***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: In recent times , attention has been focused on the role of urban green spaces in promoting human health and well-being . However , there is a lack of evidence -based research on the physiological effects of walking in urban green areas . This study aim ed to clarify the physiological and psychological effects of walking in urban parks during fall . Twenty-three males ( mean age 22.3 ± 1.2 years ) were instructed to walk predetermined 15-min courses in an urban park and in a nearby city area ( control ) . Heart rate and heart rate variability were measured to assess physiological responses , and the semantic differential method , Profile of Mood States , and State-Trait Anxiety Inventory were used to measure psychological responses . We observed that walking in an urban park result ed in a significantly lower heart rate , higher parasympathetic nerve activity , and lower sympathetic nerve activity than walking through the city area . In subjective evaluations , participants were more “ comfortable , ” “ natural , ” “ relaxed , ” and “ vigorous ” after a walk in the urban park . Furthermore , they exhibited significantly lower levels of negative emotions and anxiety . These findings provide scientific evidence for the physiological and psychological relaxation effects of walking in urban parks during fall The physiological effects of natural and urban environments on the cardiovascular system of coronary artery disease ( CAD ) patients are not fully understood . This controlled field study examines the effects of restorative walking in a park vs. in an urban street environment on CAD patients ’ stress parameters and cardiac function . Methods : Twenty stable CAD patients were r and omly allocated to 7 days controlled walking in a city park or in an urban street environment group . The relationship between different environmental exposures and health effects was analyzed using Wilcoxon signed-rank test and exact Mann-Whitney U test . Results : The mean reduction in cortisol levels and negative effects after the walk on the first day was greater in the city park than in the urban street exposed group , while a reduction in negative effects in the urban group were greater after seven days . The reduction in diastolic blood pressure ( DBP ) in the park group was evident on the seventh day before the walk ( −4 mm Hg , p = 0.031 ) and 60 min after the walk ( −6.00 mm Hg , p = 0.002 ) . The cortisol slope was negatively associated with the DBP changes ( r = −0.514 , p < 0.05 ) . Conclusions : Physical activity in a green environment with noise and air pollution levels lower than in an urban environment has a greater positive effect on CAD patients ’ stress level and hemodynamic parameters . Mitigating green environmental influences may allow urban residents to maintain health and reduce disability BACKGROUND Stress and mental fatigue are major health threats to employees in office-based occupations .  Physical activity is widely used as a stress-management intervention for employees . Moreover , experiences in contact with nature have been shown to provide stress-reduction and restoration from mental fatigue . OBJECTIVES In a pilot study design ed as a r and omized controlled trial we investigated the impact of a green-exercise intervention on psychological and physiological indicators of stress in municipality employees . METHODS Fourteen employees ( 7 females and 7 males , 49±8 yrs ) volunteered in an exercise-based intervention in workplace either outdoors in a green/nature area or in an indoor exercise- setting . The intervention consisted of an information meeting and two exercise sessions , each including a biking bout and a circuit-strength sequence using elastic rubber b and s ( 45-minutes , at about 55 % of HR reserve , overall ) . Main outcomes were perceived environmental potential for restoration , affective state , blood pressure ( BP ) and cortisol awakening response ( CAR AUC(G ) and CAR AUC(I ) ) and cortisol levels in serum . Measurements were taken at baseline and in concomitance with the exercise sessions . Furthermore , affective state and self-reported physical activity levels were measured over a 10-weeks follow-up period . RESULTS Compared with the indoor group , the nature group reported higher environmental potential for restoration ( p < 0.001 ) and Positive Affect ( p < 0.01 ) , along with improved CAR AUC(I ) ( p = 0.04 ) and , marginally , diastolic BP ( p = 0.05 ) . The nature group also reported higher ratings of Positive Affect at follow-up ( p = 0.02 ) . Differences at post-exercise were not found for any of the other components of affective state , systolic BP , CAR AUC(G ) and cortisol levels measured in serum . CONCLUSIONS Green-exercise at the workplace could be a profitable way to manage stress and induce restoration among employees . Further studies on larger sample s are needed in order to improve the generalizability of the results Background In recent years , the physiological relaxation effects of natural environments have been widely exploited , and although individual differences in the effects of forest therapy are known , assessment methods have not been clearly established . This study used a classification based on Type A and Type B behavior patterns to explain individual differences in physiological responses to forest environments . Methods We performed physiological experiments in 44 forest and urban ( controls ) areas . In total , 485 male university students ( age , 21.8 ± 1.6 years ) participated in the study . The subjects were asked to visit forest or urban environments r and omly and observe each l and scape for 15 min . The subjects ’ pulse rates and blood pressures were tested to evaluate their physiological responses . The Kwansei Gakuin daily life question naire was used to identify Type A and Type B behavior patterns in subjects . Results The pulse rate was significantly lower in the Type B group after exposure to forest areas than after exposure to urban areas , whereas no significant difference was observed in the Type A group . In addition , the pulse rate was significantly lower in the low scoring subjects in the Type B group , which was consistent with changes in their diastolic blood pressure . Conclusions These results suggest that individual differences in pulse rate and blood pressure in response to forest environments can be explained by Type A and Type B behavior patterns Stress-relieving effects of gardening were hypothesized and tested in a field experiment . Thirty allotment gardeners performed a stressful Stroop task and were then r and omly assigned to 30 minutes of outdoor gardening or indoor reading on their own allotment plot . Salivary cortisol levels and self-reported mood were repeatedly measured . Gardening and reading each led to decreases in cortisol during the recovery period , but decreases were significantly stronger in the gardening group . Positive mood was fully restored after gardening , but further deteriorated during reading . These findings provide the first experimental evidence that gardening can promote relief from acute stress Environments shape health and well-being , yet little research has investigated how different real-world environmental setting s influence the well-known determinant of health known as stress . Using a cross-over experimental design ; this pilot study investigated the effect of  four urban environments on physiological and psychological stress measures .  Participants ( N = 15 ) were exposed on separate days to one of the four setting s for 20 min . These setting s were design ated as Very Natural ; Mostly Natural ; Mostly Built and Very Built . Visitation order to the four setting s was individually r and omized . Salivary cortisol and alpha-amylase ; as well as self-report measures of stress ; were collected before and after exposure to each setting . Gender was included as a variable in analysis ; and additional data about environmental self-identity , pre-existing stress , and perceived restorativeness of setting s were collected as measures of covariance . Differences between environmental setting s showed greater benefit from exposure to natural setting s relative to built setting s ; as measured by pre-to-post changes in salivary amylase and self-reported stress ; differences were more significant for females than for males . Inclusion of covariates in a regression analysis demonstrated significant predictive value of perceived restorativeness on these stress measures , suggesting some potential level of mediation . These data suggest that exposure to natural environments may warrant further investigation as a health promotion method for reducing stress Background Sleep disturbance is a major health issue in Japan . This before-after study aim ed to evaluate the immediate effects of forest walking in a community-based population with sleep complaints . Methods Participants were 71 healthy volunteers ( 43 men and 28 women ) .  Two-hour forest-walking sessions were conducted on 8 different weekend days from September through December 2005 . Sleep conditions were compared between the nights before and after walking in a forest by self-administered question naire and actigraphy data . Results Two hours of forest walking improved sleep characteristics ; impacting actual sleep time , immobile minutes , self-rated depth of sleep , and sleep quality . Mean actual sleep time estimated by actigraphy on the night after forest walking was 419.8 ± 128.7 ( S.D. ) minutes whereas that the night before was 365.9 ± 89.4 minutes ( n = 42 ) . Forest walking in the afternoon improved actual sleep time and immobile minutes  compared with forest walking in the forenoon . Mean actual sleep times did not increase after forenoon walks ( n = 26 ) ( the night before and after forenoon walks , 380.0 ± 99.6 and 385.6 ± 101.7 minutes , respectively ) , whereas afternoon walks ( n = 16 ) increased mean actual sleep times from 342.9 ± 66.2 to 475.4 ± 150.5 minutes . The trend of mean immobile minutes was similar to the abovementioned trend of mean actual sleep times . Conclusions Forest walking  improved nocturnal sleep conditions for individuals with sleep complaints , possibly as a result of exercise and emotional improvement . Furthermore , extension of sleep duration was greater after an afternoon walk compared to a forenoon walk . Further study of a forest-walking program in a r and omized controlled trial is warranted to clarify its effect on people with insomnia The natural environment is increasingly recognized as an effective counter to urban stress , and “ Forest Therapy ” has recently attracted attention as a relaxation and stress management activity with demonstrated clinical efficacy . The present study assessed the physiological and psychological effects of a forest therapy program on middle-aged females . Seventeen Japanese females ( 62.2 ± 9.4 years ; mean ± st and ard deviation ) participated in this experiment . Pulse rate , salivary cortisol level , and psychological indices were measured on the day before forest therapy and on the forest therapy day . Pulse rate and salivary cortisol were significantly lower than baseline following forest therapy , indicating that subjects were in a physiologically relaxed state . Subjects reported feeling significantly more “ comfortable , ” “ relaxed , ” and “ natural ” according to the semantic differential ( SD ) method . The Profile of Mood State ( POMS ) negative mood subscale score for “ tension – anxiety ” was significantly lower , while that for “ vigor ” was significantly higher following forest therapy . Our study revealed that forest therapy  elicited a significant ( 1 ) decrease in pulse rate , ( 2 ) decrease in salivary cortisol levels , ( 3 ) increase in positive feelings , and ( 4 ) decrease in negative feelings . In conclusion , there are substantial physiological and psychological benefits of forest therapy on middle-aged females We measured dynamic stress responses using ambulatory heart rate monitoring as participants in Philadelphia , Pennsylvania walked past vacant lots before and after a greening remediation treatment of r and omly selected lots . Being in view of a greened vacant lot decreased heart rate significantly more than did being in view of a nongreened vacant lot or not in view of any vacant lot . Remediating neighborhood blight may reduce stress and improve health RATIONALE Allostatic load ( AL ) , a novel measure of the physiologically dysregulated response of the body to stress , represents a biomarker of chronic stress exposure . OBJECTIVES To determine whether preadolescent children with high AL are more susceptible to asthma as adolescents . METHODS This was a prospect i ve evaluation of children recruited at 7 to 10 years of age in the nested case-control arm of the Study of Asthma , Genes and Environment and followed until 11 to 14 years of age .  AL was measured using eight biomarkers : fasting glucose , total cholesterol , high-density lipoprotein cholesterol , dehydroepi and rosterone sulfate , cortisol , systolic and diastolic blood pressure , and waist-to-hip ratio . AL , created from the sum of biomarkers in a high-risk quartile , was related to prevalence and incidence of asthma using logistic regression . MEASUREMENTS AND MAIN RESULTS Among 352 participants followed until 11 to 14 years of age , prevalent asthma was four times more likely in boys with high ( > 3 ) versus low ( ≤2 ) AL after adjusting for current asthma/atopy , age , ethnicity , parental history of asthma , and overweight status . Similar results were observed in the analysis of new-onset asthma in boys ( adjusted odds ratio , 4.35 ; 95 % confidence interval , 1.19 - 15.9 ) . In girls , there were no associations between AL and asthma . In the analysis of a subset of biomarkers , combinations of total cholesterol , glucose , and cortisol were associated with similar or greater risk of asthma prevalence or onset in boys . CONCLUSIONS AL and its biomarkers are associated with an increased likelihood of asthma in adolescent boys . The observed association between AL and asthma may be attributable to a combined subset of AL biomarkers CONTEXT Horticultural therapy ( HT ) is a subgroup of occupational therapy ( OT ) . Both HT and OT have been successful as adjunctive treatment modalities in substance abuse treatment . Studies have indicated that gardening promotes neuroendocrine and affective restoration from stress . OBJECTIVES The study intended to assess the effect of HT versus nonhorticultural OT on cortisol levels , depression , symptoms of posttraumatic stress disorder ( PTSD ) , alcohol cravings , and quality of life . METHODS The research team design ed a r and omized pilot study . SETTING The study was open for participation from July 2012-October 2012 . It took place during multiple 
    Output:
    
Heart rate , blood pressure , and self‐report measures provide the most convincing evidence that spending time in outdoor environments , particularly those with green space , may reduce the experience of stress , and ultimately improve health .