Participation in a community-based Kurort Health Walking program in a forest environment was associated with significant short-term reductions in blood pressure and negative mood states, and increases in positive mood states, though the independent contributions of forest environment, physical activity, and other contextual factors could not be distinguished.
Key Findings
Results
Systolic and diastolic blood pressure decreased significantly after the Kurort Health Walking session.
The reduction in both systolic and diastolic blood pressure was statistically significant (p < 0.001).
90 participants were included, attending certified Kurort Health Walking courses between March 2024 and March 2025 in Saikai City, Nagasaki, Japan.
Blood pressure was assessed before and after the walking session using a before-after study design.
No control group was included, so the relative contributions of exercise, forest environment, and other contextual factors could not be separated.
Results
Heart rate variability indices, including the low-frequency/high-frequency (LF/HF) ratio and high-frequency (HF) power, did not show significant changes across the four measurement points.
Autonomic nervous activity was evaluated using LF/HF ratio and HF power as indices of sympathetic and parasympathetic activity.
Measurements were taken at four time points: before, during, and after the walk.
Neither LF/HF ratio nor HF power reached statistical significance across measurement points.
This finding suggests the walking program did not produce detectable short-term changes in autonomic nervous system balance as measured by heart rate variability.
Results
Negative mood states decreased significantly and multiple positive mood states increased significantly after the walking session.
Positive mood states including vigor, friendliness, pleasure, and relaxation all increased significantly (p < 0.001).
Anxiety decreased significantly after walking (p < 0.001).
Mood states were assessed using validated questionnaires before and after the walking session.
Both the reduction in negative mood and the increase in positive mood were observed at the p < 0.001 significance level.
Methods
The study was conducted as a community-based public health program in a forest environment using a before-after design without a control group.
A total of 90 participants attended certified Kurort Health Walking courses between March 2024 and March 2025.
The program was set in Saikai City, Nagasaki, Japan, in a forest environment.
The absence of a control group means the independent contributions of the forest environment, physical activity, and other contextual factors could not be distinguished.
Physiological parameters measured included systolic blood pressure, diastolic blood pressure, and pulse rate.
The study design is described as a 'before-after study,' limiting causal inference.
Conclusions
The Kurort Health Walking program was associated with short-term changes in both physiological and psychological measures among community participants.
Significant improvements were observed across both physiological (blood pressure) and psychological (mood) outcomes.
The program is described as 'community-based' and conducted as part of a public health initiative.
Authors caution that contextual factors beyond forest walking itself—such as social interaction and general physical activity—may have contributed to the observed outcomes.
The study period spanned one year, from March 2024 to March 2025, with 90 total participants across multiple certified course sessions.
What This Means
This research suggests that participating in a structured forest walking program called Kurort Health Walking—offered as a community public health initiative in Japan—was linked to meaningful short-term improvements in both physical and mental well-being. After a single walking session, participants showed lower blood pressure and reported feeling less anxious and more vigorous, friendly, relaxed, and pleasured. These changes were statistically significant, meaning they were unlikely to be due to chance. However, measures of the autonomic nervous system (which regulates involuntary body functions like heart rate) did not show significant changes.
The study followed 90 community participants over roughly one year in a forested setting in Nagasaki, Japan, measuring outcomes before and after each walking session. Because there was no comparison group of people who did not walk, it is not possible to determine how much of the benefit came specifically from the forest environment versus the physical activity of walking itself, the social experience of participating in a group, or other factors related to being outdoors.
This research suggests that community-based forest walking programs may offer a practical, accessible way to support both blood pressure management and mental well-being in the general public. However, more rigorous studies with control groups would be needed to confirm these findings and identify which specific elements of the program drive the benefits.
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Miura S, Horikawa S, Morizono K, Miyazaki M, Torii H, Kuroda H, et al.. (2026). Physiological and psychological outcomes of a community-based Kurort Health Walking program: A before-after study.. PloS one. https://doi.org/10.1371/journal.pone.0357733