Physical activity as a possible mechanism behind the relationship between green space and health: a multilevel analysis.
BACKGROUND
The aim of this study was to investigate whether physical activity (in general, and more specifically, walking and cycling during leisure time and for commuting purposes, sports and gardening) is an underlying mechanism in the relationship between the amount of green space in people's direct living environment and self-perceived health. To study this, we first investigated whether the amount of green space in the living environment is related to the level of physical activity. When an association between green space and physical activity was found, we analysed whether this could explain the relationship between green space and health.


METHODS
The study includes 4.899 Dutch people who were interviewed about physical activity, self-perceived health and demographic and socioeconomic background. The amount of green space within a one-kilometre and a three-kilometre radius around the postal code coordinates was calculated for each individual. Multivariate multilevel analyses and multilevel logistic regression analyses were performed at two levels and with controls for socio-demographic characteristics and urbanicity.


RESULTS
No relationship was found between the amount of green space in the living environment and whether or not people meet the Dutch public health recommendations for physical activity, sports and walking for commuting purposes. People with more green space in their living environment walked and cycled less often and fewer minutes during leisure time; people with more green space garden more often and spend more time on gardening. Furthermore, if people cycle for commuting purposes they spend more time on this if they live in a greener living environment. Whether or not people garden, the time spent on gardening and time spent on cycling for commuting purposes did not explain the relationship between green space and health.


CONCLUSIONS
Our study indicates that the amount of green space in the living environment is scarcely related to the level of physical activity. Furthermore, the amount of physical activity undertaken in greener living environments does not explain the relationship between green space and health.
Maas
Jolanda
J
NIVEL (Netherlands Institute for Health Services Research), PO Box 1568, 3500 BN, Utrecht, The Netherlands. j.maas@nivel.nl
Verheij
Robert A
RA
Spreeuwenberg
Peter
P
Groenewegen
Peter P
PP
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D002648:Child; D004777:Environment; D015444:Exercise; D005260:Female; D006305:Health Status Indicators; D006306:Health Surveys; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009426:Netherlands; D010944:Plants; D012111:Residence Characteristics / Q000706:statistics & numerical data; D012424:Rural Population; D012959:Socioeconomic Factors; D014505:Urban Population