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Table 1 Characteristics of the included studies

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

Author, year, country

Study design

Sample size

Criteria for the inclusion of participants

Criteria for the exclusion of participants

Forest bathing intervention

Control/comparator

Duration and frequency of the intervention

QATSDD score (0-42)

Feng et al., 2017 [41]; China

Randomized controlled trial

n = 290, 100% male; I = 190 (HT group); C = 100 (non-HT group)

Mean age: 50 ± 10; non-smokers and non-drinkers; HT with or without anti-HTN drugs

DM; CAD; CVA

Forest walking

No intervention

20 sessions; 1 session/day; walk 60-90 min/per session or walk 2 km/per session

23

Horiuchi et al., 2015 [32]; Japan

Quasi-experimental study

n = 54; males = 19 (35%); females = 35 (65%)

Mean age: 63.2 ± 9.4; taking anti-HTN drugs; non-smokers

Not specified

Forest walking (stretching; self-paced, comfortable walking) and forest viewing in a supine position

NA

1 session; 90 min/per session

26

Lanki et al., 2017 [22]; Finland

Quasi-experimental and comparative study

n = 36; 100% female

Aged 30-60; not taking anti-HTN medications

Smoking; cardiac pacemaker; hearing aid; MI; CAD; CHF; Stroke, COPD

Sedentary viewing, and walking in an urban forest and urban park

Sedentary viewing and walking in the city center

1 session; starting in the afternoon; including 15 min of sedentary viewing, 30 min of paced and unhurried walking

25

Lee and Lee, 2014 [33]; Korea

Randomized controlled trial

n = 62; 100% female; I, n = 43; C, n = 19

Aged 60-80; BP < 160/110 mmHg

Chronic liver and renal disease; CAD; CVA; cancer; disability or pain when walking; BP > 160/110 mmHg

Forest walking conducted separately 1 week apart with city walking

City walking conducted separately 1 week apart with forest walking

1 session; 1 h of paced walking in the morning

31

Li et al., 2016 [34]; Japan

Randomized crossover trial

n = 19; 100% male

Aged 40-74; not taking anti-HT drugs; high normal hypertension; living in the city

Not specified

Forest walking

Urban walking

Two sessions in a day: (AM+PM); 1 h 20 min per session

23

Mao et al., 2012 [23]; China

Randomized controlled trial

n = 24; I = 12; C = 12; does not mention gender

Aged 60-75; BP < 180/110 mmHg with or without taking anti-HTN drugs; class I-II cardiac function; ADL independent

Getting the flu; acute disease 2 weeks before; cancer, chronic liver, kidney, brain, heart or lung disease; acute MI in the previous 3 months; CVA within 6 months; Hx of severe trauma or major surgery

Forest walking

City walking

7 sessions in 7 consecutive days, 1.5 h for each session, walk in the morning or afternoon

28

Ochiai et al., 2015a [24]; Japan

Quasi-experimental study

n = 9; 100% male

Aged 40-72; SBP 130-139 mmHg or DBP 85-89 mmHg

Taking drugs for DM, HT, hyper-lipidemia

Forest therapy: strolling; sitting; lying down; deep breathing in a forest; riding in the forest train; strolling in an indoor pavilion

NA

One-day therapy program, 4 h 35 min

28

Ochiai et al., 2015b [42]; Japan

Quasi-experimental study

n = 17; 100% female; HT (n = 6) healthy adults (11)

Mean age: 62.2+/−9.4; HT with or without anti-HTN drugs; no other diseases or psychological disorders

Difficulty walking in hot weather

Forest therapy: strolling, deep breathing, lying down lecture and chatting in forest; abdominal breathing with lie down position

NA

One-day therapy program, 4 h 41 min

28

Song et al., 2017a [35]; Japan

Randomized crossover trial

n = 20; 100% male

Aged 40-75; BP > 120/80 mmHg

Taking medication for diabetes, hyper- lipidemia, HT

Landscapes of forest viewed while sitting in chair in the afternoon

Urban area viewing while sitting in a chair in the afternoon

One session, 10 min each, conducted in 2 consecutive days

29

Song et al., 2017b [43] Japan

Quasi-experimental study

n = 26; males = 14; females = 12

Aged 19-56; office workers from an IT company; BP normal or SBP > 120 mmHg

Not specified

Forest therapy: preparation stretches; blind walking; deep breathing; strolling; viewing scenery and lecture; sending stress to waterfall, sitting and lying down; backwards walking; meditation; lying in a hammock

NA

One-day forest program, 6 h 12 min; date collected, 3 days before, on the day of the forest therapy, 3 days after, and 5 days after

24

Song et al., 2015 [36]; Japan

Randomized crossover trial

n = 20; 100% male

Mean age: 58 ± 10.6; BMI: 23.4 ± 3.3 kg.m2; SBP 130–179 mmHg; DBP 85–109 mmHg

Taking drugs for DM, hyperlipidemia, HT

Walking in a forest

Walking in urban area

One session, 17 min in 2 consecutive days

25

Sung et al., 2012 [44]; Korea

Non-randomized controlled trial

n = 56; I, n = 28; C, n = 28; females, n = 34; males, n = 22

I, mean age 66+/−7; C, mean age 63+/−11; SBP 130-159 mmHg or DBP 85-99 mmHg; on anti-HTN drugs

SBP > 159 mmHg or DBP > 100 mmHg; uncontrolled hypertension and need urgent change of drug regimen; comorbidity

Cognitive behavior-based forest therapy: HTN management, motivation to make therapeutic changes in lifestyle; practicing mindfulness relaxation techniques in the forest using the five senses

Printed educational materials for HTN management; self-monitoring of BP

3 days forest program with 8 weeks follow-up monitoring

27

Yu et al., 2017 [45]; Taiwan

Quasi-experimental study

n = 128; females, n = 85 (66.4%); males, n = 43 (33.6%)

Aged 45-86; chronic disease: DM, HT, heart disease, other disease

Not specified

Forest walking

NA

One session, 2 h starting in the morning

24

Zhou et al., 2017 [46]; China

Randomized controlled trial

n = 190 100% male; I, n = 95; C, n = 95

Average age: 50 years; diagnosed with HT

DM; CAD; CVA

Forest walking

Walking around the highway

20 sessions, each walk for 2 km; starting at 9:00 am

23

  1. HT hypertension; AM in the morning; PM in the afternoon; SDM semantic differential method; MI myocardial infarction; CVA cerebrovascular accident; POMS the profile of mood states; DM diabetic mellitus; COPD chronic obstructive pulmonary disease; CAD coronary artery disease; CHF congestive heart failure; HRV heart rate variability; I intervention; C control; MOS SF-36:the medical outcomes study questionnaire short-form 36 health survey; mHF mean high frequency; HRV heart rate variability; QATSDD quality assessment tool for studies with diverse designs (Sirriyeh et al.)