Division of Epidemiology & Social Sciences, PhD Program in Public and Community Health, Institute for Health & Equity, Medical College of Wisconsin, Milwaukee, WI, United States of America.
Division of Community Health, Institute for Health & Equity, Medical College of Wisconsin, Milwaukee, WI, United States of America.
PLoS One. 2022 Nov 23;17(11):e0276517. doi: 10.1371/journal.pone.0276517. eCollection 2022.
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.
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.
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.
在全球范围内，心血管疾病（CVD）和癌症是导致发病率和死亡率的主要原因。虽然病因不同，但 CVD 和癌症之间存在多种共同的风险因素，这些因素的存在加剧了患有任何一种疾病的个体的不良后果。对于这两种病理，贫困、缺乏身体活动（PA）、不良饮食摄入和气候变化等因素增加了不良后果的风险。先前的研究表明，绿地和其他基于自然的干预措施（NBIs）有助于改善健康结果和应对气候变化的能力。
总结绿地或 NBI 对心血管健康和/或癌症相关结果的影响证据，并确定知识空白，以为未来的研究提供信息。
根据系统评价和荟萃分析的首选报告项目（PRISMA）2020 年和电子搜索策略同行评审（PRESS）指南，我们搜索了五个数据库：Web of Science、Scopus、Medline、PsycINFO 和 GreenFile。两名盲审员使用 Rayyan AI 和预定义的文章纳入和排除标准进行操作。使用改良的纽卡斯尔-渥太华量表（NOS）评估偏倚风险。本综述已在 PROSPERO 上注册，ID # CRD42021231619。
从 2565 篇文章中，有 31 篇文章符合纳入标准，整体偏倚风险较低。26 篇文章研究了心血管相关结果，5 篇文章研究了癌症相关结果。干预措施被编码为 4 类：森林沐浴、绿色运动、园艺和自然观察。结果包括血压（BP）、癌症相关生活质量（QoL）以及（更不频繁地）心血管疾病风险的生物标志物。还介绍了发现的描述以及使用 RAW 图展示发现趋势的直观表示。总体而言，纳入的研究偏倚风险较低；而冲积图趋势表明，NBIs 可能对 CVD 和癌症相关结果有有益的影响。
（1）临床意义：医疗保健提供者应考虑推广基于自然的计划，以改善健康结果。（2）政策意义：需要投资于公平的绿地，以改善健康结果并建立具有气候适应能力的社区。（3）研究或学术意义：应鼓励与社区组织建立研究伙伴关系，全面研究 NBI 带来的益处，以减少健康差距并确保代际健康公平。需要研究 NBI 如何影响 CVD 的机制，并探索 CVD 炎症生物标志物在癌症幸存者中的作用。
