Healthy Aging, Sarcopenia
Conditions
Keywords
Forest Therapy, Forest-Based Intervention, Forest Bathing, Forest Healing, Sarcopenia, Physical Performance, Muscle Strength, Sleep Quality, Mental Well-being
Brief summary
Purpose: The goal of this study is to investigate the effects of an 8-week Forest Based Intervention program on muscle strength, physical performance, and psychological well-being in older women with sarcopenia. Duration: The program lasts for 8 weeks, with 2 sessions per week (16 sessions total). Each session is approximately 180 minutes. Activities: Participants will take part in a structured program at the Caoling Shibi Forest Healing Base in Yunlin. The program includes forest trail walking, resistance training using elastic bands, stretching, and sensory activities such as aromatherapy and deep breathing. Assessments: Researchers will evaluate physical indicators and psychological well-being before the program, immediately after, and at a 1-month follow-up. Goal: We hope to determine if combining structured exercise with the forest environment can effectively improve the health and quality of life for older women with sarcopenia.
Detailed description
Background and Rationale: Sarcopenia is a common skeletal muscle disease in the elderly characterized by the loss of muscle mass, strength, and physical performance. While resistance training and nutrition are core management strategies, Forest Healing has been shown to reduce stress (cortisol), regulate the autonomic nervous system, and improve immune function. This study aims to validate a standardized "manualized" forest healing intervention for sarcopenia, utilizing a cross-border collaboration framework between Taiwan and South Korea. Study Design & Environmental Monitoring: This is a single-arm, pre-post intervention study (quasi-experimental design) conducted at the Caoling Shibi Forest Healing Base (altitude 1,500-1,700m). A unique aspect of this trial is the quantification of environmental factors, including phytoncide concentrations, negative ions, and thermal comfort indices (PMV, PPD), to explore the mechanistic relationship between the forest environment and physiological adaptations. Intervention Protocol: The standardized 180-minute sessions are designed to integrate physical conditioning with psychological relaxation. The technical protocol dictates: Aerobic and Balance Training: Forest trail walking maintained at a Rating of Perceived Exertion (RPE) of 12-13. Resistance Training: Elastic band exercises targeting upper and lower limbs (3 sets of 8-10 repetitions) at an RPE of 9-13. Core Forest Therapy: Sensory awareness, aromatherapy, and deep breathing to promote parasympathetic activation. Psychological Promotion: Facilitated group interactions and experience sharing to enhance social connection and intervention adherence. Safety Protocol: To ensure participant safety in a mountainous terrain, the study has established a comprehensive three-tier medical safety mechanism. This includes on-site first aid by certified instructors, local AED medical services, and a dedicated emergency medical "green channel" established with the National Taiwan University Hospital, Yunlin Branch.
Interventions
BEHAVIORALForest-Based Intervention Program
An 8-week structured intervention (16 sessions total, 180 min each) conducted at the Caoling Shibi Forest Healing Base. The program integrates physical exercise (forest trail walking and elastic band resistance training) with nature-based sensory immersion (aromatherapy, deep breathing, and nature awareness). The intervention follows a manualized protocol led by certified instructors, specifically designed to improve muscle strength, physical function, and psychological well-being in older women.
Sponsors
National Taiwan University Hospital
Chungnam National University
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
PREVENTION
Masking
NONE
Eligibility
Sex/Gender
FEMALE
Age
55 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Female aged 55 years or older. * Meet the AWGS 2025 criteria for sarcopenia (low handgrip strength and low skeletal muscle mass index). * Able to walk independently or with assistive devices and safely participate in low-to-moderate intensity exercise training. * Willing to commit to the 8-week intervention (16 sessions total) and provide signed informed consent.
Exclusion criteria
* History of major acute illness, hospitalization, or surgery within the past 3 months. * Severe cardiovascular, respiratory, or other systemic diseases that make moderate-intensity exercise unsafe. * Severe osteoarticular or neurological disorders that significantly impair walking or exercise safety. * Severe cognitive impairment that prevents understanding of study procedures or cooperation with the intervention. * Presence of implanted medical devices (e.g., pacemakers) that would interfere with bioelectrical impedance analysis (BIA). * Regular participation in structured resistance training or high-intensity exercise within the past 3 months.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Handgrip Strength | Baseline, 2 months, and 3 months. | Measured using a Smedley hand dynamometer for the dominant hand to evaluate maximum muscle strength. Handgrip strength is a key clinical indicator for sarcopenia diagnosis. Values are reported in kilograms (kg). |
| Short Physical Performance Battery (SPPB) | Baseline, 2 months, and 3 months. | A standardized assessment of lower extremity function, including balance tests, gait speed tests, and five times chair stand tests. Scale title: Short Physical Performance Battery (SPPB). Minimum value: 0, Maximum value: 12. Higher scores indicate better physical performance. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Skeletal Muscle Mass Index (SMI) | Baseline, 2 months, and 3 months. | Measured via Bioelectrical Impedance Analysis (BIA) using the ACCUNIQ BC380. It is calculated as Appendicular Skeletal Muscle mass divided by height squared to track muscle mass changes. Values are reported in kg/m2. |
| Health-Related Quality of Life (SF-36) | Baseline, 2 months, and 3 months. | Assessed using the Taiwan version of the Short Form-36 Health Survey (SF-36) to evaluate the participant's physical and mental health status. Scale title: 36-Item Short Form Health Survey (SF-36). Minimum value: 0, Maximum value: 100. Higher scores indicate better outcomes (better health-related quality of life). |
| Geriatric Depression Scale (SGDS) | Baseline, 2 months, and 3 months. | The Taiwan short-form version (GDS-15) is used to evaluate changes in depressive symptoms among participants based on their feelings over the past week. The assessment consists of 15 questions. Scale title: 15-item Geriatric Depression Scale (GDS-15). Minimum value: 0, Maximum value: 15. Higher scores indicate worse outcomes (more severe depressive symptoms). |
| Pittsburgh Sleep Quality Index (PSQI) | Baseline, 2 months, and 3 months. | The Taiwan version is used to assess sleep habits and quality over the previous month, calculating a global total score. Scale title: Pittsburgh Sleep Quality Index (PSQI). Minimum value: 0, Maximum value: 21. Higher scores indicate worse outcomes (poorer sleep quality). |
| Positive and Negative Affect Schedule (PANAS) | Baseline, 2 months, and 3 months. | Used to measure changes in emotional states following the forest healing intervention based on actual feelings over the past week. The questionnaire consists of 20 items rated on a 1 to 5 scale. Scale title: Positive and Negative Affect Schedule (PANAS). This assessment comprises two subscales. * For the Positive Affect subscale: Minimum value is 10, Maximum value is 50. Higher scores indicate better outcomes (higher levels of positive affect). * For the Negative Affect subscale: Minimum value is 10, Maximum value is 50. Higher scores indicate worse outcomes (higher levels of negative affect). |
Countries
Taiwan
Contacts
PRINCIPAL_INVESTIGATORKai-Chieh Chang, MD
National Taiwan University Hospital
Outcome results
None listed