{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T13:13:42Z","timestamp":1788786822332,"version":"build-2803163510"},"reference-count":91,"publisher":"BMJ","issue":"9","license":[{"start":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T00:00:00Z","timestamp":1788739200000},"content-version":"unspecified","delay-in-days":6,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"German Federal Ministry for Research, Technology and Space","award":["03TR12W08A"],"award-info":[{"award-number":["03TR12W08A"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,8,17]]},"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>\n                      Nature-based interventions aimed at promoting health, enhancing well-being and supporting medical treatment have long been a focus of public health research. In particular, forest therapy and forest bathing are well established in Asia as evidence-informed approaches to stress reduction. In Europe, research on forest therapy is expanding although the field remains comparatively young. Existing studies have mainly focused on the short-term effects of single forest visits while evidence on multiweek interventions and potential medium-term to long-term effects remains limited. The project\n                      <jats:italic>Forest|Health<\/jats:italic>\n                      (\n                      <jats:italic>Wald|Gesund<\/jats:italic>\n                      ), embedded within the research consortium\n                      <jats:italic>T!Raum-Initiative One-Health-Region Pomerania<\/jats:italic>\n                      located in northern Germany, aims to address this gap by developing a structured forest therapy intervention tailored to three different target groups.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>The study protocol describes a pilot study to evaluate a modular forest therapy intervention with regard to feasibility indicators as well as stress-related and symptom-related exploratory outcomes. A total of 120 participants will be recruited across three target groups: community-dwelling adults aged 65 years and older, adults with arterial hypertension and adults with depressive symptoms recruited from treatment waiting lists. Using a multimethod approach, two preliminary studies were conducted: a survey of community-dwelling individuals in the region and focus groups with regional stakeholders. Additionally, a 2-week pilot study of the intervention was conducted. Based on these findings, a 4-week modular forest therapy intervention will be implemented. Participants will be assigned to intervention modules with distinct content using a quasi-randomised procedure. The intervention will follow a pre\u2013post design with follow-up assessments. Feasibility indicators will be assessed as key process outcomes. The primary exploratory outcome will be stress while secondary exploratory outcomes will include psychological and physiological health-related measures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>The study was approved by the Ethics Committee of the University Medicine Greifswald. Participants will provide informed consent, receive information about potential risks and support options. The results will be disseminated through scientific publications, conferences and public outreach.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration<\/jats:title>\n                    <jats:p>This study protocol is preregistered on the Open Science Framework (OSF; Registration DOI: 10.17605\/OSF.IO\/C2D5P; last update 16 December 2025).<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2026-120224","type":"journal-article","created":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T13:00:13Z","timestamp":1788786013000},"page":"e120224","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Forest|Health: a pilot study on feasibility and exploratory outcomes of a modular forest therapy intervention in Mecklenburg-Western Pomerania"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-9565-5063","authenticated-orcid":false,"given":"Ann-Kristin","family":"Reinhard","sequence":"first","affiliation":[{"name":"Institute for Community Medicine, Department of Prevention Research and Social Medicine, University Medicine Greifswald, Greifswald, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sophie","family":"Hauck","sequence":"additional","affiliation":[{"name":"Department of Clinical Psychology and Psychotherapy, University of Greifswald, Greifswald, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2342-3949","authenticated-orcid":false,"given":"Kristin","family":"Lehnert","sequence":"additional","affiliation":[{"name":"Clinic and Policlinic for Internal Medicine B, University Medicine Greifswald, Greifswald, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernhard","family":"Lehnert","sequence":"additional","affiliation":[{"name":"Clinic and Policlinic for Ear, Nose, and Throat Diseases, Head and Neck Surgery, University Medicine Greifswald, Greifswald, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9589-3697","authenticated-orcid":false,"given":"Eva-Lotta","family":"Brakemeier","sequence":"additional","affiliation":[{"name":"Department of Clinical Psychology and Psychotherapy, University of Greifswald, Greifswald, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6924-8299","authenticated-orcid":false,"given":"Susanne","family":"Wurm","sequence":"additional","affiliation":[{"name":"Institute for Community Medicine, Department of Prevention Research and Social Medicine, University Medicine Greifswald, Greifswald, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,9,7]]},"reference":[{"key":"2026090706000783000_16.9.e120224.1","doi-asserted-by":"crossref","DOI":"10.3390\/ijerph17217769","article-title":"Nature-Based Interventions and Mind-Body Interventions: Saving Public Health Costs Whilst Increasing Life Satisfaction and Happiness","volume":"17","author":"Pretty","year":"2020","journal-title":"Int J Environ Res Public Health"},{"key":"2026090706000783000_16.9.e120224.2","unstructured":"United Nations . United nations expert group meeting on ensuring healthy lives and promoting wellbeing for all at all ages. Department of Economic and Social Affairs, Population Division; 2024."},{"key":"2026090706000783000_16.9.e120224.3","doi-asserted-by":"crossref","unstructured":"Aitken RJ . Population decline: where demography, social science, and biology intersect. Reproduction 2024;168. doi:10.1530\/REP-24-0070","DOI":"10.1530\/REP-24-0070"},{"key":"2026090706000783000_16.9.e120224.4","unstructured":"Icardi R , Gailey N , Goujon A , et al . Global demography expert survey on the drivers and consequences of demographic change. 2023."},{"key":"2026090706000783000_16.9.e120224.5","unstructured":"World Health Organization . Ageing and health. 2025. Available: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/ageing-and-health"},{"key":"2026090706000783000_16.9.e120224.6","unstructured":"World Health Organization . Global report on hypertension: The race against a silent killer. World Health Organization, 2023."},{"key":"2026090706000783000_16.9.e120224.7","doi-asserted-by":"crossref","first-page":"509","DOI":"10.1111\/jch.14653","article-title":"Comprehensive effects of lifestyle reform, adherence, and related factors on hypertension control: A review","volume":"25","author":"Ojangba","year":"2023","journal-title":"J Clin Hypertens"},{"key":"2026090706000783000_16.9.e120224.8","doi-asserted-by":"crossref","first-page":"1275","DOI":"10.1111\/jch.14236","article-title":"Non\u2010pharmacological management of hypertension","volume":"23","author":"Verma","year":"2021","journal-title":"J Clin Hypertens"},{"key":"2026090706000783000_16.9.e120224.9","doi-asserted-by":"crossref","DOI":"10.1038\/s41598-024-62381-9","article-title":"Temporal and spatial trend analysis of all-cause depression burden based on Global Burden of Disease (GBD) 2019 study","volume":"14","author":"Liu","year":"2024","journal-title":"Sci Rep"},{"key":"2026090706000783000_16.9.e120224.10","unstructured":"World Health Organization . Depressive disorder (depression). 2025. Available: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/depression"},{"key":"2026090706000783000_16.9.e120224.11","doi-asserted-by":"crossref","DOI":"10.1186\/1471-244X-14-107","article-title":"Lifestyle medicine for depression","volume":"14","author":"Sarris","year":"2014","journal-title":"BMC Psychiatry"},{"key":"2026090706000783000_16.9.e120224.12","unstructured":"Bundes\u00e4rztekammer, Bundesvereinigung K, Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften . Nationale versorgungsleitlinie unipolare depression \u2013 langfassung, version 3.2. 2022. Available: www.leitlinien.de\/depression"},{"key":"2026090706000783000_16.9.e120224.13","doi-asserted-by":"crossref","DOI":"10.3399\/BJGPO.2024.0233","article-title":"Lifestyle interventions for depression in primary care: a qualitative study","volume":"9","author":"Panjer","year":"2025","journal-title":"BJGP Open"},{"key":"2026090706000783000_16.9.e120224.14","doi-asserted-by":"crossref","first-page":"1407","DOI":"10.3390\/f14071407","article-title":"Indicators of the Psychosocial and Physiological Effects of Forest Therapy: A Systematic Review","volume":"14","author":"Chun","year":"2023","journal-title":"Forests"},{"key":"2026090706000783000_16.9.e120224.15","doi-asserted-by":"crossref","DOI":"10.1016\/j.ssmph.2021.100934","article-title":"Nature-based outdoor activities for mental and physical health: Systematic review and meta-analysis","volume":"16","author":"Coventry","year":"2021","journal-title":"SSM Popul Health"},{"key":"2026090706000783000_16.9.e120224.16","doi-asserted-by":"crossref","first-page":"126943","DOI":"10.1016\/j.ufug.2020.126943","article-title":"Forest therapy can prevent and treat depression: Evidence from meta-analyses","volume":"57","author":"Rosa","year":"2021","journal-title":"Urban Forestry & Urban Greening"},{"key":"2026090706000783000_16.9.e120224.17","doi-asserted-by":"publisher","DOI":"10.1111\/inm.13131"},{"key":"2026090706000783000_16.9.e120224.18","doi-asserted-by":"crossref","first-page":"105071","DOI":"10.1016\/j.landurbplan.2024.105071","article-title":"Connecting through nature: A systematic review of the effectiveness of nature-based social prescribing practices to combat loneliness","volume":"248","author":"Lavelle Sachs","year":"2024","journal-title":"Landsc Urban Plan"},{"key":"2026090706000783000_16.9.e120224.19","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1186\/s12199-019-0822-8","article-title":"Medical empirical research on forest bathing (Shinrin-yoku): a systematic review","volume":"24","author":"Wen","year":"2019","journal-title":"Environ Health Prev Med"},{"key":"2026090706000783000_16.9.e120224.20","doi-asserted-by":"crossref","first-page":"012027","DOI":"10.1088\/1755-1315\/959\/1\/012027","article-title":"The role of forest therapy in promoting physical and mental health: a systematic review","volume":"959","author":"Satyawan","year":"2022","journal-title":"IOP Conf Ser: Earth Environ Sci"},{"key":"2026090706000783000_16.9.e120224.21","doi-asserted-by":"crossref","DOI":"10.1186\/s12199-017-0677-9","article-title":"Health and well-being benefits of spending time in forests: systematic review","volume":"22","author":"Oh","year":"2017","journal-title":"Environ Health Prev Med"},{"key":"2026090706000783000_16.9.e120224.22","doi-asserted-by":"crossref","first-page":"1117","DOI":"10.1007\/s00484-019-01717-x","article-title":"Effects of forest bathing (shinrin-yoku) on levels of cortisol as a stress biomarker: a systematic review and meta-analysis","volume":"63","author":"Antonelli","year":"2019","journal-title":"Int J Biometeorol"},{"key":"2026090706000783000_16.9.e120224.23","doi-asserted-by":"crossref","DOI":"10.3390\/ijerph20010458","article-title":"The Effects of Forest Therapy on the Blood Pressure and Salivary Cortisol Levels of Urban Residents: A Meta-Analysis","volume":"20","author":"Qiu","year":"2022","journal-title":"Int J Environ Res Public Health"},{"key":"2026090706000783000_16.9.e120224.24","doi-asserted-by":"crossref","first-page":"1851","DOI":"10.3390\/f14091851","article-title":"The Impact of Forest Therapy Programs on Stress Reduction: A Systematic Review","volume":"14","author":"Zhang","year":"2023","journal-title":"Forests"},{"key":"2026090706000783000_16.9.e120224.25","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2024-098598","article-title":"Effect of nature-based health interventions for individuals diagnosed with anxiety, depression and\/or experiencing stress-a systematic review and meta-analysis","volume":"15","author":"Jessen","year":"2025","journal-title":"BMJ Open"},{"key":"2026090706000783000_16.9.e120224.26","unstructured":"American Psychological Association . Stress effects on the body. 2024. Available: https:\/\/www.apa.org\/topics\/stress\/body"},{"key":"2026090706000783000_16.9.e120224.27","unstructured":"Lawrenz L , Pugle M . Can stress cause death? 2022. Available: https:\/\/psychcentral.com\/stress\/is-stress-the-number-one-killer#how-stress-affects-the-body"},{"key":"2026090706000783000_16.9.e120224.28","doi-asserted-by":"publisher","DOI":"10.1037\/hea0001259"},{"key":"2026090706000783000_16.9.e120224.29","doi-asserted-by":"crossref","first-page":"517","DOI":"10.3390\/jcm10030517","article-title":"Salivary Biomarkers of Stress, Anxiety and Depression","volume":"10","author":"Chojnowska","year":"2021","journal-title":"JCM"},{"key":"2026090706000783000_16.9.e120224.30","first-page":"52","article-title":"Pain in Times of Stress","volume":"22","author":"Ahmad","year":"2015","journal-title":"Malays J Med Sci"},{"key":"2026090706000783000_16.9.e120224.31","doi-asserted-by":"publisher","DOI":"10.1016\/j.ccell.2020.06.001"},{"key":"2026090706000783000_16.9.e120224.32","doi-asserted-by":"publisher","DOI":"10.1038\/s41569-024-01024-y"},{"key":"2026090706000783000_16.9.e120224.33","doi-asserted-by":"crossref","first-page":"104166","DOI":"10.1016\/j.landurbplan.2021.104166","article-title":"Prevalence and effectiveness of nature-based interventions to impact adult health-related behaviours and outcomes: A scoping review","volume":"214","author":"Wilkie","year":"2021","journal-title":"Landsc Urban Plan"},{"key":"2026090706000783000_16.9.e120224.34","doi-asserted-by":"crossref","first-page":"851","DOI":"10.3390\/ijerph14080851","article-title":"Shinrin-Yoku (Forest Bathing) and Nature Therapy: A State-of-the-Art Review","volume":"14","author":"Hansen","year":"2017","journal-title":"IJERPH"},{"key":"2026090706000783000_16.9.e120224.35","doi-asserted-by":"crossref","first-page":"1013","DOI":"10.3390\/f15061013","article-title":"Progress and Prospects of Research on the Impact of Forest Therapy on Mental Health: A Bibliometric Analysis","volume":"15","author":"Wan","year":"2024","journal-title":"Forests"},{"key":"2026090706000783000_16.9.e120224.36","doi-asserted-by":"crossref","first-page":"1613","DOI":"10.3390\/f13101613","article-title":"Forest Therapy Trails: A Conceptual Framework and Scoping Review of Research","volume":"13","author":"Gobster","year":"2022","journal-title":"Forests"},{"key":"2026090706000783000_16.9.e120224.37","doi-asserted-by":"crossref","DOI":"10.3390\/ijerph16173202","article-title":"A Systematic Review and Meta-Analysis of Nature-Based Mindfulness: Effects of Moving Mindfulness Training into an Outdoor Natural Setting","volume":"16","author":"Djernis","year":"2019","journal-title":"Int J Environ Res Public Health"},{"key":"2026090706000783000_16.9.e120224.38","doi-asserted-by":"crossref","unstructured":"Peter B . Therapeutisches Tertium und hypnotische Rituale [therapeutic tertium and hypnotic rituals]. In: Hypnose in Psychotherapie, Psychosomatik und Medizin: Manual f\u00fcr die Praxis. Springer, 2009: 69\u201377.","DOI":"10.1007\/978-3-540-68549-4_6"},{"key":"2026090706000783000_16.9.e120224.39","doi-asserted-by":"crossref","first-page":"119421","DOI":"10.1016\/j.envres.2024.119421","article-title":"Nature-based interventions for physical health conditions: A systematic review and meta-analysis","volume":"258","author":"Struthers","year":"2024","journal-title":"Environ Res"},{"key":"2026090706000783000_16.9.e120224.40","doi-asserted-by":"crossref","first-page":"321","DOI":"10.3390\/ijerph14030321","article-title":"Effects of Forest Therapy on Depressive Symptoms among Adults: A Systematic Review","volume":"14","author":"Lee","year":"2017","journal-title":"IJERPH"},{"key":"2026090706000783000_16.9.e120224.41","unstructured":"Statistisches Bundesamt . Bev\u00f6lkerungsvorausberechnung [population projection]. 2025. Available: https:\/\/www.destatis.de\/DE\/Themen\/Gesellschaft-Umwelt\/Bevoelkerung\/Bevoelkerungsvorausberechnung\/_inhalt.html#sprg262508"},{"key":"2026090706000783000_16.9.e120224.42","unstructured":"Statistisches Bundesamt . Demografischer Wandel [demographic change]. 2025. Available: https:\/\/www.destatis.de\/DE\/Themen\/Querschnitt\/Demografischer-Wandel\/_inhalt.html"},{"key":"2026090706000783000_16.9.e120224.43","unstructured":"Wissenschaftliches Institut der AOK . Gesundheitsatlas Deutschland: Depression [health atlas of Germany: depression]. 2024. Available: https:\/\/www.gesundheitsatlas-deutschland.de\/erkrankung\/depressionen?activeValueType=praevalence&activeLayerType=state"},{"key":"2026090706000783000_16.9.e120224.44","unstructured":"Wissenschaftliches Institut der AOK . Gesundheitsatlas deutschland: bluthochdruck [health atlas of germany: hypertension]. 2024. Available: https:\/\/www.gesundheitsatlas-deutschland.de\/erkrankung\/arterielle_hypertonie?activeValueType=praevalence&activeLayerType=state"},{"key":"2026090706000783000_16.9.e120224.45","unstructured":"Bundesministerium f\u00fcr Ern\u00e4hrung und Landwirtschaft . Der Wald in Deutschland: Ausgew\u00e4hlte Ergebnisse der vierten Bundeswaldinventur [Forests in Germany: Selected results of the fourth National Forest Inventory]. 2022."},{"key":"2026090706000783000_16.9.e120224.46","unstructured":"Waldgesetz f\u00fcr das Land Mecklenburg-Vorpommern . \u00a7 22 - erholungs-, kur- und heilwald [recreational, spa and healing forest. 2011."},{"key":"2026090706000783000_16.9.e120224.47","unstructured":"Universit\u00e4t Greifswald . One-Health-Region Vorpommern. 2025. Available: https:\/\/onehealth-region.de"},{"key":"2026090706000783000_16.9.e120224.48","doi-asserted-by":"publisher","DOI":"10.1037\/hea0000161"},{"key":"2026090706000783000_16.9.e120224.49","unstructured":"Landesforst Mecklenburg-Vorpommern . Weiterbildung waldtherapie [certificate course forest therapy]. 2025. Available: https:\/\/www.wald-mv.de\/walderlebnis\/gesundheit-und-erholung\/Waldtherapie\/v"},{"key":"2026090706000783000_16.9.e120224.50","unstructured":"Hauck S , Reinhard A-K , Brakemeier E-L . Preliminary studies I & II - out into nature!? 2025. Available: https:\/\/accounts.osf.io\/login?service=https%3A%2F%2Fosf.io%2Flogin%3Fnext%3Dhttps%253A%252F%252Fosf.io%252F2dqcf"},{"key":"2026090706000783000_16.9.e120224.51","doi-asserted-by":"publisher","DOI":"10.1097\/mlr.0000000000001664"},{"key":"2026090706000783000_16.9.e120224.52","doi-asserted-by":"publisher","DOI":"10.1016\/S0165-0327(03)00198-8"},{"key":"2026090706000783000_16.9.e120224.53","doi-asserted-by":"publisher","DOI":"10.1046\/j.1525-1497.2001.016009606.x"},{"key":"2026090706000783000_16.9.e120224.54","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.181.2.158"},{"key":"2026090706000783000_16.9.e120224.55","unstructured":"Hofmann A , Seidler G , Micka R , et al . TSF (Trauma Screening Fragebogen). Unver\u00f6ffentlichtes Manuskript 2002."},{"key":"2026090706000783000_16.9.e120224.56","unstructured":"Riecher-R\u00f6ssler A , Aston J , Ventura J , et al . BSIP-Basel Screening Instrument f\u00fcr Psychosen. 2011."},{"key":"2026090706000783000_16.9.e120224.57","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.jsp.2020.11.004","article-title":"Incorporating feasibility protocols in intervention research","volume":"84","author":"Gadke","year":"2021","journal-title":"J Sch Psychol"},{"key":"2026090706000783000_16.9.e120224.58","doi-asserted-by":"crossref","DOI":"10.1016\/j.psyneuen.2020.104599","article-title":"Psychological stress reactivity and future health and disease outcomes: A systematic review of prospective evidence","volume":"114","author":"Turner","year":"2020","journal-title":"Psychoneuroendocrinology"},{"key":"2026090706000783000_16.9.e120224.59","doi-asserted-by":"crossref","first-page":"555","DOI":"10.1515\/revneuro-2015-0004","article-title":"Clinical experimental stress studies: methods and assessment","volume":"26","author":"Bali","year":"2015","journal-title":"Rev Neurosci"},{"key":"2026090706000783000_16.9.e120224.60","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbi.2008.08.010"},{"key":"2026090706000783000_16.9.e120224.61","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbi.2019.103208"},{"key":"2026090706000783000_16.9.e120224.62","unstructured":"REDCap an der Universit\u00e4tsmedizin Greifswald im Datenintegrationszentrum [redcap at the university medicine greifswald in the data-integration-centre]. Universit\u00e4tsmedizin Greifswald, Datenintegrationszentrum; 2025. Available: https:\/\/www.unimedizin-greifswald.de\/diz\/interne-tools\/redcap"},{"key":"2026090706000783000_16.9.e120224.63","unstructured":"IBM Corp . IBM spss statistics for windows. IBM Corp, 2023."},{"key":"2026090706000783000_16.9.e120224.64","unstructured":"StataCorp . Stata statistical software: release 19. College Station, TX: StataCorp LLC, 2025."},{"key":"2026090706000783000_16.9.e120224.65","unstructured":"R Core Team . R: a language and environment for statistical computing. Vienna, Austria: R Foundation for Statistical Computing, 2023."},{"key":"2026090706000783000_16.9.e120224.66","unstructured":"Kuckartz U . Qualitative Inhaltsanalyse: Methoden, Praxis. computerunterst\u00fctzung: Beltz Juventa, 2012."},{"key":"2026090706000783000_16.9.e120224.67","unstructured":"MAXQDA. Software f\u00fcr qualitative Datenanalyse, 1989 \u2013 2025. Berlin: VERBI Software. Consult. Sozialforschung GmbH, 2025."},{"key":"2026090706000783000_16.9.e120224.68","unstructured":"Hauck S , Reinhard A-K , Lehnert K , et al . Green prescriptions: a pilot study on feasibility and impact of forest therapy for diverse populations. 2025. Available: https:\/\/osf.io\/c2d5p\/overview"},{"key":"2026090706000783000_16.9.e120224.69","unstructured":"World Medical Association . Declaration of helsinki \u2013 ethical principles for medical research involving human participants. 2024."},{"key":"2026090706000783000_16.9.e120224.70","unstructured":"Reinhard A-K , Hauck S , Lehnert K , et al . Forest|Health \u2013 a project exploring forests as a health resource in Mecklenburg-Western Pomerania. 7th International Society of Forest Therapy Congress. Waren, Germany; 2025"},{"key":"2026090706000783000_16.9.e120224.71","unstructured":"Reinhard A-K , Hauck S , Lehnert K , et al . Wald|Gesund \u2013 ein Projekt zur nachhaltigen Gesundheitsressource Wald in Mecklenburg-Vorpommern [forest|health - a project on forests as a sustainable resource for health in mecklenburg western-pomerania]. Waren, Germany; 2025"},{"key":"2026090706000783000_16.9.e120224.72","unstructured":"Reinhard A-K , Hauck S , Lehnert K , et al . Wald|Gesund \u2013 Protokoll und erste Ergebnisse einer modularen waldtherapeutischen Intervention f\u00fcr \u00e4ltere Menschen [forest|health \u2013 protocol and first results of a modular forest therapy intervention for older adults]. Conference of the German Society of Gerontology. Jena, Germany; 2025"},{"key":"2026090706000783000_16.9.e120224.73","unstructured":"Reinhard A-K , Hauck S , Meyer-Wyk F , et al . Der Wald als nachhaltige Gesundheitsressource \u2013 Protokoll einer waldtherapeutischen Interventionsstudie an \u00e4lteren Menschen [the forest as a sustainable health resource \u2013 protocol of a forest therapy intervention study in older adults]. Conference of the German Society of Gerontology and Geriatrics. Kassel, Germany; 2024"},{"key":"2026090706000783000_16.9.e120224.74","doi-asserted-by":"crossref","first-page":"1637","DOI":"10.1002\/jclp.23396","article-title":"Beyond treatment modalities: Clinical decisions and relational dynamics that facilitate change in group treatments","volume":"78","author":"Aafjes\u2010van Doorn","year":"2022","journal-title":"J Clin Psychol"},{"key":"2026090706000783000_16.9.e120224.75","unstructured":"Fliege H , Rose M , Arck P , et al . PSQ-perceived stress questionnaire. 2009."},{"key":"2026090706000783000_16.9.e120224.76","unstructured":"Schallberger U . 6. Kurzskalen zur Erfassung der positiven Aktivierung, negativen Aktivierung und Valenz in Experience Sampling Studien (PANAVA-KS) [short scales for measuring positive activation, negative activation, and valence in experience sampling studies (panava-ks).] Forschungsberichte aus dem Projekt: \u201cQualit\u00e4t des Erlebens in Arbeit und Freizeit [research reports from the project \u201cquality of experience in work and leisure\u201d]. 2005.1\u201387."},{"key":"2026090706000783000_16.9.e120224.77","doi-asserted-by":"publisher","DOI":"10.1037\/\/0022-3514.63.4.596"},{"key":"2026090706000783000_16.9.e120224.78","doi-asserted-by":"publisher","DOI":"10.1111\/0022-4537.00174"},{"key":"2026090706000783000_16.9.e120224.79","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1159\/000538807","article-title":"Validierung eines Fragebogeninstrumentes zur Erfassung des Erlebens von Natur: Die Experience of Nature Scale","volume":"31","author":"B\u00fcssing","year":"2024","journal-title":"Complement Med Res"},{"key":"2026090706000783000_16.9.e120224.80","unstructured":"Engstler H , Stuth S , Alcantara Lozano A , et al . German Ageing Survey - Deutscher Alterssurvey: documentation of instruments and variables - Instrumenten- und Variablendokumentation 1996-2020\/21. 2022."},{"key":"2026090706000783000_16.9.e120224.81","first-page":"303","article-title":"Domain-Specific Views on Aging and Preparation for Age-Related Changes-Development and Validation of Three Brief Scales","volume":"75","author":"Kornadt","year":"2020","journal-title":"J Gerontol B Psychol Sci Soc Sci"},{"key":"2026090706000783000_16.9.e120224.82","unstructured":"Ware JE . How to score and interpret single-item health status measures: a manual for users of the SF-8 health survey. 2001."},{"key":"2026090706000783000_16.9.e120224.83","doi-asserted-by":"crossref","DOI":"10.1186\/s12966-016-0386-6","article-title":"Physical activity surveillance in the European Union: reliability and validity of the European Health Interview Survey-Physical Activity Questionnaire (EHIS-PAQ)","volume":"13","author":"Baumeister","year":"2016","journal-title":"Int J Behav Nutr Phys Act"},{"key":"2026090706000783000_16.9.e120224.84","doi-asserted-by":"crossref","first-page":"635","DOI":"10.1093\/eurpub\/ckaf035","article-title":"Proactive automatized multiple health risk behavior change intervention: reach and retention among general hospital patients","volume":"35","author":"Spielmann","year":"2025","journal-title":"Eur J Public Health"},{"key":"2026090706000783000_16.9.e120224.85","unstructured":"Hawkley LC , Duvoisin R , Ackva J , et al . Loneliness in older adults in the USA and Germany: Measurement invariance and validation. NORC at the University of Chicago, 2015."},{"key":"2026090706000783000_16.9.e120224.86","doi-asserted-by":"publisher","DOI":"10.1177\/0164027504268574"},{"key":"2026090706000783000_16.9.e120224.87","unstructured":"Jerusalem M , Schwarzer R , eds. Skalen zur Erfassung von Lehrer-und Sch\u00fclermerkmalen. Dokumentation der psychometrischen Verfahren im Rahmen der wissenschaftlichen Begleitung des Modellversuchs selbstwirksame Schulen. Berlin: Freie Universit\u00e4t, 1999."},{"key":"2026090706000783000_16.9.e120224.88","first-page":"82","volume-title":"Measures in health psychology: A user\u2019s portfolio Causal and control beliefs","volume":"35","author":"Schwarzer","year":"1995"},{"key":"2026090706000783000_16.9.e120224.89","unstructured":"Rammstedt B , Kemper C , Klein MC , et al . Eine kurze Skala zur Messung der f\u00fcnf Dimensionen der Pers\u00f6nlichkeit: Big-Five-Inventory-10 (BFI-10). Methoden, Daten, Analysen (Mda) 2013;7."},{"key":"2026090706000783000_16.9.e120224.90","doi-asserted-by":"publisher","DOI":"10.1007\/s40279-017-0716-0"},{"key":"2026090706000783000_16.9.e120224.91","doi-asserted-by":"crossref","unstructured":"Schneiter-Ulmann R , F\u00f6hn M . Lehrbuch Gartentherapie [Textbook on Garden Therapy]. Hogrefe AG, 2020.","DOI":"10.1024\/85742-000"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2026-120224","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T13:00:35Z","timestamp":1788786035000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2026-120224"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9]]},"references-count":91,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,9,7]]},"published-print":{"date-parts":[[2026,9]]}},"alternative-id":["10.1136\/bmjopen-2026-120224"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2026-120224","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9]]}}}