Evaluation of forest exercise for the development of health promotion indicators of forest management programs: a systematic review

Introduction Forest exercise refers to structured physical activities performed in the forest, such as walking and strength training. This systematic review aimed to evaluate the characteristics and quality of studies examining the effectiveness of forest exercise in health promotion. Furthermore, it indirectly presents implications for the development of indicators that can be utilized to evaluate the effectiveness of forest management programs in future studies.Methods A literature search was performed on the MEDLINE, PubMed, ProQuest, RISS, DBpia, and KISS databases. Eligible articles were selected using the PRISMA reporting guidelines and PICOS format. The Risk-of-Bias 2.0 and ROBINS-I tools were used to evaluate the quality of the articles. The results were derived using inductive inference, a reasoning method that draws general conclusions from individual observations.Results A total of 23 articles involving middle-aged men or women, college students, older adults, infants, and office workers were included in the analysis. Forest exercise was used as an intervention. In most cases, the untreated group was used as the control group, but in some, the outdoor and indoor exercise groups in an urban environment were used as control groups. Regarding the outcome of the included studies, physical and psychological effects were utilized as dependent variables. For the study design, 3 studies were randomized controlled trials, and the other 20 were non-RCTs. Various physical and psychological indicators can be used to measure the effectiveness of forest exercise. Although a detailed analysis of the effectiveness of forest exercise was not possible because a meta-analysis was not performed in this study, all studies showed that forest exercise had positive physiological and psychological effects.Conclusions Future research should examine the effects of forest management programs on health promotion. It is necessary to classify the measurement indicators according to the purpose and intensity of forest management activities. Additionally, designing forest management activities, such as pruning and thinning, as complex exercises will be possible. Moreover, policy measures need to be developed to convert forest management activities from the concept of “labor” to the idea of “exercise for health promotion” so as to encourage citizens to participate in forest management activities.