Measures to Promote Rural Healthcare Tourism with a Scientific Evidence-Based Approach

Int J Environ Res Public Health. 2020 May 7;17(9):3266. doi: 10.3390/ijerph17093266.


The present study aimed to evaluate the effects of physical activities on human health in forests in countryside and rural areas. The test experiment was conducted in a countryside forest, whereas the controlled experiment was conducted in an urban area where the study participants resided. A total of 22 participants (aged 20.9 ± 1.3 years) were evaluated in this study. Heart rate variability and salivary cortisol level were used as indices of physiological conditions, and semantic differential method, profile of mood states (POMS), and state-trait anxiety inventory (STAI) were used to evaluate the participants' emotional states. The participants were asked to walk around forest and urban areas for 15 min. The results were as follows. As compared to the urban area, in the forest area, (1) the power of the high-frequency (HF) component of the heart rate variability (HRV) was significantly higher; (2) low-frequency (LF)/(LF + HF) was significantly lower; (3) salivary cortisol level was significantly lower; (4) the participants felt more comfortable, natural, relaxed, and less anxious and showed higher levels of positive emotions and lower levels of negative emotions. Consequently, walking in the forest area induces relaxing short-term physiological and psychological effects on young people living in urban areas.

Keywords: POMS; STAI; forest bathing; healthcare tourism; heart rate variability; physical activity; rural and mountain economy; salivary cortisol; walking.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Female
  • Heart Rate
  • Humans
  • Hydrocortisone / analysis
  • Male
  • Relaxation*
  • Rural Health*
  • Stress, Psychological
  • Travel*
  • Young Adult


  • Hydrocortisone