SOUTH AFRICAN LIFESTYLE MEDICINE ASSOCIATION

A Walk to Remember: Reflections from SALMA’s First Guided Forest Bathing Experience

 

By Dr Nyasha Gogoma | 31 May 2025

Nestled between the established Johannesburg suburbs of Houghton and Killarney lies a perhaps lesser-known ecological sanctuary: The Wilds Nature Reserve. Spanning 16 hectares, this urban green space features bushy highveld koppie, dense pockets of indigenous evergreen forest, and serene ponds accessible by stone paths and steps.1,2 Managed by Johannesburg City Parks and Zoo, The Wilds is open daily from dawn to dusk, offering free access to the public.2 In recognition of Lifestyle Medicine Week, this natural wonder served as the setting for the South African Lifestyle Medicine Association’s (SALMA) first official forest therapy walk.

Forest therapy is a broad term that encompasses various group and individual activities that are marked by slow and mindful engagement in immersive, multisensory experiences in forests and other natural or seminatural environments.3 Participants typically engage in such activities to improve their mental and physical health.3 Related terms include nature therapy, forest walking, forest healing, and forest bathing, and these all have conceptual roots in Shinrin-yoku—a term coined by Japan’s Ministry of Agriculture, Forestry, and Fisheries in 1982.3,4 Transliterated as “forest bathing,” Shinrin-yoku refers to the immersive practice of engaging with the forest environment through all senses, promoting psychophysiological relaxation.3,4

Two representative theories, the stress recovery theory and the attention recovery theory, propose the main mechanisms by which forest therapy provides healing to humans. Ulrich et al. founded the stress recovery theory, positing that exposure to nature not only improves one’s emotional state but also benefits physiological markers such as heart rate, muscle tone, and blood pressure.5 In the attention recovery theory, Kaplan supposed that being present in the natural environment means being away from daily life, thereby reducing fatigue as no effort is required.5

These theories are strongly supported, as the therapeutic potential of forest exposure is well-documented across multiple physiological systems. A growing body of literature highlights its immunomodulatory, stress-reducing, and mood boosting benefits. Immunomodulatory effects of forest bathing include enhancement of natural killer (NK) cell activity and upregulation of anti-cancer proteins such as granulysin, perforin, and granzymes. These immune responses contribute to improved defense against malignancies and infections.5

Cardiovascular and stress-busting benefits include reductions in heart rate and blood pressure, attributed to decreased sympathetic activity and lower circulating levels of the stress hormone cortisol.5,6  In addition, forest exposure has been associated with improved sleep quality, elevated mood, increased energy levels, enhanced attentional control, and expedited recovery from acute illness.7 Finally, mental health benefits of forest immersion include a reduction in symptoms of depression and negative repetitive thought patterns, as well as increased feelings of compassion.8

These immune-enhancing and stress-reducing outcomes are thought to be mediated in part by exposure to phytoncides—volatile organic compounds released by trees and other plants to protect themselves from pests and disease.5 Phytoncides such as alpha-pinene (from pine species), camphene (pine and fir), limonene (citrus), and myrcene (found in lemongrass, mango, and cardamom) are released into the air surrounding trees and exert their effects in humans when inhaled.5,9,10

As a lifestyle medicine physician, I had the opportunity to facilitate this structured forest therapy experience. Drawing heavily from the Association of Nature and Forest Therapy (ANFT) Way, I guided the group in the three sequential phases of forest therapy: connection, the liminal space, and incorporation.11

Connection Phase: This initial stage involved participant arrival and orientation, and took place on the Fever Tree Lawn. Attendees were introduced to the principles of forest therapy, including its origins, mechanisms, and empirically supported health benefits. A brief mindfulness-based stress reduction (MBSR) breathing exercise was included to support grounding and sensory activation. Participants were encouraged to engage their full range of senses: sight, smell, hearing, touch, and taste while cultivating increasing present-moment awareness.

“The magic of the forest lies in its mysteries.
The more I search, the less I find.
The less I try, the more I heal.”12

Liminal Phase (Walking Segment): The liminal phase, or “in-between”, entailed a slow, silent walk through the reserve, designed to deepen the participants’ embodied mindfulness. This stage is called liminal because it lies between the ordinary life experienced before and after the walk.11 The route extended from the main entrance along the service road to the disused greenhouses, up the koppie to the sundial and ostrich sculptures, where participants viewed the city skyline, and back down Route 23 to the Owl Forest and Bushwillow Pond. Participants were invited to move at their own pace and rest intermittently, allowing for autonomous interaction with the landscape. Stillness and silence were emphasized to promote internal observation and sensory integration.

Incorporation Phase: The final segment took place on Giraffe Lawn, adjacent to a tranquil pond. Participants engaged in a 15-minute guided MBSR body scan, after which a group reflection was facilitated. Anecdotal feedback was overwhelmingly positive, with individuals reporting a renewed sense of spiritual connectedness, mental clarity, and emotional calm. Several participants described feelings of childlike wonder, enhanced creativity, and a therapeutic sense of perspective upon viewing the city skyline from a detached natural vantage point, echoing Kaplan’s theory of attention recovery.

SALMA’s inaugural forest therapy event was met with strong participation and favorable qualitative feedback. The health-promoting effects of forest immersion are well-supported in the scientific literature, with evidence suggesting that benefits may persist for several weeks following a single session. Regular engagement—ideally on a monthly basis—may offer sustained physiological and psychological advantages for patients and healthcare professionals alike. As the field of lifestyle medicine continues to expand, integrating evidence-based nature therapy practices into preventative and therapeutic wellness strategies holds significant promise for enhancing patient care and clinician well-being.

 

References

  1. Johannesburg City Parks and Zoo. The Wilds Nature Reserve. https://www.jhbcityparksandzoo.com/services-facilities/nature-reserves-bird-sanctuary/find-a-reserve/the-wilds-nature-reserve
  2. Wikipedia Contributors. The Wilds (Johannesburg). Wikipedia. Published August 24, 2024. https://en.wikipedia.org/wiki/The_Wilds_(Johannesburg)#Features_and_vegetation
  3. Gobster PH, Schultz CL, Kruger LE, Henderson JR. Forest Therapy Trails: A Conceptual Framework and Scoping Review of Research. Forests. 2022;13(10):1613. https://doi.org/10.3390/f13101613
  4. Kotera Y, Richardson M, Sheffield D. Effects of Shinrin-Yoku (Forest Bathing) and Nature Therapy on Mental Health: a Systematic Review and Meta-analysis. International Journal of Mental Health and Addiction. 2020;20(1):337-361. https://doi.org/10.1007/s11469-020-00363-4
  5. Yi Y, Seo E, An J. Does Forest Therapy Have Physio-Psychological Benefits? A Systematic Review and Meta-Analysis of Randomized Controlled Trials. International Journal of Environmental Research and Public Health. 2022;19(17):10512. https://doi.org/10.3390/ijerph191710512
  6. Park BJ, Tsunetsugu Y, Kasetani T, Kagawa T, Miyazaki Y. The physiological effects of Shinrin-yoku (taking in the forest atmosphere or forest bathing): evidence from field experiments in 24 forests across Japan. Environmental Health and Preventive Medicine. 2009;15(1):18-26. https://doi.org/10.1007/s12199-009-0086-9
  7. Jimenez M, DeVille N, Elliott E, et al. Associations between Nature Exposure and Health: a Review of the Evidence. International Journal of Environmental Research and Public Health. 2021;18(9). https://doi.org/10.3390/ijerph18094790
  8. Szitás D, Halamová J, Ottingerová L, Schroevers M. The effects of forest bathing on self-criticism, self-compassion, and self-protection: A systematic review. Journal of Environmental Psychology. 2024;97:102372. https://doi.org/10.1016/j.jenvp.2024.102372
  9. Heo SJ, Park SK, Jee YS. Effects of phytoncide on immune cells and psychological stress of gynecological cancer survivors: randomized controlled trials. Journal of exercise rehabilitation. 2023;19(3):170-180. https://doi.org/10.12965/jer.2346150.075
  10. Zorić M, Saša Kostić, Nebojša Kladar, et al. Phytochemical Screening of Volatile Organic Compounds in Three Common Coniferous Tree Species in Terms of Forest Ecosystem Services. Forests. 2021;12(7):928-928. https://doi.org/10.3390/f12070928
  11. Clifford MA, Page B. The ANFT Way of Forest Therapy. Association of Nature and Forest Therapy Guides and Programs; 2019:34-35. https://anft.earth/
  12. Forest Walks. Healing Forest. Published March 3, 2016. https://healingforest.org/walks/