Association Between Green Exercise and Adherence to the Mediterranean Diet in Adolescents: Preliminary Results From a Multicenter Cross-Sectional Study

Abstract

Introduction

Adolescence represents a critical period for the adoption of healthy behaviors that may influence health throughout the life course [1]. Among these, regular physical activity and adherence to the Mediterranean Diet (MD) are recognized as important determinants of health. In recent years, growing attention has been paid to green exercise (GE), defined as physical activity performed in natural environments such as urban parks, beaches, mountains, rural areas, or sports facilities characterized by a high presence of green spaces, due to its potential benefits for physical and psychological well-being.

Aims

To assess the association between physical activity, participation in GE, and adherence to the MD among adolescents.

Methods

A multicenter cross-sectional study was conducted in 10 secondary schools located across five Italian regions (Piedmont, Lombardy, Tuscany, Lazio, and Apulia). Sociodemographic, anthropometric, and lifestyle-related information was collected through a self-administered online questionnaire. Physical activity was defined as engaging in moderate-to-vigorous physical activity for at least 50 minutes, at least three times per week. GE was defined as participation in physical activity in natural environments at least once per week. Adherence to the MD was assessed using the KIDMED questionnaire and classified as low, medium, or high adherence [2,3]. Associations between variables were evaluated using the χ² test, with statistical significance set at p<0.05. The study was reported according to the STROBE Statement recommendations for observational studies [4]. Statistical analyses were performed using SPSS software. Ethical acknowledgment was obtained from the CET Lazio Area 5 Ethics Committee (No. 122/SR/24).

Results

A total of 1,714 adolescents were included, with a mean age of 16.1 years (SD=1.7) and a mean BMI of 21.2 kg/m² (SD=3.2). Preliminary analyses showed a statistically significant association between GE participation (at least once per week) and MD adherence levels (p<0.001), with a higher prevalence of high MD adherence among GE participants compared with non-participants (30.7% vs. 18.9%).

A significant association was also observed between engaging in moderate-to-vigorous physical activity at least three times per week and MD adherence (p<0.001). Specifically, the prevalence of high MD adherence was greater among physically active adolescents than among their inactive peers (24.8% vs. 11.3%).

No significant associations were found between GE participation and sex (p=0.175) or BMI categories (p=0.053). Similarly, no significant associations were observed between MD adherence levels and sex (p=0.644) or BMI categories (p=0.578).

Conclusions

Preliminary findings suggest that regular physical activity and participation in activities performed in natural environments are associated with greater adherence to the Mediterranean Diet among adolescents. These findings support the importance of integrated health promotion strategies aimed at simultaneously encouraging physical activity, contact with natural environments, and healthy dietary behaviors during adolescence.