Association Between Active Outdoor Play and Health Among Children, Adolescents, and Adults: An Umbrella Review

Background: This umbrella review examined the associations between active outdoor play (AOP) and physical, mental, social, and spiritual health across all ages. Methods: A systematic search of 8 bibliographic databases was conducted to identify quantitative, qualitative, and mixed-methods systematic reviews and meta-analyses examining associations between AOP and human physical, social, mental, and spiritual health. Included reviews were written in English or French and published in or after 2014. Assessing the Methodological Quality of Systematic Reviews 2 was used to assess the quality of reviews. Quantitative findings on statistical observations of null, favorable, and unfavorable findings were used to assess the consistency of evidence. Bradford Hill's criteria was used to assess causality. Results: Six systematic reviews-3 quantitative, 2 mixed-methods, and 1 qualitative-were included in the umbrella review, encompassing 381 articles. Four and 2 reviews were assessed as critically low and high quality, respectively. For physical, social, and spiritual health, 78% (7/9 observations, 2 reviews), 72% (13/18 observations, 3 reviews), and 100% (9/9 observations, 1 review) showed that AOP was favorably associated with the respective health outcomes based on children and adolescent studies exclusively. By contrast, 71% (53/75 observations, 4 reviews) showed that AOP was favorably associated with mental health inclusive of all ages. There was partial support for causality between AOP and all health outcomes. A figure was created to illustrate possible pathways from AOP to health outcomes. Conclusion: Largely positive associations were observed between AOP and physical, social, mental, and spiritual health, especially among children and adolescents. The greatest source of favorable evidence across all was on AOP and mental health, benefits for health.