Background

The health benefits of greenspaces have demanded the attention of policymakers since the 1800s. Although much evidence suggests greenspace exposure is beneficial for health, there exists no systematic review and meta-analysis to synthesise and quantify the impact of greenspace on a wide range of health outcomes.

Objective

To quantify evidence of the impact of greenspace on a wide range of health outcomes.

Methods

We searched five online databases and reference lists up to January 2017. Studies satisfying a priori eligibility criteria were evaluated independently by two authors.

Results

We included 103 observational and 40 interventional studies investigating ~100 health outcomes. Meta-analysis results showed increased greenspace exposure was associated with decreased salivary cortisol −0.05 (95% CI −0.07, −0.04), heart rate −2.57 (95% CI −4.30, −0.83), diastolic blood pressure −1.97 (95% CI −3.45, −0.19), HDL cholesterol −0.03 (95% CI −0.05, <-0.01), low frequency heart rate variability (HRV) −0.06 (95% CI −0.08, −0.03) and increased high frequency HRV 91.87 (95% CI 50.92, 132.82), as well as decreased risk of preterm birth 0.87 (95% CI 0.80, 0.94), type II diabetes 0.72 (95% CI 0.61, 0.85), all-cause mortality 0.69 (95% CI 0.55, 0.87), small size for gestational age 0.81 (95% CI 0.76, 0.86), cardiovascular mortality 0.84 (95% CI 0.76, 0.93), and an increased incidence of good self-reported health 1.12 (95% CI 1.05, 1.19). Incidence of stroke, hypertension, dyslipidaemia, asthma, and coronary heart disease were reduced. For several non-pooled health outcomes, between 66.7% and 100% of studies showed health-denoting associations with increased greenspace exposure including neurological and cancer-related outcomes, and respiratory mortality.

Conclusions

Greenspace exposure is associated with numerous health benefits in intervention and observational studies. These results are indicative of a beneficial influence of greenspace on a wide range of health outcomes. However several meta-analyses results are limited by poor study quality and high levels of heterogeneity. Green prescriptions involving greenspace use may have substantial benefits. Our findings should encourage practitioners and policymakers to give due regard to how they can create, maintain, and improve existing accessible greenspaces in deprived areas. Furthermore the development of strategies and interventions for the utilisation of such greenspaces by those who stand to benefit the most.

中文翻译：

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户外活动的健康益处：对绿色空间暴露和健康结果的系统回顾和荟萃分析。

 背景

自 1800 年代以来，绿色空间对健康的益处就引起了政策制定者的关注。尽管许多证据表明接触绿地有益于健康，但目前还没有系统评价和荟萃分析来综合和量化绿地对各种健康结果的影响。

 客观的

量化绿地对各种健康结果影响的证据。

 方法

截至 2017 年 1 月，我们检索了五个在线数据库和参考文献列表。满足先验资格标准的研究由两位作者独立评估。

 结果

我们纳入了 103 项观察性研究和 40 项干预性研究，调查了约 100 种健康结果。荟萃分析结果显示，绿地暴露增加与唾液皮质醇下降 -0.05 (95% CI -0.07, -0.04)、心率 -2.57 (95% CI -4.30, -0.83)、舒张压 -1.97 (95% CI) 相关。 CI -3.45, -0.19)、HDL 胆固醇 -0.03 (95% CI -0.05, <-0.01)、低频心率变异性 (HRV) -0.06 (95% CI -0.08, -0.03) 和高频 HRV 增加91.87 (95% CI 50.92, 132.82)，以及早产风险降低 0.87 (95% CI 0.80, 0.94)、II 型糖尿病 0.72 (95% CI 0.61, 0.85)、全因死亡率 0.69 (95% CI 0.55, 0.87)，胎龄较小 0.81 (95% CI 0.76, 0.86)，心血管死亡率 0.84 (95% CI 0.76, 0.93)，自我报告健康状况良好的发生率增加 1.12 (95% CI 1.05, 1.19) ）。中风、高血压、血脂异常、哮喘和冠心病的发病率降低。对于一些非汇总的健康结果，66.7% 至 100% 的研究表明健康与绿地暴露增加之间存在关联，包括神经系统和癌症相关的结果以及呼吸系统死亡率。

 结论

在干预和观察研究中，接触绿地与许多健康益处相关。这些结果表明绿色空间对广泛的健康结果产生有益影响。然而，一些荟萃分析结果受到研究质量差和异质性高的限制。涉及绿地利用的绿色处方可能会带来巨大的好处。我们的研究结果应该鼓励从业者和政策制定者适当考虑如何在贫困地区创建、维护和改善现有的无障碍绿地。此外，制定战略和干预措施，让那些受益最大的人利用这些绿色空间。