Forest Therapy as a Nature-Based Intervention: An Option for Neurological Rehabilitation?

Abstract

Background: Forest therapy demonstrates positive effects on mood, immune system, stress levels and general well-being. Studies on depression, stress-related illnesses, sleep disorders and arterial hypertension have provided evidence-based proof of this. Summary: The aim of this review was to examine the possible effects of forest therapy with regard to its evidence in the treatment of chronic neurological diseases such as stroke in the rehabilitation phase, Parkinson's disease, dementia and multiple sclerosis. Therefore, the electronic databases Medline, Scopus and Cochrane were searched for such clinical trials for the years 1970 to mid-2023 without language restriction. The literature search revealed only few studies with positive indications but too few cases to be able to make generalizable evidence-based statements. In terms of improvement in the Hamilton Depression Scale analysis of two studies in stroke patients showed slight benefits in the forest therapy group (Standard Mean Difference -0.43; 95%-CI -0.76- -0,10; p<0.01). One observational study revealed a higher rate of stroke survival in patients living in marked greenness. Few nature-based interventions in dementia patients showed certain benefits in particular details. Key messages: There are no evidence-based results on the benefit of forest therapy for chronic neurological diseases. However, there are hints that forest therapy could have a positive benefit. Therefore, a proposal for forest therapy as a component of multimodal neurological rehabilitation is presented.