Con en s lis s a ailable a ScienceDi ec
En i onmen al Resea ch
jou nal homepage: www.else ie .com/loca e/en es
Acu e effec s o isi s o u ban g een en i onmen s on ca dio ascula
physiology in women: A field expe imen
Timo Lanki
a,b,⁎
, Taina Siponen
a
, Ann Ojala
c
, Kale i Ko pela
d
, A o Pennanen
a
, Pekka Tii anen
a
,
Yuko Tsune sugu
e
, Takahide Kagawa
e
, Liisa Ty äinen
c
a
Depa men o Heal h Secu i y, Na ional Ins i u e o Heal h and Wel a e (THL), Kuopio, Finland
b
Uni o Public Heal h and Clinical Nu i ion, Uni e si y o Eas e n Finland, Kuopio, Finland
c
Na u al Resou ces Ins i u e Finland (Luke), Helsinki, Finland
d
School o Social Sciences and Humani ies / Psychology, Uni e si y o Tampe e, Finland
e
Fo es y and Fo es P oduc s Resea ch Ins i u e (FFPRI), Iba aki, Japan
ARTICLE INFO
Keywo ds:
G een space
Blood p essu e
Hea a e
Pa icula e ai pollu ion
Noise
ABSTRACT
Backg ound: Epidemiological s udies ha e epo ed posi i e associa ions be ween he amoun o g een space in
he li ing en i onmen and men al and ca dio ascula human heal h. In a sea ch o effec mechanisms, field
s udies ha e ound sho - e m isi s o g een en i onmen s o be associa ed wi h psychological s ess elie . Less
e idence is a ailable on he effec o isi s on ca dio ascula physiology.
Objec i es: To e alua e whe he isi s o u ban g een en i onmen s, in compa ison o isi s o a buil -up en-
i onmen , lead o beneficial sho - e m changes in indica o s o ca dio ascula heal h.
Me hods: Thi y-six adul emale olun ee s isi ed h ee diffe en ypes o u ban en i onmen s: an u ban o es ,
an u ban pa k, and a buil -up ci y cen e, in Helsinki, Finland. The isi s consis ed o 15 min o seden a y
iewing, and 30 min o walking. Du ing he isi s, blood p essu e and hea a e we e measu ed, and elec o-
ca diog am eco ded o he de e mina ion o indica o s o hea a e a iabili y. In addi ion, le els o espi able
ambien pa icles and en i onmen al noise we e moni o ed.
Resul s: Visi s o he g een en i onmen s we e associa ed wi h lowe blood p essu e ( iewing pe iod only), lowe
hea a e, and highe indices o hea a e a iabili y [s anda d de ia ion o no mal- o-no mal in e als (SDNN),
high equency powe ] han isi s o he ci y cen e. In he g een en i onmen s, hea a e dec eased and SDNN
inc eased du ing he isi . Associa ions be ween en i onmen and indica o s o ca dio ascula heal h weakened
sligh ly a e inclusion o pa icula e ai pollu ion and noise in he models.
Conclusions: Visi s o u ban g een en i onmen s a e associa ed wi h beneficial sho - e m changes in ca dio-
ascula isk ac o s. This can be explained by psychological s ess elie wi h con ibu ion om educed ai
pollu ion and noise exposu e du ing he isi s. Fu u e esea ch should e alua e he amoun o exposu e o g een
en i onmen s needed o longe - e m benefi s o ca dio ascula heal h.
1. In oduc ion
U baniza ion is a global phenomenon which shows no signs o
slowing down. Consequen ly, he quali y o u ban en i onmen has
become inc easingly impo an o human heal h. U ban g een en-
i onmen s, such as pa ks and u ban o es s, a e elemen s o en i on-
men which many in ui i ely conside heal hy. Al hough he e idence
canno ye be claimed sufficien and he e a e issues ela ed o po en ial
exposu e misclassifica ion and con ounding, many epidemiological
s udies indeed ha e epo ed ha pe sons li ing in g eene en i on-
men s ha e be e men al and ca dio ascula heal h han pe sons li ing
in mo e buil -up en i onmen s (Gascon e al., 2016, 2015; Maas e al.,
2009b).
Se e al mechanisms ha e been p oposed by which li ing close o
g een a eas may affec posi i ely heal h: o example, beneficial effec s
may be pa ly due o educed exposu e o affic- ela ed ai pollu ion
and noise. Inc eased amoun o g een space in a esiden ial a ea ypi-
cally implies less affic. This educes exposu e o ai pollu ion and
h p://dx.doi.o g/10.1016/j.en es.2017.07.039
Recei ed 27 Oc obe 2016; Recei ed in e ised o m 29 June 2017; Accep ed 18 July 2017
⁎
Co espondence o: Depa men o Heal h Secu i y, Na ional Ins i u e o Heal h and Wel a e (THL), Neulaniemen ie 4 (P.O. Box 95), FI-70210 Kuopio, Finland.
E-mail add ess: imo.lanki@ hl.fi(T. Lanki).
Abb e ia ions: BP, blood p essu e; HF, high equency powe ; HRV, hea a e a iabili y; LAeq, A-weigh ed equi alen con inuous sound p essu e le el; PM
10,
, espi able pa icles,
pa icles wi h ae odynamic diame e < 10 µm; SDNN, s anda d de ia ion o he no mal in e -bea in e als; RMSSD, squa e oo o he mean o he sum o he squa es o diffe ences
be ween adjacen no mal- o-no mal in e als
En i onmen al Resea ch 159 (2017) 176–185
0013-9351/ © 2017 The Au ho s. Published by Else ie Inc. This is an open access a icle unde he CC BY-NC-ND license (h p://c ea i ecommons.o g/licenses/BY-NC-ND/4.0/).
MARK
noise bo h indoo s a home and ou doo s nea home. In addi ion, e-
ge a ion may dec ease pollu an le els locally by affec ing dispe sion
and emo al (Jang e al., 2015;Ty äinen e al., 2005). Bo h long- e m
and sho - e m exposu es o affic- ela ed ai pollu ion ha e been as-
socia ed wi h de e io a ions in ca dio ascula heal h (B ook e al.,
2010). T affic noise in u n seems o be associa ed wi h ca dio ascula
heal h independen ly o ai pollu ion (Vienneau e al., 2015), and i
may be associa ed also wi h men al heal h (Floud e al., 2011; Leslie
and Ce in, 2008; Sygna e al., 2014), al hough he e a e su p isingly
ew s udies on he opic.
O he p oposed mechanisms equi e he use o g een en i onmen s.
Fo example, g een a eas offe oppo uni ies o physical ac i i y which
is an es ablished p o ec i e li e-s yle ac o agains ca dio ascula dis-
ease and dep ession (Conn, 2010; Wo ld Heal h O ganisa ion, 2010).
Some s udies ha e indeed epo ed ha li ing in p oximi y o g een
a eas inc eases he likelihood o equen exe cise (e.g. Gong e al.,
2014;Richa dson e al., 2013). Howe e , many o he ha e no ound
e idence o an associa ion be ween supply o g een a eas and le el o
physical ac i i y (e.g. Hillsdon e al., 2006;O d e al., 2013). G een
a eas ha e also been sugges ed o enhance social in e ac ions (Maas
e al., 2009a; de V ies e al., 2013), which may o may no in ol e
exe cise, bu he heal h ele ance o his has no ye been widely s u-
died (Ha ig e al., 2014; Ruijsb oek e al., 2017).
Las bu no leas , i has been sugges ed ha , because o in insic
quali ies o na u al elemen s, g een a eas ha e also mo e di ec posi i e
effec s on wellbeing and u he heal h. These effec s could be ex-
plained by es o a ion o a en ion as a esul o escaping daily ou ines
and cons an need o concen a ion (Kaplan 1995), o by inna e ig-
ge ing o posi i e emo ions (Ul ich 1983). The e is an inc easing
amoun o expe imen al s udies, as e iewed by Bowle e al. (2010),
epo ing ha sho isi s o g een en i onmen s such as pa ks, u ban
woodlands, and o es s imp o e mood and a en ion, and enhance
psychological s ess eco e y. We ha e ecen ly epo ed isi s o u ban
g een en i onmen s o be associa ed wi h inc eased eelings o e-
s o a ion, i ali y, and posi i e mood (Ty äinen e al., 2014)
E idence on he impo ance o good men al heal h o physical
heal h has inc eased especially o ca dio ascula diseases o e he las
ew decades: o example ch onic dep ession, anxie y, and wo king
s ess ha e been associa ed wi h inc eased ca dio ascula mo bidi y
(Gan e al., 2014;Ki imäki e al., 2006;Pie ilä e al., 2015;
Spa enbe ge e al., 2009). A plausible effec mechanism has been
p o ided by s udies epo ing acu e psychosocial s ess, men al effo ,
and wo y o be associa ed wi h apid changes in he le els o ca dio-
ascula isks ac o s such as blood p essu e, hea a e, and hea a e
a iabili y (HRV), a measu e o au onomic ne ous con ol o hea
(e.g. Pe e s e al., 1998;Piepe e al., 2007). No ewo hy, sho - e m
exposu e o ai pollu ion, such as expe ienced du ing commu ing in a
ci y cen e wi h busy affic, has been ound o be associa ed wi h he
same isk ac o s (e.g. Kubesch e al., 2015,Lanki e al., 2006;Sa na
e al., 2014).
Based on he p e iously epo ed associa ions be ween men al s a e
and ca dio ascula physiology, i can be hypo hesized ha e en sho
isi s o g een en i onmen s may lead o posi i e changes in ca dio-
ascula isk ac o s as a esul o s ess eco e y. An inc easing numbe
o s udies in Eu ope and US (Gidlow e al., 2016; G azule iciene e al.,
2015; Ha ig e al., 2003, 1991; Sonn ag-Ös öm e al., 2014; T igue o-
Mas e al., 2017), and mos ly smalle scale s udies in Japan (Lee e al.,
2014, 2011;Li e al., 2011;Pa k e al., 2010;Song e al., 2014), ha e
e alua ed effec s o isi s o g een a eas, in compa ison o isi s o buil -
up u ban a eas, on blood p essu e, hea a e o HRV. Se e al o he
s udies ha e epo ed posi i e effec s, mos o en o HRV, bu d awing
solid conclusions has been hampe ed by he he e ogenei y o s udy
designs and esul s (Bowle e al., 2010). Fu he , he effec o educ ion
in ai pollu ion and noise exposu e du ing isi s o g een en i onmen s
has been aken in o accoun in only one p e ious s udy (T igue o-Mas
e al., 2017), whe e u he analyses we e hampe ed by he lack o
o e all effec o g een a eas on ca dio ascula physiology. No ewo hy,
some s udies sugges ha a me e isual exposu e o g een en i onmen ,
in a o m o a pic u e o ideo, is enough o igge posi i e physiolo-
gical changes (B own e al., 2013; Lauman e al., 2003).
I can be u he hypo hesized ha psychophysiological esponses o
isi s o g een a eas a e dependen on he quali y o he a ea. Fo ex-
ample high biodi e si y, na u al s a e, soli ude, and anquili y a e a -
ibu es ha may enhance expe ience o na u e du ing isi and im-
p o e es o a ion (Ko pela and S aa s, 2014; Voig e al., 2014). These
cha ac e is ics a e mo e commonly ound in la ge o es ed a eas han
small u ban pa ks. O he de e minan s o effec s and usage o g een
a eas include e.g. walkabili y, sa e y, and acili ies (Ha ig e al., 2014).
The e is li le in o ma ion on he modi ying effec o he quali y o
g een en i onmen s on men al o ca dio ascula heal h (Ma selle e al.,
2014;Pope e al., 2015).
In o de o es he hypo heses abo e, acu e effec s o sho isi s o
wo ypes o g een u ban en i onmen s on ca dio ascula physiology
a e es ima ed in his field s udy, and compa ed o he effec s o isi s o
a buil -up u ban en i onmen . The p esen s udy includes adul em-
ployed olun ee s in con as o ea lie s udies which ha e o en elied
on s uden samples. A a e ea u e o he s udy is he inclusion o affic-
ela ed ai pollu ion and noise exposu es in he analyses.
2. Me hods
2.1. S udy design
The s udy ook place in Helsinki, he capi al o Finland, whe e o-
lun ee s isi ed once h ee diffe en ypes o en i onmen s, named he e
as: u ban o es , u ban pa k, and (buil -up) ci y cen e. The u ban o es
(Keskuspuis o) is he la ges o es ed a ea in Helsinki wi h a o al size o
1000 ha. I is 10 km in leng h, and consis s o 60–100 yea old mixed
and coni e o es s. The u ban pa k (Alppipuis o) is one o he oldes
u ban pa ks in Helsinki co e ing oge he wi h a neighbo ing pa k 20
ha. I is well-designed wi h flowe beds, wa e elemen , old pa k ees,
and acili ies such as benches and a pe o mance s age o li e music.
The en i onmen ep esen ing a ci y cen e was close o a main s ee
(Manne heimin ie) and a shopping cen e –only single u ban ees
we e ound on he a ea. Pho os o he s udy en i onmen s can be ound
in a p e ious publica ion (Ty äinen e al., 2014).
We ollowed o some ex en he p o ocol used in field expe imen s
conduc ed in Japan (Lee e al., 2014;Tsune sugu e al., 2013). S udy
pa icipan s isi ed he en i onmen s in pa ly changing g oups o ou
people in a andom o de ; no mo e han one en i onmen pe week.
Pa icipan s we e asked no o communica e wi h each o he du ing he
isi s. Each isi consis ed o a 15-min pe iod o si ing and iewing he
en i onmen , and a 30-min pe iod o unhu ied walking in he en-
i onmen . Du ing he walking pe iod, s udy pa icipan s ollowed a
esea che who kep a s eady pace (aiming a 4 km/h) on a p esc ibed
ou e (app oxima ely 2 km). Ano he esea che ollowed he pa ici-
pan s, and ca ied a backpack which con ained ins umen s o mon-
i o ing o ai pollu ion, en i onmen al noise, and ambien empe a u e.
All expe imen s s a ed a 3 p.m., i.e. a e a no mal wo king day o
mos o he pa icipan s. Pa icipan s go an SMS eminde in he
mo ning o each expe imen al day. On each isi , pa icipan s fi s a -
i ed a an office, whe e blood p essu e and elec oca diog am (ECG)
moni o s we e ins alled by esea che s. A he office, each pa icipan
also filled in a ques ionnai e on cu en heal h condi ion, and a e a
sandwich and d ank a juice in o de o s anda dize ene gy le el. Be o e
lea ing he office, pa icipan s insed hei mou hs wi h wa e o p e-
pa e o co isol measu emen s. Pa icipan s we e b ough o he s udy
en i onmen om he office in a an (20–30 min d i ing ime).
Blood p essu e was measu ed fi s a he office in o de o es he
ins umen s, and hen 3 imes du ing he expe imen : in he an a e
a i al o he s udy en i onmen (con ol alue), a e he iewing
pe iod while s ill si ing, and a e he walking pe iod in he an. ECG
T. Lanki e al. En i onmen al Resea ch 159 (2017) 176–185
177
moni o s we e unning h oughou he expe imen . Wi h he excep ion
o he office en i onmen , blood p essu e measu emen s we e always
ollowed by collec ion o sali a samples and filling in psychological
ques ionnai es. Sali a samples we e used o he de e mina ion o
co isol, a ho mone indica o o s ess. Ques ionnai es we e used o
e alua e changes in e.g. es o a ion, i ali y, and mood du ing he
isi s. Resul s o he co isol measu emen s and psychological measu es
can be ound in a pape by Ty äinen e al. (2014). The ea lie pape
included addi ional pa icipan s o which no ECG, ai pollu ion, and
noise da a was a ailable.
Da a included in he cu en pape was collec ed du ing wo pe -
iods: fi s g oup o pa icipan s isi ed he h ee en i onmen s in au-
umn 2011, and he second g oup in au umn 2012 (a e addi ional
unding was ob ained). The isi s ook place be ween mid-Augus and
mid-Sep embe , du ing which pe iod empe a u e is s ill ela i ely high
and he na u e g een in Helsinki.
2.2. S udy popula ion
S udy pa icipan s, aged 30–60 yea s, we e ec ui ed by con ac ing
pe sonal manage s in some go e nmen al and municipal o ganiza ions,
who hen o wa ded an in i a ion le e ia in ane o e-mail lis s
( olun ee s a na ional esea ch ins i u es we e es ic ed o hose no
in ol ed wi h o es and/o heal h s udies o any kind). An in i a ion
o s affwas also published in he mon hly bulle in o he Uni e si y o
Helsinki. Finally, in 2012 in i a ion le e s we e also deli e ed o
households loca ed nea by he office used as he mee ing poin o he
expe imen al isi s. The in i a ion included a sho desc ip ion o he
s udy, and ins uc ions on how o sign up o he s udy. Those exp es-
sing in e es ecei ed mo e in o ma ion on he s udy by pos o phone,
including desc ip ion o he s udy p ocedu e, isks associa ed wi h he
s udy, and confiden iali y issues. They we e also asked o fill in a
baseline ques ionnai e ha included ques ions on e.g. wo king li e, die ,
heal h and medica ion use, na u e o ien edness, noise sensi i i y, and
he use o g een a eas in e e yday li e.
Exclusion c i e ia o he s udy we e: smoking, ca diac pacemake ,
hea ing aid, doc o -diagnosed myoca dial in a c ion, co ona y hea
disease, conges i e hea ailu e, s oke, and ch onic obs uc i e pul-
mona y disease. In addi ion, pe sons wi hou medica ion o as hma,
blood p essu e o diabe es we e p e e ed. S udy pa icipan s we e
asked o a oid alcohol and obacco use as well as hea y physical ac-
i i y be o e he expe imen .
The Resea ch E hics Commi ee o he No he n Sa o Hospi al
Dis ic app o ed he s udy. All s udy pa icipan s ga e a w i en con-
sen o he s udy du ing hei fi s isi .
2.3. Medical da a
Blood p essu e (BP) and hea a e we e measu ed wi h oscillo-
me ic blood p essu e moni o s (Model 90217, Spacelabs Heal hca e,
Snoqualmie, Washing on, USA). Be o e lea ing o an expe imen al si e,
acuffwas w apped a ound he le a m o he pa icipan . An ai hose
connec ed he cuff o he blood p essu e moni o , which was ca ied in
a small case a ached o a bel o shoulde s ap.
Blood p essu e and hea a e we e measu ed in si ing posi ion
om he le a m es ing on lap. Be o e each measu emen , s udy pa -
icipan s sa s ill o a leas 3 min. A a esea che ’s eques hey hen
pushed a bu on s a ing he measu emen . A second measu emen was
s a ed 60 s a e he fi s one was finished. In he analyses, he a e age
o he wo measu emen s was used.
Elec oca diog ams we e eco ded wi h Hol e -moni o s (Medilog
AR12 Plus, Schille AG, Baa , Swi ze land). Se en elec odes, a ached
o he ches o a pa icipan , we e used o eco d ECG in 3 channels wi h
a sampling equency o 125 Hz; measu emen s we e s a ed a he o -
fice. Pa icipan s ca ied he moni o in a small case a ached o a bel
o shoulde s ap. Indica o s o hea a e a iabili y we e calcula ed
wi h he Da win So wa e (Schille AG) o he con ol, iewing, and
o al ( iewing+walking) pe iods.
Hea a e a iabili y, he change in he ime in e als be ween
adjacen hea bea s, is a measu e o he au onomic ne ous con ol o
hea a e. We used wo indica o s o HRV based on ime-domain
analyses: he s anda d de ia ion o he no mal in e -bea in e als
(SDNN), and he squa e oo o he mean o he sum o he squa es o
diffe ences be ween adjacen no mal- o-no mal in e als (RMSSD). In
addi ion, high equency powe (HF) was es ima ed based on equency
domain analyses. SDNN eflec s all ac o s ha con ibu e o HRV,
whe eas RMSSD eflec s high- equency a ia ion in HRV and is used o
es ima e agally media ed changes in HRV. HF is also used o e alua e
agal ac i i y, bu is mo e influenced by he espi a o y cycle (Shaffe
e al., 2014).
2.4. En i onmen al da a
In he da a analyses, concen a ion o espi able pa icles (PM
10
;
ae odynamic diame e < 10 µm) du ing he isi was used as an in-
dica o o exposu e o pa icula e ai pollu ion. In addi ion, black
ca bon and pa icle numbe concen a ion we e moni o ed. In u ban
a eas, spa ial dis ibu ion o PM
10
is ypically d i en by emissions o
oad affic, including oad dus . I was measu ed wi h a pho ome e
(Dus T ak DRX 5833, TSI Inc., Sho e iew, Minneso a, USA) ha was
equipped wi h a PM
10
impac o ; ime esolu ion was 5 s. The flow a e
was calib a ed o 3 l/min wi h a BIOS De ende calib a o (B and
Ins umen s Inc., P ai ie ille, Cali o nia, USA). Black ca bon was
moni o ed wi h a mic oae halome e (Magee Scien ific AE52, Magee
Scien ific Co p., Be keley, Cali o nia, USA) and pa icle numbe con-
cen a ion wi h a condensa ion pa icle coun e (TSI P-T ak, TSI Inc.,
Sho e iew, Minneso a, USA).
En i onmen al noise le els we e measu ed wi h class II La son
Da is Spa k 706 noise dosime e s (PCB Piezo onics Inc., Depew, New
Yo k, USA) oge he wi h La son Da is MPR001 in eg a ed mic o-
phone/p eamplifie s. A-weigh ed equi alen con inuous sound p essu e
le els (LAeq) du ing he isi s we e used in he da a analyses. Ambien
empe a u e and humidi y we e eco ded wi h da alogge s (Esco iLog
EI-HS-D-32-L, C yopak, Edison, New Je sey, USA) a ached o he ex-
e io o he backpack (con aining ai pollu ion moni o s) ca ied by a
esea che .
Resea che s assessed he wea he be o e each iewing and walking
pe iod, and a e he walking pe iod. Ca ego ies used o eco d he
wea he we e: sunny, pa ly cloudy, cloudy, d izzle. Expe imen was
cancelled i he e was hea y ain.
2.5. Da a analyses
In o de o compa e he effec s o isi s in diffe en en i onmen s on
indica o s o ca dio ascula heal h, mixed models we e buil using SAS
so wa e (SAS Ins i u e Inc. Ca y, NC, USA). Models included be o e and
a e isi alues o blood p essu e/hea a e o each subjec in each
en i onmen . HRV was measu ed con inuously, and he e o e a e ages
o be o e isi and du ing isi alues we e used in he models. S udy
pa icipan s we e ea ed as epea ing ac o s in he models in o de o
ake in o accoun longe - e m diffe ences be ween subjec s in he ou -
come a iables, as well as en i onmen -independen daily a ia ion
wi hin subjec s (i.e. s udy pa icipan s se ed as hei own con ols).
The obse a ions wi hin a subjec we e assumed o be equally co e-
la ed. This is he same kind o s uc u e ha a ises in a no mal linea
model wi h andom in e cep s (i.e., andom subjec s). I acknowledges
ha co ela ions exis wi hin a subjec , bu i assumes ha he co e-
la ions a e cons an o e ime.
The basic model included ambien empe a u e and wea he ca e-
go y as con ounde s. In addi ional models, also PM
10
and noise le els
du ing he isi we e included in o de o e alua e whe he (po en-
ially) lowe ai pollu ion and noise le els in g een a eas con ibu e o
T. Lanki e al. En i onmen al Resea ch 159 (2017) 176–185
178
he effec o isi s, and subsequen ly whe he he quali y o he g een
a ea is o impo ance.
I was an icipa ed ha physical s ain o walking, e en in a slow
speed, migh mask some o he effec s o en i onmen on ca dio ascula
physiology. The e o e, he effec o iewing only was e alua ed in se-
pa a e analyses.
In a complemen a y app oach, effec s o isi s on indica o s o
ca dio ascula heal h we e e alua ed by calcula ing o each pa ici-
pan in each en i onmen he diffe ence be ween ou come alues a e
isi (o du ing isi o HRV) and be o e isi . T- es was used o
e alua e s a is ical significance o he diffe ence. A posi i e alue co -
esponded o an inc ease du ing he isi , which was in e p e ed as a
ha m ul change in blood p essu e and hea a e, bu beneficial con-
ce ning he indices o HRV.
3. Resul s
Physiological measu emen s we e conduc ed on 40 olun ee s.
Howe e , 2 olun ee s isi ed only one en i onmen , and we e he e-
o e excluded om u he analyses. Because he e we e only 2 males,
he da a was u he es ic ed o include only emales, lea ing 36
pe sons in he final da a se .
Based on he baseline ques ionnai e, a e age age o he s udy pa -
icipan s was 46 yea s (s anda d de ia ion 8.7 yea s). All pa icipan s
we e employed, and 14 (39%) o hem conside ed hei wo k a leas
ai ly s ess ul. Twen y-fi e pe sons (69%) isi ed g een en i onmen s
a leas 4 imes a week in e e yday li e, and hi y- wo (89%) a leas
wice a week (da a no shown).
Mean alues and s anda d de ia ions o he ou come and main en-
i onmen al a iables du ing diffe en expe imen al pe iods a e p e-
sen ed in Table 1. Compa ed o he seden a y con ol and iewing
pe iods, SDNN was much highe du ing he walking pe iod in all en-
i onmen s. The e was a clea end in PM
10
and noise, he le els being
he highes in ci y cen e and lowes in u ban o es . In he u he
analyses on he physiological effec s o he sho isi s, each s udy
pa icipan was assigned an es ima e o exposu e o PM
10
and noise
based on he measu emen s. These es ima es diffe ed s a is ically sig-
nifican ly (p < 0.05) be ween he h ee en i onmen s. Howe e , when
diffe ences be ween he en i onmen s we e e alua ed based on one
measu emen pe g oup- isi , he diffe ences did no each s a is ical
significance o PM
10
because o ewe obse a ions. E en wi h his
app oach, noise le els du ing si ing diffe ed s a is ically significan ly
om he le els eco ded du ing he whole pe iod.
Simila o PM
10
, black ca bon and pa icle numbe concen a ions
we e he highes in ci y cen e. A e age concen a ion o black ca bon
in ci y cen e, u ban pa k, and u ban o es was 2.19, 0.60, and
0.46 µg/m
3
, espec i ely. Respec i e le els o pa icle numbe con-
cen a ion we e 8700, 3500, and 2600 pa icles/cm
3
.
High co ela ions we e obse ed be ween sys olic and dias olic
blood p essu e (posi i e co ela ion), hea a e and indices o HRV
(nega i e), and diffe en indices o HRV (posi i e) (Suppl. Table 1).
PM
10
and noise le els we e posi i ely co ela ed, especially in u ban
o es .
No diffe ences in blood p essu e we e obse ed be ween he g een
en i onmen s and ci y cen e when he effec o isi was e alua ed
based on o al expe imen al pe iod, i.e. in eg a ing he effec o iewing
and walking pe iods (Table 2). Visi s o he g een en i onmen s we e
associa ed wi h lowe hea a e and highe HF han isi s o ci y cen e,
effec es ima es we e sligh ly highe o u ban o es compa ed o u ban
pa k. SDNN was significan ly highe in u ban o es , bu no pa k,
compa ed o he ci y cen e. Effec es ima es o RMSSD we e posi i e
o g een a eas, bu no s a is ically significan .
PM
10
was s a is ically significan ly associa ed wi h RMSSD, and
bo de line significan ly (i.e. 0.05≤p- alue < 0.1) wi h SDNN; bo h
associa ions we e nega i e (Table 2). Inclusion o PM
10
in he models
dec eased effec es ima es o g een a eas o SDNN. En i onmen al
noise was nega i ely associa ed wi h HF, o SDNN and RMSS he as-
socia ion was bo de line significan . A e inclusion o noise in he
models, he associa ions o en i onmen wi h SDNN and HF we e
weake bu s ill appa en .
Si ing and iewing he landscape was associa ed wi h lowe sys olic
blood p essu e in u ban o es han in ci y cen e; he diffe ence be-
ween u ban pa k and ci y cen e was smalle and only bo de line
significan (Table 3). No simila diffe ence was obse ed o dias olic
blood p essu e. Visi s in he g een en i onmen s, especially u ban
o es , we e associa ed wi h lowe hea a e han isi s in ci y cen e.
Visi s o u ban o es , bu no u ban pa k, we e associa ed wi h highe
SDNN han isi s o ci y cen e. RMSSD and HF we e bo h highe in he
g een en i onmen s han in ci y cen e.
PM
10
was posi i ely associa ed wi h sys olic blood p essu e, and
hea a e (s a is ically bo de line significan ly), and nega i ely wi h
RMSSD (bo de line significan ly) du ing he iewing pe iod (Table 3).
Fo hese ou comes, inclusion o PM
10
in he models subs an ially de-
c eased effec es ima es o he g een a eas. En i onmen al noise was
s a is ically significan ly associa ed wi h dec eased SDNN, and bo -
de line significan ly wi h dec eased dias olic blood p essu e and
Table 1
Desc ip i e s a is ics o physiological and en i onmen al a iables.
Be o e iewing A e /du ing iewing A e /du ing walking
Ci y Pa k Fo es Ci y Pa k Fo es Ci y Pa k Fo es
BP sys olic [mm Hg] Mean 120.6 119.9 119.2 124.1 120.8 119.9 119.0 122.1 121.6
SD 14.0 12.7 13.5 16.7 13.5 16.0 13.5 12.4 13.1
BP dias olic [mm Hg] Mean 78.1 76.9 77.3 78.7 78.7 77.2 77.6 79.5 79.3
SD 9.9 8.9 8.5 9.7 9.3 9.2 8.9 8.0 9.4
Hea a e [bpm] Mean 72.3 72.0 71.4 71.3 67.8 66.7 72.1 67.5 68.7
SD 10.3 9.4 10.9 11.1 9.4 10.4 11.6 9.0 11.9
SDNN [ms] Mean 50.4 48.3 53.6 54.4 60.3 67.0 100.7 107.3 118.9
SD 16.9 15.0 19.9 20.1 25.6 29.0 28.8 34.3 32.9
RMSSD [ms] Mean 29.4 29.2 29.3 31.2 38.9 38.1 24.1 28.6 27.4
SD 14.7 15.4 17.4 15.9 24.1 20.3 10.5 15.7 13.0
HF [ms
2
]Mean 58.6 60.8 70.0 79.9 147.9 138.7 41.3 73.4 70.0
SD 55.4 60.2 84.3 78.7 176.0 140.9 37.8 86.1 66.2
PM
10
[µg/m
3
]Mean 17.8 14.4 14.6 20.8 14.3 12.8 20.3 13.4 11.8
SD 9.9 8.4 7.3 9.3 9.3 5.4 9.1 8.5 4.2
LAeq [dBA] Mean 63.4 63.6 64.6 63.3 59.2 57.9 66.4 62.5 58.6
SD 1.0 2.5 1.0 1.2 1.4 3.1 1.2 1.3 2.6
Tempe a u e [
o
C] Mean 24.1 23.9 23.7 24.8 24.7 22.3 23.6 23.5 19.9
SD 1.0 1.1 1.1 2.5 2.9 2.5 2.6 3.1 2.3
T. Lanki e al. En i onmen al Resea ch 159 (2017) 176–185
179
RMSSD. A e inclusion o noise in he models, he effec es ima es o
u ban o es dec eased; howe e , he e also eme ged a bo de line sig-
nifican diffe ence be ween u ban o es and ci y cen e o dias olic
blood p essu e.
Wi hin-pa icipan changes in he ou come a iables du ing he
isi s a e p esen ed in Figs. 1–4and Supplemen al Table 2. Looking a
he whole expe imen al pe iod (Figs. 1 and 2,Supplemen al able 2),
dias olic blood p essu e was obse ed o inc ease in he g een en-
i onmen s; inc eased alues we e obse ed also o sys olic blood
p essu e, bu he changes we e no s a is ically significan . Hea a e
dec eased significan ly in he g een en i onmen s. SDNN inc eased
du ing isi s in all en i onmen s, he mos in u ban o es , ollowed by
u ban pa k. RMSSD and HF dec eased in ci y cen e, bu we e no a -
ec ed by isi s o he g een en i onmen s.
Du ing he iewing pe iod, sys olic blood p essu e inc eased in ci y
cen e, and dias olic blood p essu e in u ban pa k (bo de line sig-
nifican ) (Figs. 3 and 4,Supplemen al Table 2). Hea a e was de-
c eased du ing iewing in all en i onmen s, especially in u ban pa k
and o es . SDNN, RMSSD, and HF we e significan ly inc eased in he
g een en i onmen s. In ci y cen e, he inc ease was significan only o
HF.
4. Discussion
In his field expe imen , emale olun ee s isi ed h ee diffe en
ypes o u ban en i onmen s: a buil -up ci y cen e, an u ban pa k, and
an u ban o es . The isi consis ed o a 15-min iewing pe iod (in a
si ing posi ion) and a 30-min walking pe iod. Visi s o g een
Table 2
Effec s o isi s o u ban g een en i onmen s on ca dio ascula physiology – o al ( iewing and walking) expe imen al pe iod. Ci y cen e used as a e e ence en i onmen .
Basic model
*
Adjus ed o ai pollu ion
†
Adjus ed o noise
§
Pa k Fo es Pa k Fo es PM10 Pa k Fo es LAeq
BP sys olic Es ima e 0.44 −0.60 0.31 −0.76 −0.15 0.03 −1.15 −0.88
SE 1.23 1.30 1.31 1.43 0.54 1.32 1.45 1.02
P- alue 0.723 0.648 0.812 0.598 0.785 0.984 0.432 0.394
BP dias olic Es ima e 0.39 −0.21 0.37 −0.24 −0.03 0.02 −0.71 −0.79
SE 0.80 0.84 0.85 0.93 0.36 0.86 0.94 0.66
P- alue 0.624 0.801 0.665 0.795 0.941 0.980 0.451 0.235
Hea a e Es ima e −2.46 −2.69 −2.23 −2.39 0.29 −2.16 −2.29 0.64
SE 0.80 0.84 0.85 0.93 0.36 0.86 0.94 0.66
P- alue 0.003 0.002 0.011 0.012 0.430 0.014 0.018 0.333
SDNN Es ima e 2.61 10.8 0.76 8.68 −2.34 0.48 7.91 −4.80
SE 3.29 3.50 3.46 3.71 1.41 3.49 3.84 2.73
P- alue 0.431 0.003 0.826 0.023 0.099 0.891 0.044 0.081
RMSSD Es ima e 2.13 1.97 1.32 1.01 −1.09 1.40 0.98 −1.65
SE 1.17 1.24 1.24 1.33 0.55 1.24 1.37 0.98
P- alue 0.075 0.118 0.291 0.449 0.048 0.265 0.479 0.093
HF Es ima e 21.9 27.4 19.1 24.1 −3.77 15.9 19.2 −13.75
SE 6.16 6.54 6.51 7.00 2.84 6.44 7.10 5.05
P- alue 0.001 < 0.001 0.005 0.001 0.187 0.017 0.009 0.007
S a is ically significan (p- alue < 0.05) es ima es in bold on .
* adjus ed o wea he and empe a u e.
†
adjus ed o wea he , empe a u e and PM
10
.Effec es ima e o PM
10
calcula ed o a 5 µg/m
3
inc ease in exposu e.
§
adjus ed o wea he , empe a u e and LAeq. Effec es ima e o noise calcula ed o a 5 dBA inc ease in exposu e.
Table 3
Effec s o isi s o u ban g een en i onmen s on ca dio ascula physiology – iewing pe iod only. Ci y cen e used as a e e ence en i onmen .
Basic model
*
Adjus ed o ai pollu ion
†
Adjus ed o noise
§
Pa k Fo es Pa k Fo es PM
10
Pa k Fo es LAeq
BP sys olic Es ima e −2.60 −3.64 −1.27 −2.24 1.21 −2.32 −3.28 0.96
SE 1.39 1.48 1.50 1.60 0.57 1.44 1.56 1.30
P- alue 0.066 0.017 0.400 0.166 0.034 0.110 0.039 0.458
BP dias olic Es ima e −0.25 −1.16 0.29 −0.59 0.49 −0.61 −1.64 −1.30
SE 0.83 0.89 0.91 0.97 0.35 0.86 0.93 0.77
P- alue 0.766 0.198 0.749 0.546 0.156 0.475 0.082 0.094
Hea a e Es ima e −2.14 −2.91 −1.56 −2.32 0.52 −1.92 −2.62 0.78
SE 0.73 0.78 0.80 0.85 0.31 0.75 0.82 0.68
P- alue 0.005 < 0.001 0.054 0.008 0.092 0.013 0.002 0.249
SDNN Es ima e 0.85 6.54 −0.02 5.62 −0.88 −0.96 4.02 −7.19
SE 2.70 2.74 2.91 2.97 1.10 2.70 2.80 2.46
P- alue 0.754 0.020 0.995 0.063 0.425 0.723 0.157 0.004
RMSSD Es ima e 4.26 4.51 2.98 3.21 −1.28 3.65 3.66 −2.46
SE 1.57 1.60 1.71 1.74 0.68 1.61 1.67 1.47
P- alue 0.009 0.006 0.085 0.069 0.062 0.027 0.032 0.096
HF Es ima e 48.3 52.3 41.7 45.4 −6.68 43.8 46.1 −17.70
SE 12.5 12.7 13.5 13.7 5.20 12.7 13.2 11.61
P- alue < 0.001 < 0.001 0.003 0.002 0.200 0.001 0.001 0.129
S a is ically significan (p- alue < 0.05) es ima es in bold on .
* adjus ed o wea he and empe a u e.
†
adjus ed o wea he , empe a u e and PM
10
.Effec es ima e o PM
10
calcula ed o a 5 µg/m
3
inc ease in exposu e.
§
adjus ed o wea he , empe a u e and LAeq. Effec es ima e o noise calcula ed o a 5 dBA inc ease in exposu e.
T. Lanki e al. En i onmen al Resea ch 159 (2017) 176–185
180

en i onmen s we e associa ed wi h lowe hea a e and highe hea
a e a iabili y (SDNN and HF) han isi s o he ci y cen e. In g een
en i onmen s, hea a e dec eased and SDNN inc eased du ing he
isi . Sys olic blood p essu e and RMSSD we e dependen on he ype o
en i onmen only in he analyses es ic ed o he iewing pe iod.
Pa icula e ai pollu ion was associa ed wi h inc eased sys olic blood
p essu e and dec eased RMSSD, and en i onmen al noise wi h de-
c eased indica o s o HRV. Associa ions be ween en i onmen and in-
dica o s o ca dio ascula heal h sligh ly weakened a e he inclusion
o ai pollu ion and noise in he models. Mos ly mino diffe ences in
effec s we e obse ed be ween he u ban pa k and o es .
S udy isi s o u ban en i onmen s we e in ended o eflec eal-li e
isi s ou doo s o elax a e wo k in ha hey ook place a e a no mal
wo king day o mos o he olun ee s, we e ela i ely b ie , and did
no include s enuous exe cise. Visi s o g een a eas we e associa ed
wi h dec eased hea a e and inc eased SDNN and HF, i.e. beneficial
changes in ca dio ascula physiology, compa ed o isi s o he ci y
cen e. G een en i onmen s ha e been associa ed wi h lowe hea a e
and/o highe HF also in se e al Japanese s udies (e.g. Lee e al., 2014;
Song e al., 2014;Tsune sugu e al., 2007). Taken oge he , he esul s
sugges ha ela ed o ca dio ascula heal h i is ad an ageous o elax
and exe cise in u ban na u e a eas a he han in buil -up ci y cen es.
Howe e , some ecen Eu opean s udies ha e no ound associa ions
be ween g een a eas and HRV (T igue o-Mas e al., 2017; Gidlow e al.,
2016), and esul s on hea a e ha e been mixed (Sonn ag-Ös öm
e al., 2014; T igue o-Mas e al., 2017).
Significan ly lowe pa icula e ai pollu ion and noise le els we e
obse ed in he g een a eas han in he buil -up ci y cen e. Exposu e o
PM
10
was associa ed wi h inc eased sys olic blood p essu e and de-
c eased RMSSD, i.e. wi h ha m ul changes. The la e esul is in line
Fo es Pa k Ci y
-20
-10
0
10
20
)gHmm(e usse pdoolbcilo sysniegnahC
Fo es Pa k Ci y
-20
-10
0
10
20
)g
H
m
m(e
u
ss
e
p
d
ool
bc
il
o
sai
d
ni
eg
nahC
Fo es Pa k Ci y
-20
-10
0
10
20
Change in hea a e (bpm)
Fig. 1. Box-plo s o wi hin-pe son changes (a e - be o e isi ) in blood p essu e and hea a e du ing he isi s ( o al expe imen al pe iod). Whiske s indica e maximum (and minimum)
obse a ions below uppe (lowe ) ence se a 1.5 × in e qua ile ange abo e (below) 75 h (25 h) pe cen ile.
Fo es Pa k Ci y
0
25
50
75
100
125
150
Change in SDNN (ms)
Fo es Pa k Ci y
-30
-20
-10
0
10
20
Change in RMSSD (ms)
Fo es Pa k Ci y
-150
-100
-50
0
50
100
150
200
Change in HF (ms*ms)
Fig. 2. Box-plo s o wi hin-pe son changes (du ing –be o e isi ) in hea a e a iabili y du ing he isi s ( o al expe imen al pe iod). Whiske s indica e maximum (and minimum)
obse a ions below uppe (lowe ) ence se a 1.5 × in e qua ile ange abo e (below) 75 h (25 h) pe cen ile.
T. Lanki e al. En i onmen al Resea ch 159 (2017) 176–185
181
wi h p e ious s udies on ca dio ascula effec s o b ie ai pollu ion
exposu es (Kubesch e al., 2015;Lanki e al., 2008;Sa na e al., 2014).
Fu he , nega i e associa ions we e obse ed be ween noise exposu e
and all HRV indica o s. This is no su p ising because noise is a s ess
ac o , and s ess is known o be associa ed wi h inc eased sympa he ic
ne ous ac i i y (Piepe e al., 2007). All in all, he cu en esul s in-
dica e ha lowe ai pollu ion and noise le els con ibu e o ca dio-
ascula heal h benefi s o isi s o g een a eas. I should be no ed ha
ai pollu ion and noise le els a e ela i ely low in Helsinki. The e o e,
he con ibu ion o educed pollu an exposu e o ca dio ascula ben-
efi s o ‘g een isi s’may be highe in ci ies whe e he con as s in
exposu e be ween ci y cen es and u ban g een a eas a e highe . Im-
po an ly, diffe ences in he effec s be ween he h ee en i onmen s
mos ly emained e en a e he inclusion o ai pollu ion and noise in
he models. This sugges s ha o he cha ac e is ics o g een a eas such
as p esence o na u al elemen s a e mos impo an o he ca dio as-
cula benefi s.
Physical ac i i y le el affec s blood p essu e, hea a e and hea
a e a iabili y. I was an icipa ed ha physical s ain du ing walking,
e en a a elaxed speed, could mask unde lying diffe ences be ween
en i onmen s, o c ea e a ificial diffe ences because o he difficul y o
adjus ing physical s ain exac ly he same in all en i onmen s (due o
mo e ough e ain in he woods, compulso y s ops because o affic
ligh s in he ci y cen e e c.). The e o e, esul s we e also calcula ed
sepa a ely o he iewing pe iod, du ing which olun ee s we e se-
den a y. These esul s confi med he associa ions obse ed du ing he
whole expe imen al pe iod. In addi ion, some new associa ions
eme ged: iewing he g een scene ies was associa ed wi h lowe
Fo es Pa k Ci y
-30
-20
-10
0
10
20
30
)gHmm(e usse pdoolbcilo sysnieg
n
ahC
Fo es Pa k Ci y
-15
-10
-5
0
5
10
15
20
)
gH
mm(e
u
sse pd
o
o
l
b
c
il
o s
aid
n
i
e
g
na
hC
Fo es Pa k Ci y
-15
-10
-5
0
5
10
Change in hea a e (bpm)
Fig. 3. Box-plo s o wi hin-pe son changes (a e - be o e isi ) in blood p essu e and hea a e du ing he iewing pe iod. Whiske s indica e maximum (and minimum) obse a ions
below uppe (lowe ) ence se a 1.5 × in e qua ile ange abo e (below) 75 h (25 h) pe cen ile.
Fo es Pa k Ci y
-40
-20
0
20
40
60
Change in SDNN (ms)
Fo es Pa k Ci y
-20
0
20
40
60
Change in RMSSD (ms)
Fo es Pa k Ci y
-200
0
200
400
600
Change in HF (ms*ms)
Fig. 4. Box-plo s o wi hin-pe son changes (du ing –be o e isi ) in hea a e a iabili y du ing he iewing pe iod. Whiske s indica e maximum (and minimum) obse a ions below
uppe (lowe ) ence se a 1.5 × in e qua ile ange abo e (below) 75 h (25 h) pe cen ile.
T. Lanki e al. En i onmen al Resea ch 159 (2017) 176–185
182
sys olic blood p essu e and highe RMSSD compa ed o iewing he ci y
cen e.
Fo blood p essu e, esul s ha e been he e ogeneous in p e ious
s udies. Se e al s udies ha e no ound, in con as o he hypo hesis,
lowe le els o blood p essu e in g een en i onmen s han in mo e
buil -up en i onmen s (Gidlow e al., 2016; Ha ig e al., 2003; Lee
e al., 2014; T igue o-Mas e al., 2017), whe eas o he s ha e epo ed
lowe le els o dias olic bu no sys olic blood p essu e (Pa k e al.,
2009; Sonn ag-Ös öm e al., 2014; Tsune sugu e al., 2013, 2007). In a
s udy conduc ed among co ona y a e y disease pa ien s
(G azule iciene e al., 2016), se e al isi s we e equi ed be o e a di -
e ence in blood p essu e was fi s ime obse ed be ween isi s o a
pa k and a s ee en i onmen .
Compa isons o he effec s o isi s o ci y cen e and g een en-
i onmen s p o ided some e idence on he ca dio ascula heal h ben-
efi s o he la e . Ano he impo an ques ion is, whe he a isi o a
g een en i onmen esul s in beneficial physiological changes. Fo
dias olic blood p essu e his seemed no o be he case as i inc eased
a he han dec eased du ing he isi . Howe e , no such effec was
e iden when he analyses we e es ic ed o he iewing pe iod.
The e o e, he inc ease may be ela ed o physical ac i i y a he han
he en i onmen . Hea a e and SDNN changed bo h du ing he
iewing and o al s udy pe iod in g een en i onmen s. Fo example,
he e was a 6% dec ease in hea a e and a 25% inc ease in SDNN in
u ban o es du ing iewing. Fo RMSSD and HF, a beneficial change in
g een a eas was obse ed only du ing he iewing pe iod. The esul
sugges s ha e en a sho - e m iewing o a na u al en i onmen has
elaxing effec s.
High es ing hea a e and dec eased HRV a e es ablished isk
ac o s o ca dio ascula diseases. Mo e s udies a e ye needed o
confi m he clinical ele ance o he obse ed sligh - o-mode a e sho -
e m changes in hea a e and HRV du ing he isi s o he g een en-
i onmen s. On a popula ion le el e en small changes a e ele an i
he change is ela i ely pe manen . Un o una ely, we we e no able o
ollow he olun ee s a e he expe imen . All in all, i is unclea how
egula he isi s o g een en i onmen s ha e o be o lead o pe manen
changes in ca dio ascula physiology. Rela ed o his, i is no known
whe he ou olun ee s we e o eac mo e o less s ongly o isi s o
g een en i onmen s because hey we e egula use s o g een a eas in
hei e e yday li e. Clea ly, ollow-up s udies a e needed also in o he
ypes o popula ion g oups (e.g. pe sons wi h men al heal h p oblems,
unemployed pe sons), and bo h psychological and physiological ac o s
affec ing long- e m physiological effec s should be in es iga ed. Visi s o
g een a eas may in eal li e include social in e ac ions, bu in his ex-
pe imen al se up mos olun ee s did no know each o he be o ehand,
and hey we e asked no o communica e du ing he isi s. An op ion
o u u e s udies is o enable na u al social in e ac ions in less su-
pe ised se ings, which would also u he educe he effec o he
p esence o s udy pe sonnel.
Sho - e m changes in men al s a e a e known o be eflec ed in
hea a e, blood p essu e and HRV (e.g. Pe e s e al., 1998;Piepe
e al., 2007). We ha e p e iously epo ed ha u ban g een a eas ha e
s ess elie ing effec s: ise o posi i e emo ions, eelings o es o a ion
and i ali y (Ty äinen e al., 2014). Cu en esul s indica e ha psy-
chological effec s o isi s o g een a eas u he affec physiological
p ocesses. In he p e ious s udy, sali a y co isol le el was no depen-
den on en i onmen . I is no su p ising ha he effec s a e diffe en o
HRV and co isol, as hey a e modula ed ia diffe en sys ems, namely
au onomic ne ous sys em and hypo halamic-pi ui a y-ad enalin axis
(Kajan ie and Phillips, 2006). Bo h o hem may affec ca dio ascula
eac i i y (B indle e al., 2014). Taken oge he , ou s udies sugges ha
hea a e and HRV may be be e indica o s o s ess elie in sho -
e m field expe imen s han co isol. I should be no ed ha he s udy
popula ion in he cu en pape is a subse o he s udy popula ion in
he p e ious pape . The eason o a smalle s udy popula ion was a
p ac ical one: ECG moni o ing is s enuous o olun ee s and labo ious
o he s udy pe sonnel.
Mos ly mino diffe ences be ween he effec s o isi s o u ban pa k
and o es we e obse ed in he cu en s udy o in ou p e ious pape
(Ty äinen e al., 2014). Alppipuis o, he u ban pa k, is well-designed
wi h flowe -beds, wa e elemen s and a ious acili ies, and well-
main ained. Keskuspuis o, he u ban o es , co e s a la ge a ea bu is
s ill affec ed by oad and ai affic noise because o he elonga ed shape
o he a ea. S udy designs wi h mo e con as s and en i onmen s, e.g.
na u al o es s u he away om ci ies and u ban was elands (i.e. no
designed pa ks) used o ec ea ional ac i i ies, can be used in u u e o
iden i y cha ac e is ics ha limi he heal h benefi s o g een en i on-
men s.
The e a e diffe ences in bo h ca dio ascula physiology and phy-
siological eac ions o s ess be ween women and men (Kajan ie and
Phillips, 2006,Koenig and Thaye , 2016;Pico-Al onso e al., 2007), and
he quali y o en i onmen may be mo e impo an o women (Beil and
Hanes, 2013). Consequen ly he ac ha he p esen s udy did no in-
clude bo h sexes can be seen as a main limi a ion. Howe e , ou esul s
on hea a e and HRV we e simila o he esul s o p e ious s udies
conduc ed among men (Lee e al., 2014;Song e al., 2014;Tsune sugu
e al., 2007), which suppo s gene alizabili y o he obse ed effec s. On
he o he hand, inclusion o adul women can be seen as s eng h o he
s udy because p e ious s udies ha e o en included males, ypically
s uden s (Bowle e al., 2010; Haluza e al., 2014). Lack o s udies on
physiological effec s o ou doo na u e among emales was highligh ed
in a ecen na a i e e iew (Haluza e al., 2014).
Aging is a main isk ac o o ca dio ascula diseases, including
a he oscle osis and hype ension. This is because aging is associa ed
wi h e.g. emodeling o ascula walls, inc eased a e ial s iffness, and
dec eased agal unc ion (F anklin, 2008; Laka a, 2003,Mee sman and
S ein 2007). Age o he olun ee s in his s udy anged om 30 o 60.
The subs an ial age ange mos likely has inc eased be ween-subjec
a ia ion in physiological esponses. I is wo h no ing ha age is only
one o many ac o s affec ing ca dio ascula unc ions, and he e o e
e.g. egula exe cise can coun e ac effec o aging o some ex en (Seals
e al., 2009).
In conclusion, esul s o he s udy suppo he hypo hesis ha e en
sho isi s o g een a eas may lead o beneficial changes in ca dio-
ascula isk ac o s. Fu he , en i onmen al quali y o g een a eas is o
impo ance because ai pollu ion and noise exposu e coun e ac he
benefi s. In his espec , la ge pa ks wi h some a eas u he away om
busy affic a e ecommendable. The cu en esul s a e a eminde o
ci y planne s and public heal h communi y on he po en ial o u ban
g een en i onmen s in p omo ing well-being and heal h.
Compe ing financial in e es s
The au ho s decla e hey ha e no ac ual o po en ial compe ing fi-
nancial in e es s.
Funding sou ces
Funding o his esea ch has been ecei ed om he Academy o
Finland (G an s No. 139699, 255440, 255423) and he Japan Socie y
o he P omo ion o Science. The sponso did no ha e any ole in he
design, da a collec ion o analyses o he s udy, and did no influence
he in e p e a ion o he esul s.
E hical app o al
The Resea ch E hics Commi ee o he No he n Sa o Hospi al
Dis ic has app o ed he s udy.
Acknowledgemen s
We hank P o . Yoshi umi Miyazaki (Chiba Uni e si y) o he
T. Lanki e al. En i onmen al Resea ch 159 (2017) 176–185
183
inno a ions o he expe imen al se up, Ph.D. Ee a Ka jalainen (Luke)
o he con ibu ion o he planning o he s udy, M.Sc. Anni Pulkkinen
(THL) o pa icipa ing in he conduc ion o he field measu emen s.
Appendix A. Supplemen a y ma e ial
Supplemen a y da a associa ed wi h his a icle can be ound in he
online e sion a h p://dx.doi.o g/10.1016/j.en es.2017.07.039.
Re e ences
Beil, K., Hanes, D., 2013. The influence o u ban na u al and buil en i onmen s on
physiological and psychological measu es o s ess –a pilo s udy. In . J. En i on.
Res. Public Heal h 10, 1250–1267.
B indle, R.C., Gin y, A.T., Phillips, A.C., Ca oll, D., 2014. A ale o wo mechanisms: a
me a-analy ic app oach owa d unde s anding he au onomic basis o ca dio ascula
eac i i y o acu e psychological s ess. Psychophysiology 51, 964–976.
Bowle , D.E., Buyung-Ali, L.M., Knigh , T.M., Pullin, A.S., 2010. A sys ema ic e iew o
e idence o he added benefi s o heal h o exposu e o na u al en i onmen s. BMC
Public Heal h 10, 456.
B ook, R.D., Rajagopalan, S., Pope 3 d, C.A., B ook, J.R., Bha naga , A., Diez-Roux, A.V.,
e al., 2010. Pa icula e ma e ai pollu ion and ca dio ascula disease: an upda e o
he scien ific s a emen om he Ame ican Hea Associa ion. Ci cula ion 121,
2331–2378.
B own, D.K., Ba on, J.L., Gladwell, V.F., 2013. Viewing na u e scenes posi i ely affec s
eco e y o au onomic unc ion ollowing acu e-men al s ess. En i on. Sci. Technol.
47, 5562–5569.
Conn, V.S., 2010. Dep essi e symp om ou comes o physical ac i i y in e en ions: me a-
analysis findings. Ann. Beha . Med. 39, 128–138.
Floud, S., Vigna-Taglian i, F., Hansell, A., Blangia do, M., Hou huijs, D., B eugelmans, O.,
Cadum, E., Babisch, W., Selande , J., Pe shagen, G., An onio i, M.C., Pisani, S.,
Dimakopoulou, K., Ha alabidis, A.S., Velonakis, V., Ja up, L., 2011. HYENA S udy
Team. Medica ion use in ela ion o noise om ai c a and oad affic in six
Eu opean coun ies: esul s o he HYENA s udy. Occup. En i on. Med. 68, 518–524.
Gascon, M., T igue o-Mas, M., Ma ínez, D., Dad and, P., Rojas-Rueda, D., Plasència, A.,
Nieuwenhuijsen, M.J., 2016. Residen ial g een spaces and mo ali y: a sys ema ic
e iew. En i on. In . 86, 60–67.
Gascon, M., T igue o-Mas, M., Ma ínez, D., Dad and, P., Fo ns, J., Plasència, A.,
Nieuwenhuijsen, M.J., 2015. Men al heal h benefi s o long- e m exposu e o e-
siden ial g een and blue spaces: a sys ema ic e iew. In . J. En i on. Res. Public
Heal h 12, 4354–4379.
Gidlow, C.J., Jones, M.V., Hu s , G., Mas e son, D., Cla k-Ca e , D., Ta ainen, M.P.,
Smi h, G., Nieuwenhuijsen, M., 2016. Whe e o pu you bes oo o wa d: psycho-
physiological esponses o walking in na u al and u ban en i onmen s. J. En i on.
Psychol. 45, 22–29.
Gong, Y., Gallache , J., Palme , S., Fone, D., 2014. Neighbou hood g een space, physical
unc ion and pa icipa ion in physical ac i i ies among elde ly men: he Cae philly
P ospec i e s udy. In . J. Beha . Nu . Phys. Ac . 11.
G azule iciene, R., Venclo iene, J., Kubilius, R., G izas, V., Dedele, A., G azule icius, T.,
Ceponiene, I., Tamule iciu e-P asciene, E., Nieuwenhuijsen, M.J., Jones, M., Gidlow,
C., 2015. The effec o pa k and u ban en i onmen s on co ona y a e y disease
pa ien s: a andomized ial. Biomed. Res. In . 2015, 403012.
G azule iciene, R., Venclo iene, J., Kubilius, R., G izas, V., Danile iciu e, A., Dedele, A.,
And usai y e, S., Vi kauskiene, A., S epano iciu e, R., Nieuwenhuijsen, M.J., 2016.
T acking es o a ion o pa k and u ban s ee se ings in co ona y a e y disease
pa ien s. In . J. En i on. Res. Public Heal h 13, 550.
De Mee sman, R.E., S ein, P.K., 2007. Vagal modula ion and aging. Biol. Phys. 74,
165–173.
de V ies, S., an Dillen, S.M., G oenewegen, P.P., Sp eeuwenbe g, P., 2013. S ee scape
g eene y and heal h: s ess, social cohesion and physical ac i i y as media o s. Soc.
Sci. Med. 94, 26–33.
F anklin, S.S., 2008. Beyond blood p essu e: a e ial s iffness as a new bioma ke o
ca dio ascula disease. J. Am. Soc. Hype ens. 2, 140–151.
Gan, Y., Gong, Y.H., Tong, X.Y., Sun, H.L., Cong, Y.J., Dong, X.X., Wang, Y.X., Xu, X., Yin,
X.X., Deng, J., Li, L.Q., Cao, S.Y., Lu, Z.X., 2014. Dep ession and he isk o co ona y
hea disease: a me a-analysis o p ospec i e coho s udies. BMC Psychia y 14, 371.
Haluza, D., Schönbaue , R., Ce inka, R., 2014. G een pe spec i es o public heal h: a
na a i e e iew on he physiological effec s o expe iencing ou doo na u e. In . J.
En i on. Res. Public Heal h 11, 5445–5461.
Ha ig, T., E ans, G.W., Jamne , L.D., Da is, D.S., Gä ling, T., 2003. T acking es o a ion
in na u al and u ban field se ings. J. En i on. Psykol. 23, 109–123.
Ha ig, T., Mi chell, R., de V ies, S., F umkin, H., 2014. Na u e and heal h. Annu. Re .
Public Heal h 35, 207–228.
Ha ig, T., Mang, M., E ans, G.W., 1991. Res o a i e effec s o na u al en i onmen ex-
pe iences. En i on. Beha . 23, 3–26.
Hillsdon, M., Pan e , J., Fos e , C., Jones, A., 2006. The ela ionship be ween access and
quali y o u ban g een space wi h popula ion physical ac i i y. Public Heal h 120,
1127–1132.
Jang, H.S., Lee, S.C., Jeon, J.Y., Kang, J., 2015. E alua ion o oad affic noise aba emen
by ege a ion ea men in a 1:10 u ban scale model. J. Acous . Soc. Am. 138,
3884–3895.
Kajan ie, E., Phillips, D.I., 2006. The effec s o sex and ho monal s a us on he
physiological esponse o acu e psychosocial s ess. Psychoneu oendoc inology 31,
151–178.
Ki imäki, M., Vi anen, M., Elo ainio, M., Kou onen, A., Väänänen, A., Vah e a, J., 2006.
Wo k s ess in he e iology o co ona y hea disease–a me a-analysis. Scand. J. Wo k
En i on. Heal h 32, 431–442.
Koenig, J., Thaye , J.F., 2016. Sex diffe ences in heal hy human hea a e a iabili y: A
me a-analysis. Neu osci. Biobeha . Re . 64, 288–310.
Ko pela, K., S aa s, H., 2014. The es o a i e quali ies o being alone wi h na u e. In:
Coplan, R.J., Bowke , J. (Eds.), A Handbook o Soli ude: Psychological Pe spec i es
on Social Isola ion, Social Wi hd awal, and Being Alone. Wiley-Blackwell, Chiches e ,
UK, pp. 351–367 (351-367).
Kubesch, N., De Nazelle, A., Gue a, S., Wes e dahl, D., Ma inez, D., Bouso, L., Ca asco-
Tu igas, G., Hoffmann, B., Nieuwenhuijsen, M.J., 2015. A e ial blood p essu e e-
sponses o sho - e m exposu e o low and high affic- ela ed ai pollu ion wi h and
wi hou mode a e physical ac i i y. Eu . J. P e . Ca diol. 22, 548–557.
Laka a, E.G., 2003. A e ial and ca diac aging: majo sha eholde s in ca dio ascula
disease en e p ise. Pa III: cellula and molecula clues o hea and a e ial aging.
Ci cula ion 107, 490–497.
Lanki, T., Hoek, G., Timonen, K.L., Pe e s, A., Tii anen, P., Vanninen, E., Pekkanen, J.,
2008. Hou ly a ia ion in fine pa icle exposu e is associa ed wi h ansien ly in-
c eased isk o ST segmen dep ession. Occup. En i on. Med. 65, 782–786.
Lanki, T., de Ha og, J.J., Hein ich, J., Hoek, G., Janssen, N.A., Pe e s, A., S ölzel, M.,
Timonen, K.L., Vallius, M., Vanninen, E., Pekkanen, J., 2006. Can we iden i y sou ces
o fine pa icles esponsible o exe cise-induced ischemia on days wi h ele a ed ai
pollu ion? The ULTRA s udy. En i on. Heal h Pe spec . 114, 655–660.
Lauman, K., Gä ling, T., S o ma k, K.M., 2003. Selec i e a en ion and hea a e e-
sponses o na u al and u ban en i onmen s. J. En i on. Psykol. 23, 125–134.
Lee, J., Pa k, B.J., Tsune sugu, Y., Ohi a, T., Kagawa, T., Miyazaki, Y., 2011. Effec o
o es ba hing on physiological and psychological esponses in young Japanese male
subjec s. Public Heal h 125, 93–100.
Lee, J., Tsune sugu, Y., Takayama, N., Pa k, B.J., Li, Q., Song, C., Koma su, M., Ikei, H.,
Ty äinen, L., Kagawa, T., Miyazaki, Y., 2014. Influence o o es he apy on ca di-
o ascula elaxa ion in young adul s. E id. Based Complemen . Al e n. Med. 2014,
834360.
Leslie, E., Ce in, E., 2008. A e pe cep ions o he local en i onmen ela ed o neigh-
bou hood sa is ac ion and men al heal h in adul s? P e . Med. 47, 273–278.
Li, Q., O suaka, T., Kobayashi, M., Wakayama, Y., Inagaki, H., Ka suma a, M., Hi a a, Y.,
Li, Y., Hi a a, K., Shimizu, T., Suzuki, H., Kawada, T., Kagawa, T., 2011. Acu e effec s
o walking in o es en i onmen s on ca dio ascula and me abolic pa ame e s. Eu .
J. Appl. Physiol. h p://dx.doi.o g/10.1007/s00421-011-1918-z.
Maas, J., an Dillen, S.M., Ve heij, R.A., G oenewegen, P.P., 2009a. Social con ac s as a
possible mechanism behind he ela ion be ween g een space and heal h. Heal h
Place 15, 586–595.
Maas, J., Ve heij, R.A., de V ies, S., Sp eeuwenbe g, P., Schelle is, F.G., G oenewegen,
P.P., 2009b. Mo bidi y is ela ed o a g een li ing en i onmen . J. Epidemiol.
Communi y Heal h 63, 967–973.
Ma selle, M.R., I ine, K.N., Lo enzo-A ibas, A., Wa be , S.L., 2014. Mo ing beyond
g een: explo ing he ela ionship o en i onmen ype and indica o s o pe cei ed
en i onmen al quali y on emo ional well-being ollowing g oup walks. In . J.
En i on. Res. Public Heal h 12, 106–130.
O d, K., Mi chell, R., Pea ce, J., 2013. Is le el o neighbou hood g een space associa ed
wi h physical ac i i y in g een space? In . J. Beha . Nu . Phys. Ac . 10, 127.
Pa k, B.J., Tsune sugu, Y., Kase ani, T., Kagawa, T., Miyazaki, Y., 2010. The physiological
effec s o Shin in-yoku ( aking in he o es a mosphe e o o es ba hing): e idence
om field expe imen s in 24 o es s ac oss Japan. En i on. Heal h P e . Med. 15,
18–26.
Pa k, B.-J., Tsune sugu, Y., Kase ani, T., Mo ikawa, T., Kagawa, T., Miyazaki, Y., 2009.
Physiological effec s o o es ec ea ion in a young coni e o es in Hinokage own,
Japan. Sil a Fenn. 43, 291–301.
Pe e s, M.L., Godae , G.L., Ballieux, R.E., an Vlie , M., Willemsen, J.J., Sweep, F.C.,
Heijnen, C.J., 1998. Ca dio ascula and endoc ine esponses o expe imen al s ess:
effec s o men al effo and con ollabili y. Psychoneu oendoc inology 23, 1–17.
Pico-Al onso, M.A., Mas o ci, F., Ce esini, G., Ceda, G.P., Manghi, M., Pino, O., T oisi, A.,
Sgoi o, A., 2007. Acu e psychosocial challenge and ca diac au onomic esponse in
women: he ole o es ogens, co icos e oids, and beha io al coping s yles.
Psychoneu oendoc inology 32, 451–463.
Piepe , S., B osscho , J.F., an de Leeden, R., Thaye , J.F., 2007. Ca diac effec s o
momen a y assessed wo y episodes and s ess ul e en s. Psychosom. Med. 69,
901–909.
Pie ilä, M., Neu onen, M., Bo odulin, K., Ko pela, K., Sie änen, T., Ty äinen, L., 2015.
The ela ionship be ween exposu e o u ban g een spaces, physical ac i i y and sel -
a ed heal h. J. Ou doo Rec ea . Tou . 10, 44–54.
Pope, D., Tisdall, R., Middle on, J., Ve ma, A., an Ameijden, E., Bi , C., B uce, N.G.,
2015. Quali y o and access o g een space in ela ion o psychological dis ess: e-
sul s om a popula ion-based c oss-sec ional s udy as pa o he EURO-URHIS 2
p ojec . Eu . J. Public Heal h (pii: ck 094).
Richa dson, E.A., Pea ce, J., Mi chell, R., Kingham, S., 2013. Role o physical ac i i y in
he ela ionship be ween u ban g een space and heal h. Public Heal h 127, 318–324.
Ruijsb oek, A., Mohnen, S.M., D oome s, M., K uize, H., Gidlow, C., G ažule ičiene, R.,
And usai y e, S., Maas, J., Nieuwenhuijsen, J., T igue o-Mas, M., e al., 2017.
Neighbou hood g een space, social en i onmen and men al heal h: an examina ion
in ou Eu opean ci ies. In . J. Public Heal h 62, 657–667.
Sa na , J.A., Golan, R., G eenwald, R., Raysoni, A.U., Kewada, P., Winquis , A., Sa na ,
S.E., Dana Flande s, W., Mi abelli, M.C., Zo a, J.E., Be gin, M.H., Yip, F., 2014.
Exposu e o affic pollu ion, acu e inflamma ion and au onomic esponse in a panel
o ca commu e s. En i on. Res. 133, 66–76.
T. Lanki e al. En i onmen al Resea ch 159 (2017) 176–185
184