***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: This study aim ed to investigate the effects of a two-day forest therapy program on individuals with chronic widespread pain . Sixty one employees of a public organization providing building and facilities management services within the Seoul Metropolitan area participated in the study . Participants were assigned to an experimental group ( n = 33 ) who participated in a forest therapy program or a control group  ( n = 28 ) on a non-r and om basis . Pre- and post- measures of heart rate variability ( HRV ) , Natural Killer cell ( NK cell ) activity , self-reported pain using the visual analog scale ( VAS ) , depression level using the Beck Depression Inventory ( BDI ) , and health-related quality of life measures using the EuroQol Visual Analog Scale ( EQ-VAS ) were collected in both groups . The results showed that participants in the forest therapy group , as compared to the control group , showed physiological improvement as indicated by a significant increase in some measures of HRV and an increase in immune competence as indicated by NK cell activity . Participants in the forest therapy group also reported significant decreases in pain and depression , and a significant improvement in health-related quality of life . These results support the hypothesis that forest therapy is an effective intervention to relieve pain and associated psychological and physiological symptoms in individuals with chronic widespread pain Objective : To assess whether forest therapy is effective for treating depression and anxiety in patients with chronic stroke by using several psychological tests . We measured reactive oxygen metabolite ( d-ROM ) levels and biological antioxidant potentials ( BAPs ) associated with psychological stress . Methods : Fifty-nine patients with chronic stroke were r and omly assigned to either a forest group ( staying at a recreational forest site ) or to an urban group ( staying in an urban hotel ) ; the duration and activities performed by both groups were the same . Scores on the Beck Depression Inventory ( BDI ) , Hamilton Depression Rating Scale ( HAM-D17 ) , Spielberger State-Trait Anxiety Inventory ( STAI ) , d-ROMs and BAPs were evaluated both before and after the treatment programs . Results : In the forest group , BDI , HAM-D17 and STAI scores were significantly lower following treatment , and BAPs were significantly higher than baseline . In the urban group , STAI scores were significantly higher following treatment . Moreover , BDI , HAM-D17 and STAI scores of the forest group were significantly lower , and BAPs were significantly higher following treatment ( ANCOVA , p < 0.05 ) . Conclusion : Forest therapy is beneficial for treating depression and anxiety symptoms in patients with chronic stroke , and may be particularly useful in patients who can not be treated with st and ard pharmacological or electroconvulsive therapies OBJECTIVE To investigate the effects of short-term forest bathing on human health . METHODS Twenty healthy male university students participated as subjects and were r and omly divided into two groups of 10 . One group was sent on a two-night trip to a broad-leaved evergreen forest , and the other was sent to a city area . Serum cytokine levels reflecting inflammatory and stress response , indicators reflecting oxidative stress , the distribution of leukocyte subsets , and plasma endothelin-1 ( ET-1 ) concentrations were measured before and after the experiment to evaluate the positive health effects of forest environments . A profile of mood states ( POMS ) evaluation was used to assess changes in mood states . RESULTS No significant differences in the baseline values of the indicators were observed between the two groups before the experiment . Subjects exposed to the forest environment showed reduced oxidative stress and pro-inflammatory level , as evidence d by decreased malondialdehyde , interleukin-6 , and tumor necrosis factor a levels compared with the urban group . Serum cortisol levels were also lower than in the urban group . Notably , the concentration of plasma ET-1 was much lower in subjects exposed to the forest environment . The POMS evaluation showed that after exposure to the forest environment , subjects had lower scores in the negative subscales , and the score for vigor was increased . CONCLUSION Forest bathing is beneficial to human health , perhaps through preventive effects related to several pathological factors PURPOSE This study was performed to determine the physical and psychological effects of an urban forest-walking program for office workers . For many workers , sedentary lifestyles can lead to low levels of physical activity causing various health problems despite an increased interest in health promotion . METHODS Fifty four office workers participated in this study . They were assigned to two groups ( experimental group and control group ) in r and om order and the experimental group performed 5 weeks of walking exercise based on Information-Motivation-Behavioral skills Model . The data were collected from October to November 2014 . SPSS 21.0 was used for the statistical analysis . RESULTS The results showed that the urban forest walking program had positive effects on the physical activity level ( U=65.00 , p<.001 ) , health promotion behavior ( t=-2.20 , p=.033 ) , and quality of life ( t=-2.42 , p=.020 ) . However , there were no statistical differences in depression , waist size , body mass index , blood pressure , or bone density between the groups . CONCLUSION The current findings of the study suggest the forest-walking program may have positive effects on improving physical activity , health promotion behavior , and quality of life . The program can be used as an effective and efficient strategy for physical and psychological health promotion for office workers 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 Aims : This study evaluated two existing group-based health promotion initiatives ( a social club and a swimming group ) and compared these to a new green exercise programme ( weekly countryside and urban park walks ) . Methods : Participants represented a clinical population ( N = 53 ) and were all experiencing a range of mental health problems . They only attended one of the three programmes and sessions were held once a week for six weeks in all initiatives . Composite question naires incorporating two st and ardized measures to analyse changes in self-esteem and mood were completed before and after all sessions . Results : A significant main effect for self-esteem and mood pre and post activity ( p < 0.001 ) was reported after participating in a single session . The change in self-esteem was significantly greater in the green exercise group compared with the social activities club ( p < 0.001 ) . Dose responses showed that both self-esteem and mood levels improved over the six-week period and improvements were related to attendance in the green exercise group . Conclusions : Green exercise as a health-promoting initiative for people experiencing mental ill health is equally as effective as existing programmes . Combining exercise , nature and social components in future initiatives may play a key role in managing and supporting recovery from mental ill health , suggesting a potential ‘ green ’ approach to mental healthcare and promotion Natural killer ( NK ) cell activity and psychological status were measured at baseline and at 3 months into treatment , as part of the National Cancer Institute ( NCI ) Protocol 79-C-111 , r and omizing breast cancer patients to lumpectomy/radiation v mastectomy . Patients who were found to have positive axillary lymph nodes also received combination chemotherapy ( Adriamycin [ Adria Laboratories , Columbus , OH ] , plus Cytoxan [ Mead Johnson Pharmaceuticals , Evansville , IN ] or methotrexate , plus 5-fluorouracil [ 5-FU ] ) . Seventy-five patients were entered onto this behavioral immunology protocol at the time of data analysis . We reported in an earlier publication that NK activity was an important predictor of patient baseline prognosis relevant to nodal status . In that study , by using multiple regression analyses , 51 % of the baseline NK activity variance could be accounted for by entering three distress indicators into the equation ( patient " adjustment , " lack of social support , and fatigue/depression symptoms ) . On re assessment of NK activity after 3 months , it was found that NK activity was not affected by the interim administration of chemotherapy and /or radiotherapy . However , consistent with our earlier findings , NK activity levels remained markedly lower in patients with positive nodes than in patients with negative nodes ( at 60 to 1 effector to target cell [ E : T ] ratio , mean of 18 % lytic activity v mean of 31 % lytic activity [ t = 1.87 , P less than .05 ] ) . Even though average levels of NK activity were lower for patients with more tumor burden , there was still a substantial range of NK activity levels within the node positive patient group , as well as within the patient group as a whole . We hypothesized that differences in levels of NK activity could be predicted on the basis of baseline distress factors found to be significant in our earlier report . In fact , we found that we could account for 30 % of NK activity level variance at 3 months follow-up on the basis of baseline NK activity , fatigue/depression , and lack of social support . Therefore , although neither radiation nor chemotherapy appeared to affect NK activity , tumor burden was again clearly associated with NK activity levels , and a significant amount of baseline and 3-month NK activity could be predicted on the basis of CNS-mediated effects . At the least , such factors provide a psychological marker of host biological status 
    Output:
    
We concluded that forest therapy is an emerging and effective intervention for decreasing adults ' depression levels .