SynthesisFrontiers in public health2026
Comparative efficacy of green exercise versus indoor exercise for depression and anxiety: a systematic review and network meta-analysis.
Synthesis in Frontiers in public health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Authors and funding
3 authors.
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Abstract
Background: Physical activity is a proven intervention for depression and anxiety, but the optimal environment for exercising remains debated. While "green exercise" (in nature) is theorized to offer superior mental health benefits to indoor exercise, a comprehensive quantitative ranking of these modalities against a no-exercise control is lacking. We aimed to determine the comparative efficacy of green exercise, indoor exercise, and control conditions for improving mental health outcomes. Methods: We conducted a systematic review and network meta-analysis of randomized controlled trials (RCTs). We searched PubMed, Embase, Web of Science, and CENTRAL from inception to December 2024 for RCTs comparing at least two of the following: green exercise, indoor exercise, or a no-exercise/standard care control group in adults. The primary outcome was a composite measure of mental health, including symptoms of depression, anxiety, and psychological distress. A random-effects network meta-analysis was performed to calculate standardized mean differences (SMDs) and rank the interventions using P-scores. The protocol was registered with PROSPERO (CRD420261279222). Results: Fifteen RCTs involving 809 participants were included. The network of evidence formed a closed three-node loop. Compared to control, green exercise showed a large and statistically significant effect on improving mental health (SMD = -0.96, 95% CI: -1.66 to -0.25). Indoor Exercise showed a small, non-significant beneficial trend (SMD = -0.21, 95% CI: -1.08 to 0.67). In direct comparison, green exercise was significantly superior to indoor exercise (SMD = -0.75, 95% CI: -1.32 to -0.18). Ranking analysis confirmed green exercise as the most effective intervention with near certainty ( Conclusion: Green exercise is a highly effective intervention for improving mental health, demonstrating benefits significantly greater than both indoor exercise and no-exercise control conditions. These findings strongly support the integration of nature-based physical activity into clinical practice and public health strategies for mental wellness. Systematic review registration: PROSPERO, CRD420261279222.
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