短期森林疗养活动对年轻健康个体部分身心健康指标的影响

摘要:

[背景]森林疗养的健康效应得到了广泛认可，但既往研究多采用森林中行走的单一活动方式，缺乏对不同类型森林疗养活动疗愈效果的研究。

[目的]探讨短期森林疗养对人群心肺健康、心理情绪和睡眠质量指标的影响，并进一步探究不同类型疗养活动的健康效应，以期为森林疗养的深入开展提供人群实证研究数据。

[方法]采用自身前后对照的研究设计，于2018年8—9月间，以北京市郊区某国家森林公园为研究地点，以31名健康大学生为研究对象，探讨森林中停留3天2夜前后研究对象身心健康变化情况。研究期间每位研究对象均先后体验漫步疗法、静坐疗法配合五感体验（简称静坐疗法）以及作业疗法3种森林疗养活动，每种活动均持续约2 h。测量研究对象进入森林前后的血压、血氧饱和度（SpO2）、肺功能和呼出气一氧化氮（FeNO），分别采用简明心境状态量表和匹兹堡睡眠质量指数量表对研究对象的心理情绪和睡眠质量指标变化进行评估，并分析不同类型森林疗养活动对研究对象上述心肺健康和心理情绪指标的影响。采用混合效应模型分析短期森林疗养及不同类型森林疗养活动前后研究对象健康指标的改变。

[结果]本次研究对象的平均年龄为（24.5±2.6）岁，平均体重指数为（20.7±1.7）kg·m−2。短期森林疗养后，研究对象心肺健康、心理情绪和睡眠质量均有所改善。研究对象的脉压差（PP）和FeNO分别下降3.02 mmHg和1.10 ppb，SpO2和呼气流量峰值（PEF）分别提高0.65%和0.50 L·s−1，负向情绪得分和睡眠质量量表总得分均呈明显的积极改变（均P<0.05）。不同疗养方式对不同健康指标的影响有所不同。漫步疗法对SpO2、肺功能和慌乱（CON）情绪指标呈明显的改善作用，其中SpO2提高0.48%，第1秒用力呼气量（FEV1）上升0.14 L，用力肺活量（FVC）上升0.12 L，CON指标降低0.97分（均P<0.05）。静坐疗法可以降低研究对象血压和紧张（TEN）情绪得分，其中收缩压（SBP）下降4.45 mmHg，PP下降4.19 mmHg，TEN指标下降0.84分（均P<0.05）。作业疗法后舒张压（DBP）小幅度上升（ΔDBP=2.44 mmHg，P=0.016），其他指标改变无统计学意义。

[结论]短期森林疗养可有效改善年轻健康个体的心肺健康，舒缓心理情绪并提升睡眠质量，不同类型森林疗养活动具有不同的健康改善效果。

Abstract:

[Background]The health effects of forest therapy have been widely recognized, while the previous studies mostly focused on a single activity mode of forest walks. The effects of different types of forest therapy activities remain unclear.

[Objective]To explore the effects of short-term forest therapy on cardiopulmonary health, psychological health, and sleep quality, and the health effects of different types of forest therapy activities, aiming to provide population empirical study data for the development of forest therapy.

[Methods]A self-control study was conducted in a national forest park in suburb of Beijing from August to September 2018. A total of 31 healthy college students were recruited as the study subjects, with a total forest stay for 3 days and 2 nights. During the period of study, each subject practiced walking therapy, sitting therapy with five senses experience (sitting therapy thereafter), and handmade work therapy, successively. Each type of forest therapy lasted about 2 h. Changes of blood pressure, oxygen saturation (SpO2), lung function, and fractional exhaled nitric oxide (FeNO) were estimated by measuring corresponding indicators before and after the forest therapy. Psychological health and sleep quality were assessed by Profile of Mood States and Pittsburgh Sleep Quality Index respectively at the same time. Mixed effects models were used to analyze the changes of these health indicators. The health effects of different types of forest therapy activities were further analyzed.

[Results]The average age and body mass index of subjects in this study were (24.5±2.6) years and (20.7±1.7) kg·m−2, respectively. After a short-term forest therapy, the selected indicators of cardiopulmonary health, psychological health, and sleep quality of subjects were all improved. In particular, the pulse pressure (PP) and FeNO decreased by 3.02 mmHg and 1.10 ppb, respectively, while the SpO2 and peak expiratory flow (PEF) increased by 0.65% and 0.50 L·s−1, respectively, and the negative emotion and global sleep quality also presented significant positive changes (all P<0.05). Furthermore, different therapy activities presented differential effects in the health indicators. Walking therapy significantly improved pulmonary function, SpO2, and confusion (CON) emotion, in which the SpO2, forced expiratory volume in the first second (FEV1), and forced vital capacity (FVC) increased by 0.48%, 0.14 L, and 0.12 L, respectively, and the score of CON decreased by 0.97 (all P<0.05). Sitting therapy significantly reduced blood pressure and tension (TEN) emotion of subjects, including a decrease of the systolic blood pressure (4.45 mmHg), PP (4.19 mmHg), and the score of TEN (0.84) (allP<0.05). The diastolic blood pressure (DBP) increased slightly after handmade work therapy (ΔDBP=2.44 mmHg,P=0.016), but there were no significant changes in other indicators.

[Conclusion]Short-term forest therapy could significantly improve cardiopulmonary health, psychological health, and sleep quality of young healthy individuals, and different types of forest therapy activities may have differential health effects.

图  1  

研究对象研究期间活动安排

Figure  1.  

Activity arrangements of subjects during the study

图  2  

研究对象进行短期森林疗养前后心理情绪指标的变化（n=31）

采用混合效应模型进行分析，对研究对象性别、年龄和BMI进行控制。排除缺失值后，疗养后样本量为30。*：P < 0.05；**：P < 0.01；（−）表示负向情绪；（+）表示正向情绪。A和B分别为POMS分指标和TMD得分。TEN：紧张；ANG：愤怒；FAT：疲劳；DEP：抑郁；CON：慌乱；VIG：精力；ERA：自尊感；TMD：情绪紊乱总值。

Figure  2.  

Changes of emotional indicators before and after short-term forest therapy (n=31)

Mixed effects models are conducted, and sex, age, and BMI of subjects are adjusted as covariates. After forest therapy, the sample size is 30 excluding missing values. *: P < 0.05; **: P < 0.01; (−): Negative emotion; (+): Positive emotion. A and B are component and TMD scores of POMS. TEN: Tension; ANG: Anger; FAT: Fatigue; DEP: Depression; CON: Confusion; VIG: Vigor; ERA: Esteem-related affect; TME: Total mood disturbance.

图  3  

研究对象进行短期森林疗养前后睡眠质量指标的变化（n=31）

采用混合效应模型进行分析，对研究对象性别、年龄和BMI进行控制。*：P < 0.05；**：P < 0.01。A和B为PSQI分指标和总量表得分。

Figure  3.  

Changes of sleep quality indicators before and after short-term forest therapy (n=31)

Mixed effects models are constructed, and sex, age, and BMI of subjects are adjusted. *: P < 0.05; **: P < 0.01. A and B are component and total scores of PSQI.

图  4  

研究对象进行不同森林疗养活动前后各健康指标的变化（n=31）

采用混合效应模型进行分析，对研究对象性别、年龄和BMI进行控制。SBP：收缩压；DBP：舒张压；PP：脉压差；SpO2：血氧饱和度；FEV1：第1秒用力呼气量；FVC：用力肺活量；PEF：呼气流量峰值；TEN：紧张；ANG：愤怒；FAT：疲劳；DEP：抑郁；CON：慌乱；VIG：精力；ERA：自尊感；TMD：情绪状态的总评分。图E中（+）表示正向情绪，（−）表示负向情绪。C和D：排除缺失值后漫步疗法后FEV1、FVC和PEF指标样本量为30。A~E分别为不同疗法下的血压、SpO2、FEV1和FVC、PEF及心理情绪指标得分改变情况。

Figure  4.  

Changes of health indicators before and after different forest therapies (n=31)

Mixed effects models are constructed, and sex, age, and BMI of subjects are adjusted as covariates. SBP: Systolic blood pressure; DBP: Diastolic blood pressure; PP: Pulse pressure; SpO2: Oxygen saturation; FEV1: Forced expiratory volume in the first second; FVC: Forced vital capacity; PEF: Peak expiratory flow; TEN: Tension; ANG: Anger; FAT: Fatigue; DEP: Depression; CON: Confusion; VIG: Vigor; ERA: Esteem-related affect; TME: Total mood disturbance. Fig. E: (−) Negative emotion; (+) Positive emotion. C and D: After walking therapy, the sample sizes of FEV1, FVC, and PEF are all 30 excluding missing values. A-E are the changes of blood pressure, SpO2, FEV1 and FVC, PEF and scores of emotional indicators under different therapy, respectively.

表  1  

研究对象进行短期森林疗养前后心肺健康指标的变化（n=31）

Table  1  

Changes of cardiopulmonary health indicators before and after short-term forest therapy (n=31)

心肺指标
Cardiopulmonary indicator疗养前
Before therapy
($ bar{x}pm s $)疗养后
After therapy
($bar x pm s$)变化量
VariationPa收缩压(SBP)/mmHg110.74±11.57108.25±11.21−2.490.080舒张压(DBP)/mmHg67.78±8.6968.31±8.110.530.639脉压差(PP)/mmHg42.96±7.9839.94±7.36−3.020.017血氧饱和度(SpO2)/%97.87±0.8598.52±0.770.650.002第1秒用力呼气量(FEV1)/L3.19±0.773.28±0.74b0.06c0.172用力肺活量(FVC)/L3.57±0.913.62±0.87b<0.01c0.903呼气流量峰值(PEF)/(L·s−1)5.64±2.236.21±2.07b0.50c0.035呼出气一氧化氮(FeNO)/ppb13.13±7.3612.03±7.15−1.100.042[注] a：采用混合效应模型进行分析，对研究对象性别、年龄和BMI进行控制。b：排除缺失值后，该指标样本量为30。c：根据排除缺失值后的数据进行计算。为便于与同类研究比较，根据文献[7]，FeNO水平表示方式为ppb。[Note] a: Mixed effects models are conducted, and sex, age, and BMI of subjects are adjusted. b: The sample size of this indicator is 30 excluding missing values. c: This variation is calculated by the data excluding missing values. To facilitate comparison with other studies, according to the reference [7], the level of FeNO is expressed in ppb. [1]

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