A Conceptual Framework of Forest Therapy as an Innovative Health Approach Combined with Local Health Resort Medicine in Alpine Regions to Increase Mental Health and Well-Being

Research Article

Phys Med Rehabil Int. 2021; 8(2): 1179.

A Conceptual Framework of Forest Therapy as an Innovative Health Approach Combined with Local Health Resort Medicine in Alpine Regions to Increase Mental Health and Well-Being

Immich G1,2,3* and Schuh A1,2,3

1Chair of Public Health & Health Services Research at the Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-University Munich, Germany

2Pettenkofer School of Public Health, Ludwig Maximilians-University Munich, Germany

3Competence Center of Forest Medicine and Nature Therapy, Bad Wörishofen, Germany

*Corresponding author: Immich G, Chair of Public Health & Health Services Research at the Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-University Munich, Germany; Pettenkofer School of Public Health, Ludwig Maximilians-University Munich, Germany; Competence Center of Forest Medicine and Nature Therapy, Bad Wörishofen, Germany

Received: May 05, 2021; Accepted: June 12, 2021; Published: June 19, 2021


Introduction: There has been a constant increase in mental health disorders in Western industrialized nations, and the current Covid 19 pandemic is increasingly exacerbating the problem. The health resorts in Germany are well equipped to improve mental, emotional and physical health with their local remedies and procedures to improve the individual health status.

Method: The available alpine health resort procedures/interventions as well as the novel forest therapy with their various effects are described in order to develop a novel health resort concept for the treatment of mental-health disorders and well-being.

Result: Based on the principles of health resort medicine and the available alpine interventions, a three-week treatment concept has been developed. Different procedures such as climatotherapy, balneotherapy, forest therapy & nature connection, mindfulness practice and physiotherapy have been combined in a healthy manner. Alpine health resorts are particularly well suited because of their excellent health-promoting climate factors.

Conclusion: The novel combination of HRM with forest therapy will to lead to stress reduction and an increase in mental health and general well-being. This new approach shows promising benefits for future health resort treatments. Studies on this new approach are needed to confirm the effectiveness of the conceptual framework.

Keywords: Health resort medicine; Forest therapy; Climatotherapy; Cure regime; Prevention; Mental health; Well-being


The mental health crisis is worldwide increasing, especially in cities. Prior to covid-19 pandemic, 12% of the German population were already seriously mentally ill and 28% of the population already experienced mild mental illnesses [1], 34% of the reasons for occupational disability were mental illness with an average duration of a sick note of 33.7 days. Another survey classifies one in six Europeans as mentally ill [2]) with rising trend. These data indicate that mental and behavioral disorders represent a serious public health issue which will be accelerates and worsens by the current covid-19 pandemic worldwide [3]. On the other hand, health resorts are special places that are conducive to good health [4]. They are located in high mountain areas, on the shore and in low mountain areas and mainly situated in a preferred quiet natural environment with special climatic conditions that are beneficial to health. The traditional Health Resort Medicine (HRM) is well known for its wealth of experience and sound scientific evidence of the effectiveness of its local resources [5]. New health resort concepts for future medical topics have already been conceived, evaluated and implemented in different German health resorts which demonstrate sustainable results in the improvement of various diseases [6-8]. HRM offers different therapeutic options for the treatment of gastrointestinal, circulatory, respiratory, bone and joint, psychosomatic and mental health diseases, and skin and soft tissue disorders. This paper will highlight the positive effects of HRM in alpine areas and highlight the benefit of forest therapy as a new additive therapeutical approach.

Materials and Methods

Health resort medicine

Health Resort Medicine (HRM) can be described as a field of medicine with long-lasting tradition worldwide [4]. HRM includes different interventions and methods for health promotion, prevention, therapy and rehabilitation based on its local natural resources. The health-promoting health resort atmosphere is very important for the recovery of the patients. The quiet tranquil and well-structured health resort is mostly surrounded by nature and offers relief from urban noise, heat and air pollutants. Additional to the health-promoting environment, the different interventions and methods have been structured chronobiologically in a 1-3 week cure regime [6-8]. Each therapeutic intervention will be scheduled in a chronobiological order at the optimal time of day to increase the success of the intervention. For example, psychoeducation should be planned for the later morning, as concentration and attention to cognitive tasks are highest [9]. Hot applications such as sauna should not be carried out in the evening, as they impede the chronobiologically controlled temperature reduction of the body. Another HRM principle is the daily alternation of load and rest in order to increase the ability to recover. This should prevent physical overstrain during recovery [10].

Local natural resources of an (alpine) health resort: its specific climate

There are a variety of local health resort resources in mountain areas available such as thermal water, gases or specific climatic conditions. The most important natural “remedy” in alpine health resort the mountain climate itself. The high mountain climate is predominantly irritant intensive, but is also characterized by the relieving effect of the climate factors high air purity and allergen reduction [11]. With increasing altitude, solar radiation and wind speed increase, while air pressure, oxygen partial pressure, water vapour pressure and air temperature decrease. The high mountain climate is particularly advantageous for people with allergies, as the short vegetation phase and the altitude significantly reduces pollen and mould and, from 1600 above sea level, house dust mites are no longer present [12]. The mountain climate has particularly pure, clean air, which is enhanced by the abundance of forests. This affects positively the relief of the respiratory tract due to the absence of anthropogenic pollutants, which is important for the prevention and therapy of lung diseases [13].

In the high mountains, there are also particularly high UVB radiation intensities all year round, which can be used to promote health and therapeutically to stimulate vitamin D synthesis in the skin [13]. This procedure is called heliotherapy and is performed without cosmetic skin protection in order not to limit the biopositive effects of UVB radiation. Therefore, it is important to ensure that the radiation doses of the individual heliotherapeutic units are applied in suberythematous doses. In addition to heliotherapy, the high light intensities can also be used therapeutically for the readjustment of the circadian rhythm or for the therapy of the seasonal affective disorder, e.g. in the case of derhythmization of the inner clock through a constant indoor lifestyle.

As the altitude increases, the air temperature, the oxygen content of the air and the air humidity decrease. These climatic factors will be used when conducting the climatic terrain cure which is an endurance capacity training under cool skin temperature conditions [11]. As a result, sweat can evaporate more easily during physical activity and the thermoregulation system is relieved which is beneficial for patients suffering on atopic or non-allergic skin diseases.

In summary, the clean, cool air in combination with the alpine altitude and the abundance of forests are particularly favourable climatic health factors.

Interventions in health resort medicine

The core HRM interventions consists of (1) Balneotherapy (usage of natural mineral water/medical peloids/natural gases for bathing, drinking or inhalation), (2) Hydrotherapy (application of plain water), and (3) Climatotherapy (therapeutic usage of climatic factors) [14]. Rehabilitation strategies in HRM may include physiotherapeutic methods such as therapeutic massage, water massage, numerous forms of exercise such as water exercise, breathing, balance, and muscle-strengthening and endurance exercises, health education in form of psychoeducational seminars, psychological interventions, and other complementary treatments [15].

Forest therapy in health resort medicine

“Forest therapy” is derived from the Japanese original “Shinrin- Yoku” which literally means “immersion in the atmosphere of the forest” [16]. Because different terms are used internationally, we define “forest bathing” as the health-promoting and preventive use of the forest, whereas forest therapy describes the therapeutic application of forest visits. A large number of studies clearly prove the positive effects of forest visits on the psyche and mental well-being [17,18]. Positive emotional regulation by reduction of anxiety, anger, fatigue and sadness, increase of attentiveness and concentration. In addition to the mental improvement, the special forest climate with its cool and clean air and high humidity relieves the respiratory system [11]. Also, microbes and BVOCs show an influence on the human immune system [19,20]. In addition, visits to nature promote physical activity [21].

Besides the classical health resort medicine, forest therapy qualifies as a new innovative approach in HRM [22]. Forest therapy can be combined in a special HRM regime with mindfulness practice, nature connectedness, and health resorts elements like climatotherapy and hydrotherapy. The interventions are based on the scientific knowledge of medical climatology, naturopathic medicine, recreation and stress research as well as psychological and mindfulness knowledge. The forest-based program should be guided by a specially trained forest health trainers/forest therapy guide/forest therapist. Depending on the target group, different concepts of health promotion, prevention or therapy can be carried out in the natural environment of an alpine health resort [14].


The focus in the therapy of mental health disorders is the reduction of existing symptoms (emotionally and cognitive recuperation) as well as physical regeneration, and the improvement of sleep quality, everyday functions and participation which will be initiated by a conceptional framework of a multimodal 3 week cure program.

After arrival at the health resort, a medical admission examination including pneumological, internal and psychological diagnostics has to be conducted. Depending on the severity of the symptoms and the rehabilitation goals, individual therapy planning has to be carried out. The following innovative concept of a 3 week rehabilitation program is designed for patients with mental health disorders and reduced general well-being. This therapeutic cure region has now been compiled for the first time as a multimodal, health resort rehabilitation programme based on the principles of health resort medicine and its local health resort resource.

The new concept of a 3-week rehabilitation programme consists of a variety of different interventions that complement each other in their effects: 1) Specific health resort resources and its treatment (climatotherapy, balneotherapy); 2) Physiotherapy and respiratory therapy (inhalations); 3) Physical and endurance training, strength and balance training (e.g. climatotherapy); 4) Forest therapy for mental and emotional well-being and cognitive restoration (forestbased mindfulness practice, connection to nature, climatotherapy); 5) Psychoeducational trainings to impart knowledge about the disease and its effects, stress management training, introduction to mindfulness practice, teaching of naturopathic self-treatment forms as well as learning coping strategies on an individual level in order to better deal with the burden of disease now and in the future when back home. Additioanlly, if necessary, psychpsychological counseling for patients with post-traumatic stress disorder, depression and anxiety disorders like persistent fears are recommended.

The conceptual framework of a 3-week therapy plan for increasing mental health and well-being in an alpine health resort is chronobiologially structured and a balanced alternation of stress and relief (change in the level of demand) as well as activation and deactivation (change in the level of activation) is necessary (Table 1) [10].

Citation: Immich G and Schuh A. A Conceptual Framework of Forest Therapy as an Innovative Health Approach Combined with Local Health Resort Medicine in Alpine Regions to Increase Mental Health and Well-Being. Phys Med Rehabil Int. 2021; 8(2): 1179.