Effect of nature prescriptions on cardiometabolic and mental health, and physical activity: a systematic review.
Level 1 - systematic review of randomized trials
Systematic review and meta-analysis of randomized and non-randomized controlled trials
PubMed 37019572 · doi:10.1016/S2542-5196(23)00025-6
What was done
Authors searched five databases through July 25, 2021, for randomized and non-randomized controlled studies evaluating nature prescriptions (referrals or organized programs by health or social professionals encouraging time in nature). Two reviewers independently screened studies, and one extracted data and evaluated risk of bias. Random-effects DerSimonian-Laird meta-analyses were conducted for five key health outcomes.
What was found
Across 92 identified studies (28 meta-analyzed), nature prescriptions significantly lowered systolic blood pressure (mean difference -4.82 mm Hg [-8.92 to -0.72]) and diastolic blood pressure (mean difference -3.82 mm Hg [-6.47 to -1.16]) versus controls. They improved depression scores (post-intervention SMD -0.50 [-0.84 to -0.16]; change from baseline SMD -0.42 [-0.82 to -0.03]) and anxiety scores (post-intervention SMD -0.57 [-1.12 to -0.03]; change from baseline SMD -1.27 [-2.20 to -0.33]). Nature prescriptions increased daily physical activity by 900 steps (mean difference 900 steps [790 to 1010]), but did not significantly increase weekly minutes of moderate physical activity (mean difference 25.90 min [-10.26 to 62.06]). Interventions involving social professionals drove anxiety and depression improvements, whereas those involving health professionals drove blood pressure and step count improvements.
Why it matters
This review provides quantitative evidence that formal nature social prescriptions can yield tangible cardiometabolic, psychological, and physical activity improvements across healthcare and social care channels.
Limits
Most included studies had a moderate to high risk of bias. Only 28 of 92 identified studies contributed data to the meta-analyses. Data extraction and risk of bias assessment were conducted by only a single reviewer. The synthesis combined randomized and non-randomized designs, and the abstract did not report long-term clinical endpoints or adherence.
Cited by
- context Walking in nature compared to walking in an urban metropolitan area produces a significantly greater reduction in clinical symptoms of depression and anxiety.