Tracking Restoration of Park and Urban Street Settings in Coronary Artery Disease Patients.

Regina Grazuleviciene,Asta Danileviciute,Sandra Andrusaityte,Jone Vencloviene,Raimondas Kubilius,Audrius Dedele,Astra Vitkauskiene,Rasa Steponaviciute,Vytautas Grizas,Mark Nieuwenhuijsen

doi:10.3390/ijerph13060550

Abstract

The physiological effects of natural and urban environments on the cardiovascular system of coronary artery disease (CAD) patients are not fully understood. This controlled field study examines the effects of restorative walking in a park vs. in an urban street environment on CAD patients’ stress parameters and cardiac function. Methods: Twenty stable CAD patients were randomly allocated to 7 days controlled walking in a city park or in an urban street environment group. The relationship between different environmental exposures and health effects was analyzed using Wilcoxon signed-rank test and exact Mann-Whitney U test. Results: The mean reduction in cortisol levels and negative effects after the walk on the first day was greater in the city park than in the urban street exposed group, while a reduction in negative effects in the urban group were greater after seven days. The reduction in diastolic blood pressure (DBP) in the park group was evident on the seventh day before the walk (−4 mm Hg, p = 0.031) and 60 min after the walk (−6.00 mm Hg, p = 0.002). The cortisol slope was negatively associated with the DBP changes (r = −0.514, p < 0.05). Conclusions: Physical activity in a green environment with noise and air pollution levels lower than in an urban environment has a greater positive effect on CAD patients’ stress level and hemodynamic parameters. Mitigating green environmental influences may allow urban residents to maintain health and reduce disability.

Highlights

Environmental non-communicable diseases, such as coronary artery disease (CAD), represent a growing global public health emergency
The findings suggest that even short-term visits to nature areas, such as urban parks, and urban woodland, have a positive effect on perceived stress relief compared to the built-up environment, but there were no differences in the decrease of salivary cortisol levels during the experiment [9]
The cortisol slope was negatively associated with heart rate (HR) decrease and diastolic blood pressure (DBP)

Summary

Conclusions

This controlled field study extends the evidence for a biological pathway of the beneficial effects of green space exposure on health, which support the notion of stress relief and restoration as possible mechanisms through which natural environments confer health benefit. Our findings indicate that physical activities in the park environment, coherent with stress reduction, can have a better restorative effect on post-MI patients’ cardiac function, compared to the urban street environment with higher noise and air pollution levels. Further research with a bigger sample size and a longer treatment is required to confirm our conclusion. Understanding of the mechanisms could expand the appropriate use of the green environment to decrease stress and improve cardiac function, thereby increasing the effectiveness of contact with nature at a population level for the prevention of CVD

Introduction

Materials and Methods

Results

The First-Day and the Seven-Day Exposure Effects

Discussion