Effects of Forest Therapy on Cognitive Performance and Mental Health in Older Adults Health in Older Adults

Effects of Forest Therapy on Cognitive Performance and Mental Health in Older Adults

In Taiwan, aging is happening at a fast pace. The Taiwan Ministry of Interior officially announced that Taiwan will become an aged society in April 2018 and is expected to transition into a hyper-aged society within eight years. Critically, scholars recognize that optimizing cognitive activity and wellbeing influences quality of life in a late life which in turn is a key factor for successful aging. To alleviate the social and economic impact of aging, as well as impact on families, there is a need for studying anti-aging approaches. The World Health Organization suggests that the general public should have a healthy lifestyle which includes participating in activities for physical health, as well as cognitive and mental health involving maintaining social interactions. This present research is part of a broader integrated program in which the purpose is to promote and study the efficacy of forest therapy on physical health, and cognitive and mental health in older adults. The study site is located at the National Taiwan Science Education Center (NTSEC) which includes wetlands, waterfronts, green-spaces and urban parks. The investigators will evaluate two types of interventions for participants, "forest therapy program" and "fitness program" for older adults. The study approach applies a between-subjects and pretest-posttest design. The investigators will collect participants' physical data, psychological responses, and cognitive performance in the course of both programs. By comparing these data before and after the intervention programs, the investigators seek to understand the both programs' effects on physical health, and cognitive and mental health.

Study Overview

• Status: Recruiting
• Conditions: Forest Therapy for Cognition
• Intervention / Treatment: Behavioral: Board Games; Behavioral: Forest therapy training; Behavioral: Senior fitness training

Detailed Description

In Taiwan, aging is happening at a fast pace. The Taiwan Ministry of Interior officially announced that Taiwan will become an aged society in April 2018 and is expected to transition into a hyper-aged society within eight years. Critically, scholars recognize that optimizing cognitive activity and wellbeing influences quality of life in a late life which in turn is a key factor for successful aging. To alleviate the social and economic impact of aging, as well as impact on families, there is a need for studying anti-aging approaches. The World Health Organization suggests that the general public should have a healthy lifestyle which includes participating in activities for physical health, as well as cognitive and mental health involving maintaining social interactions. This present research is part of a broader integrated program in which the purpose is to promote and study the efficacy of forest therapy on physical health, and cognitive and mental health in older adults. The study site is located at the National Taiwan Science Education Center (NTSEC) which includes wetlands, waterfronts, green-spaces and urban parks. The investigators will evaluate two types of interventions for participants, "forest therapy program" and "fitness program" for older adults. The study approach applies a between-subjects and pretest-posttest design. The investigators will collect participants' physical data, psychological responses, and cognitive performance in the course of both programs. By comparing these data before and after the intervention programs, the investigators seek to understand the both programs' effects on physical health, and cognitive and mental health. In addition, the investigators will elucidate the efficacy of the forest therapy program through measurement of the changes in physical, cognitive, and mental health performance and status indicators. The forest therapy and fitness programs at National Taiwan Science Education Center (NTSEC), along with a robot programming training and tinkering activities that are part of the broader project, acts as a public education and service window towards addressing cognitive aging issues in Taiwan. It should be further noted that this will be a critical platform for obtaining ecological research data on a novel class of cognitive interventions for cognitive aging using psychological and brain imaging techniques to bridge critical neural mechanistic knowledge gaps.

• Study Type: Interventional
• Enrollment (Anticipated): 120
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Chia-Pin Yu, Ph.D.; Phone Number: +886 2 33664618; Email: simonyu@ntu.edu.tw

Study Locations

• Taiwan
  • Taipei, Taiwan, 11165
    • Recruiting
    • National Taiwan Science Education Center
    • Contact: Carmen Lui, B. Sc; Phone Number: +886-2-6610-1234; Email: luicarmen21@gmail.com
    • Sub-Investigator: Chia-Pin Yu, Ph.D.
  • Taipei, Taiwan, 10617
    • Recruiting
    • School of Forestry and Resource Conservation, National Taiwan University
    • Contact: Chia-Pin Yu, Ph.D.; Phone Number: +886 2 33664618; Email: simonyu@ntu.edu.tw

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 65 years and older (Older Adult)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Literate in Mandarin and Taiwanese.
• Willing to participate entirely in this research.
• Age > 65.

Exclusion Criteria:

• Participated in cognitive-related training in the past two months.
• Diagnosed with mild cognitive impairment(MCI)
• Severe psychological or behavioral disorder that would seriously interfere with the progress of activity.
• Severe hearing Impairments or visual Impairment
• History of degenerative cognitive disorders, Organic Mental Disorders, Brain Dysfunction, Psychogenic neurosis.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Basic Science
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Triple

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Placebo Comparator: Board Games; Participants will play boards games under a schedule matching the Experimental and Active Comparator arms.	Behavioral: Board Games; Participants will play board games with each other.
Experimental: Forest therapy training; Participants will expect to have an improvement of cognitive functions via a serial nature-based therapy/intervention.	Behavioral: Forest therapy training; Participants will experience nature-based interventions including forest hiking, horticultural therapy and green wellness activities for their mental health and physical conditions.
Active Comparator: Senior fitness training; Participants will expect to have an improvement of cognitive functions through a structural senior fitness program.	Behavioral: Senior fitness training; The fitness program includes physics fitness of stamina, coordination and aerobic exercise in 12 weeks. Participants will join the senior fitness program including physical fitness, aerobic exercise and exercise prescription during the 12 weeks program.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Changes of neural functional activity during inferential processing	Participants will undergo a Rule Inference fMRI task to infer underlying rules that map color configurations of circles in a triangular arrangement to a target color category within as few tries as possible under active or passive conditions.The goal for participants will be to infer the cue-category association rules using as few cues as possible. The primary outcome measure here is the degree of neural response estimate change in blood oxygen level dependent (BOLD)signal pre- and post-intervention.	week 0, week 12
Changes of overall accuracy during inferential processing	Changes from pre- to post-intervention in participant overall accuracy in identifying latent rules in the Rule Inference fMRI task.	week 0, week 12
Changes of learning rate during inferential processing	Changes from pre- to post-intervention in participant number of trials to criterion in the Rule Inference fMRI task.	week 0, week 12
Changes of strategic performance during inferential processing	Changes from pre- to post-intervention in participant coefficients of expression of modeled response strategies in the Rule Inference fMRI task will be assessed.	week 0, week 12
Changes in the Montreal Cognitive Assessment (MoCA) score	Pre- to post-intervention changes in participant MoCA score. Score range from 0 to 30 with higher scores indicating better cognitive ability.	week 0, week 12
Change in Wechsler Memory Scale III Logical Memory I & II	Score range 0 - 75. Higher score indicates better verbal episodic memory.	week 0, week 12
Change in Wechsler Memory Scale III Face Memory	Score range 0 - 48. Higher score indicates better visual face memory.	week 0, week 12
Change in Wechsler Memory Scale III Verbal Paired Memory	Score range 0 - 32. Higher score indicates better verbal memory and learning.	week 0, week 12
Change in Wechsler Memory Scale III Family Pictures I & II	Score range 0 - 64. Higher score indicates better visual memory and learning.	week 0, week 12
Change in Wechsler Memory Scale III Word Lists I & II	Score range 0 - 36. Higher score indicates better verbal memory and learning. For II, recall score range is 0 to 8; recognition score range is 0 to 24.	week 0, week 12
Change in Wechsler Memory Scale III Visual Reproduction I & II	Score range 0 - 104. Higher score indicates better visual memory. For II, recall score range is 0-104; recognition score range is 0-48.	week 0, week 12
Change in Wechsler Memory Scale III Spatial Span	Score range 0 - 32. Higher score indicates better spatial memory. range is 0-48.	week 0, week 12
Change in Wechsler Memory Scale III Digit Span	Score range 0 - 32. Higher score indicates better auditory memory.	week 0, week 12
Change in Wechsler Adult Intelligence Scale III Vocabulary	Score range 0 - 66. Higher score indicates better vocabulary.	week 0, week 12
Change in Wechsler Adult Intelligence Scale III Digit Symbol	Score range 0 - 133. Higher score indicates better processing speed.	week 0, week 12
Change in Wechsler Adult Intelligence Scale III Block Design	Score range 0 - 68. Higher score indicates better visual processing.	week 0, week 12
Change in Wechsler Adult Intelligence Scale III Arithmetic	Score range 0 - 22. Higher score indicates better mathematical computation ability.	week 0, week 12
Change in Wechsler Adult Intelligence Scale III Matrix Reasoning	Score range 0 - 26. Higher score indicates better reasoning.	week 0, week 12
Change in the Profile of Mood States(POMS)	Pre- to post-intervention changes in participant POMS score. Score range from 0 to 24 with higher scores indicating the level of each mood States, as tension-anxiety, anger-hostility, depression-dejection, fatigue-inertia, confusion-bewilderment, vigor-activity.	week 0, week 12
Change in State-Trait Anxiety Inventory(STAI)	Pre- to post-intervention changes in participant STAI score. Score range from 0 to 80 with higher scores indicating higher anxiety level.	week 0, week 12
Change in Chinese Word Remote Associate Task(CWRAT)	Pre- to post-intervention changes in participant CWRAT score. Score range from 0 to 80 with higher scores indicating better creativity.	week 0, week 12
Change in Diastolic Blood Pressure(DBP) and Systolic Blood Pressure(SBP)	Pre- to post-intervention changes in participant blood pressure. Normal SBP of an adult under 120 mmHg and normal DBP under 80 mmHg with lower pressure indicating better health.	week 0, week 12
Change in heart rate	Pre- to post-intervention changes in participant heart rate. The normal heart rate of an adult beats between 60 to 100 times per minute, with lower times indicating better health.	week 0, week 12
Change in heart rate variability (HRV)	Changes from pre- to post-intervention in participant HRV. In sympathetic nervous system, with lower ratio of Low/High Frequency and higher high Frequency indicating better relaxation.	week 0, week 12
Change in Body Mass Index(BMI)	Changes from pre- to post-intervention in participant Body Mass Index.	week 0, week 12
Change in Waist-Hip Ratio	Changes from pre- to post-intervention in participant Waist-Hip Ratio.	week 0, week 12
Change in 30s arm curl test	Changes from pre- to post-intervention in participant 30s arm curl test, with higher times indicating better strength.	week 0, week 12
Change in 30s chair stand test	Changes from pre- to post-intervention in participant 30s chair stand test, with higher times indicating better endurance.	week 0, week 12
Change in back scratch test	Changes from pre- to post-intervention in participant 30s back scratch test, with higher times indicating better upper limb flexibility.	week 0, week 12
Change in chair sit-and-reach test	Changes from pre- to post-intervention in participant 30s chair sit-and-reach test, with higher times indicating better lower limb flexibility.	week 0, week 12
Change in Seated Up- and- Go Test	Changes from pre- to post-intervention in participant Seated Up- and- Go Test, with fewer time indicating better dynamic balance and agility.	week 0, week 12
Change in 2-minute step test	Changes from pre- to post-intervention in participant Seated Up- and- Go Test, with higher times indicating better cardiorespiratory fitness.	week 0, week 12

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Changes of neural functional activity during resting-state	Brain functional activity measured using fMRI during rest with eyes-open	week 0, week 12

Collaborators and Investigators

• Sponsor: National Taiwan University Hospital
• Collaborators: Ministry of Science and Technology, Taiwan; National Taiwan University; National Taiwan Science Education Center
• Investigators: Principal Investigator: Chia-Pin Yu, Ph.D., National Taiwan University

Study record dates

Study Major Dates

• Study Start (Actual): September 1, 2021
• Primary Completion (Anticipated): July 1, 2023
• Study Completion (Anticipated): July 1, 2024

Study Registration Dates

• First Submitted: April 7, 2022
• First Submitted That Met QC Criteria: April 27, 2022
• First Posted (Actual): May 3, 2022

Study Record Updates

• Last Update Posted (Actual): May 3, 2022
• Last Update Submitted That Met QC Criteria: April 27, 2022
• Last Verified: August 1, 2021

More Information

Terms related to this study

• Keywords: cognitive health; brain imaging; clinic trial; forest therapy; successful ageing; physical and mental health; senior fitness
• Other Study ID Numbers: 202105HM079

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: Data that can be shared include anonymized neuropsychological assessment scores, cognitive behavioral performance scores, brain imaging data that have been published.
• IPD Sharing Time Frame: Data will become available 1 year after primary results are published by the central research team. Data are anticipated to be available for sharing for an indefinite period after the above criteria is met.
• IPD Sharing Access Criteria: Data sharing will be done based direct requests and on case-by-case evaluation for appropriateness. Use of shared data will require agreement on appropriate citation of data sources at least or authorship inclusion or acknowledgement.
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL; SAP; ANALYTIC_CODE

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No