Search Results (50)

Background/Objectives: Depression is a serious mental illness worldwide, with a continuously increasing prevalence. As evidence supporting forest therapy as a non-pharmacological intervention has accumulated, the need for collaboration between the medical and forest therapy sectors has emerged; however, practical tools applicable in real-world clinical settings remain limited. This study aimed to derive components of a diagnostic assessment sheet to support clinicians in developing personalized forest therapy programs for patients with depression. Methods: Program-related literature and case materials from diverse disciplines were systematically analyzed to identify transferable program development elements and therapeutic activities. Based on these findings, a two-round Delphi survey was conducted with 17 experts in forest therapy and medicine. Results: Through the Delphi process, 26 therapeutic activities were identified and classified into six final activity types. Assessment items were developed to support clinicians in selecting appropriate activity types, and nine key precaution items were identified to enhance safety and appropriateness during program design and implementation. Conclusions: This study provides a structured framework to guide clinicians and forest therapy instructors in composing individualized forest therapy programs for patients with depression, supporting practical medical–forest therapy integration. Future research should validate the diagnostic assessment sheet through empirical field testing. Full article

Forest therapy, guided by clinical professionals (psychologists or psychotherapists), is increasingly recognized as a preventive and complementary health practice with evidence-based therapeutic potential; however, the specific contribution of therapist guidance compared to self-guided immersion remains unclear. This retrospective study evaluated the short-term mental health outcomes of therapist-guided (TG) compared to self-guided (SG) forest immersion, based on the validated State–Trait Anxiety Inventory and Profile of Mood States questionnaires. Data were collected from 282 adults participating in eight paired TG–SG sessions conducted at the same forest sites across Italy. The results showed that TG sessions were associated with greater improvements in state anxiety, self-esteem, and total mood disturbance, with statistically significant effects in most cases. Therapist-led guidance also occasionally reduced interindividual variability, suggesting enhanced emotional regulation. An illustrative economic assessment, based on standardized psychometric improvements translated into quality-adjusted life years (QALYs), indicated that the TG sessions yielded approximately 1.7 times the annual per-person economic value of the SG sessions, outweighing the associated therapist-related costs. These findings suggest that TG forest therapy interventions deliver significant and economically quantifiable added value compared to SG experiences, supporting their inclusion in preventive health and mental well-being programs and justifying further longitudinal and cost-effectiveness investigations. Full article

Chronic hemophilic synovitis (CHS), driven by hemosiderin-laden macrophages from recurrent hemarthrosis, is a major cause of joint damage in hemophilia. Platelet-rich plasma (PRP) is a promising regenerative therapy for joint diseases. This study investigated PRP’s ability to modulate macrophage polarization from a pro-inflammatory (M1) to a pro-resolving, tissue-repairing (M2) phenotype in CHS. We analyzed synovial fluid (SF) from CHS patients (N = 22), both pre- and post-PRP treatment. Ex vivo analysis revealed a predominant M1 profile with an increased proportion of CD11⁺CD14⁺CD64^hi compared with CD206⁺ or CD163⁺ M2 macrophages in CHS SF. In vitro experiments showed that CHS SF skewed monocyte-derived macrophages toward an M1 inflammatory program, evaluated by flow cytometry, qPCR, and ELISA. However, adding PRP significantly modulated the pro-inflammatory macrophage program, promoting an M2 tissue repair profile. Furthermore, a random forest machine learning algorithm, applied to public scRNAseq data, confirmed PRP’s macrophage reprogramming effect. Functional assays also showed increased TGF-β secretion and macrophage fusion when challenged with neutrophil extracellular traps (NETs). A small patient follow-up cohort treated with intra-articular PRP showed similar results, including normalization of cellular content and reduced CD64/CD206 expression. These findings indicate that PRP treatment effectively shifts SF-associated M1 macrophages to an M2-like phenotype, highlighting its potential as a therapeutic strategy for CHS. Full article

Background/Objectives: Ovarian cancer is a heterogeneous malignancy with molecular subtypes that strongly influence prognosis and therapy. High-dimensional mRNA data can capture this biological diversity, but its complexity and noise limit robust subtype characterization. Furthermore, current classification approaches often fail to reflect subtype-specific transcriptional programs, underscoring the need for computational strategies that reduce dimensionality and identify discriminative molecular features. Methods: We designed a multi-stage feature selection and network analysis framework tailored for high-dimensional transcriptomic data. Starting with ~65,000 mRNA features, we applied unsupervised variance-based filtering and correlation pruning to eliminate low-information genes and reduce redundancy. The applied supervised Select-K Best filtering further refined the feature space. To enhance robustness, we implemented a hybrid selection strategy combining recursive feature elimination (RFE) with random forests and LASSO regression to identify discriminative mRNA features. Finally, these features were then used to construct a gene co-expression similarity network. Results: This pipeline reduced approximately 65,000 gene features to a subset of 83 discriminative transcripts, which were then used for network construction to reveal subtype-specific biology. The analysis identified four distinct groups. One group exhibited classical high-grade serous features defined by TP53 mutations and homologous recombination deficiency, while another was enriched for PI3K/AKT and ARID1A-associated signaling consistent with clear cell and endometrioid-like biology. A third group displayed drug resistance-associated transcriptional programs with receptor tyrosine kinase activation, and the fourth demonstrated a hybrid profile bridging serous and endometrioid expression modules. Conclusions: This pilot study shows that combining unsupervised and supervised feature selection with network modeling enables robust stratification of ovarian cancer subtypes. Full article

Monitoring forearm muscle contraction force in home-based rehabilitation remains challenging. Electromyography (EMG), as a standard technique, is considered impractical and complex for independent use by patients at home, which poses a risk of device misattachment and inaccurate recorded data. Considering the muscle-related modality, several studies have demonstrated an excellent correlation between stretch sensors and EMG, which provides significant potential for addressing the monitoring issue at home. Additionally, due to its flexible nature, it can be attached to the finger, which facilitates the logging of the kinematic mechanisms of a finger. This study proposes a method for estimating forearm muscle contraction in a cylinder grasping environment during home-based rehabilitation using a stretch-sensor glove. This study employed support vector machine (SVM), multi-layer perceptron (MLP), and random forest (RF) to construct the estimation model. The root mean square (RMS) of the EMG signal, representing the muscle contraction force, was collected from 10 participants as the target learning for the stretch-sensor glove. This study constructed an experimental design based on a home-based therapy protocol known as the graded repetitive arm supplementary program (GRASP). Six cylinders with varying diameters and weights were employed as the grasping object. The results demonstrated that the RF model achieved the lowest root mean square error (RMSE) score, which differed significantly from the SVM and MLP models. The time series waveform comparison revealed that the RF model yields a similar estimation output to the ground truth, which incorporates the contraction–relaxation phases and the muscle’s contraction force. Additionally, despite the subjectivity of the participants’ grasping power, the RF model could produce similar trends in the muscle contraction forces of several participants. Utilizing a stretch-sensor glove, the proposed method demonstrated great potential as an alternative modality for monitoring forearm muscle contraction force, thereby improving the practicality for patients to self-implement home-based rehabilitation. Full article

This study aims to provide foundational data for developing forest therapy programs to improve mental health conditions by reviewing program development studies, casebooks published by governmental organizations, and existing programs conducted in forest therapy settings and analyzing the status and activities of programs from various disciplines in Korea and abroad. During the collection phase of mental health improvement programs, studies that were not related to depression, anxiety, or stress, or were not relevant to program development, were excluded. Additionally, studies that did not include detailed program plans were omitted from the activity analysis. The literature review focused on academic articles and theses published between 1990 and 2023, identifying 403 relevant studies. Casebooks were collected from three domains, while forest therapy programs were obtained from three forest welfare organizations. These programs were categorized/analyzed based on their general characteristics, structure, and activity content. The findings indicated that research on psychotherapy (forest therapy) programs peaked between 2010 and 2014 (2020 and 2023) in casebooks and field settings. Programs documented in the literature commonly involved 11–20 sessions lasting 60–90 min, whereas casebooks and field programs typically featured fewer than five sessions, each lasting over 180 min. Nineteen purpose-driven and 40 practical activities were identified, providing a theoretical basis for developing forest therapy programs tailored toward alleviating depression, anxiety, and stress. The proposed activities and elements can support the diversification and professionalization of forest therapy programs, fostering more effective and specialized approaches to improve mental health. Full article

Currently, in cities in different regions of the world, forest bathing (FB) is considered a practice to promote public health in vulnerable groups, such as the elderly, who have a higher risk of hypertension. This practice has had limited development in Latin American countries, and therefore, the objective of this study was to evaluate the benefits of forest baths on blood pressure and heart rate in a group of older adults in Guadalajara, Mexico. A program of six sessions was designed, the first to welcome and recognize the natural environment of the urban forest and the other five dedicated to each of the senses (hearing, touch, smell, sight, and taste), using the methodology of the Forest Therapy Hub (FTHub). The type of study was observational (before and after) with a single group, where the participants’ blood pressure and heart rate were evaluated. The results obtained showed significant effects of FB on reduction in high systolic blood pressure and diastolic hypertension before and after FB, with no significance on heart rate. Forest baths can be considered as an alternative strategy to manage the risk of hypertension in older adults, due to their ability to induce relaxation and normalize blood pressure levels. Full article

The purpose of this study is to more quantitatively identify changes in body function through various bio-signal parameters. (1) Background: Forest therapy is effective in stabilizing cognitive, emotional, cardiovascular, and autonomic nervous systems. In particular, it is necessary to more quantitatively confirm changes in body functions through various bio signals. (2) Methods: As a forest therapy program (FTP) for the elderly, it consisted of strength training in the forest, respiratory aerobic exercises, and cognitive function training, and a total of 19 sessions were performed for 12 weeks. The electroencephalography (EEG) and Photoplethysmography (PPG) before and after the program were measured and compared between program participants (FTP group) and non-participants (control group). (3) Results: the FTP group showed increase in the alpha band power in EEG and a decrease in the PRV index, Tad, and Tae after the program compared to the control group; (4) Conclusions: Significant differences occurred in the physiological functioning of the elderly participants after the program. This is a result that can confirm the effectiveness of forest therapy more quantitatively. Forest therapy has a positive effect on mental stress reduction and cardiovascular function. Full article

The aim of this review is to investigate the impacts of various forest therapy activities on the physical and mental health of college students. Additionally, it evaluates the research methodologies and existing issues in current studies, providing an important agenda for future research. Research was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The findings suggest significant effects of forest therapy activities on the physiology and psychology of college students, notably improving the cardiovascular system, enhancing the immune system, boosting emotional well-being, alleviating job-related stress, and enhancing academic performance. This study further clarifies forest therapy as an emerging and effective intervention to reduce stress levels among college students, particularly when carried out continuously in easily accessible campus forest environments. Such therapeutic activities could serve as a component of daily stress-relieving programs for college students. This assessment offers valuable information for college students, educational institutions, and policymakers to promote the development of forest therapy on university campuses. However, some of the studies included in this investigation lacked methodological rigor. Future research should employ rigorous study designs to assess the long-term impacts of various forest therapy approaches on the mental and physical health of college students and identify the primary influencing factors. This will aid in determining suitable content, forms, and strategies for forest therapy projects tailored to college students, thereby maximizing the potential benefits of forest therapy on their mental and physical well-being. Full article

The purpose of this study was to examine the effects of exercise intensity and the duration of an exercise-based forest therapy program on physiological changes in older adults. The forest therapy program consisted of 20 sessions over 10 weeks. Forty-one older adults aged 65 years and older were divided into no treatment (daily activity group) and experimental (forest therapy) groups. The experimental group was further divided into the medium-intensity forest exercise group and the high-intensity forest exercise group to analyze physiological changes according to exercise intensity and duration. The physiological changes were analyzed by collecting saliva and measuring changes in the levels of immunoglobulin A and dehydroepiandrosterone, a hormone used to predict aging. Changes within the daily activity group and the forest therapy group after their respective exercises were analyzed using paired t-tests. Saliva testing was performed before and in weeks 5 and 10 of the program and analyzed using a repeated measures analysis of variance to assess the effects of the forest therapy on the medium-intensity forest exercise group and the high-intensity forest exercise group based on the duration of exercise. As a result of the study, a significant increase in immunoglobulin A was observed in the medium-intensity forest exercise group. The daily activity group and the high-intensity forest exercise group showed an increase, but there was very little change and no significance. Changes in dehydroepiandrosterone decreased in the daily activity group and significantly increased in the moderate-intensity forest exercise group at 5 and 10 weeks, showing that regular moderate-intensity forest exercise has an effect on dehydroepiandrosterone. The high-intensity forest exercise group improved over time, but no significant level of change was observed. This study shows that forest exercise has a beneficial effect on immunoglobulin A and dehydroepiandrosterone levels in older adults. Full article

Head and neck squamous-cell carcinoma (HNSCC) is a disease with a generally poor prognosis; half of treated patients eventually develop recurrent and/or metastatic (R/M) disease. Patients with R/M HNSCC generally have incurable disease with a median survival of 10 to 15 months. Although immune-checkpoint blockade (ICB) has improved outcomes in patients with R/M HNSCC, identifying patients who are likely to benefit from ICB remains a challenge. Biomarkers in current clinical use include tumor mutational burden and immunohistochemistry for programmed death-ligand 1, both of which have only modest predictive power. Machine learning (ML) has the potential to aid in clinical decision-making as an approach to estimate a tumor’s likelihood of response or a patient’s likelihood of experiencing clinical benefit from therapies such as ICB. Previously, we described a random forest ML model that had value in predicting ICB response using 11 or 16 clinical, laboratory, and genomic features in a pan-cancer development cohort. However, its applicability to certain cancer types, such as HNSCC, has been unknown, due to a lack of cancer-type-specific validation. Here, we present the first validation of a random forest ML tool to predict the likelihood of ICB response in patients with R/M HNSCC. The tool had adequate predictive power for tumor response (area under the receiver operating characteristic curve = 0.65) and was able to stratify patients by overall (HR = 0.53 [95% CI 0.29–0.99], p = 0.045) and progression-free (HR = 0.49 [95% CI 0.27–0.87], p = 0.016) survival. The overall accuracy was 0.72. Our study validates an ML predictor in HNSCC, demonstrating promising performance in a novel cohort of patients. Further studies are needed to validate the generalizability of this algorithm in larger patient samples from additional multi-institutional contexts. Full article

Research is increasingly focusing on the health-promoting effects of forest healing programs. A number of different health indicators are in use, necessitating the establishment of standardized health measurement tools and protocols for forest healing. Also, it is necessary to improve the indicators and protocols by incorporating the opinions of program participants and instructors, so we conducted a qualitative analysis based on focus group interviews (FGIs) and in-depth interviews (IDIs). We collected opinions through interviews conducted for about 1 h with 32 participants in the pilot study and three instructors of the forest healing program. We utilized the MAXQDA program, commonly employed for qualitative research, such as coding and analyzing interview transcripts and literature reviews, as part of the qualitative research process. Three researchers coded and categorized the data, and the first author and corresponding author performed the final coding and categorization. Opinions on the five mental health questionnaires, three physical health measures, and exercise behavior measures used in the forest healing program were solicited. Opinions on the measurement protocol were also solicited. Participants faced challenges in completing the mental health questionnaire due to inappropriate terminology, difficulty in providing truthful responses due to repetitive questions, and the complexity of answering exercise-type questions due to the length of the survey and the absence of clear examples. It was identified that improvements are needed in the future. Some participants commented on the need to measure blood circulation and short-term health changes, and others noted that performing measurements in large groups was difficult, such that there was a need to introduce a measurement protocol for groups. This study is the first to qualitatively evaluate the validity of health measurement tools associated with forest therapy programs. It can contribute to the establishment of standardized health indicators and protocols, as well as serve as a valuable reference for selecting measurement tools to evaluate the effectiveness of forest healing interventions. Full article

This study investigated the effect of mobile-based forest therapy programs on relieving depression to advance non-pharmaceutical treatments for patients with depression. The effects of depression, sleep quality, and physical symptoms were analyzed as measurement indicators to determine the effectiveness of symptom relief in patients with depression. This study used a randomized controlled experiment design. Participants were randomly assigned, and a total of 44 people participated, including 23 in the experimental group and 21 in the control group. The experimental group participated in a mobile-based forest therapy program (participating once a week) for six sessions. As a result of this study, depression patients who participated in the mobile-based forest therapy program conducted in urban forests showed a significant reduction in MADRS (from 21.48 ± 4.05 to 7.13 ± 7.00). In addition, PSQI (from 19.78 ± 7.69 to 14.48 ± 8.11) and PHQ-15 (from 9.87 ± 5.08 to 7.57 ± 5.03) were also found to significantly improve symptoms. This suggests that forest-therapy programs using mobile applications can be applied as non-pharmaceutical interventions to relieve symptoms in patients with depression. Full article

(1) Background: Although interest in the health-promoting effects of forest therapy is increasing, few researchers have investigated the mid-long-term impact of such therapy on health indicators or exercise behaviors. We explored changes in physical health, mental health, and exercise behaviors 1, 2, and 4 weeks after a forest therapy program concluded. We sought to establish a solid foundation for such programs and a standardized evaluation system. (2) Method: We measured the blood pressure and heart rate variability of 99 adults before and after participation in a forest therapy program. We used the State-Trait Anxiety Inventory to assess anxiety, the Beck Depression Inventory to evaluate both anxiety and depression, the Profile of Mood States to explore mood, the Euro-Quality of Life-5 Dimension scale to assess the overall quality of life, and the Positive and Negative Effect Schedule to measure positive and negative mood. We employed the Global Physical Activity Questionnaire to determine exercise time, intensity, and changes in exercise type before the program and 1–4 weeks after program completion. (3) Results: Anxiety, depression, mood, quality of life, heart rate, and blood pressure control improved significantly after the program. The reduced depression and increased medium-intensity exercise time persisted for 1, 2, and 4 weeks after the end of the program. (4) Conclusions: We tracked various health indicators and clearly distinguished those that were useful in the short term from those more appropriate for evaluation in the long term. This is the first report to show that a forest therapy program affects exercise behavior; this suggests that health behaviors should be continuously tracked. Full article

This systematic review aims to examine key findings of previous studies in order to explore how forest therapy programs impact stress reduction on physiological and psychological levels. It was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Quantitative studies that compared forest therapy program interventions with urban exposure were searched in February 2023 in six databases: CINAHL, EMBASE, Medline, PsycINfo, PubMed, and Web of Science (core collection). This review included 17 relevant articles selected from a total of 495 individual studies, in accordance with the set inclusion and exclusion criteria. The results of this review indicated that forest therapy programs were effective at relieving stress, particularly on a psychological level. Forest therapy programs could be used as a part of stress reduction projects. However, results regarding physiological effects have yet to be confirmed, and in the future, more in-depth and well-designed research will be required. Full article