Nature-based interventions in fibromyalgia.
| Study | Design | Population | Intervention | Main outcomes | Key findings | Major limitations |
|---|---|---|---|---|---|---|
| Yavne et al., 2019 [28] | Prospective cohort | Women with FM | Floristry-based therapy program | SF-36, FIQ, depression and anxiety measures | Significant improvements in physical health, mental health, depression, anxiety, and FM-related symptoms | No control group; limited generalizability |
| López-Pousa et al., 2015 [29] | Pilot intervention | Patients with FM | Aerobic exercise in a mature forest | Pain, insomnia, well-being | Reduced perceived pain and insomnia; improved well-being | Small sample size; difficult to isolate effect of forest exposure from exercise |
| Gungormus et al., 2024 [30] | RCT | Women with FM | Multisensory nature-based stimulation | Pain intensity and pain threshold | Reduced pain intensity and increased pain threshold | Short-term intervention |
| Serrat et al., 2023 [31] | Pilot intervention | Patients with FM and ME/CFS | Guided forest bathing/hiking | Pain, anxiety, depression, insomnia, mood, mindfulness | Improvements across psychological and symptom domains | Limited sample size; lack of long-term follow-up |
| Serrat et al., 2020 (NAT-FM) [32] | RCT | Patients with FM | Multicomponent intervention including education, exercise, psychological support, and nature exposure | Physical activity, kinesiophobia, coping, self-efficacy, emotional regulation | Improvements in PRO | Contribution of nature exposure cannot be determined |
FIQ: fibromyalgia impact questionnaire; FM: fibromyalgia; ME/CFS: Myalgic Encephalomyelitis/Chronic Fatigue Syndrome; PRO: patient-reported outcomes; RCT: randomized controlled trial; SF-36: Short Form-36 Health Survey.