The impact of greenspace or nature-based interventions on cardiovascular health or cancer-related outcomes: A systematic review of experimental studies

Abstract

Significance Globally, cardiovascular disease (CVD) and cancer are leading causes of morbidity and mortality. While having different etiologies, CVD and cancer are linked by multiple shared risk factors, the presence of which exacerbate adverse outcomes for individuals with either disease. For both pathologies, factors such as poverty, lack of physical activity (PA), poor dietary intake, and climate change increase risk of adverse outcomes. Prior research has shown that greenspaces and other nature-based interventions (NBIs) contribute to improved health outcomes and climate change resilience. Objective To summarize evidence on the impact of greenspaces or NBIs on cardiovascular health and/or cancer-related outcomes and identify knowledge gaps to inform future research. Methods Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 and Peer Review of Electronic Search Strategies (PRESS) guidelines, we searched five databases: Web of Science, Scopus, Medline, PsycINFO and GreenFile. Two blinded reviewers used Rayyan AI and a predefined criteria for article inclusion and exclusion. The risk of bias was assessed using a modified version of the Newcastle–Ottawa Scale (NOS). This review is registered with PROSPERO, ID # CRD42021231619. Results & discussion Of 2565 articles retrieved, 31 articles met the inclusion criteria, and overall had a low risk of bias. 26 articles studied cardiovascular related outcomes and 5 studied cancer-related outcomes. Interventions were coded into 4 categories: forest bathing, green exercise, gardening, and nature viewing. Outcomes included blood pressure (BP), cancer-related quality of life (QoL) and (more infrequently) biomarkers of CVD risk. Descriptions of findings are presented as well as visual presentations of trends across the findings using RAW graphs. Overall studies included have a low risk of bias; and alluvial chart trends indicated that NBIs may have beneficial effects on CVD and cancer-related outcomes. Conclusions & implications (1) Clinical implication: Healthcare providers should consider the promotion of nature-based programs to improve health outcomes. (2) Policy implication: There is a need for investment in equitable greenspaces to improve health outcomes and build climate resilient neighborhoods. (3) Research or academic implication: Research partnerships with community-based organizations for a comprehensive study of benefits associated with NBIs should be encouraged to reduce health disparities and ensure intergenerational health equity. There is a need for investigation of the mechanisms by which NBIs impact CVD and exploration of the role of CVD biological markers of inflammation among cancer survivors.

Nature-based allied health: current practice, challenges and opportunities

“…Our sample comprised predominantly of psychologists (29%), social workers (25%) and occupational therapists (17%) who often work in mental health settings; hence, the bias in our sample may have led to the dominance of mental health outcomes. Although research on physical health [5,11,[13][14][15]18,20,23,38,63,64], social [8,23] and developmental outcomes [7,10] is still emerging, it shows promising growth.…”

“…There is increasing evidence that supports the health benefits of exposure to nature [1][2][3][4][5][6][7][8][9][10][11][12][13], and engaging in nature-based activities [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28]. Allied health professionals (AHPs) can play an important role in improving people's access to and use of nature, by working with individual patients/clients, communities and from a broader public health perspective, including advocacy for and input into the design of public natural environments.…”

“…While there has been a shift away from healthcare settings in nature, there has been an increase in research into the benefits of exposure to nature (e.g. green [1][2][3][4][5][6][7][8][9][10][11][12][13] and blue spaces [2,10,13]), and nature-based activities to improve health and wellbeing [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28]. Allied health professionals are well placed to integrate NBAs -by encompassing outdoor and indoor nature-based activities which may be recommended or directly engaged in with the patient/ client, and advocacy for or the provision of improvements to natural spaces -into their practice.…”

Nature-Based Interventions and Exposure among Cancer Survivors: A Scoping Review

“…We were unable to find an existing scoping review examining NBIs and exposure among cancer survivors published within the last ten years. There are examples of systematic reviews and qualitative meta-synthesis regarding cancer-related outcomes [8] and the role of nature in cancer patients' lives [9] but not on cancer survivorship. NBIs are effective interventions to reduce anxiety, depression, and psychological as well as psychosocial distress among individuals diagnosed with cancer [9][10][11][12][13][14][15][16][17] and should be utilized to promote well-being among cancer survivors.…”

Virtual Forest Environment Influences Inhibitory Control

“…A growing number of studies have highlighted the significant impact of a natural environment, particularly forestry, on people's psychophysical well-being. As a matter of fact, forest exposure is associated with beneficial effects at both the physiological [1][2][3][4] and psychological levels [5][6][7][8].…”