THE EFFECTS OF GREEN EXERCISE ON THE PHYSICAL AND MENTAL HEALTH OF PEOPLE WITH CHRONIC DISEASES, A SYSTEMATIC REVIEW

A. Tsokani¹, V. Stefanouli¹, E. Kapreli¹, N. Strimpakos^1,2

¹University of Thessaly, Department of Physiotherapy, Lamia, Greece, ²University of Manchester, Division of Musculoskeletal & Dermatological Sciences, Manchester, United Kingdom

Background: Physical exercise has plenty of benefits for various populations with chronic illnesses and for this reason it is recommended in their clinical care. Physical therapists should include exercise regimes in the treatment plans of chronic patients as a disease management tool. However, lack of motivation and low adherence to exercise are reasons that lead to low levels of physical activity. Green exercise is defined as any physical activity performed in nature and is a promising means of augmenting participation in physical exercise programs.

Purpose: To assess the role of green exercise interventions in people with chronic health conditions through a systematic review of Randomized Controlled Trials. Particularly, to examine the effects of green exercise in the physical and mental health of chronic patients as well as in their adherence to physical activity.

Methods: Τhis systematic review was conducted in accordance with the PRISMA statement. Six electronic databases (MEDLINE via PubMed, AMED, Embase and PsycINFO via OVID, Web of Science and, GreenFILE) were searched for publications from 1992 to 2022. Two independent reviewers examined if studies met inclusion criteria and assessed them using the PEDro scale. Studies were included if they were Randomized Controlled Trials of green exercise interventions in populations with chronic conditions, mentioning at least one physical/mental health outcome and/or physical activity adherence.

Results: Of the 7702 screened articles, 15 trials (16 reports) met the inclusion criteria. Their methodological quality according to total PEDro scores were 6 to 8 for ten studies and 4 to 5 for five studies. A total number of 717 participants were included, 148 cancer patients, 136 patients with COPD, 225 patients with CVD or risk for CVD, 80 people with low back pain, 65 patients with schizophrenia, 39 stroke patients, and 24 people with ADHD. Green exercise is a safe and well-tolerated intervention, with low drop-out levels. It appeared to have a positive effect in the quality of life and overall mental health of participants. Green exercise was also an effective suggestion for enhancing functional performance. Physiological outcomes were not extensively examined by the included RCTs, however, there is a potential improving impact for factors as cholesterol and blood pressure, especially in people with cardiovascular conditions.

Conclusions: Green exercise is a safe intervention with a beneficial impact on people with chronic conditions. Additional research is needed regarding its effect on physical and physiological health. The certainty of this evidence might be affected by attrition biases. The lack of consistency in interventions used in studies has resulted in no widely recommended form of green exercise for these populations. Future research should prioritize sound and qualitative design.

Implications: The results of this systematic review suggested that green exercise is a feasible and effective intervention for people with chronic conditions and clinicians should include it in their treatment plans.

Funding acknowledgements: Framework "Smart Tourist". Co-financed by Greece and EU (European Regional Development Fund) NSRF 2014-2020, MIS
5047243

Keywords:
Green exercise
Chronic conditions
Health promotion

Topics:
Non-communicable diseases (NCDs) & risk factors
Health promotion & wellbeing/healthy ageing/physical activity
Mental health

Did this work require ethics approval? Yes

Institution: University of Thessaly

Committee: Research Ethics Committee of University of Thessaly

Ethics number: 41 / 09.12.2020