Blood pressure-lowering effect of Shinrin-yoku (Forest bathing): a systematic review and meta-analysis

doi:10.1186/s12906-017-1912-z

Review

. 2017 Aug 16;17(1):409.

doi: 10.1186/s12906-017-1912-z.

Blood pressure-lowering effect of Shinrin-yoku (Forest bathing): a systematic review and meta-analysis

Yuki Ideno¹, Kunihiko Hayashi², Yukina Abe³, Kayo Ueda⁴, Hiroyasu Iso⁵, Mitsuhiko Noda⁶, Jung-Su Lee⁷, Shosuke Suzuki⁸

Affiliations

¹ Gunma University Initiative for Advanced Research, 3-39-22 Showa-machi, Maebashi City, Gunma, 371-8511, Japan. y-ideno@gunma-u.ac.jp.
² Graduate School of Health Science, Gunma University, 3-39-22 Showa-machi, Maebashi City, Gunma, 371-8511, Japan.
³ Tochigi Prefectural Western District Health and Welfare Services Center, 1664-1 Imamiya-cho, Kanuma City, Tochigi, 322-0068, Japan.
⁴ Department of Environmental Engineering, Kyoto University Graduate School of Engineering, Yoshida Honmachi, Sakyo-ku, Kyoto, 606-8501, Japan.
⁵ Public Health, Department of Social and Medicine, Graduate School of Medicine, Osaka University, 1-1 Yamadaoka, Suita, Osaka, 565-0871, Japan.
⁶ Department of Endocrinology and Diabetes, Saitama Medical University, 38 Morohongo, Moroyama-cho, Iruma-gun, Saitama, 350-0495, Japan.
⁷ School of Public Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8654, Japan.
⁸ Professor Emeritus, Gunma University and NPO International Eco-Health Research Group, 3-39-22 Showa-machi, Maebashi City, Gunma, 371-8511, Japan.

PMID: 28814305
PMCID: PMC5559777
DOI: 10.1186/s12906-017-1912-z

Review

Blood pressure-lowering effect of Shinrin-yoku (Forest bathing): a systematic review and meta-analysis

Yuki Ideno et al. BMC Complement Altern Med. 2017.

. 2017 Aug 16;17(1):409.

doi: 10.1186/s12906-017-1912-z.

Authors

Yuki Ideno¹, Kunihiko Hayashi², Yukina Abe³, Kayo Ueda⁴, Hiroyasu Iso⁵, Mitsuhiko Noda⁶, Jung-Su Lee⁷, Shosuke Suzuki⁸

Affiliations

¹ Gunma University Initiative for Advanced Research, 3-39-22 Showa-machi, Maebashi City, Gunma, 371-8511, Japan. y-ideno@gunma-u.ac.jp.
² Graduate School of Health Science, Gunma University, 3-39-22 Showa-machi, Maebashi City, Gunma, 371-8511, Japan.
³ Tochigi Prefectural Western District Health and Welfare Services Center, 1664-1 Imamiya-cho, Kanuma City, Tochigi, 322-0068, Japan.
⁴ Department of Environmental Engineering, Kyoto University Graduate School of Engineering, Yoshida Honmachi, Sakyo-ku, Kyoto, 606-8501, Japan.
⁵ Public Health, Department of Social and Medicine, Graduate School of Medicine, Osaka University, 1-1 Yamadaoka, Suita, Osaka, 565-0871, Japan.
⁶ Department of Endocrinology and Diabetes, Saitama Medical University, 38 Morohongo, Moroyama-cho, Iruma-gun, Saitama, 350-0495, Japan.
⁷ School of Public Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8654, Japan.
⁸ Professor Emeritus, Gunma University and NPO International Eco-Health Research Group, 3-39-22 Showa-machi, Maebashi City, Gunma, 371-8511, Japan.

PMID: 28814305
PMCID: PMC5559777
DOI: 10.1186/s12906-017-1912-z

Abstract

Background: Shinrin-yoku (experiencing the forest atmosphere or forest bathing) has received increasing attention from the perspective of preventive medicine in recent years. Some studies have reported that the forest environment decreases blood pressure. However, little is known about the possibility of anti-hypertensive applications of Shinrin-yoku. This study aimed to evaluate preventive or therapeutic effects of the forest environment on blood pressure.

Methods: We systematically reviewed the medical literature and performed a meta-analysis.Four electronic databases were systematically searched for the period before May 2016 with language restriction of English and Japanese. The review considered all published, randomized, controlled trials, cohort studies, and comparative studies that evaluated the effects of the forest environment on changes in systolic blood pressure. A subsequent meta-analysis was performed.

Results: Twenty trials involving 732 participants were reviewed. Systolic blood pressure of the forest environment was significantly lower than that of the non-forest environment. Additionally, diastolic blood pressure of the forest environment was significantly lower than that of the non-forest environment.

Conclusions: This systematic review shows a significant effect of Shinrin-yoku on reduction of blood pressure.

Keywords: Blood pressure; Forest bathing; Meta-analysis; Pulse rate; Systematic review.

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Figures

**Fig. 1**
Flow chart of the study selection process for the present study

**Fig. 2**
Forest plot comparing changes in SBP (mmHg) between the forest environment and the non-forest environment based on 20 studies or subgroups CI, confidence interval.

**Fig. 3**
Two forest plots of the change in SBP (mmHg) in the two subgroup analyses of SBP levels of 1) ≥ 130 and 2) < 130 mmHg before the intervention. 1) SBP ≥ 130 mmHg. 2) SBP < 130 mmHg. CI, confidence interval

**Fig. 4**
Two forest plots of the change in SBP (mmHg) in the two subgroup analyses of differences in intervention methods (walking and non-walking). 1) Walking group. 2) Non-walking group. CI, confidence interval

**Fig. 5**
Three forest plots of the change in SBP (mmHg) in the two subgroup analyses of the three groups of sex and age differences. 1) Young male (university student) group. 2) Middle-aged or older male group. 3) Middle-aged or older female group. CI, confidence interval

**Fig. 6**
Funnel plot, using data from 20 trials of therapeutic effects of the forest environment on systolic blood pressure. SE, standard error; MD, mean difference

See this image and copyright information in PMC

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References

1. Tsunetsugu Y, Park BJ, Miyazaki Y. Trend in research related to "Shinrin-yoku" (taking in the forest atmosphere or forest bathing) in Japan. Environ Health Prev Med. 2010;15:27–37. doi: 10.1007/s12199-009-0091-z. - DOI - PMC - PubMed
1. Lee J, Park BJ, Tsunetsugu Y, Ohira T, Kagawa T, Miyazaki Y. Effect of forest bathing on physiological and psychological responses in young Japanese male subjects. Public Health. 2011;125:93–100. doi: 10.1016/j.puhe.2010.09.005. - DOI - PubMed
1. Li Q, Kawada T. Possibility of clinical applications of forest medicine. Nihon Eiseigaku Zasshi (Jpn J Hyg) 2014;69:117–121. doi: 10.1265/jjh.69.117. - DOI - PubMed
1. Miyazaki Y, Ikei H, Song C. Forest medicine research in Japan. Nihon Eiseigaku Zasshi (Jpn J Hyg) 2014;69:122–135. doi: 10.1265/jjh.69.122. - DOI - PubMed
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[1] Tsunetsugu Y, Park BJ, Miyazaki Y. Trend in research related to "Shinrin-yoku" (taking in the forest atmosphere or forest bathing) in Japan. Environ Health Prev Med. 2010;15:27–37. doi: 10.1007/s12199-009-0091-z. - DOI - PMC - PubMed

[2] Tsunetsugu Y, Park BJ, Miyazaki Y. Trend in research related to "Shinrin-yoku" (taking in the forest atmosphere or forest bathing) in Japan. Environ Health Prev Med. 2010;15:27–37. doi: 10.1007/s12199-009-0091-z. - DOI - PMC - PubMed

[3] Lee J, Park BJ, Tsunetsugu Y, Ohira T, Kagawa T, Miyazaki Y. Effect of forest bathing on physiological and psychological responses in young Japanese male subjects. Public Health. 2011;125:93–100. doi: 10.1016/j.puhe.2010.09.005. - DOI - PubMed

[4] Lee J, Park BJ, Tsunetsugu Y, Ohira T, Kagawa T, Miyazaki Y. Effect of forest bathing on physiological and psychological responses in young Japanese male subjects. Public Health. 2011;125:93–100. doi: 10.1016/j.puhe.2010.09.005. - DOI - PubMed

[5] Li Q, Kawada T. Possibility of clinical applications of forest medicine. Nihon Eiseigaku Zasshi (Jpn J Hyg) 2014;69:117–121. doi: 10.1265/jjh.69.117. - DOI - PubMed

[6] Li Q, Kawada T. Possibility of clinical applications of forest medicine. Nihon Eiseigaku Zasshi (Jpn J Hyg) 2014;69:117–121. doi: 10.1265/jjh.69.117. - DOI - PubMed

[7] Miyazaki Y, Ikei H, Song C. Forest medicine research in Japan. Nihon Eiseigaku Zasshi (Jpn J Hyg) 2014;69:122–135. doi: 10.1265/jjh.69.122. - DOI - PubMed

[8] Miyazaki Y, Ikei H, Song C. Forest medicine research in Japan. Nihon Eiseigaku Zasshi (Jpn J Hyg) 2014;69:122–135. doi: 10.1265/jjh.69.122. - DOI - PubMed

[9] James P, Banay RF, Hart JE, Laden F. A review of the health benefits of greenness. Curr Epidemiol Rep. 2015;2:131–142. doi: 10.1007/s40471-015-0043-7. - DOI - PMC - PubMed

[10] James P, Banay RF, Hart JE, Laden F. A review of the health benefits of greenness. Curr Epidemiol Rep. 2015;2:131–142. doi: 10.1007/s40471-015-0043-7. - DOI - PMC - PubMed

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