Forest bathing in cardiovascular diseases - a narrative review

Introduction.People of all ages have always enjoyed the forest, due to the peaceful environment, mild climate, extremely beautiful landscapes, fresh air, pleasant flower and plant scents. Over the past years, a new medical science termed forest medicine has developed, as an interdisciplinary science belonging to the fields of alternative medicine, environmental medicine and preventive medicine, which comprises the effects of forest environments on human health. However, beyond its use for pleasure, there is increasing evidence suggesting that the forest can offer very many benefits for health, including in cardiovascular diseases. Objectives.To bring to attention a less known and studied therapeutic issue, i.e. the effects of forest bathing on the human body, especially in cardiovascular diseases. Material and method. Given the heterogeneous nature of the evidence in the literature, these findings should be put together in order to allow an adequate interpretation. Thus, we reviewed the observational clinical studies (on prospective cohorts, case-control studies, retrospective cohorts), the randomized controlled trials (RCT) and nonrandomized controlled trials in PubMed, over the past 20 years, until June 2020, focusing on the effects of the forest in cardiovascular diseases. The search terms included forest, forest bathing, cardiovascular effects, blood pressure, diabetes mellitus, coronary artery disease, stress, psychological effects. Results and discussions.The results of the studies show that the benefits of the forest on the cardiovascular system are obvious regardless of age, sex, socioeconomic environment or previous exposure to a natural environment. Also, walking in the forest environment can promote cardiovascular relaxation by facilitating the parasympathetic nervous system and by suppressing the sympathetic nervous system. In addition, forest therapy can be effective in reducing negative psychological symptoms. The current literature supports the benefits of exposure to nature and green environments for human health, through the effects on: the immune system (increase of natural killer cells/cancer prevention); the cardiovascular system (hypertension/coronary artery disease); the respiratory system (allergies and respiratory diseases); depression and anxiety (mood disorders and stress); mental relaxation. Conclusions.The studies conducted show the cardiovascular benefits associated with continuous immersion in nature, but further research regarding this aspect is definitely required.