{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,11]],"date-time":"2026-07-11T17:19:33Z","timestamp":1783790373881,"version":"3.55.0"},"reference-count":45,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2025,7,17]],"date-time":"2025-07-17T00:00:00Z","timestamp":1752710400000},"content-version":"vor","delay-in-days":197,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,1,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death worldwide, responsible for 3.5 million deaths in 2021. Effective preventive measures are needed. Forest bathing has been reported to have positive effects on the immune system. In addition, the clean air, mild climate, phytoncides, high oxygen concentration, and other elements of forests are expected to have benefits for respiratory diseases such as COPD. Based on the above background, this study used a randomized crossover design to examine the improving effects of forest bathing on inflammatory markers and subjective symptoms related to COPD.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Thirty male subjects aged 63.1\u2009\u00b1\u20097.5\u00a0years were recruited after obtaining informed consent. These subjects participated in day trips to a Japanese cypress forest park and to a city area of Nagano Prefecture as a control in June 2024. Blood samples were taken in the afternoon of each day before and after the walks. Concentrations of \u03b11-antitrypsin (\u03b11-AT), C-reactive protein (CRP), fibrinogen, and interleukin 6 (IL-6) in blood were measured. Percutaneous oxygen saturation (SpO2), the profile of mood states (POMS), and questionnaires for subjective fatigue and respiratory symptoms and sleep quality were carried out before and after each trip.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Forest bathing significantly decreased the concentrations of blood CRP, \u03b11-AT, IL-6, and fibrinogen, significantly increased SpO2, reduced subjective fatigue and respiratory symptoms, improved sleep and the scores of positive feelings, and reduced the scores for negative emotions in POMS.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Forest bathing may improve inflammatory markers, SpO2, and subjective symptoms related to COPD.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/joccuh\/uiaf041","type":"journal-article","created":{"date-parts":[[2025,7,17]],"date-time":"2025-07-17T09:49:42Z","timestamp":1752745782000},"source":"Crossref","is-referenced-by-count":6,"title":["Forest bathing improves inflammatory markers, SpO2, and subjective symptoms related to chronic obstructive pulmonary disease (COPD) in male subjects at risk of developing COPD"],"prefix":"10.1093","volume":"67","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2660-1464","authenticated-orcid":false,"given":"Qing","family":"Li","sequence":"first","affiliation":[{"name":"Department of Rehabilitation Medicine, Graduate School of Medicine, Nippon Medical School , Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Norimasa","family":"Takayama","sequence":"additional","affiliation":[{"name":"Forestry and Forest Products Research Institute, Forest Research and Management Organization , Tsukuba, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yukako","family":"Kimura","sequence":"additional","affiliation":[{"name":"itswellness org , Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroshi","family":"Takayama","sequence":"additional","affiliation":[{"name":"Takayama Orthopedic Clinic , Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shigeyoshi","family":"Kumeda","sequence":"additional","affiliation":[{"name":"Nagano Prefectural Kiso Hospital , Nagano Prefecture, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takashi","family":"Miura","sequence":"additional","affiliation":[{"name":"Agematsu Town Office , Nagano Prefecture, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tsunemi","family":"Kitagawa","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, Graduate School of Medicine, Nippon Medical School , Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoichiro","family":"Aoyagi","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, Graduate School of Medicine, Nippon Medical School , Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michiko","family":"Imai","sequence":"additional","affiliation":[{"name":"INFOM (International Society of Nature and Forest Medicine) , Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,7,17]]},"reference":[{"key":"2025100620063178600_ref1"},{"key":"2025100620063178600_ref2"},{"issue":"4","key":"2025100620063178600_ref3","doi-asserted-by":"publisher","first-page":"458","DOI":"10.1111\/j.1440-1843.2004.00637.x","article-title":"COPD in Japan: the Nippon COPD epidemiology study","volume":"9","author":"Fukuchi","year":"2004","journal-title":"Respirology."},{"issue":"22","key":"2025100620063178600_ref4","doi-asserted-by":"publisher","first-page":"2353","DOI":"10.1001\/jama.2013.5732","article-title":"Inflammatory biomarkers and exacerbations in chronic obstructive pulmonary disease","volume":"309","author":"Thomsen","year":"2013","journal-title":"JAMA."},{"issue":"6","key":"2025100620063178600_ref5","doi-asserted-by":"publisher","first-page":"1446","DOI":"10.1016\/j.chest.2019.12.038","article-title":"Chronic cough in individuals with COPD: a population-based cohort study","volume":"157","author":"Landt","year":"2020","journal-title":"Chest."},{"issue":"5","key":"2025100620063178600_ref6","doi-asserted-by":"publisher","first-page":"439","DOI":"10.1136\/thoraxjnl-2018-211855","article-title":"Biomarkers and clinical outcomes in COPD:a systematic review and meta-analysis","volume":"74","author":"Fermont","year":"2019","journal-title":"Thorax."},{"issue":"1","key":"2025100620063178600_ref7","doi-asserted-by":"publisher","first-page":"32","DOI":"10.1111\/j.1447-0594.2010.00629.x","article-title":"Clinical and inflammatory factors associated with body mass index in elderly patients with chronic obstructive pulmonary disease","volume":"11","author":"Higashimoto","year":"2011","journal-title":"Geriatr Gerontol Int"},{"issue":"1","key":"2025100620063178600_ref8","doi-asserted-by":"publisher","first-page":"128","DOI":"10.1111\/j.1440-1843.2007.01170.x","article-title":"Systemic inflammation in chronic obstructive pulmonary disease and asthma: similarities and differences","volume":"13","author":"Higashimoto","year":"2008","journal-title":"Respirology."},{"issue":"13","key":"2025100620063178600_ref9","doi-asserted-by":"publisher","first-page":"3855","DOI":"10.3390\/jcm13133855","article-title":"CRP, fibrinogen, white blood cells, and blood cell indices as prognostic biomarkers of future COPD exacerbation frequency: the TIE cohort study","volume":"13","author":"Ellingsen","year":"2024","journal-title":"J Clin Med"},{"issue":"5","key":"2025100620063178600_ref10","doi-asserted-by":"publisher","first-page":"391","DOI":"10.3390\/arm90050049","article-title":"Adipolin and IL-6 serum levels in chronic obstructive pulmonary disease","volume":"90","author":"Aslani","year":"2022","journal-title":"Adv Respir Med"},{"key":"2025100620063178600_ref11","doi-asserted-by":"publisher","first-page":"43","DOI":"10.1265\/ehpm.22-00160","article-title":"Effects of forest environment (Shinrin-yoku\/forest bathing) on health promotion and disease prevention\u2014the establishment of \u2018Forest medicine\u2019","volume":"27","author":"Li","journal-title":"Environ Health Prev Med"},{"issue":"1","key":"2025100620063178600_ref12","first-page":"45","article-title":"A forest bathing trip increases human natural killer activity and expression of anti-cancer proteins in female subjects","volume":"22","author":"Li","year":"2008","journal-title":"J Biol Regul Homeost Agents"},{"issue":"4","key":"2025100620063178600_ref13","doi-asserted-by":"publisher","first-page":"951","DOI":"10.1177\/039463200902200410","article-title":"Effect of phytoncide from trees on human natural killer cell function","volume":"22","author":"Li","year":"2009","journal-title":"Int J Immunopathol Pharmacol"},{"issue":"3","key":"2025100620063178600_ref14","doi-asserted-by":"publisher","first-page":"212","DOI":"10.3967\/bes2016.026","article-title":"Health effect of forest bathing trip on elderly patients with chronic obstructive pulmonary disease","volume":"29","author":"Jia","year":"2016","journal-title":"Biomed Environ Sci"},{"issue":"0","key":"2025100620063178600_ref15","doi-asserted-by":"publisher","first-page":"44","DOI":"10.1265\/ehpm.22-00136","article-title":"Effects of forest bathing (shinrin-yoku) on serotonin in serum, depressive symptoms and subjective sleep quality in middle-aged males","volume":"27","author":"Li","year":"2022","journal-title":"Environ Health Prev Med"},{"issue":"4","key":"2025100620063178600_ref16","doi-asserted-by":"publisher","first-page":"100","DOI":"10.3390\/diseases13040100","article-title":"Impacts of forest bathing (Shinrin-Yoku) in female participants with depression\/depressive tendencies","volume":"13","author":"Li","year":"2025","journal-title":"Diseases"},{"issue":"1","key":"2025100620063178600_ref17","doi-asserted-by":"publisher","first-page":"117","DOI":"10.1177\/039463200802100113","article-title":"Visiting a forest, but not a city, increases human natural killer activity and expression of anti-cancer proteins","volume":"21","author":"Li","year":"2008","journal-title":"Int J Immunopathol Pharmacol"},{"issue":"1","key":"2025100620063178600_ref18","doi-asserted-by":"publisher","first-page":"18","DOI":"10.1007\/s12199-009-0086-9","article-title":"The physiological effects of Shinrin-yoku (taking in the forest atmosphere or forest bathing): evidence from field experiments in 24 forests across Japan","volume":"15","author":"Park","year":"2010","journal-title":"Environ Health Prev Med"},{"issue":"1","key":"2025100620063178600_ref19","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1007\/s12199-009-0091-z","article-title":"Trends in research related to \"Shinrin-yoku\" (taking in the forest atmosphere or forest bathing) in Japan","volume":"15","author":"Tsunetsugu","year":"2010","journal-title":"Environ Health Prev Med"},{"issue":"8","key":"2025100620063178600_ref20","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph14080897","article-title":"Effects of short forest bathing program on autonomic nervous system activity and mood states in middle-aged and elderly individuals","volume":"14","author":"Yu","year":"2017","journal-title":"Int J Environ Res Public Health"},{"issue":"6","key":"2025100620063178600_ref21","doi-asserted-by":"publisher","first-page":"488","DOI":"10.1539\/joh.l9070","article-title":"Chronic exposures to cholinesterase-inhibiting pesticides adversely affect respiratory health of agricultural workers in India","volume":"51","author":"Chakraborty","year":"2009","journal-title":"J Occup Health"},{"issue":"4","key":"2025100620063178600_ref22","doi-asserted-by":"publisher","first-page":"333","DOI":"10.1539\/joh.15-0317-BR","article-title":"Comparison of biomarkers in serum and induced sputum of patients with occupational asthma and chronic obstructive pulmonary disease","volume":"58","author":"Kleniewska","year":"2016","journal-title":"J Occup Health"},{"issue":"2","key":"2025100620063178600_ref23","doi-asserted-by":"publisher","first-page":"85","DOI":"10.1080\/15412550801940721","article-title":"Development and initial validation of a self-scored COPD population screener questionnaire (COPD-PS)","volume":"5","author":"Martinez","year":"2008","journal-title":"COPD"},{"issue":"1","key":"2025100620063178600_ref24","doi-asserted-by":"publisher","first-page":"1199","DOI":"10.1080\/07853890.2021.1949486","article-title":"Performance of COPD population screener questionnaire in COPD screening: a validation study and meta-analysis","volume":"53","author":"Gu","year":"2021","journal-title":"Ann Med"},{"key":"2025100620063178600_ref25","first-page":"1","volume-title":"A Report on Physiological and Psychological Effects and Physical and Chemical Evaluation of the Proposed Forest Therapy Base and Walking Road Sites in Agematsu Town.","author":"Forestry and Forest Products Research Institute","year":"2006"},{"issue":"6","key":"2025100620063178600_ref26","doi-asserted-by":"publisher","first-page":"835","DOI":"10.1515\/CCLM.2010.153","article-title":"New quantitative electrochemiluminescence method (ECLIA) for interleukin-6 (IL-6) measurement","volume":"48","author":"Prieto","year":"2010","journal-title":"Clin Chem Lab Med"},{"key":"2025100620063178600_ref27","doi-asserted-by":"publisher","first-page":"114","DOI":"10.1016\/j.rmed.2017.08.015","article-title":"Identification of a new defective SERPINA1 allele (PI*Zla palma) encoding an alpha-1-antitrypsin with altered glycosylation pattern","volume":"131","author":"Hern\u00e1ndez-P\u00e9rez","year":"2017","journal-title":"Respir Med"},{"issue":"3","key":"2025100620063178600_ref28","doi-asserted-by":"publisher","DOI":"10.1088\/1752-7155\/9\/3\/036001","article-title":"Biomarkers of inflammation in persons with chronic tetraplegia","volume":"9","author":"Radulovic","year":"2015","journal-title":"J Breath Res"},{"issue":"4","key":"2025100620063178600_ref29","doi-asserted-by":"publisher","first-page":"815","DOI":"10.1016\/j.chest.2019.10.030","article-title":"Validation of the COPD assessment test (CAT) as an outcome measure in bronchiectasis","volume":"157","author":"Finch","year":"2020","journal-title":"Chest."},{"issue":"2","key":"2025100620063178600_ref30","doi-asserted-by":"publisher","first-page":"122","DOI":"10.1539\/joh.16-0182-OA","article-title":"The practice of active rest by workplace units improves personal relationships, mental health, and physical activity among workers","volume":"59","author":"Michishita","year":"2017","journal-title":"J Occup Health"},{"issue":"1","key":"2025100620063178600_ref31","doi-asserted-by":"publisher","first-page":"1077","DOI":"10.1080\/02656736.2021.1922761","article-title":"The effects of endurance exercise combined with high-temperature head-out water immersion on serum concentration of brain-derived neurotrophic factor in healthy young men","volume":"38","author":"Ohko","year":"2021","journal-title":"Int J Hyperth"},{"issue":"23","key":"2025100620063178600_ref32","doi-asserted-by":"publisher","first-page":"2372","DOI":"10.3390\/healthcare12232372","article-title":"Effects of barefoot walking in urban forests on CRP, IFNgamma, and serotonin levels","volume":"12","author":"Kim","year":"2024","journal-title":"Healthcare (Basel)"},{"issue":"4","key":"2025100620063178600_ref33","doi-asserted-by":"publisher","first-page":"E368","DOI":"10.3390\/ijerph14040368","article-title":"The salutary influence of forest bathing on elderly patients with chronic heart failure","volume":"14","author":"Mao","year":"2017","journal-title":"Int J Environ Res Public Health"},{"issue":"2","key":"2025100620063178600_ref34","doi-asserted-by":"publisher","first-page":"159","DOI":"10.3967\/bes2018.020","article-title":"Additive benefits of twice forest bathing trips in elderly patients with chronic heart failure","volume":"31","author":"Mao","year":"2018","journal-title":"Biomed Environ Sci"},{"issue":"6","key":"2025100620063178600_ref35","doi-asserted-by":"publisher","first-page":"734","DOI":"10.4187\/respcare.06312","article-title":"Oxygen therapy in COPD","volume":"63","author":"Branson","year":"2018","journal-title":"Respir Care"},{"issue":"153","key":"2025100620063178600_ref36","doi-asserted-by":"publisher","first-page":"190064","DOI":"10.1183\/16000617.0064-2019","article-title":"Sleep in chronic respiratory disease: COPD and hypoventilation disorders","volume":"28","author":"McNicholas","year":"2019","journal-title":"Eur Respir Rev"},{"key":"2025100620063178600_ref37","doi-asserted-by":"publisher","first-page":"282","DOI":"10.1016\/j.sleep.2023.10.034","article-title":"Prevalence and clinical characteristics of sleep disorders in chronic obstructive pulmonary disease: a systematic review and meta-analysis","volume":"112","author":"Du","year":"2023","journal-title":"Sleep Med"},{"issue":"18","key":"2025100620063178600_ref38","doi-asserted-by":"publisher","first-page":"6548","DOI":"10.3390\/ijerph17186548","article-title":"Effect of forest therapy for menopausal women with insomnia","volume":"17","author":"Kim","year":"2020","journal-title":"Int J Environ Res Public Health"},{"issue":"3","key":"2025100620063178600_ref39","doi-asserted-by":"publisher","first-page":"350","DOI":"10.3390\/ijerph21030350","article-title":"The inverse association between the frequency of forest walking (Shinrin-yoku) and the prevalence of insomnia symptoms in the general Japanese population: a Japan multi-institutional collaborative cohort Daiko study","volume":"21","author":"Morita","year":"2024","journal-title":"Int J Environ Res Public Health"},{"key":"2025100620063178600_ref40","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1155\/2022\/1553716","article-title":"Effect of forest-based health and wellness on sleep quality of middle-aged people","volume":"2022","author":"Quan","year":"2022","journal-title":"J Sens"},{"issue":"4","key":"2025100620063178600_ref41","doi-asserted-by":"publisher","first-page":"501","DOI":"10.1016\/j.explore.2023.11.006","article-title":"Impact of sleeping in a forest on sleep quality and mental well-being","volume":"20","author":"Hassan","year":"2024","journal-title":"EXPLORE"},{"issue":"18","key":"2025100620063178600_ref42","doi-asserted-by":"publisher","first-page":"2065","DOI":"10.2147\/COPD.S426897","article-title":"The association between cognitive functions and psychological factors in patients with severe COPD","volume":"18","author":"Hansen","year":"2023","journal-title":"Int J Chron Obstruct Pulmon Dis"},{"key":"2025100620063178600_ref43","doi-asserted-by":"publisher","first-page":"e20230273","DOI":"10.1590\/1980-220X-REEUSP-2023-0273en","article-title":"Analysis of the relationship between perceived stress level and death anxiety in individuals with COPD","volume":"57","author":"Gen\u00e7","year":"2024","journal-title":"Rev Esc Enferm USP"},{"issue":"2","key":"2025100620063178600_ref44","doi-asserted-by":"publisher","first-page":"319","DOI":"10.1080\/08923970600809439","article-title":"Phytoncides (wood essential oils) induce human natural killer cell activity","volume":"28","author":"Li","year":"2006","journal-title":"Immunopharmacol Immunotoxicol"},{"issue":"12","key":"2025100620063178600_ref45","doi-asserted-by":"publisher","first-page":"7541","DOI":"10.3390\/ijerph19127541","article-title":"A review of the respiratory health burden attributable to short-term exposure to pollen","volume":"19","author":"Idrose","year":"2022","journal-title":"Int J Environ Res Public Health"}],"container-title":["Journal of Occupational Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/joh\/advance-article-pdf\/doi\/10.1093\/joccuh\/uiaf041\/63786192\/uiaf041.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/joh\/article-pdf\/67\/1\/uiaf041\/63786192\/uiaf041.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/joh\/article-pdf\/67\/1\/uiaf041\/63786192\/uiaf041.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,7]],"date-time":"2025-10-07T00:06:40Z","timestamp":1759795600000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/joh\/article\/doi\/10.1093\/joccuh\/uiaf041\/8204797"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1]]},"references-count":45,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2025,1,7]]}},"URL":"https:\/\/doi.org\/10.1093\/joccuh\/uiaf041","relation":{},"ISSN":["1348-9585"],"issn-type":[{"value":"1348-9585","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,1]]},"published":{"date-parts":[[2025,1]]},"article-number":"uiaf041"}}