported not only in the context of physical therapy, but also within nature-inspired techniques, such as forest-bathing as well as body self-healing. Combining a targeted physiotherapeutic approach with an appropriate diet as well as nature-based therapy could thus help with the recovery of bed ridden patients.

Population-weighted exposure to green spaces tied to lower COVID-19 mortality rates: A nationwide dose-response study in the USA

The COVID-19 pandemic has caused a huge loss of human life globally. However, few studies investigated the link between exposure to green space and risk of COVID-19 mortality rate, while also distinguishing the effects of various types of green space, considering the spatial distribution of human population and green space, and identifying the optimal buffer distances of nearby green space. It is critical and pressing to fill these significant knowledge gaps to protect and promote billions of people's health and life across the world. This study adopted a negative binomial generalized linear mixed-effects model to examine the association between the ratios of various types of green space, population-weighted exposure to those various types of green space, and COVID-19 mortality rates across 3025 counties in the USA, adjusted for sociodemographic, pre-existing chronic disease, policy and regulation, behavioral, and environmental factors. The findings show that greater exposure to forest was associated with lower COVID-19 mortality rates, while developed open space had mixed associations with COVID-19 mortality rates. Forest outside park had the largest effect size across all buffer distances, followed by forest inside park. The optimal exposure buffer distance was 1 km for forest outside park, with per one-unit of increase in exposure associated with a 9.9 % decrease in COVID-19 mortality rates (95 % confidence interval (CI): 6.9 %-12.8 %). The optimal exposure buffer distance of forest inside park was 400 m, with per one-unit of increase in exposure associated with a 4.7 % decrease in mortality rates (95 % CI: 2.4 %-6.9 %). The results suggest that greater exposure to green spaces, especially to nearby forests, may mitigate the risk of COVID-19 mortality. Although findings of an ecological study cannot be directly used to guide medical interventions, this study may pave a critical new way for future research and practice across multiple disciplines.

Green spaces, especially nearby forest, may reduce the SARS-CoV-2 infection rate: A nationwide study in the United States

The coronavirus pandemic is an ongoing global crisis that has profoundly harmed public health. Although studies found exposure to green spaces can provide multiple health benefits, the relationship between exposure to green spaces and the SARS-CoV-2 infection rate is unclear. This is a critical knowledge gap for research and practice. In this study, we examined the relationship between total green space, seven types of green space, and a year of SARS-CoV-2 infection data across 3,108 counties in the contiguous United States, after controlling for spatial autocorrelation and multiple types of covariates. First, we examined the association between total green space and SARS-CoV-2 infection rate. Next, we examined the association between different types of green space and SARS-CoV-2 infection rate. Then, we examined forest-infection rate association across five time periods and five urbanicity levels. Lastly, we examined the association between infection rate and population-weighted exposure to forest at varying buffer distances (100 m to 4 km). We found that total green space was negative associated with the SARS-CoV-2 infection rate. Furthermore, two forest variables (forest outside park and forest inside park) had the strongest negative association with the infection rate, while open space variables had mixed associations with the infection rate. Forest outside park was more effective than forest inside park. The optimal buffer distances associated with lowest infection rate are within 1,200 m for forest outside park and within 600 m for forest inside park. Altogether, the findings suggest that green spaces, especially nearby forest, may significantly mitigate risk of SARS-CoV-2 infection.

The impact of greenspace or nature-based interventions on cardiovascular health or cancer-related outcomes: A systematic review of experimental studies

SIGNIFICANCE

Globally, cardiovascular disease (CVD) and cancer are leading causes of morbidity and mortality. While having different etiologies, CVD and cancer are linked by multiple shared risk factors, the presence of which exacerbate adverse outcomes for individuals with either disease. For both pathologies, factors such as poverty, lack of physical activity (PA), poor dietary intake, and climate change increase risk of adverse outcomes. Prior research has shown that greenspaces and other nature-based interventions (NBIs) contribute to improved health outcomes and climate change resilience.

OBJECTIVE

To summarize evidence on the impact of greenspaces or NBIs on cardiovascular health and/or cancer-related outcomes and identify knowledge gaps to inform future research.

METHODS

Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 and Peer Review of Electronic Search Strategies (PRESS) guidelines, we searched five databases: Web of Science, Scopus, Medline, PsycINFO and GreenFile. Two blinded reviewers used Rayyan AI and a predefined criteria for article inclusion and exclusion. The risk of bias was assessed using a modified version of the Newcastle-Ottawa Scale (NOS). This review is registered with PROSPERO, ID # CRD42021231619.

RESULTS & DISCUSSION

Of 2565 articles retrieved, 31 articles met the inclusion criteria, and overall had a low risk of bias. 26 articles studied cardiovascular related outcomes and 5 studied cancer-related outcomes. Interventions were coded into 4 categories: forest bathing, green exercise, gardening, and nature viewing. Outcomes included blood pressure (BP), cancer-related quality of life (QoL) and (more infrequently) biomarkers of CVD risk. Descriptions of findings are presented as well as visual presentations of trends across the findings using RAW graphs. Overall studies included have a low risk of bias; and alluvial chart trends indicated that NBIs may have beneficial effects on CVD and cancer-related outcomes.

CONCLUSIONS & IMPLICATIONS

(1) Clinical implication: Healthcare providers should consider the promotion of nature-based programs to improve health outcomes. (2) Policy implication: There is a need for investment in equitable greenspaces to improve health outcomes and build climate resilient neighborhoods. (3) Research or academic implication: Research partnerships with community-based organizations for a comprehensive study of benefits associated with NBIs should be encouraged to reduce health disparities and ensure intergenerational health equity. There is a need for investigation of the mechanisms by which NBIs impact CVD and exploration of the role of CVD biological markers of inflammation among cancer survivors.

Toward a Theory of Nature Experience and Health

This article presents an integrated theoretical framework to study the socioenvironmental attributes of the nature experience as a basic health behavior. After first reviewing existing literature on theories behind nature exposure, we discuss social cognitive theory (SCT) to explain individual nature experience through the model's triadic dynamic of environment, cognitions, and behaviors. We then expand beyond SCT's focus on the individual to examine structural and societal spheres of influence on nature experience found in ecological systems theory and ecosocial theory. In moving from proximal to distal influences, we identify the core constructs of each theory that may reinforce or deter decisions inclining individuals toward nature engagement. In synthesizing aspects of these three theories, we propose an integrated theoretical framework of nature experience distinguished by three ideas. First, individual-level formative influences in nature pervade higher level ecologies as a learned social behavior. Second, nature experience happens within multiple systems and timepoints. Third, social relationships within historical processes shape contextual factors of the nature experience, resulting in disparities in nature access and nature responses that manifest heterogeneously. Theorizing behind nature experience can inform why this occurs. We offer suggestions for further research to build on the groundwork put forth here: for hypothesizing around present observations, for collecting data to confirm and/or refute parts of the theory, and for further hypothesis generation inspired by the theory to inform the research agenda. In conclusion, we consider the practical implications of theory underlying nature experience as a health behavior relevant to research, interventions, and policy.

An Analysis of Theoretical Perspectives in Research on Nature-Based Interventions and Pain

Chronic pain results from a complex series of biomechanical, inflammatory, neurological, psychological, social, and environmental mechanisms. Pain and pain-related diseases are the leading causes of disability and disease burden globally. Employing nature-based interventions for the treatment of pain is an emerging field. Current theory driving the suggested mechanism(s) linking the pain reducing effects of nature-based interventions is lacking. A two-step approach was taken to complete a theoretical review and analysis. First, a literature review was completed to gather a substantive amount of research related to theoretical frameworks on the topic of nature-based interventions and pain. Secondly, a theoretical analysis as proposed by Walker and Avant was completed to explore current theoretical frameworks accepted in the literature on nature-based interventions and pain. Stress reduction theory and attention restoration theory were the most common theoretical frameworks identified. Neither theoretical framework explicitly identifies, describes, or intends to adequately measure the concept of pain, revealing a limitation for their application in research with nature-based interventions and pain. Theoretical development is needed, as it pertains to nature-based interventions and pain. Without this development, research on nature-based interventions and pain will continue to use proxy concepts for measurement and may result in misrepresented findings.

Ecosystem restoration is integral to humanity's recovery from COVID-19

COVID-19 has devastated global communities and economies. The pandemic has exposed socioeconomic disparities and weaknesses in health systems worldwide. Long-term health effects and economic recovery are major concerns. Ecosystem restoration-ie, the repair of ecosystems that have been degraded-relates directly to tackling the health and socioeconomic burdens of COVID-19, because stable and resilient ecosystems are fundamental determinants of health and socioeconomic stability. Here, we use COVID-19 as a case study, showing how ecosystem restoration can reduce the risk of infection and adverse sequelae and have an integral role in humanity's recovery from COVID-19. The next decade will be crucial for humanity's recovery from COVID-19 and for ecosystem repair. Indeed, in the absence of effective, large-scale restoration, 95% of the Earth's land could be degraded by 2050. The UN Decade on Ecosystem Restoration (2021-30) declaration reflects the growing urgency and scale at which we should repair ecosystems. Importantly, ecosystem restoration could also help to combat the health and socioeconomic issues that are associated with COVID-19, yet it is poorly integrated into current responses to the disease. Ecosystem restoration can be a core public health intervention and assist in COVID-19 recovery if it is closely integrated with socioeconomic, health, and environmental policies.

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.

A Modeling Approach for Quantifying Human-Beneficial Terpene Emission in the Forest: A Pilot Study Applying to a Recreational Forest in South Korea

(1) Background: Recent economic developments in South Korea have shifted people’s interest in forests from provisioning to cultural services such as forest healing. Although policymakers have attempted to designate more forests for healing purposes, there are few established standards for carrying out such designations based on the quantified estimation. (2) Methods: We suggest a modeling approach to estimate and analyze the emission rate of human-beneficial terpenes. For this purpose, we adopted and modified the Model of Emissions of Gases and Aerosols from Nature (MEGAN), a commonly used biogenic volatile organic compounds (BVOCs) estimation model which was suitable for estimating the study site’s terpene emissions. We estimated the terpene emission rate for the whole year and analyzed the diurnal and seasonal patterns. (3) Results: The results from our model correspond well with other studies upon comparing temporal patterns and ranges of values. According to our study, the emission rate of terpenes varies significantly temporally and spatially. The model effectively predicted spatiotemporal patterns of terpene emission in the study site. (4) Conclusions: The modeling approach in our study is suitable for quantifying human-beneficial terpene emission and helping policymakers and forest managers plan the efficient therapeutic use of forests.

Rethinking minority stress: A social safety perspective on the health effects of stigma in sexually-diverse and gender-diverse populations

For over two decades, the minority stress model has guided research on the health of sexually-diverse individuals (those who are not exclusively heterosexual) and gender-diverse individuals (those whose gender identity/expression differs from their birth-assigned sex/gender). According to this model, the cumulative stress caused by stigma and social marginalization fosters stress-related health problems. Yet studies linking minority stress to physical health outcomes have yielded mixed results, suggesting that something is missing from our understanding of stigma and health. Social safety may be the missing piece. Social safety refers to reliable social connection, inclusion, and protection, which are core human needs that are imperiled by stigma. The absence of social safety is just as health-consequential for stigmatized individuals as the presence of minority stress, because the chronic threat-vigilance fostered by insufficient safety has negative long-term effects on cognitive, emotional, and immunological functioning, even when exposure to minority stress is low. We argue that insufficient social safety is a primary cause of stigma-related health disparities and a key target for intervention.

Nature and Mindfulness to Cope with Work-Related Stress: A Narrative Review

In recent years, work-related stress has grown exponentially and the negative impact that this condition has on people's health is considerable. The effects of work-related stress can be distinguished in those that affect workers (e.g., depression and anxiety) and those that affect the company (e.g., absenteeism and productivity). It is possible to distinguish two types of prevention interventions. Individual interventions aim at promoting coping and individual resilience strategies with the aim of modifying cognitive assessments of the potential stressor, thus reducing its negative impact on health. Mindfulness techniques have been found to be effective stress management tools that are also useful in dealing with stressful events in the workplace. Organizational interventions modify the risk factors connected to the context and content of the work. It was found that a restorative workplace (i.e., with natural elements) reduces stress and fatigue, improving work performance. Furthermore, practicing mindfulness in nature helps to improve the feeling of wellbeing and to relieve stress. In this paper, we review the role of mindfulness-based practices and of contact with nature in coping with stressful situations at work, and we propose a model of coping with work-related stress by using mindfulness in nature-based practices.

Developing Forest Therapy Programmes Based on the Health Benefits of Terpenes in Dominant Tree Species in Tara National Park (Serbia)

Numerous medical studies have shown the positive effects of forests on different aspects of human health. This study deals with the content of major terpenes in dominant coniferous species in Tara National Park, Serbia, in order to explore the potential for the development of a novel health tourism programme based on forest therapy. Main terpenes were analysed using a headspace-sampling technique coupled with gas-chromatography-mass spectrometry (Head-space-GC/MS). Needles of fir and spruce growing in the vicinity of hiking trails were investigated for possibilities to perform such therapy. Major detected terpenes were α-cadinol and spathulenol previously described as antiviral, antitumor, antimicrobial and immunomodulatory agents. The results of the study were favourable and worked well with the existing walking infrastructure in the observed area of the Tara Mountain, as they act as invaluable resources for designing the structured forest bathing walks. The study not only adds to the knowledge in the environmental and public health realm but also to tourism and sustainability studies.

Essential Oils, Phytoncides, Aromachology, and Aromatherapy—A Review

Chemical compounds from plants have been used as a medicinal source for various diseases. Aromachology is a unique field that studies the olfactory effects after inhaling aromatic compounds. Aromatherapy is a complementary treatment methodology involving the use of essential oils containing phytoncides and other volatile organic compounds for various physical and mental illnesses. Phytoncides possess an inherent medicinal property. Their health benefits range from treating stress, immunosuppression, blood pressure, respiratory diseases, anxiety, and pain to anti-microbial, anti-larvicidal, anti-septic, anti-cancer effects, etc. Recent advancements in aromatherapy include forest bathing or forest therapy. The inhalation of phytoncide-rich forest air has been proven to reduce stress-induced immunosuppression, normalize immune function and neuroendocrine hormone levels, and, thus, restore physiological and psychological health. The intricate mechanisms related to how aroma converts into olfactory signals and how the olfactory signals relieve physical and mental illness still pose enormous questions and are the subject of ongoing research. Aromatherapy using the aroma of essential oils/phytoncides could be more innovative and attractive to patients. Moreover, with fewer side effects, this field might be recognized as a new field of complementary medicine in alleviating some forms of physical and mental distress. Essential oils are important assets in aromatherapy, cosmetics, and food preservatives. The use of essential oils as an aromatherapeutic agent is widespread. Detailed reports on the effects of EOs in aromatherapy and their pharmacological effects are required to uncover its complete biological mechanism. This review is about the evolution of research related to phytoncides containing EOs in treating various ailments and provides comprehensive details from complementary medicine.