Natural Forces Guide · Overview

Using Natural Forces in Everyday Life: Light, Cold, Heat, Movement, Air and Rhythm

These stimuli are not miracle remedies. Your body can respond to them with adaptation when the dose, the pause and your starting point are right. Here you will find which parts are guideline, which are observation, which are small studies and which are tradition.

SJ
Shukri Jarmoukli · Physician, Integrative Medicine · ViveCura Berlin
Light, cold, heat, movement, air, rhythm Hormesis and its limits From guideline to tradition 62 checked sources, 60 of them with a DOI
My starting point

Many of us live in a friendly, permanent middle ground: 21 degrees, artificial light, sitting, the same air from morning to night. But our bodies evolved in a world that fluctuated.

So the question is not whether stimuli are healthy. The question is which ones, how much, when and for whom.

Just before seven. You are standing in the shower, hand on the lever. Yesterday you read that cold water is supposed to make you more resilient.

The day before, it was morning light. Before that, ice bathing, breathing exercises, walking barefoot and sauna four times a week. Each single recommendation sounds reasonable.

Many people know what happens next. Five good ideas turn into a list that creates more pressure than it gives strength.

This article is the overview of natural forces in everyday life: light, cold, heat, movement, air and rhythm, plus nature, forest and Kneipp. For depth there are separate articles, which I point to in the right places. What connects all of these forces has a name: hormesis. It is the common thread of this text, and its limits matter just as much as its promise.

Before you read on

Cold and heat are not a harmless stimulus for every body

If you have cardiovascular disease, heart rhythm disorders, uncontrolled high blood pressure, Raynaud's, cold urticaria or epilepsy, or if you are pregnant, discuss cold and heat stimuli with your doctor first.

Never go into open cold water alone, and never combine cold water with breathing exercises or breath holding. Prescribed medication, such as blood pressure medication or antidepressants, is not changed, reduced or stopped on your own because of sauna, cold or light. With chest pain, sudden shortness of breath, impaired consciousness, new paralysis or a speech disorder: call 112 immediately (the emergency number in Germany and across the EU). More on this in the safety section at the end.

If you have suicidal thoughts or are in an emotional crisis, get help immediately: you can reach the Telefonseelsorge around the clock and free of charge at 0800 111 0 111 and 0800 111 0 222 (these are German numbers; outside Germany, please use your local crisis line), and in acute danger call 112 or go to the nearest psychiatric hospital or emergency department.

What to expect here

  • Hormesis and its limits
  • Light and light therapy
  • Cold showers, contrast showers
  • Sauna and warm baths
  • Nature, breathing, air, rhythm
  • Kneipp, safety, getting started
Guideline guideline or expert consensus RCT / Meta randomized or pooled Observation cohort, cross-sectional, small laboratory study Overview review, commentary, hypothesis Animal model here only via reviews Cell model here only via reviews

The dose makes the stimulus: hormesis as the common thread

Do you remember your first splash of cold water? First the shock. Then a strange clarity in your head.

Maybe you also know the other end. Too long in a cold lake, then chilled to the bone for hours, shaky, empty. The same stimulus, a different amount, a different result.

This very pattern is described by a term from toxicology. There, hormesis refers to a biphasic dose response: a low dose stimulates or benefits, a high dose inhibits or harms. In biology and medicine, the term refers to an adaptive response to moderate, usually intermittent stress. Imagine a muscle: a few repetitions with rest can make it stronger over time, a hundred without rest can injure it.

The principle as a sketch adaptation possible too much: strain, harm no effect dose, duration, frequency Effect

Schematic sketch, not measured data. Where the curve crosses the zero line for you depends on your starting point, sleep and recovery.

Mechanistically plausible, not proven in humans

What is described in cells and animal models

Cell models, via reviewAnimal models, via review
  • A moderate stimulus can set signaling pathways in motion. As examples, a review by Mattson names exercise, energy restriction, a brief targeted reduction in blood flow and low doses of certain plant compounds.
  • Switches such as Nrf-2 and NF-kappaB can activate genes, and the cell can produce more protective proteins, such as antioxidant enzymes.
  • For the mitochondria this is called mitohormesis: beneficial consequences of low mitochondrial stress, first studied in invertebrates and cell cultures, and now also in mammalian models.

These steps come mostly from cell and animal models, summarized in reviews (Mattson 2008, PMID: 18162444; Gunawan, Liparulo, Stahl 2025, PMID: 40926120). They do not show that an everyday stimulus plays out exactly this way in your body.

Where the word comes from

The observation is older than the word. In the 1880s, the Greifswald physician Hugo Schulz studied what disinfectants do to yeasts: high doses inhibited their metabolism, low doses seemed to do the opposite. Together with Rudolph Arndt, this became the Arndt-Schulz law. Schulz, however, saw it as the explanatory principle of homeopathy. According to a historical analysis by Calabrese, himself a prominent proponent of the concept, it was precisely this connection that caused the idea to be rejected for decades.

The word only came in 1943: Southam and Ehrlich used it to describe how extracts from red cedar wood affected wood-decaying fungi, derived from the Greek word for to stimulate. So it comes from fungal research, not from the wellness world.

Two readings, both belong here

A revolution in dose response or an overgeneralization?

ProponentsCalabrese and Baldwin describe hormesis as frequently observed and broadly generalizable, independent of agent, model and endpoint.
CriticsA team around Thayer calls the assumption that hormesis is generally adaptive an oversimplification. Axelrod and colleagues warn that extrapolations ignore exposure and human susceptibility.

Even the critics do not dispute that low doses can have different effects. They warn against making a law out of individual findings. Here, hormesis is therefore a way of thinking about dose, pause and recovery, not proof that every cold or heat exposure is healthy.

What studies in humans show: the stimulus itself counts

Controlled trial, 39 men When protection takes away the stimulus

A team around Ristow had 19 untrained and 20 trained young men exercise for four weeks, with or without vitamin C and E (in the study 1000 mg vitamin C and 400 IU vitamin E per day).

Insulin sensitivity increased with training in both groups only without the antioxidants, and the body's own protective enzymes were also not upregulated in the same way under the vitamins.

What this means for you: the small oxidative stimulus of exercise appears to be part of its benefit. This does not amount to a recommendation against vitamins.

Ristow M, Zarse K, Oberbach A, et al. Proc Natl Acad Sci U S A. 2009;106(21):8665-70. PMID: 19433800 · DOI: 10.1073/pnas.0903485106 [Controlled Clinical Trial]
RCT, 21 men Two stimuli that can interfere

A team around Roberts followed 21 physically active men through 12 weeks of strength training. After each session came 10 minutes of cold water immersion or active recovery.

Strength and muscle mass increased more with active recovery than with cold water.

What this means for you: cold right after strength training could slow down exactly the adaptation you are working toward. Stimuli do not simply add up.

Roberts LA, Raastad T, Markworth JF, et al. J Physiol. 2015;593(18):4285-301. PMID: 26174323 · DOI: 10.1113/JP270570 [RCT]

For your everyday life this means: think in three steps, stimulus, pause, recovery. Start smaller than your ambition would like, and change only one stimulus at a time if possible. How hormesis plays out using cold as an example is covered in Cold, the immune system and hormesis, and why movement itself can be understood as a dosed stimulus in Exercise as medicine at the cellular level.

Shift in perspective

Hormesis does not mean: what doesn't kill you makes you stronger. It means: the right amount at the right time can invite the body to adapt. The wrong amount is simply stress.

And now you know why this article talks so often about dose, pause and starting point.

Light and darkness: the timekeeper of your day

Monday morning. The alarm goes off, and your body feels about two hours behind. In the evening, the opposite: tired eyes, but a wide-awake mind in front of the screen.

Many people see this as a matter of character. Part of it is predisposition. Another part is light.

Light-sensitive cells in the retina tell the master clock in the brain whether it is day or night, and in chronobiology light is considered the most important timekeeper of this clock. How it works in detail is covered in Chronobiology: morning light and the internal clock. Here the question is how much light makes sense and when.

Expert consensus for indoor spaces

Three numbers for three times of day

Expert consensus, healthy adults
min. 250 luxduring the day, melanopic EDI at the eye
max. 10 luxin the evening, starting at least 3 hours before sleep
max. 1 luxin the sleep environment

These values come from an international expert consensus around Brown for indoor spaces. Daylight should be used first, with artificial light as a supplement. This is a lighting recommendation, not a clinical guideline, and melanopic EDI is not the number a lux app shows you.

Brown TM, Brainard GC, Cajochen C, et al. PLoS Biol. 2022;20(3):e3001571. PMID: 35298459 · DOI: 10.1371/journal.pbio.3001571 [Consensus Guideline, Expert Consensus]

Cohort, over 400,000 people More hours outdoors, better mood?

A team around Burns analyzed data from the UK Biobank: people aged 37 to 73 reported how many hours a day they spend outdoors in daylight, with a median of 2.5 hours.

Each additional hour was associated with lower odds of lifetime depression (95 percent confidence interval of the odds ratio 0.92 to 0.98), as well as with less tiredness and fewer insomnia symptoms.

What this means for you: people who spend more time in daylight report better mood and better sleep. Whether the light is the cause, or whether better mood tends to draw people outdoors, this study cannot separate.

Burns AC, Saxena R, Vetter C, Phillips AJK, Lane JM, Cain SW. J Affect Disord. 2021;295:347-352. PMID: 34488088 · DOI: 10.1016/j.jad.2021.08.056 [Cohort, Cross-sectional and Longitudinal]

Measured with light sensors in 88,905 people from the same biobank, brighter days were associated with a lower and brighter nights with a higher risk of death, each compared with darker environments. In older people in Japan, night-time light of 5 lux or more in the bedroom was associated with more frequent later depressive symptoms than less than 5 lux (HR 1.89). Both are observations. In the laboratory around Chang, people who read on a light-emitting e-book device in the evening instead of a printed book took longer to fall asleep and produced less melatonin. More on this in Blue light, circadian rhythm and sleep.

And the sun? It is a question of dose, depending on skin type, season, time of day and where you live, covered in detail in How much sun does the body need, and why it is often not enough for vitamin D in winter, in Vitamin D deficiency in winter. Red light devices are a different question from daylight, see Red light and infrared.

Light therapy: what the guideline says

Guideline German National Care Guideline (NVL) Unipolar Depression

Recommendation 9-4: “In depression with a seasonal pattern, a trial of light therapy shall be offered.” This is the strongest grade of recommendation (⇑⇑), with moderate certainty of evidence.

Recommendation 9-5: “In depression without a seasonal pattern, a trial of light therapy can be offered.” This is an open recommendation (⇔) with very low certainty of evidence. According to the guideline, light therapy is usually given in addition to and in support of other treatments, and only for mild and purely seasonal forms does the guideline group also consider a first treatment attempt as a stand-alone measure conceivable.

Bundesärztekammer, Kassenärztliche Bundesvereinigung, AWMF. Nationale VersorgungsLeitlinie Unipolare Depression, Kurzfassung, Version 3.2. 2022. DOI: 10.6101/AZQ/000506 [Guideline]

A meta-analysis around Pjrek pooled 19 randomized, blinded trials on seasonal depression. In 18 of them with 610 patients, depression scores under bright light were lower than under placebo conditions (standardized mean difference minus 0.37), in heterogeneous and rather small studies. Without a winter pattern, a meta-analysis around Menegaz de Almeida (11 studies, 858 patients) found remission with light as an add-on treatment in 40.7 percent compared with 23.5 percent in the control groups. For prevention, a Cochrane review found only one single study with 46 people, with very low quality of evidence.

For sleep disorders, the European insomnia guideline from 2023 names light therapy and exercise as possible adjuncts (grade of recommendation B) to cognitive behavioral therapy, which remains the first choice (A).

When it is more than a winter low

Depression is a serious illness, not a question of too little light or willpower. Light therapy belongs under medical or psychotherapeutic supervision. It does not replace treatment and is no reason to postpone treatment.

Prescribed antidepressants are never stopped or reduced on your own. Stopping abruptly carries its own risks, and any change belongs in the hands of the doctor who prescribed them. With bipolar disorder, light therapy also belongs under psychiatric supervision.

If you have suicidal thoughts, get help immediately. You can reach the Telefonseelsorge around the clock and free of charge at 0800 111 0 111 and 0800 111 0 222 (these are German numbers; outside Germany, please use your local crisis line). In acute danger, call 112 or go to the nearest psychiatric hospital or emergency department.

For everyday life this means: in the morning, go outdoors rather than just to the window, dim the lights in the evening, and keep the night as dark as possible. A personal number of minutes cannot be derived from this, but a direction can. In my clinical practice I observe that the evening is often the easier place to start, because dimming the lights is easier than getting up earlier. That is an observation, not a study finding.

Shift in perspective

Light is not only there for seeing. It is the time of day that your body reads.

And now you know why daylight in the morning and a dark bedroom at night belong together.

Cold: cold showers, contrast showers, cold water

Your hand is on the shower lever. One part of you has read that cold water makes you alert and resilient. Another part is still negotiating. Five seconds? Just the legs? Tomorrow?

You don't need to be ashamed of this negotiation. It is the sensible reaction of a body that initially classifies sudden cold as a threat.

When cold water hits the skin without warning, a cold shock response can follow: gasping, uncontrollable hyperventilation, a racing heart, narrowing of the blood vessels and a rise in blood pressure. A Norwegian review reports on a study in which gasping and hyperventilation were accompanied by reduced cerebral blood flow, disorientation and loss of consciousness. For immersion, Shattock and Tipton additionally describe the hypothesis of an autonomic conflict: cold shock drives the heart, the diving reflex slows it down, and both at once could favor rhythm disturbances in susceptible people. Cold water can be a threat or a treatment, depending on the circumstances, as a review around Tipton sums it up. More about the first minute in an ice bath is covered in Ice bathing for beginners.

RCT, 3,018 adults Fewer days off work, not less illness

In the Netherlands, a team around Buijze randomly assigned 3,018 adults without serious pre-existing conditions to four groups. Three of them showered as warm as they liked for 30 days and ended the shower with 30, 60 or 90 seconds of the coldest water, and the fourth was the control group.

In the cold shower groups there were 29 percent fewer self-reported sickness absence days from work (incidence rate ratio 0.71). For days of illness, there was no significant difference. No serious adverse events occurred, and 79 percent kept it up.

What this means for you: less often absent, but not measurably less often ill, in an unblinded study based on self-report.

Buijze GA, Sierevelt IN, van der Heijden BC, Dijkgraaf MG, Frings-Dresen MH. PLoS One. 2016;11(9):e0161749. PMID: 27631616 · DOI: 10.1371/journal.pone.0161749 [RCT]
Meta-analysis, 11 studies In the short term, more an inflammatory stimulus than an inflammatory brake

A team around Cain pooled 11 randomized trials in healthy adults on water of no more than 15 degrees Celsius. Of the 3,177 participants, 3,018 came from the shower study above.

Immediately afterwards and after one hour, inflammatory markers were elevated (standardized mean difference 1.03 and 1.26). Stress was lower after 12 hours (minus 1.00), but not at other time points. Sleep quality and quality of life improved, mood did not, although the sleep finding comes from a single study in men after heat training.

What this means for you: in the short term, cold appears to be more of an inflammatory stimulus, which fits the idea of hormesis. The authors name the limitations themselves: few studies, small groups, little diversity.

Cain T, Brinsley J, Bennett H, Nelson M, Maher C, Singh B. PLoS One. 2025;20(1):e0317615. PMID: 39879231 · DOI: 10.1371/journal.pone.0317615 [Systematic Review with Meta-analysis]

Through the lens of Clinical Psychoneuroimmunology this fits together: a cold stimulus can address nerves, stress hormones, the immune system and metabolism at the same time, and a brief inflammatory response can be part of an adaptation. A thinking model, not proven as a benefit in humans.

And metabolism? The Norwegian review of 104 studies writes cautiously that cold water appears to improve insulin sensitivity, in mostly small studies. It also leaves open whether winter swimmers are simply healthier to begin with. A frequently cited study around Hanssen found about 43 percent higher insulin sensitivity after 10 days of cold acclimation at 14 to 15 degrees Celsius. However, only eight people with type 2 diabetes were studied, and the abstract does not mention a comparison group. Mechanistically interesting, thinly supported in humans, and no reason to change diabetes treatment. The feeling of elation after 5 minutes of cold water has also been measured, in a study around Yankouskaya without a control group.

Contrast showers: a lot of tradition, few studies

By the way, the Dutch study did not test contrast showers, but a cold finish. For repeated alternation, only one randomized trial was found, in athletes.

RCT, 60 athletes After the break, the difference was gone

A team around Hagner-Derengowska randomly assigned 60 trained martial arts athletes: for four weeks after training, 10 minutes of contrast showering or 10 minutes of a thermoneutral shower.

After four weeks, resting heart rate, heart rate variability and perceived recovery had developed more favorably with contrast showers, with resting heart rate lower by 2.10 beats per minute. After a two week break, these differences had disappeared. Morning cortisol and the response of small blood vessels did not differ clearly.

What this means for you: contrast showers could show up in the short term in pulse and sense of recovery. According to the authors, statements about lasting adaptation should remain cautious.

Hagner-Derengowska M, Trybulski R, Kruk J, Clemente FM, Olchowy C, Pilis K. J Sports Sci Med. 2026;25(3):675-690. PMID: 42713556 · DOI: 10.52082/jssm.2026.675 [RCT]

Morning or evening? Direct comparisons are missing, but many people experience cold as activating and avoid it before sleep. If you are healthy and would like to try cold: step by step and starting warm, not directly after strength training, never into open cold water alone, and never breathing exercises in or near the water. More on cold and immune defense is covered in Cold, the immune system and hormesis, and on cold as a vagus stimulus in Gut-brain axis and vagus stimulation.

Shift in perspective

Fewer sick notes is not the same as less illness. The honest message of the largest study is quieter than its headline.

And now you know why the cold shower is a stimulus you can get to know, and not a protective shield.

Warmth: sauna, warm baths and the Finnish data

The door clicks shut. Wood, silence, a warmth that slowly creeps under your skin. After a few minutes, your thoughts grow quieter.

The best-known figures on sauna come from the Kuopio study in eastern Finland. Precisely because they are impressive, a close look is worthwhile.

Cohort, 2,315 men More frequent sauna, less frequent sudden cardiac death

Between 1984 and 1989, a team around Laukkanen asked a total of 2,315 men aged 42 to 60 how often they go to the sauna, and followed them for a median of 20.7 years.

Compared with one sauna session per week, the risk of sudden cardiac death with 2 to 3 sessions was HR 0.78 (0.57 to 1.07), meaning no significant difference, and with 4 to 7 sessions HR 0.37 (0.18 to 0.75). Similar associations were seen for cardiovascular death and all-cause mortality.

What this means for you: Finnish men who used the sauna frequently died less often of heart disease. That is not proof that the sauna is the cause.

Laukkanen T, Khan H, Zaccardi F, Laukkanen JA. JAMA Intern Med. 2015;175(4):542-8. PMID: 25705824 · DOI: 10.1001/jamainternmed.2014.8187 [Cohort, prospective]

In the same cohort, among 1,621 men without high blood pressure, 4 to 7 sauna sessions compared with one per week were associated with less frequent new-onset high blood pressure (HR 0.54; after further adjustment including fitness 0.53). Are sauna users simply fitter? In an analysis around Kunutsor with 2,277 men, high fitness was associated with a clearly lower risk of cardiovascular death (HR 0.51), and frequent sauna with a somewhat lower one (HR 0.74). Both together showed the lowest risk (HR 0.42 compared with low fitness and infrequent sauna). So fitness showed the stronger association.

Where the data draw a line

Sauna does not replace blood pressure treatment

Among 2,575 men, a systolic blood pressure of 140 or higher was associated with a higher risk of cardiovascular death even with frequent sauna (HR 1.52 compared with normal blood pressure and frequent sauna). Frequent sauna may offset the risk with high-normal, but not with elevated blood pressure, the authors conclude. A prescribed blood pressure medication is therefore neither stopped nor reduced because of sauna use.

Laukkanen JA, Jae SY, Kauhanen J, Kunutsor SK. J Nutr Health Aging. 2023;27(5):348-353. PMID: 37248758 · DOI: 10.1007/s12603-023-1895-1 [Cohort, prospective]

Three limitations apply to all of these figures. Only middle-aged men were studied, in a country with a deep sauna culture. The comparison group was one sauna session per week, or at most two in the combined analyses with fitness or blood pressure level, never no sauna at all. And the review that describes possible mechanisms, such as better vascular function and effects on the autonomic nervous system, comes from the same research group. Plausible, but not proof that the sauna is the cause. Dose and heart disease are covered in depth in Sauna and the heart: how often is healthy.

Meta-analysis, 17 studies Warmth before sleep

A team around Haghayegh included 17 studies on warm showers or baths before sleep and analyzed 13 of them in meta-analyses.

Water at 40 to 42.5 degrees Celsius was associated with better self-rated sleep quality. When the application took place 1 to 2 hours before bedtime, the time to fall asleep was shorter from a duration of just 10 minutes. The authors explain this with a stronger drop in core body temperature via the hands and feet.

What this means for you: for the evening, warmth is better studied than cold. The figures are study data, not instructions.

Haghayegh S, Khoshnevis S, Smolensky MH, Diller KR, Castriotta RJ. Sleep Med Rev. 2019;46:124-135. PMID: 31102877 · DOI: 10.1016/j.smrv.2019.04.008 [Systematic Review with Meta-analysis]

Warmth is also being studied in depression. In a double-blind study around Janssen with 29 analyzed adults not taking psychotropic medication, depression scores were lower over six weeks after a single session of whole-body hyperthermia than after a sham treatment. Clinical hyperthermia, however, is not the same as sauna. In a pilot study around Naumann with 45 outpatients, hyperthermic baths in addition to usual treatment showed an advantage over exercise after two weeks. In the exercise group, however, 13 of 23 dropped out, in the per-protocol analysis only a trend remained, and the authors consider the effect possibly overestimated. Both are small, intended as complementary, and not self-treatment.

On safety, an older review describes sauna as well tolerated by most healthy people and names unstable angina pectoris, a recent heart attack and severe aortic stenosis as contraindications. According to this review, alcohol in the sauna increases the risk of a drop in blood pressure, rhythm disturbances and sudden death. It considers sauna safe in uncomplicated pregnancies of healthy women. A meta-analysis around Moretti, however, found a higher risk of neural tube defects with overheating in early pregnancy (OR 1.92). This overall value pools the studies, and the abstract does not separate fever, bath or sauna. This question belongs in a discussion with your gynecologist.

For everyday life: warmth rather in the evening, sauna as a ritual rather than a heat record, and never with alcohol.

Shift in perspective

The Finnish figures are impressive. They describe people who use the sauna, and not the sauna alone.

And now you know why, when it comes to sauna, I prefer to speak of a ritual rather than a therapy.

Movement outdoors and nature for the mind

Twenty minutes on the treadmill, eyes on a wall. Twenty minutes on a path by the water, wind in your face. On paper the same movement, and yet many people feel a difference. But first, what is best established here.

Guideline What is considered established: movement at all

In its 2020 guideline, the WHO recommends that all adults do 150 to 300 minutes of moderate-intensity or 75 to 150 minutes of vigorous-intensity physical activity per week, or an equivalent combination, plus muscle strengthening and less sitting. And: some physical activity is better than none.

The German National Care Guideline (NVL) Unipolar Depression states in recommendation 9-8 that people affected who have no contraindication to physical exertion shall be “motivated to take part in structured and supervised physical training and supported in doing so” (⇑⇑). It describes the effect as small to moderate and rather short-term.

What this means for you: movement itself is among the best-supported natural forces. The figures are guideline data, not a personal training goal.

Bull FC, Al-Ansari SS, Biddle S, et al. Br J Sports Med. 2020;54(24):1451-1462. PMID: 33239350 · DOI: 10.1136/bjsports-2020-102955 [Guideline]
Systematic review, 11 studies Outdoors: more vitality, sometimes less calm

A team around Thompson Coon found 11 controlled studies with 833 mostly young adults that compared exercise outdoors in nature with exercise indoors, each time in a single session.

Outdoors, participants reported more revitalization and energy and less tension, anger and depressed mood, but in some cases also less calmness. Enjoyment was greater, as was the intention to come back.

What this means for you: outdoors, exercise often feels more alive in the short term. Long-term health effects were not measured, and the authors describe the study quality as weak.

Thompson Coon J, Boddy K, Stein K, Whear R, Barton J, Depledge MH. Environ Sci Technol. 2011;45(5):1761-72. PMID: 21291246 · DOI: 10.1021/es102947t [Systematic Review]

How much green is needed? An analysis by Barton and Pretty of 10 British studies with 1,252 participants found better scores for self-esteem and mood with activity in nature. The biggest jump came with short sessions, after which the gain decreased but remained positive, and with water nearby the effects were larger. This describes short-term mood, not a specific number of minutes.

Cross-sectional, 19,806 adults The 120 minute study, read closely

A team around White analyzed a representative survey of 19,806 adults in England: how much time had they spent in nature over the past seven days, and how were they doing?

Compared with people without nature contact, good health and high wellbeing were significantly more likely from 120 minutes per week, with a plateau at 200 to 300 minutes. Whether in one go or spread out made no difference.

What this means for you: the 120 minutes are a turning point in this survey, not a minimum dose. In their own words, the authors cannot rule out that healthier and happier people simply spend more time in nature.

White MP, Alcock I, Grellier J, et al. Sci Rep. 2019;9(1):7730. PMID: 31197192 · DOI: 10.1038/s41598-019-44097-3 [Cross-sectional, Survey]

A meta-analysis around Twohig-Bennett linked more green space in the surroundings with lower salivary cortisol, lower heart rate, less frequent type 2 diabetes and lower mortality, with often weak study quality and high heterogeneity. In Denmark, a team around Engemann linked the green space around the place of residence in childhood with later diagnoses. Growing up with the least green space was associated, depending on the condition, with an up to 55 percent higher risk of mental disorders than growing up with the most green space. This is an argument for urban planning and a childhood outdoors, but not evidence of a cause and not a personal prescription.

And the forest? A meta-analysis around Antonelli found lower salivary cortisol in forest groups than in city groups, after the intervention but also before it, with high heterogeneity in some cases. The authors note that expectation effects can play an important role. More on this in Forest bathing (Shinrin-yoku).

For everyday life: move an activity you already do outdoors, think in routes rather than appointments, and if you have the choice, take the path with trees or water. Intensity and endurance are covered in depth in Understanding Zone 2 training, and prolonged sitting in Sitting and lack of movement.

Shift in perspective

Nature is not a substitute for therapy. It is a place where your nervous system can grow quieter.

And now you know why the park around the corner is more than a backdrop, and why nobody can still promise you a number of minutes for it.

Breath and air: breathe slowly, ventilate well, take particulate matter seriously

Three in the afternoon in the meeting room. The windows have been closed since morning, six people, a pot of coffee. Your thoughts become sluggish, and you read the same sentence for the third time.

In this scene, two natural forces meet: how you breathe and what you breathe.

Breathing is one of the few bodily functions that run on their own and that you can still consciously change. A systematic review around Zaccaro pooled 15 studies on slow breathing at fewer than 10 breaths per minute in healthy people: it was associated with higher heart rate variability, more relaxation and less anxiety and anger.

Meta-analysis, 12 RCTs on stress A small effect and a warning against the hype

A team around Fincham pooled randomized trials on breathwork, meaning consciously controlled breathing techniques compared with control conditions.

In 12 studies with 785 adults, breathwork was associated with less stress (Hedges' g minus 0.35). For anxiety the value was minus 0.32 in 20 studies, and for depressive symptoms minus 0.40 in 18 studies.

What this means for you: conscious breathing was associated with somewhat less stress, a small to medium effect. The authors explicitly urge caution so that enthusiasm and the evidence do not drift apart.

Fincham GW, Strauss C, Montero-Marin J, Cavanagh K. Sci Rep. 2023;13(1):432. PMID: 36624160 · DOI: 10.1038/s41598-022-27247-y [Meta-analysis of RCTs]

How exhalation, the vagus nerve and heart rate variability are connected is covered in Breathing techniques for the nervous system. There is deliberately no breathing technique to copy here.

Air: ventilation is also a matter for the mind

A team around Allen had 24 office workers work in a controlled office on six working days, without knowing which air condition applied at the time. On a day with few volatile organic compounds, cognitive scores were 61 percent higher than on a conventional day, and on the two days with additional high outdoor air supply 101 percent higher. A critical review around Du of 37 experimental studies tempers this pointed claim. Pure CO2 at usual indoor concentrations affected only complex decision-making tasks, and poorer ventilation with accumulated substances might slow speed more than accuracy, with inconsistent results overall. Ventilating remains sensible, but the claim that CO2 makes you stupid goes beyond the data.

Outdoors, the air is not automatically better. A systematic review around Chen and Hoek, commissioned by the WHO, pooled 107 studies. Per 10 µg/m³ more PM2.5, the relative risk of mortality from natural causes was 1.08 (95 percent confidence interval 1.06 to 1.09). Studies with low average levels also showed similar or higher risks. In 2021 the WHO lowered its guideline value for the annual mean of PM2.5 from 10 to 5 µg/m³ and for the 24 hour value from 25 to 15 µg/m³, mainly because of new data on effects at low exposure.

For everyday life: air out rooms thoroughly and regularly, especially when several people sit in one room for a long time. Exercise outdoors preferably away from busy roads. And slow exhalation as a tool for the moment, not as a miracle remedy.

Shift in perspective

Fresh air is not a wellness extra. It is the environment in which your brain has to work every day.

And now you know why the open window and the detour through the park belong to the same natural force.

Rhythm: when you eat, sleep and get up

Friday night runs late. On Saturday you sleep until ten, on Sunday too. And on Monday at seven, the alarm feels like landing after a night flight.

There is a term for this. In 2006, Wittmann, Dinich, Merrow and Roenneberg described social jetlag: the discrepancy between workdays and free days, between social and biological time. In their survey of 501 volunteers, late chronotypes had the largest differences. A large epidemiological study around Roenneberg later found that social jetlag was associated with a higher body mass index beyond sleep duration, as a cross-sectional finding without evidence of a cause.

Cohort, 60,977 people Regularity before number of hours?

A team around Windred used accelerometer data from 60,977 UK Biobank participants to calculate how regularly they slept, and followed them for a mean of 6.30 years.

Compared with the people with the most irregular sleep, the more regular groups were associated with a 20 to 48 percent lower risk of all-cause mortality. Regularity predicted mortality more strongly than sleep duration.

What this means for you: regular sleep and wake times could matter more than the perfect number of hours. Here too: observation, not a proven cause.

Windred DP, Burns AC, Lane JM, et al. Sleep. 2024;47(1):zsad253. PMID: 37738616 · DOI: 10.1093/sleep/zsad253 [Cohort, prospective]

Light sets the master clock, but food also has a say. In the laboratory, a team around Wehrens shifted three meals 5 hours later in 10 healthy young men. Afterwards, the daily rhythm of blood glucose was delayed by 5.69 hours and the rhythm of the clock gene PER2 in adipose tissue by 0.97 hours, while melatonin and cortisol remained unchanged. A randomized crossover trial around Vujović compared late with early eating at the same nutrient intake in adults with overweight or obesity: late eating was associated with more hunger and lower energy expenditure while awake. This describes metabolic pathways and is not a diet recommendation.

For everyday life: take your wake-up time as an anchor, roughly on weekends too. Link light and your first meal to the day, and watch late eating as one adjusting screw without turning it into a rigid rule. More on this in Chronobiology and morning light, Putting sleep hygiene into practice and Intermittent fasting 16:8.

Shift in perspective

Your body does not have one clock, but many. Light mainly sets the big one, food can help set the small ones.

And now you know why a Saturday that starts three hours later can still make itself felt on Monday.

Kneipp: a German tradition and what studies say about it

The water treading pool in the spa park. Cold water, a handrail, the stork walk from one end to the other. Many people know this from childhood and remember the tingling afterwards more than any health doctrine.

Kneipp therapy, meaning traditional knowledge and practice according to the teachings of Sebastian Kneipp, has been listed since 2015 in the national inventory of intangible cultural heritage of the German Commission for UNESCO. This is a national inventory, not an international UNESCO list. According to the entry, Kneipp therapy is based on five elements: water, nutrition, medicinal plants, movement and a balanced way of life. That says a lot about cultural significance and nothing about health benefit. That requires studies, and three recent reviews come to very different conclusions.

The conditions named describe study populations, not recommendations. Sources: Ortiz 2023 (PMID: 37423627), Stier-Jarmer 2021 (PMID: 33049739), Reisecker 2026 (PMID: 42373873).
ReviewWhat was includedResult and conclusion
Ortiz and colleagues, 2023 [Systematic Review of RCTs]20 randomized trials with 4,247 participants, Kneipp hydrotherapy in sick and healthy peopleOf 132 comparisons, 46 favored hydrotherapy, 81 showed no difference and 5 favored the control group, positive among others in chronic venous insufficiency, menopausal symptoms and sickness absence days. No meta-analysis possible, risk of bias mostly unclear, only half reported on safety.
Stier-Jarmer and colleagues, 2021 [Systematic Review]25 sources from 2000 to 2019, including 14 controlled studies, mostly of moderate or weak quality9 of the 14 controlled studies (64 percent) with significant between-group differences, among others in chronic venous insufficiency, hypertension, mild heart failure, menopausal symptoms and sleep disorders. No difference, among others, for colds in children.
Reisecker and colleagues, 2026, online ahead of print [Systematic Review of RCTs]Only randomized trials with a comparison group and the endpoints mortality, morbidity or quality of lifeOf 77 hits, a single study met the criteria, a feasibility study with 30 patients. Conclusion: Kneipp as a comprehensive approach without robust confirmation from high-quality randomized trials, with its significance mainly in tradition, wellness and commerce.

How can three reviews turn out so differently? Because they ask different questions. The first two look at individual applications and many outcome measures. The third asks strictly whether Kneipp as an overall concept improves hard endpoints. These are different yardsticks, and none of them provides the kind of foundation a guideline would need.

The fact that Kneipp has been studied in people with high blood pressure or mild heart failure is not an invitation to start cold stimuli on your own with these conditions. Precisely then, it should be discussed with a doctor first, and prescribed medication is not changed because of it.

In my clinical practice I often experience Kneipp as a friendly entry point: a cold arm affusion is small enough not to overwhelm, and it creates a moment of attention for your own body. That is experience from my consultations, not a study result. So understand Kneipp as an everyday ritual and not as a therapy. Why lifestyle can be thought of as part of treatment at all is described in Lifestyle as therapy for mind and body.

Shift in perspective

Tradition is not proof. But it is not disproof either. It is an invitation to look closely.

And now you know why I like the water treading pool and still do not claim that it prevents disease.

Starting without overwhelm, safety, and where science ends

You know these lists. Get up at five, ice bath, breathing exercise, morning light, journal, green juice. Reading them, people often feel not inspired but behind.

Many people experience exactly this: the routine itself can become a stressor, and stress without a pause is the opposite of hormesis. So first, an honest map.

How far each one carries

Classification of the sources cited here, as of September 2026. No guideline was found for cold, contrast showers, sauna, Kneipp, forest bathing or grounding in healthy people.
LevelNatural forceWhat this means
GuidelineLight therapy for depression with a seasonal pattern (shall) and without (can); structured training for depression; physical activity according to the WHO; light and exercise as adjuncts in insomnia; guideline values for particulate matterWell supported for the specific question, usually as one building block of treatment
Meta-analyses with limitationsLight therapy, breathwork, green space, forest bathing and cortisol, warm bath before sleep, cold water in healthy peopleA direction is visible, but often small or heterogeneous studies
Large observational studiesSauna, daylight and night-time light, sleep regularity, green space in childhood, 120 minutes of natureClear associations, no statement about causes
Small or single studiesCold showers, contrast showers, cold and insulin, hyperthermia in depression, KneippSignals that would first need to be confirmed
Hypothesis or traditionCold showers for depression, grounding while walking barefootNo solid evidence, to be classified as an idea
Where I am cautious

Grounding and the cold shower for depression

Grounding, also called earthing, means direct contact of the body with the surface of the earth, for example barefoot. A frequently cited review around Chevalier relies mostly on pilot studies. According to the disclosure, three of the five authors work as independent contractors for the company that sponsors earthing research, with small shareholdings in it. A second review around Menigoz speaks of around 20 studies and explicitly also relies on case reports. I have not found an independent systematic review. Walking barefoot outdoors is contact with nature and movement. That contact with the earth itself measurably changes inflammation, pain or sleep has not been shown.

Anyone reading about cold showers for depression often ends up at a hypothesis article by Shevchuk from 2008. It contains no clinical trial, only a number of people without a diagnosis of depression that the author himself calls statistically insignificant. Depression belongs in professional treatment, and cold is no substitute for it.

Safety

Who should talk to a doctor first, and when immediate help is needed

Before cold and heat stimuli, a conversation with your doctor belongs first if you have:

  • cardiovascular disease, heart rhythm disorders or uncontrolled high blood pressure, and for sauna additionally a recent heart attack, unstable angina pectoris or severe aortic stenosis
  • Raynaud's syndrome, in which cold can trigger vascular spasms in the fingers and toes, or cold urticaria
  • epilepsy, or if you are pregnant
  • fever or an acute infection, in which case: no cold or heat stimuli

The cold shock response can set in immediately on immersion. So never go into open cold water alone, never do breathing exercises or breath holding in or near the water, and never combine cold or sauna with alcohol.

Prescribed medication is never stopped or reduced on your own, including blood pressure medication, antidepressants, thyroid hormones or diabetes medication. In the Finnish cohort, the risk with elevated blood pressure remained higher despite frequent sauna use.

Call 112 immediately (the emergency number in Germany and across the EU) with chest pain, sudden shortness of breath, impaired consciousness, new paralysis or a speech disorder, or a strongly racing heart with dizziness. In an emotional crisis, you can reach the Telefonseelsorge around the clock at 0800 111 0 111 and 0800 111 0 222 (these are German numbers; outside Germany, please use your local crisis line).

Three levers for getting started

If none of the points in the safety box apply to you, these three small directions fit the evidence well.

Directions, not prescriptions

  • Light in the morning, darkness in the evening. Part of your way outdoors in the morning, dimmed light in the evening, a dark bedroom. This is where expert consensus and large observational studies meet.
  • Move an activity you already do outdoors. The way to work, a phone call, a walk after a meal.
  • Get to know a single temperature stimulus slowly. A warm bath in the evening or a short cold finish to your shower, not both at once. Pay attention to how you sleep and feel, and plan breaks.

In my clinical practice I observe that people who start with a single small stimulus are more likely to stick with it than people who completely rebuild their life on a Monday. That is observation, not a study. This is not about optimization, but about a body that can once again respond to light, cold, warmth and a path under trees. Energy is not a luxury. It is freedom of movement in your own life.

Shift in perspective

Natural forces are not a competition. The small stimulus that becomes a regular part of your life will probably carry you further than the big one you give up after a week.

And now you know why the best start is usually smaller than you think.

If you don't just want to read but want to get started right away: below this article you will find the option to book an appointment.

Frequently asked questions about natural forces in everyday life

What does hormesis mean, in simple terms?

Hormesis describes a biphasic dose response: a small, usually intermittent stimulus can prompt an adaptation, while a large dose of the same stimulus causes harm. The word was introduced by Southam and Ehrlich in 1943. Whether the principle can be broadly generalized remains disputed. In everyday life it serves as a way of thinking about dose, pause and recovery, not as proof that every cold or heat stimulus is healthy.

Are cold showers healthy?

In the largest randomized trial, with 3,018 adults, a warm shower followed by 30, 60 or 90 seconds of cold water was associated with 29 percent fewer self-reported sickness absence days, but not with significantly fewer days of illness. A meta-analysis found short-term increases in inflammatory markers and no better mood, based on few and small studies. So cold showers are not a proven form of health protection.

What are the downsides of cold showers?

Sudden cold can trigger a cold shock response with gasping, hyperventilation, a racing heart and a rise in blood pressure. With cardiovascular disease, uncontrolled high blood pressure, Raynaud's, epilepsy or during pregnancy, this should be discussed with a doctor first. And in a randomized trial with 21 men, strength and muscle mass increased less with cold water after strength training than with active recovery.

Can I take a cold shower in the evening before bed?

Direct studies on this are largely missing. Warmth is better studied: in a meta-analysis, a warm shower or bath at 40 to 42.5 degrees Celsius, 1 to 2 hours before bedtime and from as little as 10 minutes, was associated with falling asleep faster. Many people experience cold as activating. For the evening, the evidence therefore points more toward warmth, and the figures are study data, not instructions.

Are contrast showers healthy, and are they dangerous?

Contrast showers are mainly tradition. The only randomized trial found was in 60 martial arts athletes: resting heart rate, heart rate variability and perceived recovery developed more favorably after 4 weeks, and after a 2 week break the differences had disappeared. Strong temperature changes can be risky with cardiovascular disease, uncontrolled blood pressure, Raynaud's or during pregnancy, and then they should be discussed with a doctor first.

Contrast showers in the morning or in the evening?

There are no studies comparing the two. Many people experience a cold finish as waking them up and place it in the morning, while warmth is better studied for the evening. This is orientation, not evidence for a right time of day.

How much morning light does the internal clock need?

A personal number of minutes cannot be derived from the studies. An international expert consensus for indoor spaces names at least 250 lux melanopic EDI at the eye during the day, at most 10 lux in the evening starting at least 3 hours before sleep, and at most 1 lux in the sleep environment. Daylight should be used first, so spending part of your way outdoors in the morning is an obvious place to start.

What does light therapy do for winter depression?

According to the German National Care Guideline (NVL) Unipolar Depression, a trial of light therapy shall be offered for depression with a seasonal pattern, and can be offered without a seasonal pattern. Light therapy belongs under medical or psychotherapeutic supervision and does not replace treatment. Prescribed antidepressants are never stopped on your own. If you have suicidal thoughts, you can reach the Telefonseelsorge around the clock at 0800 111 0 111 or 0800 111 0 222 (German numbers; outside Germany, use your local crisis line), and in acute danger call 112.

How often is sauna healthy, and who should avoid it?

In a Finnish cohort of 2,315 men aged 42 to 60, 4 to 7 sauna sessions per week compared with one session were associated with a lower risk of sudden cardiac death (HR 0.37). This is observation, not proof that the sauna is the cause. A review names unstable angina pectoris, a recent heart attack and severe aortic stenosis as contraindications, alcohol never belongs with it, and sauna during pregnancy belongs in a discussion with your gynecologist.

How much time in nature is good for you?

In a survey of 19,806 adults in England, good health and high wellbeing were significantly more likely from about 120 minutes of nature contact per week, with a plateau at 200 to 300 minutes. This is a cross-sectional study based on self-report, and healthier people may simply spend more time outdoors. The 120 minutes are therefore an observation and not a minimum dose.

Is exercising outdoors better than indoors?

A systematic review of 11 studies with 833 mostly young adults found more revitalization and energy and less tension after single sessions outdoors, but in some cases less calmness. Study quality was weak, and long-term effects were not measured. According to the WHO guideline, what matters most is that movement happens at all.

What are Kneipp applications, and what is proven?

Kneipp therapy is based on water, nutrition, medicinal plants, movement and a balanced way of life, and it is known for affusions, water treading and alternating stimuli. Since 2015 it has been listed in Germany's national inventory of intangible cultural heritage. One review found that of 132 comparisons from 20 randomized trials, 46 favored hydrotherapy, 81 showed no difference and 5 favored the control. A stricter review from 2026 sees Kneipp as an overall concept without robust confirmation from high-quality studies.

What is behind grounding and walking barefoot?

Grounding means direct contact of the body with the surface of the earth. The reviews come mostly from proponents, and in one of them, according to the disclosure, three of the five authors work for the company that sponsors earthing research. Walking barefoot outdoors is contact with nature and movement. That contact with the earth itself measurably changes inflammation, pain or sleep has not been shown.

How do I get started without overwhelming myself?

With a single stimulus instead of five at once, and smaller than your ambition would like: light in the morning and darkness in the evening, moving one exercise session outdoors, or getting to know a temperature stimulus slowly. Plan breaks. If you have cardiovascular disease, high blood pressure, Raynaud's, epilepsy or are pregnant, talk to your doctor before cold and heat stimuli, and never go into open cold water alone.

Where this overview leads into depth

This article is the entry point to the Natural Forces Guide. The following texts pick out individual building blocks and go further than an overview can.

When your morning won't get going
Chronobiology: morning light and the internal clock

How the master clock in the brain reads light, and what morning light has to do with cortisol and melatonin.

When the screen stays bright late into the evening
Blue light, circadian rhythm and sleep

Why light in the evening can shift the internal clock, and what matters from this in everyday life.

When you want to know how much sun makes sense
How much sun does the body need

Sun as a question of dose, depending on skin type, time of day, season and where you live.

When winter is long and grey
Vitamin D deficiency in winter

Why the sun is often not enough for vitamin D in winter, and why the lab value belongs in the picture.

When cold and immune defense interest you
Cold, the immune system and hormesis

Hormesis explored in depth using cold as an example, with brown adipose tissue, the immune system and the limits of the studies.

When you are thinking about cold water
Ice bathing for beginners

What happens in the first minute, what adaptation over weeks can look like, and which safety rules apply.

When sauna and the heart are both on your mind
Sauna and the heart: how often is healthy

The Finnish data in detail, the question of dose, and when caution is needed with heart disease.

When the forest does you good
Forest bathing (Shinrin-yoku)

What studies describe about tree scent compounds, immune cells and stress hormones in the forest.

When your mind won't settle
Breathing techniques for the nervous system

How exhalation, the vagus nerve and heart rate variability are connected.

When you want to build endurance calmly
Understanding Zone 2 training

What intensity zones mean and why calm training can play a role of its own in metabolism.

When you want to understand what movement sets off in the cell
Exercise as medicine at the cellular level

Why training can be thought of as a dosed stimulus that sets off adaptations in the body.

When rhythm starts with sleep
Putting sleep hygiene into practice

What counts according to the evidence and what is overrated, from wake-up time to the bedroom.

SJ

Shukri Jarmoukli

Physician, Integrative Medicine · ViveCura Berlin

In my private practice I work at the interface of conventional medicine, functional medicine and Clinical Psychoneuroimmunology. Light, movement, temperature and rhythm interest me because they can act on several systems at once: on nerves, hormones, the immune system and metabolism.

On this topic I deliberately keep my distance from both extremes. Not every cold shower is a health measure, and tradition is not worthless just because studies are missing. This article does not replace medical advice and is not a guide to changing an existing treatment. It is meant to help you dose stimuli wisely and ask good questions at your next appointment.

ViveCura, Privatpraxis Shukri Jarmoukli, Skalitzer Straße 137, 10999 Berlin

Scientific sources

  1. Bundesärztekammer (BÄK), Kassenärztliche Bundesvereinigung (KBV), Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF). Nationale VersorgungsLeitlinie Unipolare Depression, Kurzfassung, Version 3.2. 2022. AWMF register nvl-005. DOI: 10.6101/AZQ/000506 [Guideline]
  2. Riemann D, Espie CA, Altena E, et al. The European Insomnia Guideline: An update on the diagnosis and treatment of insomnia 2023. J Sleep Res. 2023;32(6):e14035. PMID: 38016484 · DOI: 10.1111/jsr.14035 [Guideline]
  3. Bull FC, Al-Ansari SS, Biddle S, et al. World Health Organization 2020 guidelines on physical activity and sedentary behaviour. Br J Sports Med. 2020;54(24):1451-1462. PMID: 33239350 · DOI: 10.1136/bjsports-2020-102955 [Guideline]
  4. World Health Organization. WHO global air quality guidelines: particulate matter (PM2.5 and PM10), ozone, nitrogen dioxide, sulfur dioxide and carbon monoxide. Geneva: World Health Organization; 2021. ISBN 978-92-4-003422-8. No DOI, NCBI Bookshelf NBK574594 [Guideline]
  5. Brown TM, Brainard GC, Cajochen C, et al. Recommendations for daytime, evening, and nighttime indoor light exposure to best support physiology, sleep, and wakefulness in healthy adults. PLoS Biol. 2022;20(3):e3001571. PMID: 35298459 · DOI: 10.1371/journal.pbio.3001571 [Consensus Guideline, Expert Consensus]
  6. Deutsche UNESCO-Kommission. Kneippen, traditionelles Wissen und Praxis nach der Lehre Sebastian Kneipps. Entry in the national inventory of intangible cultural heritage (Bundesweites Verzeichnis des Immateriellen Kulturerbes), added 2015. No DOI, unesco.de, accessed 16 September 2026 [Registry Entry]
  7. Mattson MP. Hormesis defined. Ageing Res Rev. 2008;7(1):1-7. PMID: 18162444 · DOI: 10.1016/j.arr.2007.08.007 [Review, narrative]
  8. Calabrese EJ, Baldwin LA. Hormesis: the dose-response revolution. Annu Rev Pharmacol Toxicol. 2003;43:175-97. PMID: 12195028 · DOI: 10.1146/annurev.pharmtox.43.100901.140223 [Review, narrative, proponent position]
  9. Calabrese EJ. The Emergence of the Dose-Response Concept in Biology and Medicine. Int J Mol Sci. 2016;17(12):2034. PMID: 27929392 · DOI: 10.3390/ijms17122034 [Overview, historical]
  10. Calabrese EJ, Calabrese V, Giordano J. The role of hormesis in the functional performance and protection of neural systems. Brain Circ. 2017;3(1):1-13. PMID: 30276298 · DOI: 10.4103/2394-8108.203257 [Review, narrative]
  11. Gunawan AL, Liparulo I, Stahl A. Mammalian mitohormesis: from mitochondrial stressors to organismal benefits. EMBO J. 2025;44(20):5640-5661. PMID: 40926120 · DOI: 10.1038/s44318-025-00549-3 [Review, narrative, mammalian and cell models]
  12. Thayer KA, Melnick R, Burns K, Davis D, Huff J. Fundamental flaws of hormesis for public health decisions. Environ Health Perspect. 2005;113(10):1271-6. PMID: 16203233 · DOI: 10.1289/ehp.7811 [Commentary, critical]
  13. Axelrod D, Burns K, Davis D, von Larebeke N. "Hormesis"--an inappropriate extrapolation from the specific to the universal. Int J Occup Environ Health. 2004;10(3):335-9. PMID: 15473091 · DOI: 10.1179/oeh.2004.10.3.335 [Commentary, critical]
  14. Ristow M, Zarse K, Oberbach A, et al. Antioxidants prevent health-promoting effects of physical exercise in humans. Proc Natl Acad Sci U S A. 2009;106(21):8665-70. PMID: 19433800 · DOI: 10.1073/pnas.0903485106 [Controlled Clinical Trial]
  15. Roberts LA, Raastad T, Markworth JF, et al. Post-exercise cold water immersion attenuates acute anabolic signalling and long-term adaptations in muscle to strength training. J Physiol. 2015;593(18):4285-301. PMID: 26174323 · DOI: 10.1113/JP270570 [RCT]
  16. Pjrek E, Friedrich ME, Cambioli L, et al. The Efficacy of Light Therapy in the Treatment of Seasonal Affective Disorder: A Meta-Analysis of Randomized Controlled Trials. Psychother Psychosom. 2020;89(1):17-24. PMID: 31574513 · DOI: 10.1159/000502891 [Meta-analysis of RCTs]
  17. Nussbaumer-Streit B, Forneris CA, Morgan LC, et al. Light therapy for preventing seasonal affective disorder. Cochrane Database Syst Rev. 2019;3(3):CD011269. PMID: 30883670 · DOI: 10.1002/14651858.CD011269.pub3 [Systematic Review, Cochrane]
  18. Menegaz de Almeida A, Aquino de Moraes FC, Cavalcanti Souza ME, et al. Bright Light Therapy for Nonseasonal Depressive Disorders: A Systematic Review and Meta-Analysis. JAMA Psychiatry. 2025;82(1):38-46. PMID: 39356500 · DOI: 10.1001/jamapsychiatry.2024.2871 [Meta-analysis of RCTs]
  19. Burns AC, Saxena R, Vetter C, Phillips AJK, Lane JM, Cain SW. Time spent in outdoor light is associated with mood, sleep, and circadian rhythm-related outcomes: A cross-sectional and longitudinal study in over 400,000 UK Biobank participants. J Affect Disord. 2021;295:347-352. PMID: 34488088 · DOI: 10.1016/j.jad.2021.08.056 [Cohort, Cross-sectional and Longitudinal]
  20. Windred DP, Burns AC, Lane JM, et al. Brighter nights and darker days predict higher mortality risk: A prospective analysis of personal light exposure in >88,000 individuals. Proc Natl Acad Sci U S A. 2024;121(43):e2405924121. PMID: 39405349 · DOI: 10.1073/pnas.2405924121 [Cohort, prospective]
  21. Chang AM, Aeschbach D, Duffy JF, Czeisler CA. Evening use of light-emitting eReaders negatively affects sleep, circadian timing, and next-morning alertness. Proc Natl Acad Sci U S A. 2015;112(4):1232-7. PMID: 25535358 · DOI: 10.1073/pnas.1418490112 [Clinical Laboratory Study]
  22. Obayashi K, Saeki K, Kurumatani N. Bedroom Light Exposure at Night and the Incidence of Depressive Symptoms: A Longitudinal Study of the HEIJO-KYO Cohort. Am J Epidemiol. 2018;187(3):427-434. PMID: 28992236 · DOI: 10.1093/aje/kwx290 [Cohort, prospective]
  23. Buijze GA, Sierevelt IN, van der Heijden BC, Dijkgraaf MG, Frings-Dresen MH. The Effect of Cold Showering on Health and Work: A Randomized Controlled Trial. PLoS One. 2016;11(9):e0161749. PMID: 27631616 · DOI: 10.1371/journal.pone.0161749. Correction: PLoS One. 2018;13(8):e0201978 [RCT]
  24. Cain T, Brinsley J, Bennett H, Nelson M, Maher C, Singh B. Effects of cold-water immersion on health and wellbeing: A systematic review and meta-analysis. PLoS One. 2025;20(1):e0317615. PMID: 39879231 · DOI: 10.1371/journal.pone.0317615 [Systematic Review with Meta-analysis]
  25. Esperland D, de Weerd L, Mercer JB. Health effects of voluntary exposure to cold water: a continuing subject of debate. Int J Circumpolar Health. 2022;81(1):2111789. PMID: 36137565 · DOI: 10.1080/22423982.2022.2111789 [Review, narrative]
  26. Tipton MJ, Collier N, Massey H, Corbett J, Harper M. Cold water immersion: kill or cure? Exp Physiol. 2017;102(11):1335-1355. PMID: 28833689 · DOI: 10.1113/EP086283 [Review, narrative]
  27. Shattock MJ, Tipton MJ. 'Autonomic conflict': a different way to die during cold water immersion? J Physiol. 2012;590(14):3219-30. PMID: 22547634 · DOI: 10.1113/jphysiol.2012.229864 [Review, narrative, with hypothesis]
  28. Hanssen MJ, Hoeks J, Brans B, et al. Short-term cold acclimation improves insulin sensitivity in patients with type 2 diabetes mellitus. Nat Med. 2015;21(8):863-5. PMID: 26147760 · DOI: 10.1038/nm.3891 [Uncontrolled Intervention Study, n=8]
  29. Yankouskaya A, Williamson R, Stacey C, Totman JJ, Massey H. Short-Term Head-Out Whole-Body Cold-Water Immersion Facilitates Positive Affect and Increases Interaction between Large-Scale Brain Networks. Biology (Basel). 2023;12(2):211. PMID: 36829490 · DOI: 10.3390/biology12020211 [Experimental Pre-Post Study]
  30. Hagner-Derengowska M, Trybulski R, Kruk J, Clemente FM, Olchowy C, Pilis K. Contrast Heat-Cold Versus Thermoneutral Showering in Trained Combat Sport Athletes: A Randomized Field Trial of Recovery Outcomes. J Sports Sci Med. 2026;25(3):675-690. PMID: 42713556 · DOI: 10.52082/jssm.2026.675 [RCT]
  31. Laukkanen T, Khan H, Zaccardi F, Laukkanen JA. Association between sauna bathing and fatal cardiovascular and all-cause mortality events. JAMA Intern Med. 2015;175(4):542-8. PMID: 25705824 · DOI: 10.1001/jamainternmed.2014.8187 [Cohort, prospective]
  32. Zaccardi F, Laukkanen T, Willeit P, Kunutsor SK, Kauhanen J, Laukkanen JA. Sauna Bathing and Incident Hypertension: A Prospective Cohort Study. Am J Hypertens. 2017;30(11):1120-1125. PMID: 28633297 · DOI: 10.1093/ajh/hpx102 [Cohort, prospective]
  33. Laukkanen JA, Jae SY, Kauhanen J, Kunutsor SK. The Interplay between Systolic Blood Pressure, Sauna Bathing, and Cardiovascular Mortality in Middle-Aged and Older Finnish Men: A Cohort Study. J Nutr Health Aging. 2023;27(5):348-353. PMID: 37248758 · DOI: 10.1007/s12603-023-1895-1 [Cohort, prospective]
  34. Kunutsor SK, Khan H, Laukkanen T, Laukkanen JA. Joint associations of sauna bathing and cardiorespiratory fitness on cardiovascular and all-cause mortality risk: a long-term prospective cohort study. Ann Med. 2018;50(2):139-146. PMID: 28972808 · DOI: 10.1080/07853890.2017.1387927 [Cohort, prospective]
  35. Laukkanen JA, Laukkanen T, Kunutsor SK. Cardiovascular and Other Health Benefits of Sauna Bathing: A Review of the Evidence. Mayo Clin Proc. 2018;93(8):1111-1121. PMID: 30077204 · DOI: 10.1016/j.mayocp.2018.04.008 [Review, narrative]
  36. Hannuksela ML, Ellahham S. Benefits and risks of sauna bathing. Am J Med. 2001;110(2):118-26. PMID: 11165553 · DOI: 10.1016/s0002-9343(00)00671-9 [Review, narrative]
  37. Moretti ME, Bar-Oz B, Fried S, Koren G. Maternal hyperthermia and the risk for neural tube defects in offspring: systematic review and meta-analysis. Epidemiology. 2005;16(2):216-9. PMID: 15703536 · DOI: 10.1097/01.ede.0000152903.55579.15 [Meta-analysis of Observational Studies]
  38. Haghayegh S, Khoshnevis S, Smolensky MH, Diller KR, Castriotta RJ. Before-bedtime passive body heating by warm shower or bath to improve sleep: A systematic review and meta-analysis. Sleep Med Rev. 2019;46:124-135. PMID: 31102877 · DOI: 10.1016/j.smrv.2019.04.008 [Systematic Review with Meta-analysis]
  39. Janssen CW, Lowry CA, Mehl MR, et al. Whole-Body Hyperthermia for the Treatment of Major Depressive Disorder: A Randomized Clinical Trial. JAMA Psychiatry. 2016;73(8):789-95. PMID: 27172277 · DOI: 10.1001/jamapsychiatry.2016.1031 [RCT, Sham-controlled]
  40. Naumann J, Kruza I, Denkel L, Kienle G, Huber R. Effects and feasibility of hyperthermic baths in comparison to exercise as add-on treatment to usual care in depression: a randomised, controlled pilot study. BMC Psychiatry. 2020;20(1):536. PMID: 33176757 · DOI: 10.1186/s12888-020-02941-1 [RCT, Pilot]
  41. White MP, Alcock I, Grellier J, et al. Spending at least 120 minutes a week in nature is associated with good health and wellbeing. Sci Rep. 2019;9(1):7730. PMID: 31197192 · DOI: 10.1038/s41598-019-44097-3 [Cross-sectional, Survey]
  42. Barton J, Pretty J. What is the best dose of nature and green exercise for improving mental health? A multi-study analysis. Environ Sci Technol. 2010;44(10):3947-55. PMID: 20337470 · DOI: 10.1021/es903183r [Meta-analysis, 10 studies]
  43. Thompson Coon J, Boddy K, Stein K, Whear R, Barton J, Depledge MH. Does participating in physical activity in outdoor natural environments have a greater effect on physical and mental wellbeing than physical activity indoors? A systematic review. Environ Sci Technol. 2011;45(5):1761-72. PMID: 21291246 · DOI: 10.1021/es102947t [Systematic Review]
  44. Twohig-Bennett C, Jones A. The health benefits of the great outdoors: A systematic review and meta-analysis of greenspace exposure and health outcomes. Environ Res. 2018;166:628-637. PMID: 29982151 · DOI: 10.1016/j.envres.2018.06.030 [Systematic Review with Meta-analysis]
  45. Engemann K, Pedersen CB, Arge L, Tsirogiannis C, Mortensen PB, Svenning JC. Residential green space in childhood is associated with lower risk of psychiatric disorders from adolescence into adulthood. Proc Natl Acad Sci U S A. 2019;116(11):5188-5193. PMID: 30804178 · DOI: 10.1073/pnas.1807504116 [Cohort, Registry]
  46. Antonelli M, Barbieri G, Donelli D. Effects of forest bathing (shinrin-yoku) on levels of cortisol as a stress biomarker: a systematic review and meta-analysis. Int J Biometeorol. 2019;63(8):1117-1134. PMID: 31001682 · DOI: 10.1007/s00484-019-01717-x [Systematic Review with Meta-analysis]
  47. Fincham GW, Strauss C, Montero-Marin J, Cavanagh K. Effect of breathwork on stress and mental health: A meta-analysis of randomised-controlled trials. Sci Rep. 2023;13(1):432. PMID: 36624160 · DOI: 10.1038/s41598-022-27247-y [Meta-analysis of RCTs]
  48. Zaccaro A, Piarulli A, Laurino M, et al. How Breath-Control Can Change Your Life: A Systematic Review on Psycho-Physiological Correlates of Slow Breathing. Front Hum Neurosci. 2018;12:353. PMID: 30245619 · DOI: 10.3389/fnhum.2018.00353 [Systematic Review]
  49. Chen J, Hoek G. Long-term exposure to PM and all-cause and cause-specific mortality: A systematic review and meta-analysis. Environ Int. 2020;143:105974. PMID: 32703584 · DOI: 10.1016/j.envint.2020.105974 [Systematic Review with Meta-analysis]
  50. Allen JG, MacNaughton P, Satish U, Santanam S, Vallarino J, Spengler JD. Associations of Cognitive Function Scores with Carbon Dioxide, Ventilation, and Volatile Organic Compound Exposures in Office Workers: A Controlled Exposure Study of Green and Conventional Office Environments. Environ Health Perspect. 2016;124(6):805-12. PMID: 26502459 · DOI: 10.1289/ehp.1510037 [Blinded Exposure Study]
  51. Du B, Tandoc MC, Mack ML, Siegel JA. Indoor CO2 concentrations and cognitive function: A critical review. Indoor Air. 2020;30(6):1067-1082. PMID: 32557862 · DOI: 10.1111/ina.12706 [Review, critical]
  52. Wittmann M, Dinich J, Merrow M, Roenneberg T. Social jetlag: misalignment of biological and social time. Chronobiol Int. 2006;23(1-2):497-509. PMID: 16687322 · DOI: 10.1080/07420520500545979 [Cross-sectional]
  53. Roenneberg T, Allebrandt KV, Merrow M, Vetter C. Social jetlag and obesity. Curr Biol. 2012;22(10):939-43. PMID: 22578422 · DOI: 10.1016/j.cub.2012.03.038 [Cross-sectional, epidemiological]
  54. Wehrens SMT, Christou S, Isherwood C, et al. Meal Timing Regulates the Human Circadian System. Curr Biol. 2017;27(12):1768-1775.e3. PMID: 28578930 · DOI: 10.1016/j.cub.2017.04.059 [Clinical Laboratory Study]
  55. Vujović N, Piron MJ, Qian J, et al. Late isocaloric eating increases hunger, decreases energy expenditure, and modifies metabolic pathways in adults with overweight and obesity. Cell Metab. 2022;34(10):1486-1498.e7. PMID: 36198293 · DOI: 10.1016/j.cmet.2022.09.007 [RCT, Crossover]
  56. Windred DP, Burns AC, Lane JM, et al. Sleep regularity is a stronger predictor of mortality risk than sleep duration: A prospective cohort study. Sleep. 2024;47(1):zsad253. PMID: 37738616 · DOI: 10.1093/sleep/zsad253 [Cohort, prospective]
  57. Ortiz M, Koch AK, Cramer H, et al. Clinical effects of Kneipp hydrotherapy: a systematic review of randomised controlled trials. BMJ Open. 2023;13(7):e070951. PMID: 37423627 · DOI: 10.1136/bmjopen-2022-070951 [Systematic Review of RCTs]
  58. Stier-Jarmer M, Throner V, Kirschneck M, Frisch D, Schuh A. Effekte der Kneipp-Therapie: Ein systematischer Review der aktuellen wissenschaftlichen Erkenntnisse (2000-2019). Complement Med Res. 2021;28(2):146-159. PMID: 33049739 · DOI: 10.1159/000510452 [Systematic Review]
  59. Reisecker N, Riegler S, Safran J, et al. Systematic review of clinical evidence for Kneipp medicine. Wien Klin Wochenschr. 2026 Jun 29. Online ahead of print. PMID: 42373873 · DOI: 10.1007/s00508-026-02780-2 [Systematic Review of RCTs]
  60. Chevalier G, Sinatra ST, Oschman JL, Sokal K, Sokal P. Earthing: health implications of reconnecting the human body to the Earth's surface electrons. J Environ Public Health. 2012;2012:291541. PMID: 22291721 · DOI: 10.1155/2012/291541 [Review, narrative, conflict of interest disclosed]
  61. Menigoz W, Latz TT, Ely RA, Kamei C, Melvin G, Sinatra D. Integrative and lifestyle medicine strategies should include Earthing (grounding): Review of research evidence and clinical observations. Explore (NY). 2020;16(3):152-160. PMID: 31831261 · DOI: 10.1016/j.explore.2019.10.005 [Review, narrative]
  62. Shevchuk NA. Adapted cold shower as a potential treatment for depression. Med Hypotheses. 2008;70(5):995-1001. PMID: 17993252 · DOI: 10.1016/j.mehy.2007.04.052 [Hypothesis Article]
Transparency on the evidence: where the data are thin
  1. Many statements are based on observational studies. The sauna data from Finland, the UK Biobank analyses on light and sleep, the Danish registry data on green space in childhood and the 120 minute survey from England show associations, not causes.
  2. Guidelines exist only for individual areas: light therapy and exercise for depression, light and exercise as adjuncts in insomnia, physical activity in general and guideline values for particulate matter. For cold, contrast showers, sauna, Kneipp, forest bathing and grounding in healthy adults, no guideline was found that recommends or rejects these applications.
  3. The cold water meta-analysis relies to a large extent on a single study. 3,018 of the 3,177 participants come from the Dutch shower study. The sleep finding in it goes back to a single study in men after heat training.
  4. Several central studies included only men: the Finnish sauna cohort as well as the studies on antioxidants and exercise, on cold water after strength training and on shifting meal times in the laboratory. Whether the results can be transferred to women and other age groups is open.
  5. The mechanistic statements on hormesis come mostly from cell and animal models, summarized in reviews. No animal or cell study of its own is cited in this article.
  6. Several reviews come from the circle of proponents. This applies to the historical and conceptual papers on hormesis, to the sauna review from the same Finnish research group as the cohort data, and to both grounding reviews, one of which discloses a conflict of interest.
  7. The light consensus gives values in melanopic EDI for indoor spaces in healthy adults. It is not a clinical guideline, and the values cannot be checked with a simple lux app.
  8. Some data are very new. The study on contrast showers was published in 2026, and the strictest Kneipp review was online ahead of print at the time of research. New studies may change this classification.
  9. The note on Raynaud's stands without a study citation, because cold-induced vascular spasms are part of the description of the condition.
  10. What is deliberately not included here. No protocols for ice bathing, sauna, contrast showers or breathing exercises, no personal target for minutes or temperatures, and no advice to change, reduce or stop an existing treatment or medication. This applies especially to blood pressure medication, antidepressants, thyroid hormones and diabetes medication. Figures on temperatures, times, light levels and vitamin doses are study data and not recommendations. What I describe from my consultations is marked as observation and is not a study result.

Have questions or want to book an appointment?

We'd be happy to advise you personally at our practice.

Book appointment