***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 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 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 BACKGROUND This r and omized controlled trial investigates the efficacy of two non-pharmacologic treatments , bright light and high-density negative air ions for non-seasonal chronic depression .  Both methods have shown clinical success for seasonal affective disorder ( SAD ) . METHOD Patients were 24 ( 75 % ) women and 8 ( 25 % ) men , ages 22 - 65 years ( mean age + /- S.D. , 43.7 + /- 12.4 years ) , with Major Depressive Disorder , Single Episode ( DSM-IV code , 296.2 ) , Chronic ( episode duration > or = 2 years ) . Patients were entered throughout the year and r and omly assigned to exposure to bright light ( 10 000 lux , n = 10 ) , or high-density ( 4.5 x 10(14 ) ions/s flow rate , n = 12 ) or low-density ( 1.7 x 10(11 ) ions/s , n = 10 , placebo control ) negative air ions . Home treatment sessions occurred for 1 h upon awakening for 5 weeks . Blinded raters assessed symptom severity weekly with the Structured Interview Guide for the Hamilton Depression Rating Scale -- Seasonal Affective Disorder ( SIGH-SAD ) version . Evening saliva sample s were obtained before and after treatment for ascertainment of circadian melatonin rhythm phase . RESULTS SIGH-SAD score improvement was 53.7 % for bright light and 51.1 % for high-density ions v. 17.0 % for low-density ions . Remission rates were 50 % , 50 % and 0 % respectively . The presence or severity of atypical symptoms did not predict response to either treatment modality , nor were phase advances to light associated with positive response . CONCLUSIONS Both bright light and negative air ions are effective for treatment of chronic depression . Remission rates are similar to those for SAD , but without a seasonal dependency or apparent mediation by circadian rhythm phase shifts . Combination treatment with antidepressant drugs may further enhance clinical response 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 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 OBJECTIVE : To test the feasibility of creating a valid and reliable checklist with the following features : appropriate for assessing both r and omised and non-r and omised studies ; provision of both an overall score for study quality and a profile of scores not only for the quality of reporting , internal validity ( bias and confounding ) and power , but also for external validity . DESIGN : A pilot version was first developed , based on epidemiological principles , review s , and existing checklists for r and omised studies . Face and content validity were assessed by three experienced review ers and reliability was determined using two raters assessing 10 r and omised and 10 non-r and omised studies . Using different raters , the checklist was revised and tested for internal consistency ( Kuder-Richardson 20 ) , test-retest and inter-rater reliability ( Spearman correlation coefficient and sign rank test ; kappa statistics ) , criterion validity , and respondent burden . MAIN RESULTS : The performance of the checklist improved considerably after revision of a pilot version . The Quality Index had high internal consistency ( KR-20 : 0.89 ) as did the subscales apart from external validity ( KR-20 : 0.54 ) . Test-retest ( r 0.88 ) and inter-rater ( r 0.75 ) reliability of the Quality Index were good . Reliability of the subscales varied from good ( bias ) to poor ( external validity ) . The Quality Index correlated highly with an existing , established instrument for assessing r and omised studies ( r 0.90 ) . There was little difference between its performance with non-r and omised and with r and omised studies . Raters took about 20 minutes to assess each paper ( range 10 to 45 minutes ) . CONCLUSIONS : This study has shown that it is feasible to develop a checklist that can be used to assess the method ological quality not only of r and omised controlled trials but also non-r and omised studies . It has also shown that it is possible to produce a checklist that provides a profile of the paper , alerting review ers to its particular method ological strengths and weaknesses . Further work is required to improve the checklist and the training of raters in the assessment of external validity 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 Positive effects of green exercise on physical and psychological wellbeing have been found , yet little is known about the underlying cognitive mechanisms responsible for such effects . The purpose of this visual sensation study was to establish the extent to which the color green , as a primitive visual feature of many natural environments , contributes to the green exercise effect . Fourteen participants performed three moderate-intensity 5-min cycling tasks  ( 50 % peak power output ) while watching video footage of a rural cycling course that simulated cycling through a real natural environment . The three r and omly counter-balanced video conditions were unedited ( V(GREEN ) ) , achromatic ( V(GRAY ) ) or red filter ( V(RED ) ) . Lower total mood disturbance and ratings of perceived exertion were found during the V(GREEN ) compared to V(GRAY ) and V(RED ) . Feelings of anger were higher after V(RED ) compared to the other conditions . Feelings of tension , depression , fatigue , vigor , and confusion did not differ among conditions . This is the first study to show that the color green , as a primitive feature of visual sensation , has a contributory effect toward positive green exercise outcomes We previously reported that the forest environment enhanced human natural killer ( NK ) cell activity , the number of NK cells , and intracellular anti-cancer proteins in lymphocytes , and that the increased NK activity lasted for more than 7 days after trips to forests both in male and female subjects . To explore the factors in the forest environment that 
    Output:
    
The results demonstrated that forest bathing activities might have the following merits : remarkably improving cardiovascular function , hemodynamic indexes , neuroendocrine indexes , metabolic indexes , immunity and inflammatory indexes , antioxidant indexes , and electrophysiological indexes ; significantly enhancing people ’s emotional state , attitude , and feelings towards things , physical and psychological recovery , and adaptive behaviors ; and obvious alleviation of anxiety and depression .
Conclusion Forest bathing activities may significantly improve people ’s physical and psychological health .