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Peer-reviewedCC BY-NC-NDPublic health in practice (Oxford, England)

Mediation of physical activity and sedentary behavior on the relationship between neighborhood greenness and cardiovascular outcomes.

  • Dongwoo Yang1,2
  • Jung-Min Lee3
  • Junhao Shen3
  • Xiaolin Wen3
  • Jahyun Kim4
4 affiliations
  1. 1Center for Regional Development, Chonnam National University, 77 Yongbong-ro, Buk-gu, Jeonnam-Gwangju, 61186, Republic of Korea.
  2. 2Department of Smart City and Real Estate, Kyung Hee University, 26 Kyungheedae-ro, Dongdaemun-gu, Seoul, 02477, Republic of Korea.
  3. 3Department of Physical Education, Kyung Hee University, 1732 Deogyeong-daero, Yongin, Giheung-gu, 17104, Republic of Korea.
  4. 4Department of Kinesiology, California State University Bakersfield, 9001 Stockdale Hwy, Mail Stop: 22 EDUC, Bakersfield, CA, 93311, USA.
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Abstract

Objectives

Neighborhood greenness has been associated with cardiovascular outcomes, with physical activity commonly suggested as a key behavioural mediator. However, whether sedentary behaviour also mediates this association remains unclear. Although it has been recognised as a critical factor for cardiovascular outcomes, limited studies investigated the association between neighborhood greenness and sedentary behaviour. This study investigated whether physical activity and sedentary behaviour serve as potential mediators in the relationship between neighborhood greenness and cardiovascular outcomes.Study design

A cross-sectional, population-based study using national survey data and geographic information system (GIS) metrics.Methods

Data from the 2020 Korea National Health and Nutrition Examination Survey (KNHANES) (N = 6133) were linked with neighborhood greenness metrics from national landcover maps. Structural equation modelling was used to evaluate whether domain-specific physical activity, by intensity (vigorous and moderate) and context (work-related, leisure-purposed, and commuting), and sitting time showed significant indirect associations between neighborhood greenness and cardiovascular outcomes.Results

Neighborhood greenness was significantly associated with reduced sitting time (p < .001), and lower sitting time was negatively associated with diagnosis of hypertension (p < .001), hyperlipidemia (p = .007), and stroke (p < .001). In the structural equation modelling analyses, sedentary time showed significant indirect associations between greenness and three of the cardiovascular outcomes examined. No comparable indirect associations were observed for the physical activity domains. Contrary to our hypothesis, most domains of physical activity were associated neither with neighborhood greenness nor cardiovascular outcomes.Conclusions

These cross-sectional findings suggest that sedentary behaviour was consistently associated with the relationship between neighborhood greenness and cardiovascular outcomes. Place-making strategies that address sedentary behaviour may complement those that promote physical activity.

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Cite

BibTeXRIS
BibTeX
@article{yang2026mediation,
  title = {{Mediation of physical activity and sedentary behavior on the relationship between neighborhood greenness and cardiovascular outcomes.}},
  author = {Dongwoo Yang and Jung-Min Lee and Junhao Shen and Xiaolin Wen and Jahyun Kim},
  journal = {Public health in practice (Oxford, England)},
  year = {2026},
  month = oct,
  doi = {10.1016/j.puhip.2026.100873},
  url = {https://europepmc.org/article/MED/42927316},
  note = {CC BY-NC-ND},
}
RIS
TY  - JOUR
TI  - Mediation of physical activity and sedentary behavior on the relationship between neighborhood greenness and cardiovascular outcomes.
AU  - Dongwoo Yang
AU  - Jung-Min Lee
AU  - Junhao Shen
AU  - Xiaolin Wen
AU  - Jahyun Kim
PY  - 2026
DA  - 2026/10/10
JO  - Public health in practice (Oxford, England)
DO  - 10.1016/j.puhip.2026.100873
UR  - https://europepmc.org/article/MED/42927316
AB  - Objectives  Neighborhood greenness has been associated with cardiovascular outcomes, with physical activity commonly suggested as a key behavioural mediator. However, whether sedentary behaviour also mediates this association remains unclear. Although it has been recognised as a critical factor for cardiovascular outcomes, limited studies investigated the association between neighborhood greenness and sedentary behaviour. This study investigated whether physical activity and sedentary behaviour serve as potential mediators in the relationship between neighborhood greenness and cardiovascular outcomes.Study design  A cross-sectional, population-based study using national survey data and geographic information system (GIS) metrics.Methods  Data from the 2020 Korea National Health and Nutrition Examination Survey (KNHANES) (N = 6133) were linked with neighborhood greenness metrics from national landcover maps. Structural equation modelling was used to evaluate whether domain-specific physical activity, by intensity (vigorous and moderate) and context (work-related, leisure-purposed, and commuting), and sitting time showed significant indirect associations between neighborhood greenness and cardiovascular outcomes.Results  Neighborhood greenness was significantly associated with reduced sitting time (p < .001), and lower sitting time was negatively associated with diagnosis of hypertension (p < .001), hyperlipidemia (p = .007), and stroke (p < .001). In the structural equation modelling analyses, sedentary time showed significant indirect associations between greenness and three of the cardiovascular outcomes examined. No comparable indirect associations were observed for the physical activity domains. Contrary to our hypothesis, most domains of physical activity were associated neither with neighborhood greenness nor cardiovascular outcomes.Conclusions  These cross-sectional findings suggest that sedentary behaviour was consistently associated with the relationship between neighborhood greenness and cardiovascular outcomes. Place-making strategies that address sedentary behaviour may complement those that promote physical activity.
SN  - 2666-5352
ER  -