Interview with Dr. Qing Li, Forest Bathing Expert & Forest Medicine Researcher

Green Blue Active was fortunate and grateful for the opportunity to interview renowned forest medicine expert, Clinical Professor at Nippon Medical School, Vice President of the International Society of Nature and Forest Medicine, and President of the Japanese Society of Forest Medicine, Dr. Qing Li. Dr. Qing Li is the author of "Forest Bathing How Trees Can Help You Find Health and Happiness", and was featured on BBC Earth. The interview includes the relationship with forest bathing, immune function and Covid-19, and mental stress.

The first ever forest bathing study was conducted by Dr. Qing Li in 2005, which you can find here:

Li Q, et al. Forest bathing enhances human natural killer activity and expression of anti-cancer proteins. Int J Immunopathol Pharmacol. 2007;20(2):3-8.

Interviewer: Laura Scott, Founder-Green Blue Active

"Mental stress and various mental disorders due to “lockdown” and “isolation” are also major social problems. In fact, Shinrin-yoku reduces the symptoms of anxiety, depression, anger, fatigue and confusion, reduces stress and stress hormones, and increases vigor. Therefore, Shinrin-yoku may have a preventive effect on COVID-19-induced mental stress and mental disorders."  - Dr. Qing Li

Laura: As you are a renowned expert on forest medicine/Shinrin Yoku, can you describe your research on forest medicine and share some examples of the most exciting findings? Have there been recent developments in your research?

Dr. Qing Li: Some people study forests. Some people study medicine. I study forest medicine to find out all the ways in which walking in the forest can improve our well-being.
Since 2004 I have conducted many studies to investigate the effect of forest environments (shinrin-yoku) on human health. Now we have established a new science called Forest Medicine and have published a new book: Forest Medicine by an American publisher in NY in February of 2012. This book has been translated into Chinese and Korean.

What is Forest Medicine?
Imagine a new medical science that could let you know how to be more active, more relaxed and healthier with reduced stress and reduced risk of lifestyle-related disease and cancer by visiting forests. This new medical science is called forest medicine. Forest medicine encompasses the effects of forest environments on human health and is a new interdisciplinary science, belonging to the categories of alternative medicine, environmental medicine and preventive medicine. This book presents up-to-date findings in forest medicine to show the beneficial effects of forest environments on human health. 

My new book: Shinrin-Yoku (The Art and Science of Forest Bathing – How Trees Can Help You Find Health and Happiness) was published by Penguin Random House UK on April 5, 2018. The book also was published in the USA under the title of Forest Bathing on April 17, 2018 by Viking Books (Penguin Random House USA). Forest Bathing ranked in the bestseller list in the USA. Moreover, the book has been translated into 26 languages.

Recently, I co-edited a new book: International Handbook of Forest Therapy published in 2019 by Cambridge Scholars Publishing.

Books

Laura: Are you aware of any examples where forest bathing has been integrated into healthcare services? Have there been forest bathing initiatives supported by public health agencies, the workplace, or school programs? If so, how was it received by the public?

Dr. Qing Li: In Japan, many medical doctors have applied forest bathing into preventive medicine for prevention of some diseases such as hypertension and depression and for stress management; however, shinrin-yoku have not yet applied to clinical medicine as a treatment because of the limitation of health insurance system. In Japan, before the application of shinrin-yoku into clinical treatment, forest bathing needs to be approved by the health insurance system as a treatment. 
In Japan, many companies have applied the forest bathing into stress management.
Many medical doctors in other countries have shown interesting on the application of shinrin-yoku on the prevention of diseases, even for the treatment of some diseases such as depression and hypertension.

In the future, forest bathing can be applied in preventive medicine, clinical medicine and rehabilitation medicine.

Laura: Health enhancing physical activity is viewed as an effective method to reduce the risk of certain chronic diseases. Do you also believe forest bathing plays an important role?
Dr. Qing Li: Yes. Shinrin-Yoku has preventive effect on lifestyle related diseases by reducing stress because stress can induce many diseases such as cancers, hypertension, depression, cardiovascular diseases (myocardial infarction), stroke (cerebral haemorrhage), gastric ulcer, obesity, alcoholism, panic disorder, eating disorder. You name it.

Laura: The Covid-19 pandemic has put a heavy toll on peoples' mental health- could forest bathing be a potential public health resource for mental health? From your experience, do you have any ideas on how to communicate this to the public?
Dr. Qing Li: I would like to give the following information on the relationship between forest bathing and COVID-19 to the public:

The relationship among forest bathing and Immune function and COVID-19

  1. Elderly people with impaired immune function are easy to develop COVID-19 and become more severe, and the mortality rate is also higher.
  2. Patients with underlying diseases such as diabetes, hypertension, heart diseases and respiratory diseases are also easy to get serious and have a high mortality rate because of the reduced immune function in these patients.
  3. Therefore, immune function is very important to prevent COVID-19. 
  4. In fact, Shinrin-yoku boosts immune function. 
  5. Therefore, Shinrin-yoku may have a preventive effect on COVID-19.

The relationship among forest bathing and mental stress and the outbreak of COVID-19

  1. Mental stress and various mental disorders due to “lockdown” and “isolation” are also major social problems.
  2. In fact, Shinrin-yoku reduces the symptoms of anxiety, depression, anger, fatigue and confusion, reduces stress and stress hormones, and increases vigor. 
  3. Therefore, Shinrin-yoku may have preventive effect on COVID-19-induced mental stress and mental disorders.

Take home message: Let’s go to forest bathing to overcome COVID-19

Laura: How can one get started with a forest bath, and what steps can be done to maximize the health benefits? For those without access to a forest, how could they have the forest bath experience in a park?

Dr. Qing Li: It is very important to use five senses to start a forest bathing as follows:
Sense of sight: green color, yellow color, natural colors, forest and natural landscape
Sense of smell: special good smell, fragrance from plants and trees called phytoncides
Sense of hearing: forest sounds, nature sounds, bird song, murmuring of river, sounds of the wind, etc
Sense of touch: Touching trees, put your whole body in the forest and nature atmosphere,
Sense of taste: Eating foods from forests and nature, taste the fresh air in forests and nature, drink water from forest and nature.

I have ten tips for Shinrin-yoku as follows:

  1. Make a plan based on your own physical abilities and avoid tiring yourself out.
  2. If you have an entire day, stay in the forest for about 4 hours and walk about 5 kilometres. If you have just a half day, stay in the forest for about 2 hours and walk about 2.5 kilometres.
  3. Take a rest whenever you have tired.
  4. Drink water/tea whenever you feel thirsty.
  5. Find a place you like, then sit for a while and read or enjoy the scenery.
  6. If possible, bathe in a hot spring after the forest trip.
  7. Select the forest bathing course based on your aims.
  8. If you want to boost your immunity (natural killer activity), a three-day/two-night trip is recommended. The effect of a three-day/two-night forest bathing can last 30 days, so it is better to take a three-day/two-night forest bathing once a month. 
  9. If you just want to relax and relieve stress, a day trip to a forested park near your home would be recommended. The effect of a day trip of forest bathing can last 7 days, so it is better to take a day trip of forest bathing once a week.
  10. Forest bathing is a preventive measure, so if you come down with an illness, see a doctor.

If the park is enough big and there are lots of big trees, walking in city parks also may have benefits. 
My studies have shown that walking in city parks can reduce negative emotions such as anxiety, depression, anger, fatigue, confusion and improve your positive feelings such as vigor. Walking in city parks also can reduce stress and stress hormones.
Therefore, for those without access to a forest, they also can enjoy forest bathing in big city parks and steps are similar to forest bathing in a forest. (Five senses).

Laura: Many families are following lock-down regulations and must remain at home during the Covid-19 pandemic-do you have any tips for family forest bathing with children? Are there any specific benefits of forest bathing shown with children and youth?

Dr. Qing Li: You can take children to do forest bathing in city parks, my studies have shown that walking in city parks can reduce negative emotions such as anxiety, depression, anger, fatigue, confusion and improve your positive feelings such as vigor. Walking in city parks also can reduce stress and stress hormones.
You can use aroma inside your homes to enjoy the sense of smell of forest bathing.
You can put some plants inside your homes to enjoy the sense of sight of forest bathing.
You can watch video (YouTube) taken from forest landscape to enjoy the senses of sight and hearing.  Walking in your back yard also has a small effect.
I have published the following paper with Italian researchers: (also see PDF file attached)

pubmed.ncbi.nlm.nih.gov/33143327/

Comparative Study of the Restorative Effects of Forest and Urban Videos during COVID-19 Lockdown: Intrinsic and Benchmark Values. Zabini F, Albanese L, Becheri FR, Gavazzi G, Giganti F, Giovanelli F, Gronchi G, Guazzini A, Laurino M, Li Q, Marzi T, Mastorci F, Meneguzzo F, Righi S, Viggiano MP.Int J Environ Res Public Health. 2020 Oct 30;17(21):8011. doi: 10.3390/ijerph17218011.

Laura: Have you developed forest bathing protocols? If so, are there any protocols that should be followed to maximize the health benefits?

Dr. Qing Li: The protocols are as follows:

  1. If you have an entire day, stay in the forest for about 4 hours and walk about 5 kilometres. If you have just a half day, stay in the forest for about 2 hours and walk about 2.5 kilometres. 
  2. If you want to boost your immunity (natural killer activity), a three-day/two-night trip is recommended.
  3. If you just want to relax and relieve stress, a day trip to a forested park near your home would be recommended.

Laura: There are a growing number of international Shinrin Yoku/forest bathing studies being conducted, is there anything you would like to see in future research on forest bathing?

Dr. Qing Li: In the future, forest bathing can apply to the following three fields:

  1. Preventive Medicine: Forest bathing may be a preventive medicine for some diseases, such as hypertension and depression.
  2. Clinical Medicine: Forest bathing may apply to clinical medicine to treat some diseases such as hypertension and depression; or to reduce the dose of medicine.
  3. Rehabilitation Medicine: Forest bathing may apply to rehabilitation medicine.

Take home message: Let’s go to forest bathing to overcome COVID-19
If you want to know more about forest bathing/shinrin-yoku, please read my book: Shinrin-yoku (https://www.penguin.co.uk/books/308285/shinrin-yoku/9780241346952.html) and Into the Forest (https://www.penguin.co.uk/books/312/312580/into-the-forest/9780241377598.html).