Forest therapy is an emerging holistic health practice that uses multisensory immersive engagements in forest settings to achieve health and wellbeing outcomes. Many forest therapy engagements take place via slow walks along a trail to optimally experience the array of sensory phenomena afforded along the route, yet surprisingly few forest therapy studies to date have investigated the characteristics of forest sites and trails that give rise to healthful experiences. In this research, we employ a hybrid approach to understand the conditions and features that contribute to a good forest therapy trail, using interviews with forest therapy guides to identify and highlight concepts for further refinement and structuring via a broad, integrative review of the relevant research and planning literature. Through this iterative approach, we identify and describe three site-related criteria (landscape character and quality, tranquility, and accessibility) and two trail-related criteria (design and construction and key features and qualities), each with a number of sub-criteria detailing specific conditions and considerations. This effort helps build a conceptual foundation and evidence base for assessment procedures that can be used to identify existing trails and design new ones that meet the needs of forest planners, managers, guides, and participants for the growing international practice of forest therapy.

The health benefits of physical activity and spending time in nature are well established. However, children and adults in the United States are not participating in sufficient levels of physical activity and are not spending much time outdoors. Recently, increased access to nature for the health and wellness of all populations has seen growing public health attention, though a specific focus on nature-based physical activity has been limited. The purpose of this scoping review is to operationalize the health benefits of nature-based physical activity to provide guidance to program administrators, advocates, and researchers for nature-based physical activity to facilitate collaborations. Peer-reviewed literature was searched in PubMed, Medline, Web of Science, and Google Scholar as well as in published reviews of the literature. The literature was divided into three categories of: 1) amount and location of nature-based components and physical activity; 2) added health benefits of exposure to nature-based components and physical activity; and 3) nature-based components and physical activity effect on non-white, marginalized, and vulnerable populations. This review supports and encourages multiple strategies to increase nature-based physical activity as this provides even greater benefit to health and wellness than exposure to nature or physical activity alone. Although many of the physical and mental health benefits of nature and physical activity are well established, additional research is needed to better understand the relationship between exposure to nature and nature-based physical activity. However, the existing information justifies the promotion of nature-based physical activities in public health initiatives.

While most definitions of forest therapy emphasize the role of multisensory, immersive experiences in nature to achieve human health and wellbeing outcomes, reviews of research on forest therapy to date have predominantly focused on outcomes and provide limited insight on the factors and conditions that give rise to nature experiences. In this scoping review we employ a conceptual framework developed in the context of landscape perception research to examine empirical studies of forest therapy in terms of how the fuller process of human, forest, interaction, and outcome components are conceptualized and measured. Our literature search identified 266 studies focused on forest therapy and related activities, which were coded on a number of variables related to each of the four components in our framework. While most studies reported positive mental and/or physiological health outcomes using a wide array of measures, the typical study used small, homogeneous samples of participants who engaged in limited interactions with a forest environment that was minimally described. However, our analysis also identified a wider range of findings with regard to human-forest interactions, which together provide important insights for guiding forest therapy research and the provision of forest therapy trails, settings, and programs.

Background: eHealth technologies offer an efficient method to integrate park prescriptions into clinical practice by primary health care (PHC) providers to help patients improve their health via tailored, nature-based health behavior interventions. This paper describes the protocol of the GoalRx Prescription Intervention (GPI) which was designed to leverage community resources to provide tailored park prescriptions for PHC patients.Methods: The GPI study was designed as a 3-arm, multi-site observational study. We enrolled low-income, rural adults either at-risk of or living with hypertension or diabetes (n = 75) from Federally Qualified Health Centers (FQHC) in two counties in North Carolina, USA into the 3-month intervention. Eligible participants self-selected to receive (1) a tailored park prescription intervention; (2) a tailored home/indoor PA prescription intervention; or (3) a healthy eating prescription (with no PA prescription beyond standard PA counseling advice that is already routinely provided in PHC) as the comparison group. The GPI app paired patient health data from the electronic health record with stated patient preferences and triggered app-integrated SMS motivation and compliance messaging directly to the patient. Patients were assessed at baseline and at a 3-month follow-up upon the completion of the intervention. The primary outcome (mean difference in weekly physical activity from baseline (T0) to post-intervention (T1) as measured by the Fitbit Flex 2) was assessed at 3 months. Secondary outcomes included assessment of the relationship between the intervention and biological markers of health, including body mass index (BMI), systolic and diastolic blood pressure, HbA1c or available glucose test (if applicable), and a depression screen score using the Patient Health Questionnaire 9. Secondary outcomes also included the total number of SMS messages sent, number of SMS messages responded to, number of SMS messages ignored, and opt-out rate.Discussion: The goal was to create a protocol utilizing eHealth technologies that addressed the specific needs of rural low-income communities and fit into the natural rhythms and processes of the selected FQHC clinics in North Carolina. This protocol offered a higher standard of health care by connecting patients to their PHC teams and increasing patient motivation to make longer-lasting health behavior changes.

Although perceptions and uses vary, nature-based health interventions (NBHIs) help facilitate the additional health benefits of physical activity (PA) experienced in nature, thereby reducing all-cause morbidity and mortality. The purpose of this mixed-methods, cross-sectional study was to better understand perceptions, terminology, and participation in NBHIs. A questionnaire was developed by reviewing validated instruments and gauging expert experience with stakeholders. Distributed electronically, a community partner listserv promoting active living served as the population. Quantitative questionnaire measures assessed familiarity with NBHI terms, concepts, experience, how NBHI should be used, and the importance of NBHI components. Qualitative themes included the strengths and weaknesses of NBHIs. Participants (n = 53) were familiar with the terms nature play (82%), forest bathing (78%), and park and nature prescriptions (74%) and moderately familiar with NBHIs (5-point Likert scale, M = 3.27, SD = 1.17). Most thought NBHIs could be useful in treating physical (96%) and mental health conditions (100%) and would follow or write one (80%). The location was reported as the most important component, followed by access, social comfort, dosage, and ongoing support. This study suggests stakeholders are familiar with and support NBHIs conceptually; however, policies, support, and funding opportunities are needed to operationalize components to increase use of NBHIs.