The Impact of Green Exercise on Cardiovascular and Musculoskeletal Health in Middle-Aged Adults and Older Adults: A Scoping Review

The growing urbanization has significantly contributed to the global burden of cardiovascular and musculoskeletal diseases in adult populations. Green exercise, defined as structured physical activity performed in natural outdoor environments, has emerged as a promising intervention to address multiple health outcomes simultaneously. This scoping review aims to synthesize the current scientific evidence on the cardiovascular and musculoskeletal health benefits of green exercise among adults and older adults, by examining the mechanisms of action, dose-response relationships, and practical implications for health promotion. A literature search was conducted across PubMed, Web of Science, Scopus, and Google Scholar databases. The search strategy employed terms and keywords related to green exercise, outdoor physical activity, cardiovascular health, musculoskeletal health, adults, and older populations. The evidence demonstrates consistent cardiovascular benefits including improvements in blood pressure regulation, heart rate variability, and cardiorespiratory fitness. Musculoskeletal benefits encompassed enhanced muscle strength, improved balance, better functional capacity, and reduced fall risk. The mechanisms underlying these benefits involve enhanced autonomic nervous system function, improved vascular reactivity, increased muscle activation patterns, and optimized neuromuscular coordination in natural environments. Green exercise provides significant cardiovascular and musculoskeletal health benefits and may offer additional advantages compared to equivalent indoor exercise.