Shuda · Complementary therapies in medicine 2020 · systematic review · n=12 studies

Effect of nature exposure on perceived and physiologic stress: A systematic review.

Cited 147 times in the scientific literature.

Level 2 - randomized trial

Systematic review combining randomized controlled trials and cross-sectional studies.

PubMed 33066853 · doi:10.1016/j.ctim.2020.102514 · record verified 2026-08-31

What was done

Researchers systematically reviewed PubMed and JSTOR for randomized controlled trials and cross-sectional studies assessing real or simulated nature exposure against controls in cohorts of more than 30 male and female volunteers. Twelve studies met criteria. Measured outcomes included perceived stress (PSS, DASS) and physiological markers (salivary cortisol, blood pressure, fMRI neural activation, heart rate variability, skin conductance, muscle tension, respiratory sinus arrhythmia, and pulse transit time).

What was found

The abstract provides directional results without numerical effect sizes or confidence intervals. An inverse relationship between nature exposure and physiological stress markers was observed in all 7 studies measuring physiological parameters. Nature exposure was associated with lower perceived stress on PSS and DASS in 5 of 6 studies evaluating self-reported stress.

Why it matters

This review aggregates multi-modal evidence indicating that contact with nature, whether real or simulated, consistently associates with decreased subjective and autonomic stress markers.

Limits

No quantitative effect sizes, confidence intervals, or meta-analytic syntheses are provided in the abstract. The search was limited to two databases and included cross-sectional designs alongside trials. Total participant numbers, nature exposure types (real vs. simulated), exposure durations, and specific cohort health statuses are not reported in the abstract.

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