Preprint Article Version 1 Preserved in Portico This version is not peer-reviewed

Effects of Integrated Indirect Forest Therapy on Emotion, Fatigue, Stress, and Immune Function in Hemodialysis Patients

Version 1 : Received: 21 December 2020 / Approved: 22 December 2020 / Online: 22 December 2020 (12:42:59 CET)

A peer-reviewed article of this Preprint also exists.

Kang, H.; Chae, Y. Effects of Integrated Indirect Forest Experience on Emotion, Fatigue, Stress and Immune Function in Hemodialysis Patients. Int. J. Environ. Res. Public Health 2021, 18, 1701. Kang, H.; Chae, Y. Effects of Integrated Indirect Forest Experience on Emotion, Fatigue, Stress and Immune Function in Hemodialysis Patients. Int. J. Environ. Res. Public Health 2021, 18, 1701.

Journal reference: Int. J. Environ. Res. Public Health 2021, 18, 1701
DOI: 10.3390/ijerph18041701

Abstract

(1) Background: Most hemodialysis patients may experience physiological and psychological stress. Exposure to nature has been previously reported to reduce the measures of psychological and physiological stress, and immune function. This study aimed to investigate psychological and physiological effects of integrated indirect forest therapy on chronic renal failure patients undergoing hemodialysis. (2) Methods: As a quasi-experiment, this study employed a nonequivalent control group, repeated measurements, and a non-synchronized design. A total of 54 participants were included: 26 and 28 in the experimental and control groups, respectively. During hemodialysis, five types of forest therapy stimuli (visual, auditory, olfactory, tactile, and motor) were applied 3 times per week for 4 weeks during 15-minute sessions. (3) Results: Positive but not negative emotion measures differed between the groups after the intervention. Fatigue and physiological stress levels were significantly reduced in the experimental group, whereas no significant difference was found between the groups on the measures of psychological stress. Activation of both the parasympathetic and sympathetic nervous systems was similar in both groups, as was the number of natural killer cells. (4) Conclusion: Integrated indirect forest therapy may help increase positive emotions and reduce fatigue and stress levels during hemodialysis in patients with chronic renal failure.

Keywords

hemodialysis; indirect forest therapy; emotion; fatigue; stress; heart rate variability; natural killer cells

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