A Study on the Effects of Forest Therapy on Sarcopenia

June 11, 2026 updated by: National Taiwan University Hospital

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 2-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.

Study Overview

Status

Active, not recruiting

Conditions

Intervention / Treatment

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.

Study Type

Interventional

Enrollment (Estimated)

36

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Taiwan
      • Yunlin County, Taiwan, 640
        • National Taiwan University Hospital Yunlin Branch

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Adult
  • Older Adult

Accepts Healthy Volunteers

No

Description

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.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Prevention
  • Allocation: N/A
  • Interventional Model: Single Group Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Forest-Based Intervention Group

Participants will undergo an 8-week structured forest healing program (2 sessions/week, 16 sessions total) at the Caoling Shibi Forest Healing Base

. Each 180-minute session, led by certified instructors, includes forest trail walking (aerobic/balance), elastic band resistance training, nature-based sensory immersion (forest therapy), and group psychological support. The intervention follows a standardized manual focused on improving muscle strength and physical function.
Behavioral: Forest-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.
Other Names:
  • Forest Therapy

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Handgrip Strength
Time Frame: Baseline, 8 weeks, and 4 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).
Baseline, 8 weeks, and 4 months.
Short Physical Performance Battery (SPPB)
Time Frame: Baseline, 8 weeks, and 4 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.
Baseline, 8 weeks, and 4 months.

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Skeletal Muscle Mass Index (SMI)
Time Frame: Baseline, 8 weeks, and 4 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.
Baseline, 8 weeks, and 4 months.
Health-Related Quality of Life (SF-36)
Time Frame: Baseline, 8 weeks, and 4 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).
Baseline, 8 weeks, and 4 months.
Geriatric Depression Scale (SGDS)
Time Frame: Baseline, 8 weeks, and 4 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).
Baseline, 8 weeks, and 4 months.
Pittsburgh Sleep Quality Index (PSQI)
Time Frame: Baseline, 8 weeks, and 4 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).
Baseline, 8 weeks, and 4 months.
Positive and Negative Affect Schedule (PANAS)
Time Frame: Baseline, 8 weeks, and 4 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).
Baseline, 8 weeks, and 4 months.

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

National Taiwan University Hospital

Collaborators

Chungnam National University

Investigators

  • Principal Investigator: Kai-Chieh Chang, MD, National Taiwan University Hospital

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

May 13, 2026

Primary Completion (Estimated)

June 26, 2026

Study Completion (Estimated)

May 11, 2027

Study Registration Dates

First Submitted

June 2, 2026

First Submitted That Met QC Criteria

June 2, 2026

First Posted (Actual)

June 8, 2026

Study Record Updates

Last Update Posted (Actual)

June 15, 2026

Last Update Submitted That Met QC Criteria

June 11, 2026

Last Verified

June 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • 202603112RINA

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

UNDECIDED

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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