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

Study Overview
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Brief Summary
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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.

Detailed Description
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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.

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

Conditions
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Forest Therapy for Cognition

Intervention / Treatment
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* Behavioral: Forest therapy training
* Behavioral: Senior fitness training
* Behavioral: Board Games


Participation Criteria
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Eligibility Criteria
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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.

Ages Eligible for Study
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Minimum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

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


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Forest therapy training<br>Participants will expect to have an improvement of cognitive functions via a serial nature-based therapy/intervention. | Behavioral: Forest therapy training<br>* Participants will experience nature-based interventions including forest hiking, horticultural therapy and green wellness activities for their mental health and physical conditions.<br>|
| Active Comparator: Senior fitness training<br>Participants will expect to have an improvement of cognitive functions through a structural senior fitness program. | Behavioral: Senior fitness training<br>* 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.<br>|
| Placebo Comparator: Board Games<br>Participants will play boards games under a schedule matching the Experimental and Active Comparator arms. | Behavioral: Board Games<br>* Participants will play board games with each other.<br>|

What is the study measuring?
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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 | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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forest therapy, successful ageing, physical and mental health, cognitive health, senior fitness, clinic trial, brain imaging