AIM:The study aimed to assess the effect of exercise intervention on the management of obese T2DM patients.

METHODS:The literature retrieval was conducted in relevant databases from their inception to 2015, with predefined searching strategy and selection criteria. The Cochrane Collaboration's tool was utilized to assess the quality of included studies. Weighted mean difference (WMD) with its corresponding 95% CI (confidence interval) was used as the effect size.

RESULTS:A subset of 13 eligible studies was selected. Exercise significantly reduced the concentration of high sensitivity C reactive protein (4 months: WMD=-1.03, 95% CI: -1.77 to -0.29, P<0.01), triglyceride (6 months: WMD=-24.75, 95% CI: -27.67 to -21.83, P<0.01), diastolic blood pressure (6 months: WMD=-2.70, 95% CI: -4.12 to -1.28, P=0.0002), systolic blood pressure (WMD=-7.98, 95% CI: -9.87 to -6.08, P<0.01)), HbA1c (4 months: WMD=-0.25, 95% CI: -0.49 to -0.02, P=0.04) and homeostasis model assessment-insulin resistance (3 months: WMD=-0.19, 95% CI: -0.37 to -0.01, P=0.04); and a pronounced increase of HDL-C (12 months: WMD=3.57, 95% CI: 1.92 to 5.21, P<0.01).

CONCLUSION:Exercise was beneficial to obese T2DM patients.

Background and objectives:Nonalcoholic steatohepatitis (NASH) is strongly associated with obesity. A weight loss of≥10% is necessary to improve NASH severity, but this goal has rarely been achieved in published studies using different diet protocols. The effect of a ketogenic, hypocaloric, commercial diet ("Ideal Protein,"IP) on body weight, metabolic markers, and liver tests in a group of NASH patients is evaluated in this study. Daily calorie intake was tailored to achieve a weight loss of≥10%.

Methods:We analyzed 38 patients with NASH who were placed on the IP diet between 2014 and 2018 and compared their outcomes with 6 control patients who declined the diet. All patients were evaluated by a trained health coach in weekly intervals throughout the study period. Clinical and laboratory data obtained before and at 6.5 months after intervention were compared using paired t-testing.

Results:The patients on the IP diet experienced a significant weight reduction (217± 8 lb. 194± 7 lb; mean ± S.E.M.), corresponding to an average weight loss of 9.7% ± 1.6%. Significant changes in systolic blood pressure (133 ± 3 mmHg. 123± 3 mmHg), triglycerides (200 ± 21 mmol/L. 132± 11 mmol/L), hemoglobin A1c (6.71% ± 0.29%. 5.74%± 0.19%), SGPT (97.3 ± 11.1 IU/L. 44.2± 5.9 IU/L), SGOT (82.4 ± 10.5 IU/L. 32.8± 5.2 IU/L), and Fib-4 scores (2.25 ± 0.23. 1.40± 0.13) were also observed (<0.05 in all cases). In the IP group, 50.5% of patients lost≥10% body weight. In contrast, no significant changes were observed in the control group. The IP diet was well tolerated, and no safety signals were noticed.

Conclusions:A ketogenic, hypocaloric resulted in striking weight loss and significant improvements in metabolic parameters and liver tests, suggesting that this approach carries promise for the dietary management of patients with NASH.

OBJECTIVE:To evaluate the effects of a laughter yoga activities (LY) program for older people living in residential aged care homes (RACHs).

METHODS:A 6-week LY program was implemented at three RACHs with twenty-eight residents. A pre-post design was used to measure positive and negative affect, happiness, blood pressure and pulse.

RESULTS:Post-session mean scores for positive mood, and happiness were significantly higher than pre-session scores in weeks 1, 3 and 6, and the post-session mean negative mood scores were significantly lower than pre-session scores in weeks 3 and 6. Post-session readings for mean systolic blood pressure were significantly lower than pre-session readings in weeks 1 and 6.

CONCLUSION:This study demonstrates the potential for using LY to improve mood and lower blood pressure of older people living in RACHs.

OBJECTIVE:To evaluate the effects of a laughter yoga activities (LY) program for older people living in residential aged care homes (RACHs).

METHODS:A 6-week LY program was implemented at three RACHs with twenty-eight residents. A pre-post design was used to measure positive and negative affect, happiness, blood pressure and pulse.

RESULTS:Post-session mean scores for positive mood, and happiness were significantly higher than pre-session scores in weeks 1, 3 and 6, and the post-session mean negative mood scores were significantly lower than pre-session scores in weeks 3 and 6. Post-session readings for mean systolic blood pressure were significantly lower than pre-session readings in weeks 1 and 6.

CONCLUSION:This study demonstrates the potential for using LY to improve mood and lower blood pressure of older people living in RACHs.

AIMS:The purpose of the present study was to compare different modes of exercise in chronic modification of cardiovascular diseases risk factors.

METHODS:A total of 48 healthy elderly men were randomly assigned to an aerobic training group (n = 15, aged 71.7± 4.7 years), a combined (aerobic and resistance) training group (n = 16, aged 68.5 ± 3.5 years) and a control group (n = 17, aged 67.0 ± 5.8 years). Both training programs were of moderate-to-vigorous intensity, 3 days per week for 9 months. Primary outcome measures included body composition, blood pressure and lipid profile. Odds ratios (OR) between hypertension, obesity and dyslipidemia were calculated. The independence between risk factors, aggregation and group factor was tested (baseline vs post-test).

RESULTS:There was significant aggregation between hypertension and obesity (OR 2.57, 95% CI 1.24-5.33). After 32 weeks, there was a significant change in the number of hypertensive (χ(2) = 8.1, P = 0.004) and dyslipidemic (χ(2) = 3.9, P = 0.049) participants, and also a favorable modification in the risk factors aggregation (χ(2) = 7.9, P = 0.019), but only in the combined training group.

CONCLUSIONS:Combined aerobic and resistance training is more effective in the chronic modification of blood pressure and lipid profile, and in the reduction of total risk factors aggregated.

AIMS:The purpose of the present study was to compare different modes of exercise in chronic modification of cardiovascular diseases risk factors.

METHODS:A total of 48 healthy elderly men were randomly assigned to an aerobic training group (n = 15, aged 71.7± 4.7 years), a combined (aerobic and resistance) training group (n = 16, aged 68.5 ± 3.5 years) and a control group (n = 17, aged 67.0 ± 5.8 years). Both training programs were of moderate-to-vigorous intensity, 3 days per week for 9 months. Primary outcome measures included body composition, blood pressure and lipid profile. Odds ratios (OR) between hypertension, obesity and dyslipidemia were calculated. The independence between risk factors, aggregation and group factor was tested (baseline vs post-test).

RESULTS:There was significant aggregation between hypertension and obesity (OR 2.57, 95% CI 1.24-5.33). After 32 weeks, there was a significant change in the number of hypertensive (χ(2) = 8.1, P = 0.004) and dyslipidemic (χ(2) = 3.9, P = 0.049) participants, and also a favorable modification in the risk factors aggregation (χ(2) = 7.9, P = 0.019), but only in the combined training group.

CONCLUSIONS:Combined aerobic and resistance training is more effective in the chronic modification of blood pressure and lipid profile, and in the reduction of total risk factors aggregated.

Medical yoga is defined as the use of yoga practices for the prevention and treatment of  medical conditions. Beyond the physical elements of yoga, which are important and effective for  strengthening  the  body,  medical  yoga  also  incorporates  appropriate  breathing  techniques,  mindfulness, and meditation in order to achieve the maximum benefits. Multiple studies have  shown that yoga can positively impact the body in many ways, including helping to regulate blood  glucose levels, improve musculoskeletal ailments and keeping the cardiovascular system in tune. It  also has been shown to have important psychological benefits, as the practice of yoga can help to  increase mental energy and positive feelings, and decrease negative feelings of aggressiveness,  depression and anxiety.

Medical yoga is defined as the use of yoga practices for the prevention and treatment of  medical conditions. Beyond the physical elements of yoga, which are important and effective for  strengthening  the  body,  medical  yoga  also  incorporates  appropriate  breathing  techniques,  mindfulness, and meditation in order to achieve the maximum benefits. Multiple studies have  shown that yoga can positively impact the body in many ways, including helping to regulate blood  glucose levels, improve musculoskeletal ailments and keeping the cardiovascular system in tune. It  also has been shown to have important psychological benefits, as the practice of yoga can help to  increase mental energy and positive feelings, and decrease negative feelings of aggressiveness,  depression and anxiety.

OBJECTIVES:Ragas of Indian music are said to be beneficial in normalizing blood pressure (BP). The objective of this study was to evaluate the effect of passive listening to relaxing raga on the autonomic functions of hypertensives and prehypertensives and provide scientific evidence.

METHODS:Ethical clearance was obtained from the institutional review board. A prospective, randomized controlled trial was done on hundred prehypertensives/stage I hypertensives, randomly divided into two groups (n=50 in each). Group 1 received music intervention along with lifestyle modifications while Group 2 received only lifestyle modifications (according to Joint national committee VII guidelines). Group 1 listened to raga bhimpalas played on flute for 15min daily for at least 5 days/week for 3 months. The main outcome measures were heart rate variability (HRV) (Power lab 15T, AD Instruments), BP and stress levels (State Trait anxiety inventory score). All HRV variables were log transformed for analysis. Statistical analysis was done using SPSS version 18.0 with P<0.05 being considered statistically significant.

RESULTS:Group 1 exhibited significant reduction in stress levels, diastolic BP and systolic BP decreased in Group 2 after intervention. Insignificant rise in parasympathetic parameters of HRV (SDNN, RMSSD, HF ms(2), HF nu) was seen after intervention in both the groups. We found significantly increased parasympathetic and lower sympathetic parameters (LF ms(2), LF nu, LF/HF) in Group 1 and 2 males and females of Group 2. The results suggest that females of Group 1 were least compliant with the given intervention.

CONCLUSIONS:Passive listening to Indian music along with conventional lifestyle modifications has a role in normalizing BP through autonomic function modification and thus can be used as a complementary therapy along with other lifestyle modifications.

OBJECTIVES:Ragas of Indian music are said to be beneficial in normalizing blood pressure (BP). The objective of this study was to evaluate the effect of passive listening to relaxing raga on the autonomic functions of hypertensives and prehypertensives and provide scientific evidence.

METHODS:Ethical clearance was obtained from the institutional review board. A prospective, randomized controlled trial was done on hundred prehypertensives/stage I hypertensives, randomly divided into two groups (n=50 in each). Group 1 received music intervention along with lifestyle modifications while Group 2 received only lifestyle modifications (according to Joint national committee VII guidelines). Group 1 listened to raga bhimpalas played on flute for 15min daily for at least 5 days/week for 3 months. The main outcome measures were heart rate variability (HRV) (Power lab 15T, AD Instruments), BP and stress levels (State Trait anxiety inventory score). All HRV variables were log transformed for analysis. Statistical analysis was done using SPSS version 18.0 with P<0.05 being considered statistically significant.

RESULTS:Group 1 exhibited significant reduction in stress levels, diastolic BP and systolic BP decreased in Group 2 after intervention. Insignificant rise in parasympathetic parameters of HRV (SDNN, RMSSD, HF ms(2), HF nu) was seen after intervention in both the groups. We found significantly increased parasympathetic and lower sympathetic parameters (LF ms(2), LF nu, LF/HF) in Group 1 and 2 males and females of Group 2. The results suggest that females of Group 1 were least compliant with the given intervention.

CONCLUSIONS:Passive listening to Indian music along with conventional lifestyle modifications has a role in normalizing BP through autonomic function modification and thus can be used as a complementary therapy along with other lifestyle modifications.

A hemp seed protein isolate, prepared from defatted hemp seed meals by alkaline solubilization/acid precipitation, was subjected to extensive chemical hydrolysis under acid conditions (6 M HCl). The resulting hydrolysate was fractionated by semipreparative RP-HPLC, and the purified fractions were tested as inhibitors of angiotensin converting enzyme (ACE). Mono- and bidimensional NMR experiments and LC-MS analyses led to the identification of four potentially bioactive peptides, i.e. GVLY, IEE, LGV, and RVR. They were prepared by solid-phase synthesis, and tested for ACE-inhibitory activity. The IC50 values were GVLY 16± 1.5 μM, LGV 145 ± 13 μM, and RVR 526 ± 33 μM, confirming that hemp seed may be a valuable source of hypotensive peptides.

Beyond the well-known effects on blood pressure (BP) of the dietary approaches to stop hypertension (DASH) and the Mediterranean diets, a large number of studies has investigated the possible BP lowering effect of different dietary supplements and nutraceuticals, the most part of them being antioxidant agents with a high tolerability and safety profile. In particular relatively large body of evidence support the use of potassium, L-arginine, vitamin C, cocoa flavonoids, beetroot juice, coenzyme Q10, controlled-release melatonin, and aged garlic extract. However there is a need for data about the long-term safety of a large part of the above discussed products. Moreover further clinical research is advisable to identify between the available active nutraceuticals those with the best cost-effectiveness and risk-benefit ratio for a large use in general population with low-added cardiovascular risk related to uncomplicated hypertension.

OBJECTIVES:This study sought to determine whether a relatively low single dose or a week-long dosage of dietary inorganic nitrate could improve exercise tolerance in patients with heart failure with preserved ejection fraction (HFpEF).

BACKGROUND:Exercise intolerance is the primary manifestation of HFpEF and is largely due to noncardiac factors that reduce oxygen delivery to active skeletal muscles. A recent study showed improved exercise capacity in patients with HFpEF after a single, acute dose of beetroot juice (BRJ) (12.9 mmol inorganic nitrate) while another recent study showed neutral and negative effects of an organic nitrate.

METHODS:Twenty HFpEF patients (69± 7 years of age ) were enrolled in an initial cross-over design comparing a single, acute dose of BRJ (6.1 mmol nitrate) to a nitrate-depleted placebo BRJ. A second phase, 1 week of daily doses, used an all-treated design in which patients consumed BRJ for an average of 7 days. The primary outcomeof the study was submaximal aerobic endurance, measured as cycling time to exhaustion at 75% of measured maximal power output.

RESULTS:No adverse events were associated with the intervention. Submaximal aerobic endurance improved 24% after 1 week of daily BRJ dosing (p = 0.02) but was not affected by the single, acute dose of the BRJ compared to placebo. Consumption of BRJ significantly reduced resting systolic blood pressure and increased plasma nitrate and nitrite in both of the dosing schemes.

CONCLUSIONS:One week of daily dosing with BRJ (6.1 mmol inorganic nitrate) significantly improves submaximal aerobic endurance and blood pressure in elderly HFpEF patients.

OBJECTIVE:To study the effects of 12 week yoga-based lifestyle intervention on cardio-metabolic risk factors and adipocytokines in overweight/obese subjects with pre-hypertension [systolic blood pressure (SBP) 130-139 mmHg or diastolic blood pressure (DBP) 85-89 mmHg] or hypertension (HTN).

DESIGN AND METHOD:This prospective, single arm, lifestyle intervention study was conducted in overweight/obese (body mass index; BMI 23-24.9/≥ 25 kg/m) subjects (n = 44), with pre-HTN or previously diagnosed HTN. The subjects underwent pre-tested yoga-based lifestyle intervention including asanas, pranayama, relaxation techniques, lectures, group support, nutrition awareness program and individualized advice under supervision forapprox. 2 hrs each day for 2 week followed by continuation of the practices at home for next 10 week. Outcome measures included cardio-metabolic risk factors: SBP, DBP, weight, BMI, waist circumference (WC), hip circumference (HC), waist-hip ratio (WHR), fasting plasma glucose (FPG), serum lipid profile and adipocytokines (plasma leptin and adiponectin levels). These were assessed at baseline, after 2 weeks of intervention and at end of week 12.

RESULTS:The mean age of subjects was 40.3 ± 5.5 yrs; mean BMI was 32.1 ± 4.9 Kg/m, SBP/DBP was 135.5 ± 13.2/85.6 ± 8.7 mmHg respectively. After intervention, there was significant reduction in weight, BMI, SBP, DBP, WC, HC, WHR, total cholesterol, and triglycerides (p < 0.05) from baseline to week 12. Likewise, there was significant reduction in leptin from baseline to week 12, however changes in adiponectin were not statistically significant (Fig. 1). Further a strong significant positive correlation between the change in weight and the change in WC (r = 0.9; p < 0.01)&HC (r = 0.7; p < 0.01) followed by 12 weeks of intervention was seen.

CONCLUSIONS:These findings suggest that yoga-based lifestyle intervention might serve as an important treatment modality in reducing the risk of cardiovascular disease through weight loss, reduction in blood pressure, cardio-metabolic risk factors and adipocytokines in subjects with pre- HTN or HTN.

OBJECTIVE:In patients with pulmonary arterial hypertension (PAH), supportive therapies may be beneficial in addition to targeted medical treatment. Here, we evaluated the effectiveness and safety of oscillatory whole-body vibration (WBV) in patients on stable PAH therapy.

METHODS:Twenty-two patients with PAH (mean PAP≥25 mm Hg and pulmonary arterial wedge pressure (PAWP)≤15 mm Hg) who were in world health organization (WHO)-Functional Class II or III and on stable PAH therapy for≥3 months, were randomised to receive WBV (16 sessions of 1-hour duration within 4 weeks) or to a control group, thatsubsequently received WBV. Follow-up measures included the 6-min walking distance (6MWD), cardiopulmonary exercise testing (CPET), echocardiography, muscle-power, and health-related quality of life (HRQoL; SF-36 and LPH questionnaires).

RESULTS:When compared to the control group, patients receiving WBV exhibited a significant improvement in the primary endpoint, the 6MWD (+35.4±10.9 vs -4.4±7.6 m), resulting in a net benefit of 39.7±7.8 m (p=0.004). WBV was also associated with substantial improvements in CPET variables, muscle power, and HRQoL. The combined analysis of all patients (n=22) indicated significant net improvements versus baseline in the 6MWD (+38.6 m), peakVO2 (+65.7 mL/min), anaerobic threshold (+40.9 mL VO2/min), muscle power (+4.4%), and HRQoL (SF-36 +9.7, LPH -11.5 points) (all p<0.05). WBV was well tolerated in all patients, and no procedure-related severe adverse events (SAEs) occurred.

CONCLUSIONS:WBV substantially improves exercise capacity, physical performance, and HRQoL in patients with PAH who are on stable targeted therapy. This methodology may be utilised in structured training programmes, and may be feasible for continuous long-term physical exercise in these patients.

TRIAL REGISTRATION NUMBER:NCT01763112; Results.

OBJECTIVE:This study was designed to investigate blood pressure (BP) profiles among Taiwanese women with different dietary patterns.

STUDY DESIGN:Cross-sectional study.

METHODS:A total of 269 non-hypertensive Taiwanese women, 40 years of age or older, were surveyed using structured questionnaires, and measurements of BP and physiological parameters were made. To assess differences among vegans, ovo-vegetarians, and meat eaters in terms of BP, demographic, and health behavior data, the chi-squared and Fisher's exact tests were employed for categorical variables, and analysis of variance and independent t-tests were performed for continuous variables. Multiple regression analysis was used to examine the relationship between BP and dietary patterns while controlling for potential confounding factors.

RESULTS:A significant difference was found among the three test groups in terms of age, education, employment, stress, and waist-hip ratio. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) significantly differed among the three groups. After controlling for age, body weight, waist circumference, and hip circumference, the three groups were observed to be a significant risk factor of the SBP and DBP. The SBP and DBP of the ovo-vegetarian group were significantly lower than those of the meat-eater group. No significant differences were found between the vegan and meat-eater groups in terms of SBP and DBP.

CONCLUSION:Dietary pattern is a likely risk factor for SBP and DBP outcomes in Taiwanese women. In particular, the SBP and DBP of ovo-vegetarians are the lowest among the values observed for all dietary patterns. This finding suggests that an ovo-vegetarian diet is beneficial for long-term BP control and prevention of hypertension in females.

PURPOSE:To determine the physiological and psychological effects of adding a Himalayan singing bowl (HSB) to a directed relaxation (DR) session.

DESIGN:Randomized crossover study.

SETTING:Community-based counseling practice.

SUBJECTS:Fifty-one participants completed two randomly assigned sessions beginning with either 12 minutes of HSB or silence, followed by a 20-minute DR session.

INTERVENTION:Random order of HSB intervention/silence prior to DR.

MEASURES:Blood pressure (BP), heart rate (HR), Positive and Negative Affect Schedule (PANAS) scores measured before and after both sessions.

ANALYSIS:Analysis of variance (ANOVA) compared differences between variables over time between both study days, and analysis of covariance (ANCOVA) analyzed changes from baseline, controlling for baseline, age, and sex.

RESULTS:Fifty-one participants completed both sessions. There was a greater decline in systolic BP (p = .044) and HR (p = .003) with HSB compared to silence prior to DR. Changes in diastolic BP were greater with HSB, with a nonsignificant trend (p = .073). Hypertensive subjects (n = 20) had similar and significant BP changes with HSB and silence when compared to normotensive subjects (n = 31). PANAS scores fell significantly with both interventions.

CONCLUSIONS:BP and HR responses were enhanced by HSB exposure. HSB may be used as an adjunct to DR to produce physiological and psychological responses prior to DR.

Time spent walking and relaxing in a forest environment ("forest bathing"or"forest therapy") has well demonstrated anti-stress effects in healthy adults, but benefits for ill or at-risk populations have not been reported. The present study assessed the physiological and psychological effects of forest therapy (relaxation and stress management activity in the forest) on middle-aged males with high-normal blood pressure. Blood pressure and several physiological and psychological indices of stress were measured the day before and approximately 2 h following forest therapy. Both pre- and post-treatment measures were conducted at the same time of day to avoid circadian influences. Systolic and diastolic blood pressure (BP), urinary adrenaline, and serum cortisol were all significantly lower than baseline following forest therapy (p<0.05). Subjects reported feeling significantly more"relaxed"and"natural"according to the Semantic Differential (SD) method. Profile of Mood State (POMS) negative mood subscale scores for"tension-anxiety,""confusion,"and"anger-hostility,"as well as the Total Mood Disturbance (TMD) score were significantly lower following forest therapy. These results highlight that forest is a promising treatment strategy to reduce blood pressure into the optimal range and possibly prevent progression to clinical hypertension in middle-aged males with high-normal blood pressure.

BACKGROUND AND AIMS:High dietary polyphenol intake is associated with reduced all-cause mortality and lower incidence of cardiovascular events. However, the mechanisms involved are not fully understood. The aim of this sub-study of the PREDIMED (Prevention with Mediterranean diet) trial was to analyze the relationship of polyphenol intake measured by total urinary polyphenol excretion (TPE), with circulating inflammatory biomarkers and cardiovascular risk factors in elderly individuals.

MATERIALS AND METHODS:A sub-study of 1139 high-risk participants was carried out within the PREDIMED trial. The subjects were randomly assigned to a low-fat control diet or to two Mediterranean diets, supplemented with either extra-virgin olive oil or nuts. Dietary intake, anthropometrics, clinical and laboratory assessments including inflammatory biomarkers, and urinary TPE were measured at baseline and after one-year intervention.

RESULTS:Participants in the highest tertile of changes in urinary TPE (T3) showed significant lower plasma inflammatory biomarkers [VCAM-1 (-9.47 np/mL), ICAM-1 (-14.71 np/mL), IL-6 (-1.21 pg/mL), TNF-α (-7.05 pg/mL), and MCP-1 (-3.36 pg/mL)] than those in the lowest tertile (T1, P < 0.02; all). A significant inverse correlation existed between urinary TPE and plasma concentration of VCAM-1(r = -0.301; P < 0.001). In addition, systolic and diastolic blood pressure (BP) decreased and plasma HDL-cholesterol increased in parallel with increasing urinary TPE (T3 vs T1)(P < 0.005 and P = 0.004, respectively).

CONCLUSIONS:Increases in polyphenol intake measured as urinary TPE are associated with decreased inflammatory biomarkers, suggesting a dose-dependent anti-inflammatory effect of polyphenols. In addition, high polyphenol intake improves cardiovascular risk factors, mainly BP and the lipid profile. This article is protected by copyright. All rights reserved.

Since 2004, we have conducted a series of studies of the effect of forest therapy on human health and established forest therapy as a new preventive strategy. We have found that forest therapy has many beneficial effects on human health. However, there is almost no study dealing with the possibility of clinical applications of forest therapy. In this review, we discuss the possibility of clinical applications of forest therapy from the following viewpoints: 1. Forest therapy can decrease blood pressure, heart rate, sympathetic nerve activity, and levels of stress hormones, such as urinary adrenaline and noradrenaline, and can increase parasympathetic nerve activity, suggesting its preventive effect on hypertension. 2. Forest therapy can also decreace the scores for anxiety, depression, anger, fatigue, and confusion and increase the score for vigor in the Profile of Mood States (POMS) test, suggesting its preventive effect on mental depression. 3. Forest therapy can increase the activity and number of human natural killer (NK) cells and the intracellular levels of anticancer proteins, suggesting its preventive effect on cancers. 4. These findings suggest that forest therapy may have preventive effects on lifestyle-related diseases. However, the above preventive effects of forest therapy should be confirmed in clinical research.