***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Objective To summarize the evidence for curative and health enhancement effects through  forest therapy  and to assess the quality of studies based on a review of r and omized controlled trials ( RCTs ) . Study design A systematic review based on RCTs . Methods Studies were eligible if they were RCTs . Studies included one treatment group in which forest therapy was applied .  The following data bases – from 1990 to November 9 , 2010 – were search ed : MEDLINE via PubMed , CINAHL , Web of Science , and Ichushi- Web . All Cochrane data bases and Campbell Systematic Review s were also search ed up to November 9 , 2010 . Results Two trials met all inclusion criteria . No specific diseases were evaluated , and both studies reported significant effectiveness in one or more outcomes for health enhancement . However , the results of evaluations with the CONSORT ( Consoli date d St and ards of Reporting Trials ) 2010 and CLEAR NPT ( A Checklist to Evaluate a Report of a Nonpharmacological Trial ) checklists generally showed a remarkable lack of description in the studies . Furthermore , there was a problem of heterogeneity , thus a meta- analysis was unable to be performed . Conclusion Because there was insufficient evidence on forest therapy due to poor method ological and reporting quality and heterogeneity of RCTs , it was not possible to offer any conclusions about the effects of this intervention . However , it was possible to identify problems with current RCTs of forest therapy , and to propose a strategy for strengthening study quality and stressing the importance of study feasibility and original check items based on characteristics of forest therapy as a future research agenda Objective To compare the pain-reducing effect of forest bathing alone versus forest bathing in combination with stretching and strengthening exercises in patients with chronic posterior neck pain . Methods Sixty-four subjects with posterior neck pain that had lasted more than 3 months were enrolled . They were r and omly divided into a forest bathing alone ( FBA ) group and a forest bathing with exercise ( FBE ) group ; each group included 32 subjects . All subjects from both groups walked every morning in the forest for about 2 hours for 5 days . In the afternoon , the FBE group did a stretching and strengthening exercise for about 4 hours ; the FBA group had free time in the woods . Visual analog scale ( VAS ) on one day , VAS over the previous week , neck disability index ( NDI ) , EuroQol 5D-3L VAS ( EQ VAS ) and index ( EQ index ) , McGill pain question naire ( MPQ ) , the number of trigger points in the posterior neck region ( TRPs ) , and the range of motion of the cervical spine were evaluated on the first and last day of the program and compared between the two groups . Results The number of TRPs were significantly reduced in the FBE group compared with the FBA group ( p=0.013 ) . However , the other scales showed no significant difference between the two groups . Conclusion When patients with chronic posterior neck pain underwent a short-term forest bathing ( less than 7 days ) program , FBE was more effective in the reduction of the number of TRPs than FBA . However , all other pain measurement scales we evaluated showed no statistically significant difference between the two protocol OBJECTIVE To provide scientific evidence supporting the efficacy of forest bathing as a natural therapy for human hypertension . METHODS Twenty-four elderly patients with essential hypertension were r and omly divided into two groups of 12 . One group was sent to a broad-leaved evergreen forest to experience a 7-day/7-night trip , and the other was sent to a city area in Hangzhou for control . Blood pressure indicators , cardiovascular disease-related pathological factors including endothelin-1 , homocysteine , renin , angiotensinogen , angiotensin II , angiotensin II type 1 receptor , angiotensin II type 2 receptor as well as inflammatory cytokines interleukin-6 and tumor necrosis factor α were detected . Meanwhile ,  profile of mood states ( POMS ) evaluation was used to assess the change of mood state of subjects . In addition , the air quality in the two experimental sites was monitored during the 7-day duration , simultaneously . RESULTS The baselines of the indicators of the subjects were not significantly different . Little alteration in the detected indicators in the city group was observed after the experiment . While subjects exposed to the forest environment showed a significant reduction in blood pressure in comparison to that of the city group . The values for the bio-indicators in subjects exposed to the forest environment were also lower than those in the urban control group and the baseline levels of themselves . POMS evaluation showed that the scores in the negative subscales were lowered after exposure to the forest environment . Besides , the air quality in the forest environment was much better than that of the urban area evidence d by the quantitative detection of negative ions and PM10 ( particulate matter < 10 μm in aerodynamic diameter ) . CONCLUSION Our results provided direct evidence that forest bathing has therapeutic effects on human hypertension and induces inhibition of the renin-angiotensin system and inflammation , and thus inspiring its preventive efficacy against cardiovascular disorders Forest bathing trip is a short , leisurely visit to forest . In this study we determined the health effects of forest bathing trip on elderly patients with chronic obstructive pulmonary disease ( COPD ) . The patients were r and omly divided into two groups . One group was sent to forest , and the other was sent to an urban area as control . Flow cytometry , ELISA , and profile of mood states ( POMS ) evaluation were performed . In the forest group , we found a significant decrease of perforin and granzyme B expressions , accompanied by decreased levels of pro-inflammatory cytokines and stress hormones . Meanwhile , the scores in the negative subscales of POMS decreased after forest bathing trip . These results indicate that forest bathing trip has health effect on elderly COPD patients by reducing inflammation and stress level BACKGROUND Psycho-oncological care , including spiritual care , is essential for cancer patients .  Integrated medicine , a therapy combining modern western medicine with various kinds of complementary and alternative medicine , can be appropriate for the spiritual care of cancer because of the multidimensional characteristics of the spirituality . In particular , therapies that enable patients to establish a deeper contact with nature , inspire feelings of life and growth of plants , and involve meditation may be useful for spiritual care as well as related aspects such as emotion . The purpose of the present study was to examine the effect of spiritual care of cancer patients by integrated medicine in a green environment . METHODS The present study involved 22 cancer patients .  Integrated medicine consisted of forest therapy , horticultural therapy , yoga meditation , and support group therapy , and sessions were conducted once a week for 12 weeks . The spirituality ( the Functional Assessment of Chronic Illness Therapy-Spiritual well-being ) , quality of life ( Short Form-36 Health Survey Question naire ) , fatigue ( Cancer Fatigue Scale ) , psychological state ( Profile of Mood States , short form , and State-Trait Anxiety Inventory ) and natural killer cell activity were assessed before and after intervention . RESULTS In Functional Assessment of Chronic Illness Therapy-Spiritual well-being , there were significant differences in functional well-being and spiritual well-being pre- and postintervention . This program improved quality of life and reduced cancer-associated fatigue . Furthermore , some aspects of psychological state were improved and natural killer cell activity was increased . CONCLUSIONS It is indicated that integrated medicine performed in a green environment is potentially useful for the emotional and spiritual well-being of cancer patients BACKGROUND Clinical trials have not been reported concerning the health benefits of viewing indoor plants on stress and recovery of surgical patients within a hospital setting . Using various medical and psychologic measurements , this study performed a r and omized clinical trial with surgical patients to evaluate whether plants in hospital rooms have therapeutic influences . METHODS Ninety ( 90 ) patients recovering from a hemorrhoidectomy were r and omly assigned to either control or plant rooms . With half the patients , live plants were placed in their rooms during postoperative recovery periods . Data collected for each patient included length of hospitalization , analgesics used for postoperative pain control , vital signs , ratings of pain intensity , pain distress , anxiety and fatigue , the State-Trait Anxiety Inventory Form Y-1 , the Environmental Assessment Scale , and the Patient 's Room Satisfaction Question naire . RESULTS Viewing plants during the recovery period had a positive influence linking directly to health outcomes of surgical patients . Patients in hospital rooms with plants and flowers had significantly more positive physiologic responses evidence d by lower systolic blood pressure , and lower ratings of pain , anxiety , and fatigue than patients in the control room . Patients with plants also felt more positively about their rooms and evaluated them with higher satisfaction when compared with patients in similar rooms without plants . Based on patients ' comments , plants brightened up the room environment , reduced stress , and also conveyed positive impressions of hospital employees caring for patients . CONCLUSIONS Findings of this study confirmed the therapeutic value of plants in the hospital environment as a noninvasive , inexpensive , and effective complementary medicine for surgical patients . Health care professionals and hospital administrators need to consider the use of plants and flowers to enhance healing environments for patients Objective : This article aim ed to develop the “ forest therapy ” program , which is a cognitive behavior therapy (CBT)-based intervention program using forest environment , and investigate its effects on blood pressure ( BP ) , salivary cortisol , and quality of life ( QoL ) measures in patients with hypertension . Methods : A total of 56 men and women were enrolled for this study , being referred from local health centers in Republic of Korea , from April to October 2009 . They were conveniently assigned to either “ forest ” group participating in the forest therapy program or control group doing self-monitoring of BP . Measurements of salivary cortisol level and QoL were done at initial visits and at 8-week final visits . Results : Both groups did not differ significantly in baseline clinical characteristics . The BP change at week 4 and week 8 did not differ between the two groups . Salivary cortisol level reduction was significantly larger and QoL measures improved significantly more in the forest group at week 8 compared with the control group . Conclusions : The forest therapy program did not induce prolonged systolic blood pressure ( SBP ) reduction . However , considering the significant decrease in cortisol level and improvement in QoL measures , this may be a useful model of community hypertension management program 
    Output:
    
Conclusion Forest therapy may play an important role in health promotion and disease prevention .