Physiological and psychological outcomes of a community-based Kurort Health Walking program: A before–after study

Article Abstract
Objective
This study aimed to evaluate short-term physiological and psychological changes associated with participation in a community-based Kurort Health Walking program conducted in a forest environment.

Patients and methods
This study was conducted as part of a public health program in Saikai City, Nagasaki, Japan. A total of 90 participants who attended certified Kurort Health Walking courses between March 2024 and March 2025 were included. Physiological parameters, including systolic and diastolic blood pressure and pulse rate, and psychological status were assessed before and after the walking session. Autonomic nervous activity was evaluated using heart rate variability indices, including the low-frequency/high-frequency ratio and high-frequency power, measured at four time points before, during, and after the walk. Mood states were assessed using validated questionnaires.

Results
Systolic and diastolic blood pressure decreased significantly after the walking session (p < 0.001). Neither the low-frequency/high-frequency ratio nor high-frequency power showed significant changes across the measurement points. Negative mood states decreased significantly, whereas positive mood states, including vigor, friendliness, pleasure, and relaxation, increased, and anxiety decreased after walking (p < 0.001).

Conclusion
Participation in the community-based Kurort Health Walking program was associated with short-term changes in physiological and psychological measures. However, because this study did not include a control group, the independent contributions of the forest environment, physical activity, and other contextual factors could not be distinguished.