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Article

Do Hospice Gardens Need a Guide? Comparing Guided and Unguided Forest Bathing for Wellbeing, Nature Connectedness and Heart Rate Variability: A Pilot Study

by
Yangang Xing
1,*,
Rachel Pitzettu
1 and
Kirsten McEwan
2
1
School of Architecture, Design and Built Environment, Nottingham Trent University, Nottingham NG1 4FQ, UK
2
College of Health, Psychology and Social Care, University of Derby, Derby DE22 1GB, UK
*
Author to whom correspondence should be addressed.
Int. J. Environ. Res. Public Health 2026, 23(9), 1233; https://doi.org/10.3390/ijerph23091233
Submission received: 19 August 2026 / Revised: 11 September 2026 / Accepted: 13 September 2026 / Published: 17 September 2026
(This article belongs to the Special Issue Nature Immersion, Health, and the Community)
Versions Notes

Highlights

Public health relevance—How does this work relate to a public health issue?
  • Palliative-care services need accessible, non-pharmacological approaches that support wellbeing, connection and quality of life for people with life-limiting illness.
  • Hospice gardens may provide a practical setting for nature-based support, but the appropriate level of specialist guidance remains uncertain.
Public health significance—Why is this work of significance to public health?
  • Both guided forest bathing and a lightly facilitated hospice-garden walk were associated with immediate improvements in self-reported wellbeing and nature connectedness.
  • Guided forest bathing did not show greater benefit than the lower-resource format, although the small non-randomised pilot cannot establish effectiveness or equivalence.
Public health implications—What are the key implications or messages for practitioners, policy makers and/or researchers in public health?
  • Lightly facilitated garden walks could be explored as a complementary, scalable form of nature-based support delivered by appropriately trained staff or volunteers.
  • Larger multi-site studies should evaluate effectiveness, safety, equity, accessibility, implementation costs and the environmental qualities of hospice gardens that support benefit.

Abstract

Nature-based interventions may support health and wellbeing, but evidence directly comparing guided and less-resource-intensive formats in clinical populations remains limited. This non-randomised pilot study examined one-hour guided forest bathing and a matched, lightly facilitated unguided nature walk in hospice gardens. Seventeen adult hospice service users selected either the guided (n = 8) or unguided (n = 9) session. The Warwick–Edinburgh Mental Wellbeing Scale (WEMWBS), Inclusion of Nature in Self (INS) scale, and heart rate variability, indexed by the standard deviation of normal-to-normal intervals (SDNN), were assessed before and immediately after the sessions. In 2 × 2 mixed analyses of variance, WEMWBS and INS scores improved significantly over time, but neither outcome showed a significant group-by-time interaction. SDNN showed neither a significant time effect nor a group-by-time interaction; its significant between-group effect was consistent with baseline differences. Exploratory Reliable Change Index analyses identified improvement for some individuals, although these findings require cautious interpretation. Both formats were associated with short-term improvements in self-reported wellbeing and nature connectedness, but the design does not establish causality or equivalence. A lightly facilitated nature walk may warrant evaluation as an accessible, lower-resource addition to palliative-care programmes.

1. Introduction

Palliative care seeks to improve quality of life for people with life-limiting illness and for their families [1]. The physical setting is part of that care: it can shape comfort, mood, and everyday experience [2]. Many hospices therefore provide gardens intended for rest, reflection, and social contact [3]. Ecotherapy treats the relationship between people and the natural world as a resource for health [4], while biophilic design translates that relationship into the design of buildings and landscapes. In healthcare settings, natural elements and patterns have been linked with emotional wellbeing, satisfaction with the environment, and attachment to place [5,6]. This work is grounded in the proposition that humans retain a biologically rooted affinity with nature [7].
Forest bathing (shinrin-yoku) is a slow, attentive way of spending time in nature, usually through guided sensory activities. Field studies and reviews report reductions in stress and improvements in mood and relaxation [8,9,10].
A forest visit, however, may be unrealistic for someone living with serious illness, fatigue, or restricted mobility. Although hospice gardens differ from forests in characteristics such as scale, biodiversity, tree density and exposure to forest-derived volatile organic compounds, they may provide a more familiar, accessible and supportive nature-based setting for individuals with limited mobility or complex health needs, enabling regular engagement with restorative natural environments. An on-site hospice garden may be more feasible because it is close to care facilities and may provide accessible paths, seating, shelter and staff support, but it is uncertain whether the presence of a trained forest bathing guide is essential.
Attention Restoration Theory (ART) proposes that natural environments replenish directed attention through softly fascinating stimuli [11,12], whereas Stress Reduction Theory (SRT) links safe natural settings with psychophysiological recovery [13]. Nature exposure has also been associated with less rumination and reduced activity in brain regions involved in maladaptive self-focused thought [14]. Prospect-Refuge Theory (PRT) adds a spatial dimension: an open outlook can invite exploration, while shelter and enclosure provide security. Xing et al. [6] further suggest that biophilic settings may elicit inspiration as well as recovery, attention, and refuge. Their findings point to a possible Inspiration-Motivation Pathway (IMP), in which varied but coherent natural forms, colours, and textures not only calm and restore but also prompt curiosity, new ideas, and a willingness to engage. This combination of restoration, safety, and inspiration may be especially valuable in palliative care, where interventions need to be gentle, meaningful, and easy to access.
Nature connectedness—the extent to which nature forms part of a person’s sense of self [15]—may provide another route to wellbeing. It is associated with wellbeing and mindfulness [16], including eudaimonic aspects such as meaning and personal growth [17], and emotional regulation may partly explain this relationship [18]. Guided forest-bathing studies have also reported changes in wellbeing, nature connectedness, and HRV [19,20]. Few studies, however, have involved hospice service users or compared guided forest bathing with a closely matched nature walk.
Hospice gardens vary considerably in size, vegetation, biodiversity, canopy cover, accessibility, and sensory characteristics, which may influence the extent to which they provide restorative experiences and replicate elements of forest environments. In this study, the research was conducted in a semi-urban hospice garden comprising mixed woodland areas, planted gardens, ponds, and open green spaces, offering a range of natural features while remaining readily accessible to participants.
Psychosocial needs in palliative care are varied and often change over time [21]. Both contact with nature and a felt connection to nature may contribute to wellbeing [22,23,24]. Against this background, the present pilot study compared a guided forest bathing session with a lightly facilitated walk along the same hospice-garden route. Both sessions were expected to improve wellbeing, nature connectedness, and HRV, with a larger improvement anticipated in the guided group. Route, duration, stopping points, and walking pace were matched as closely as possible.

2. Materials and Methods

2.1. Study Design

A single-site, non-randomised pre–post design compared guided forest bathing with a lightly facilitated nature walk that did not include formal forest-bathing prompts. The study was designed to test delivery in a hospice garden and to generate preliminary estimates for a larger evaluation. As a pilot, it was not powered to establish efficacy or equivalence [25]. The study was conducted in accordance with the Declaration of Helsinki and approved by the Nottingham Trent University Ethics Committee for Non-Invasive Research (protocol 1619917; 1 November 2022). All participants provided written informed consent.

2.2. Participants

A volunteer sample of 17 adults accessing hospice services participated (12 women; mean age = 67.0 years, SD = 10.10, range = 44–80 years; 15 White British and two of multiple ethnic backgrounds). Eight participants attended the guided session and nine attended the unguided session. Exclusion criteria were inability to access the hospice woodland paths, use of medication known to affect heart rate, or inability to communicate questionnaire responses.

2.3. Outcome Measures

2.3.1. Heart Rate Variability

Heart rate variability reflects variation in the interval between successive heartbeats. The standard deviation of normal-to-normal intervals (SDNN) was used as a time-domain measure of autonomic function [26]. Although SDNN is conventionally interpreted over longer recordings, it is also reported in short and ultra-short assessments; such values require cautious interpretation [27]. Lower SDNN has been associated with adverse health outcomes in clinical populations [28]. Polar H10 chest straps and the Elite HRV smartphone application were used to obtain 90 s seated recordings immediately before and after the intervention.

2.3.2. Warwick–Edinburgh Mental Wellbeing Scale

The 14-item Warwick–Edinburgh Mental Wellbeing Scale (WEMWBS) assesses positive mental health across affective, cognitive-evaluative, and psychological-functioning domains [29]. Items are rated from 1 (none of the time) to 5 (all of the time), producing a total score from 14 to 70; higher scores indicate better wellbeing. The scale has demonstrated good internal consistency and test–retest reliability [30]. Its standard two-week reference period was retained, although the implications of administering it immediately before and after a one-hour session are considered in the limitations.

2.3.3. Inclusion of Nature in Self Scale

The Inclusion of Nature in Self (INS) scale is a single-item graphical measure comprising seven pairs of circles labelled ‘self’ and ‘nature’, with increasing overlap from 1 to 7. Participants selected the pair that best represented their relationship with the natural world at that moment. The scale has been used as a concise index of perceived interconnectedness with nature [31,32,33].
Demographic information included age, gender, ethnicity, current medication, weight, height, smoking status, and weekly alcohol consumption.

2.4. Intervention and Procedure

Treetops Hospice in the East Midlands, UK, identified potential participants and provided verbal and written study information. Participants chose a morning or afternoon session according to their availability. A trained forest bathing (FB) guide led the morning forest bathing session; a researcher led the afternoon comparison walk for safety, pacing and protocol consistency without formal mindfulness or sensory prompts. In the UK, ‘forest bathing guide’ is not a statutorily protected title governed by one national certification system. The FB guide had completed a formal forest bathing training. Participants were not told in advance which format they would receive. Because session choice determined both condition and time of day, allocation was neither random nor independent of session time. Those who attended the comparison walk were offered a guided session on a later date. The intervention and comparison activities were documented in line with recommendations for forest-therapy research [34].
On arrival, participants completed consent procedures, demographic questions, and baseline measures. They maintained their normal sleep routine and were asked to avoid alcohol on the preceding day. After approximately 30 min of being seated in a common room, a 90 s HRV recording was obtained while participants remained seated, still, and silent. Polar-H10-based short HRV assessment has demonstrated acceptable validity when appropriately implemented [35].
Both groups then completed a one-hour accessible walk of less than one mile through mixed woodland, planted gardens, ponds, and open fields. The route, stopping points, duration, and very gentle pace were matched to minimise differences in physical exertion. Both groups walked mainly in silence and paused at the same locations. During the guided session, the practitioner used structured prompts to encourage multisensory, mindful engagement, including noticing shades of green, exploring natural textures, smelling soil and leaves, listening attentively, and visually scanning trees. During the comparison session, no explicit sensory exercises were given; however, the researcher set the pace, maintained periods of silence, and invited comments at agreed stopping points. It is therefore described as ‘unguided’ in relation to formal forest-bathing instruction, but it remained a lightly facilitated group walk.
Data collection was undertaken at Treetops Hospice, Derby, East Midlands, UK, on 14 April 2023. Sessions were conducted between 10:00 and 12:00 for guided and 13:00 and 15:00 for unguided. The weather on the day was dry with sunny intervals, good visibility, and light winds (approximately 8–15 km/h), with temperatures ranging from 11 to 13 °C in the morning and 12 to 14 °C in the early afternoon, providing favourable conditions for outdoor activities and forest bathing. This garden is situated in a peaceful semi-rural environment surrounded by mature trees. The hospice grounds provide a variety of outdoor spaces, including accessible garden pathways, lawns, seasonal planting, seating areas, and quiet contemplative spaces designed to support relaxation, reflection, and wellbeing. The gardens offer opportunities for contact with nature through visual, auditory, and olfactory stimuli, including vegetation, birdsong, natural light, and changing seasonal landscapes. These characteristics create a restorative setting that is particularly suitable for nature-based interventions such as forest bathing and therapeutic outdoor activities.
After the walk, participants returned to a room overlooking the gardens, completed the post-session measures, and underwent a second 90 s HRV recording. They were then verbally and formally debriefed.

2.5. Statistical Analysis

Each outcome was analysed using a 2 × 2 mixed analysis of variance (ANOVA), with condition (guided or unguided) as the between-participants factor and time (before or after the session) as the within-participants factor. F-statistics, p-values, and partial eta-squared are reported. Because a group mean can obscure marked improvement or deterioration in individual participants, Reliable Change Index (RCI) analyses were also undertaken [36]. WEMWBS change was interpreted in relation to the published general-population mean of 50.70, used here as a reference value rather than a clinical threshold. For SDNN, a change of approximately 5 ms was treated as potentially meaningful in this exploratory analysis [19,37,38]. RCI analysis was not applied to the single-item INS scale.

3. Results

3.1. Descriptive Results and Baseline Differences

Pre- and post-session scores are shown in Table 1. Before the sessions, the unguided group had lower WEMWBS and SDNN scores than the guided group. The baseline difference was significant for WEMWBS, with t(15) = 2.31 and p = 0.035 (two-tailed), but not for SDNN, where t(15) = 1.92 and p = 0.074 (two-tailed). The groups therefore began the study from different psychological and physiological baselines.

3.2. Heart Rate Variability (SDNN): Baseline Differences Between Guided and Unguided Conditions

SDNN differed between conditions, where F(1,15) = 4.83, p = 0.044, and partial eta-squared = 0.243. Across the two measurements, mean SDNN was 26.24 ms in the unguided group and 43.10 ms in the guided group. There was no effect of time, where F(1,15) = 0.854, p = 0.370, and partial eta-squared = 0.054, and no condition-by-time interaction, where F(1,15) = 0.013, p = 0.911, and partial eta-squared = 0.001. The condition effect is therefore best understood as a baseline difference rather than evidence of a different response to the two sessions.

3.3. Wellbeing

WEMWBS scores showed a significant main effect of time, where F(1,15) = 20.98, p < 0.001, and partial eta-squared = 0.583, indicating higher wellbeing scores after the nature sessions. The main effect of condition was not significant, where F(1,15) = 3.42, p = 0.084, and partial eta-squared = 0.186, and the condition-by-time interaction was not significant, where F(1,15) = 1.12, p = 0.307, and partial eta-squared = 0.069.

3.4. Nature Connectedness

INS scores showed a significant main effect of time, where F(1,15) = 18.72, p < 0.001, and partial eta-squared = 0.555, indicating greater reported nature connectedness after the sessions. Neither the main effect of condition, where F(1,15) = 0.65, p = 0.434, and partial eta-squared = 0.042, nor the condition-by-time interaction, where F(1,15) = 2.85, p = 0.112, and partial eta-squared = 0.160, was significant.

3.5. Exploratory Reliable Change Analysis

Individual WEMWBS change was considered in relation to both the sample baseline mean and the published population reference mean. Eleven of the 17 participants moved towards the reference range, and two—one from each condition—met the study’s criterion for reliable change (Table 2). These results are descriptive and should be interpreted in the context of the small sample and the immediate post-session assessment.
For SDNN, two participants met the study’s criterion for movement towards the normative range, although one was already within that range at baseline. No participant was classified as showing statistically reliable change (Table 3).

4. Discussion

This pilot study examined whether guided forest bathing produced greater immediate improvements in wellbeing, nature connectedness, and HRV than a lightly facilitated walk along the same hospice-garden route. Although WEMWBS and INS scores increased following both sessions, neither outcome showed a significant condition-by-time interaction. SDNN likewise showed no significant change over time and no differential response between conditions; the observed group difference reflected values that were already dissimilar at baseline. The individual-level findings reinforce the need for caution, as only two participants met the study’s criterion for reliable improvement in wellbeing and none showed reliable change in SDNN. Taken together, the results suggest possible short-term self-reported benefits from structured time in the garden, but they neither establish the superiority of guided forest bathing nor demonstrate equivalence between the two formats.
The improvement in self-reported wellbeing is broadly consistent with previous forest-bathing studies and reviews [8,9,10,19,20]. Nevertheless, the present design cannot identify whether this change arose from nature exposure, focused sensory attention, gentle movement, social contact, expectations, or some combination of these influences. ART and SRT offer plausible interpretative frameworks: softly fascinating natural stimuli may reduce demands on directed attention, while a familiar and non-threatening environment may facilitate emotional recovery [11,12,13]. Prospect and refuge may further support the experience by combining visual interest with a sense of shelter and security, while visually rich natural settings may encourage inspiration and engagement [6]. As these mechanisms were not measured directly, they should be regarded as theoretically informed explanations rather than demonstrated pathways.
Within this theoretical context, the increase in INS scores indicates that participants felt more connected with nature immediately after both sessions. Nature contact and nature connectedness are related but distinct: the former concerns exposure, whereas the latter reflects a person’s felt relationship with the natural world [24]. Even brief contact may support both wellbeing and this sense of connection [22,23]. In the present study, both groups experienced the same route, duration, pace, stopping points, and social setting. These shared features may therefore have contributed substantially to the observed changes, potentially leaving limited additional benefit attributable to the specialist sensory prompts. Although a larger study might detect a smaller effect of guidance, no such effect was evident in this pilot. The role and training of forest bathing guides should also be considered when interpreting these findings. Guides may support participants in engaging with visual, auditory, olfactory, and tactile aspects of the natural environment through structured invitations and reflective activities. However, the positive outcomes observed in the unguided condition suggest that direct interaction with nature may also provide wellbeing benefits without formal facilitation. Future research should explore the circumstances under which guided and unguided approaches are most effective.
This interpretation depends, however, on an accurate characterisation of the comparison condition. The term ‘unguided’ may imply unrestricted garden use, whereas participants actually took part in a lightly facilitated and structured experience. They followed a planned route, walked slowly and mainly in silence, paused together, and discussed what they had noticed. These elements overlap with mindful and group walking, which have been associated with emotional and social benefits [39,40,41]. The study therefore compared two active interventions that shared several potentially therapeutic components. Future research could separate these components by comparing unrestricted garden use, a facilitated social walk, and specialist-guided forest bathing. Such a design would help determine whether structured guidance offers benefits beyond movement, quiet attention, companionship, and access to the garden. Social interactions may also have influenced participant experiences and outcomes. Companionship, shared silence, informal conversations among participants, and interactions with the forest bathing guide may have contributed to psychological restoration and wellbeing, but these factors were not systematically assessed in the present study. Future research should document group size, periods of silence, verbal exchanges, perceived social support, and facilitator–participant interactions to better understand the relative contributions of social and environmental components to forest bathing experiences.
Any comparison between conditions is also constrained by the allocation procedure and timing of the sessions. In this pilot study, guided participants attended in the morning, whereas all comparison participants attended in the afternoon. Morning preference has been associated with proactivity and positive affect [42,43], and participants who were able or willing to attend earlier may have differed from those choosing a later session. The baseline differences in WEMWBS and SDNN are consistent with this possibility. Future studies should therefore randomise allocation where feasible, schedule both conditions at comparable times, and balance groups on baseline wellbeing and relevant clinical characteristics. A crossover design may be appropriate for a small hospice population because each participant could experience both conditions, although burden and carry-over effects would need careful consideration.
The absence of a significant SDNN response should be considered separately from the self-reported improvements. Psychological benefits may occur without a detectable short-term change in this HRV measure, particularly within a small and clinically heterogeneous sample. Equally, the measurement protocol may have limited sensitivity: the 90 s recordings were shorter than the five-minute periods generally recommended for stable short-term assessment [26,44], and limited equipment delayed some post-session recordings. Consequently, the findings provide no evidence of an autonomic benefit, but neither do they offer a sufficiently robust basis for excluding one. Longer or continuous recordings, standardised assessment times, and careful control of relevant physiological influences would strengthen future evaluation. The absence of a significant SDNN response should be considered separately from the self-reported improvements. The 90 s pre- and post-session recordings were shorter than the five-minute periods generally recommended for stable short-term assessment [26,44] and could not capture transient responses during the walk. Future studies should combine continuous ambulatory HRV monitoring with standardised five-minute resting measurements and record activity, respiration, posture and exertion. The present findings neither demonstrate an autonomic benefit nor provide a robust basis for excluding one. In this study, HRV was measured using a 90 s recording period before and after the intervention following a five-minute seated rest, which may have reduced the sensitivity to detect subtle changes in autonomic nervous system activity. Future studies could consider combining standardised five-minute resting HRV assessments with continuous ambulatory monitoring throughout forest bathing sessions. In addition, recording contextual factors such as physical activity, posture, respiration, environmental conditions, and perceived exertion would provide a more comprehensive understanding of real-time physiological responses and the mechanisms through which forest bathing may influence health and wellbeing.
These interpretations must be considered in light of several limitations. The study involved 17 participants at one hospice; allocation was not random, and there was no indoor, usual-care or unrestricted-garden control. WEMWBS uses a two-week reference period and is poorly aligned with an immediate one-hour comparison. Researcher’s or practitioner’s presence, group interaction, expectations, repeated measurements and regression to the mean may have influenced the results. Social interaction, acceptability, intervention fidelity and adverse events were not measured systematically. Future studies should document group size, periods of silence, verbal exchanges, perceived social support and facilitator interaction. The findings are therefore hypothesis-generating rather than evidence of efficacy, equivalence or cost-effectiveness. While the current study was not designed as an epidemiological investigation, future research could adopt more comprehensive epidemiological methods, including larger and more representative samples, longitudinal study designs, and population-level analyses of health outcomes. Such approaches would enable a more detailed examination of prevalence, risk factors, and potential causal relationships associated with the phenomena investigated in this study.
Notwithstanding these limitations, the study identifies a relevant public health question for palliative care, where quality of life, dignity, connection, and meaning are central [1,45,46,47,48,49]. If effectiveness is demonstrated in a larger evaluation, lightly facilitated garden walks could widen access to nature-based support through trained staff or volunteers, while specialist-led sessions could remain available for people who prefer or require more structured sensory guidance. Equitable access must remain central, as mobility, fatigue, sensory impairment, weather, transport, cultural preferences, staffing, and garden quality may all influence participation. A multi-site, co-designed study should therefore examine effectiveness, safety, reach, uptake, equity, fidelity, environmental exposure, implementation costs, and longer-term outcomes, alongside qualitative accounts from service users, families, staff, and volunteers. The key question for future research is not simply whether a guide is necessary, but which combination of people, place, and facilitation is most appropriate, for whom, and under what conditions.

5. Conclusions

This pilot study suggests that structured time in a hospice garden may support short-term improvements in self-reported wellbeing and nature connectedness. Guided forest bathing did not outperform the lightly facilitated walk, and HRV did not change significantly; however, the small, non-randomised design does not establish causality or equivalence. The public health relevance lies in the possibility that hospice gardens could widen access to supportive nature experiences through appropriately trained staff, volunteers, and community partnerships, without requiring specialist delivery for every session. A larger multi-site evaluation should determine effectiveness, reach, equity, safety, implementation requirements, environmental influences, and cost, while identifying which participants benefit from different levels of guidance. Until such evidence is available, lightly facilitated garden activities should be regarded as a promising complement to established palliative care rather than a substitute for specialist or clinical support.

Author Contributions

Conceptualization, Y.X., K.M. and R.P.; methodology, K.M., Y.X. and R.P.; formal analysis, R.P.; investigation, R.P.; resources, Y.X. and K.M.; data curation, R.P.; writing—original draft preparation, R.P.; writing—review and editing, R.P., K.M. and Y.X.; visualisation, R.P.; supervision, Y.X.; project administration, R.P.; funding acquisition, Y.X. All authors have read and agreed to the published version of the manuscript.

Funding

This research was funded by Nottingham Trent University Strategic Research Theme Funding. The funder had no role in the design of the study; in the collection, analysis, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

Institutional Review Board Statement

The study was conducted in accordance with the Declaration of Helsinki and approved by the Nottingham Trent University Ethics Committee for Non-Invasive Research (protocol code 1619917, 1 November 2022).

Informed Consent Statement

Written informed consent was obtained from all participants involved in the study.

Data Availability Statement

The data presented in this study are available from the corresponding authors on reasonable request. The data are not publicly available because they contain potentially sensitive participant information and are subject to ethical and data-protection restrictions.

Acknowledgments

The authors thank Treetops Hospice, Risley, Derbyshire, for supporting recruitment, providing access to the hospice grounds, and assisting with study delivery.

Conflicts of Interest

The authors declare no conflicts of interest.

Abbreviations

The following abbreviations are used in this manuscript:
AbbreviationDefinition
ANOVAAnalysis of variance
FBForest bathing
HRVHeart rate variability
INSInclusion of Nature in Self
RCIReliable Change Index
SDNNStandard deviation of normal-to-normal intervals
WEMWBSWarwick–Edinburgh Mental Wellbeing Scale

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Table 1. Means (standard deviations) for wellbeing, nature connectedness, and SDNN by condition and time.
Table 1. Means (standard deviations) for wellbeing, nature connectedness, and SDNN by condition and time.
OutcomeUnguided: PreUnguided: PostGuided: PreGuided: Post
WEMWBS36.67 (8.19)46.67 (7.57)45.25 (6.96)51.50 (10.25)
INS4.22 (1.20)5.11 (0.78)4.75 (1.04)5.88 (0.64)
SDNN (ms)24.00 (18.18)28.48 (23.31)40.23 (16.39)45.96 (18.23)
WEMWBS, Warwick–Edinburgh Mental Wellbeing Scale; INS, Inclusion of Nature in Self; SDNN, standard deviation of normal-to-normal intervals.
Table 2. Individual WEMWBS change and Reliable Change Index classifications.
Table 2. Individual WEMWBS change and Reliable Change Index classifications.
ParticipantPrePostMoved Towards Normative RangeRCIReliable at p < 0.05
1 (G)3436No1.778No
2 (G)4458Yes0.445Yes
3 (G)4645No1.778No
4 (G)5366Yes1.037No
5 (G)4645No0.889No
6 (G)4742No4.001No
7 (G)5559Yes0.593No
8 (G)3848Yes0.889No
9 (UG)3345Yes3.007No
10 (UG)4851No1.511No
11 (UG)3951Yes0.378No
12 (UG)4956Yes1.511No
13 (UG)3238Yes0.882No
14 (UG)2653Yes0.756Yes
15 (UG)2832No3.400No
16 (UG)4147Yes0.504No
17 (UG)3447Yes0.756No
G—Guided; UG—unguided; RCI, Reliable Change Index.
Table 3. Individual SDNN change and Reliable Change Index classifications.
Table 3. Individual SDNN change and Reliable Change Index classifications.
ParticipantPre SDNNPost SDNNMoved Towards Normative RangeRCIReliable at p < 0.05
1 (G)28.4846.90No1.257No
2 (G)71.3689.04Yes1.206No
3 (G)28.3246.86No1.265No
4 (G)23.9428.64No0.321No
5 (G)52.0032.58No−1.325No
6 (G)27.0639.38No0.840No
7 (G)46.4948.20No0.117No
8 (G)44.1936.11No−0.551No
9 (UG)25.4524.88No0.819No
10 (UG)25.4789.04Yes0.205No
11 (UG)17.0615.21No0.819No
12 (UG)13.7012.67No0.478No
13 (UG)8.4418.77No0.409No
14 (UG)70.1522.85No1.842No
15 (UG)15.4920.19No0.273No
16 (UG)22.5922.06No0.409No
17 (UG)17.6730.61No0.887No
G, Guided; UG, unguided; SDNN, standard deviation of normal-to-normal intervals; RCI, Reliable Change Index.
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MDPI and ACS Style

Xing, Y.; Pitzettu, R.; McEwan, K. Do Hospice Gardens Need a Guide? Comparing Guided and Unguided Forest Bathing for Wellbeing, Nature Connectedness and Heart Rate Variability: A Pilot Study. Int. J. Environ. Res. Public Health 2026, 23, 1233. https://doi.org/10.3390/ijerph23091233

AMA Style

Xing Y, Pitzettu R, McEwan K. Do Hospice Gardens Need a Guide? Comparing Guided and Unguided Forest Bathing for Wellbeing, Nature Connectedness and Heart Rate Variability: A Pilot Study. International Journal of Environmental Research and Public Health. 2026; 23(9):1233. https://doi.org/10.3390/ijerph23091233

Chicago/Turabian Style

Xing, Yangang, Rachel Pitzettu, and Kirsten McEwan. 2026. "Do Hospice Gardens Need a Guide? Comparing Guided and Unguided Forest Bathing for Wellbeing, Nature Connectedness and Heart Rate Variability: A Pilot Study" International Journal of Environmental Research and Public Health 23, no. 9: 1233. https://doi.org/10.3390/ijerph23091233

APA Style

Xing, Y., Pitzettu, R., & McEwan, K. (2026). Do Hospice Gardens Need a Guide? Comparing Guided and Unguided Forest Bathing for Wellbeing, Nature Connectedness and Heart Rate Variability: A Pilot Study. International Journal of Environmental Research and Public Health, 23(9), 1233. https://doi.org/10.3390/ijerph23091233

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