The Efficacy of Forest-based Exercise Program as an Alternative Primary Prevention of CAD in Korea

PURPOSE: To compare the effect of unstructured forest-based exercise(UFBE) with structured center-based exercise(SCBE) in improving CAD risk factors, and verify the efficacy of forest-based exercise program for primary prevention. METHODS: Participants with cardiometabolic risks (metabolic syndrome, hypertension, diabetes) were recruited from a local area by health screening and randomly divided into two groups (UFBE: 67.9 ± 8.3 yr vs SCBE: 65.5 ± 3.9 yr). UFBE group took part in the intensive education program at National Forest Healing Center for 1 week followed by self-directed forest-tracking with minimum supervision for the next 11 weeks. SCBE group took part in the supervised exercise program consisting of both aerobic and resistance workouts for 12 weeks. Cardiometabolic variables were compared by using 2 x 2 (Group x Time) repeated ANOVA. Independent t-test compared energy expenditure between two groups. RESULTS: Body Weight-kg(63.95 ± 8.4 to 61.46 ± 7.6 vs 57.78 ± 5.84 to 57.48 ± 5.52, p < 0.001), %Body Fat (34.46 ± 8.3 to 31.97 ± 8.8 vs 33.66 ± 6.45 to 32.49 ± 6.86, p < 0.001), LDL-mg/dL (116 ± 40.6 to 105.91 ± 38.2 vs 120.59 ± 59.1 to 96.71 ± 41.2, p = 0.029), HDL-mg/dL (56.64 ± 9.1 to 64.64 ± 11.5 vs 58.0 ± 10.64 to 59.47 ± 9.55, p < 0.001), SBP-mmHg (132.4 ± 7.3 to 123.27 ± 12.4 vs 133.83 ± 19.92 to 126.24 ± 12.8, p = 0.031), Absolute Risk-% (11.18 ± 5.13 to 6.45 ± 3.45 vs 9.59 ± 6.55 to 7.76 ± 5.86, p < 0.001), Relative Risk (1.31 ± 0.53 to 0.79 ± 0.43 vs 1.22 ± 0.82 to 0.99 ± 0.74, p < 0.001) were changed significantly in both groups without difference between groups. VO2peak-ml/kg/min (32.48 ± 5.7 to 40.72 ± 38.2 vs 26.68 ± 10.92to 28.58 ± 11.76, P < 0.001) and METpeak (9.44 ± 1.77 to 11.67 ± 1.5 vs 7.61 ± 3.12 to 8.13 ± 3.3, p < 0.001) changed significantly in both groups as well as these variables showed significant difference between groups (p = 0.032 and p = 0.023, respectively). Average energy expenditure of physical activity showed significant difference between two groups (2568 ± 969 vs 1399.40 ± 40, p = 0.0018). CONCLUSION: We confirmed UFBE was as effective as SCBE in improving CAD risks. Higher amount of energy expenditure and the accompanied higher changes of VO2peak and METpeak showed in UFBE implies this group was more motivated to active lifestyle.