The association between green space and mental health, physical activity, and sedentary behaviour in rural populations: A systematic review

OBJECTIVE: To review evidence on associations between green space with mental health and physical activity in rural populations. METHODS: We searched PubMed, CINAHL, Scopus, Web of Science, and SPORTDiscus databases for studies published through August 2024. Eligible studies examined the relationships between green space with depression, anxiety, depression anxiety, physical activity or sedentary behaviour. Studies in care facilities or virtual green space exposure were excluded. Methodological quality was assessed using Joanna Briggs Institute Tools. Due to heterogeneity, we conducted narrative syntheses. RESULTS: Of 4,441 records identified, 25 met inclusion criteria, most (80%) of which were cross-sectional studies. Evidence on green space and mental health outcomes was mixed. However, beneficial associations were observed for private green spaces, including gardening and high-quality spaces. Associations between green space and physical activity were inconsistent, but accessibility and quality were positively associated with moderate-to-vigorous physical activity. CONCLUSIONS: Private and high-quality green space may improve mental health and physical activity in rural populations, although overall evidence remains heterogeneous and limited. IMPLICATIONS FOR PUBLIC HEALTH: Public health interventions and policies should prioritise improving green space access, quality, and support backyard gardening or similar initiatives. Longitudinal and qualitative research is needed to advance understanding and guide context-specific rural health strategies.