Content uploaded by Ulrich Schmutz
Author content
All content in this area was uploaded by Ulrich Schmutz on Jun 16, 2014
Content may be subject to copyright.
The benefits of gardening and food
growing for health and wellbeing
Health
Growing
Food growing for
health and wellbeing
By Garden Organic and Sustain
Ulrich Schmutz, Margi Lennartsson, Sarah Williams, Maria Devereaux and Gareth Davies
April 2014
The Benefits of Gardening and Food Growing for Health and Wellbeing 2
Contents
Foreword by Professor Tim Lang ...................................................................................... 3
Summary highlights of the literature review ..................................................................... 4
1. Introduction and approach .............................................................................................. 5
2. General benefits of community gardening .................................................................... 6
3. Social and therapeutic horticulture ................................................................................ 7
3.1 Horticultural therapy ................................................................................................. 7
3.2 Therapeutic horticulture ........................................................................................... 8
4. Mental health and wellbeing ............................................................................................ 9
4.1 Background .............................................................................................................. 9
4.2 Benefits of gardening and food growing for mental health and wellbeing ............... 9
4.3 Benefits of gardens and gardening for stress and depression ............................. 11
4.4 Benefits for sufferers of dementia and Alzheimer’s disease .................................. 12
5. Obesity, healthy weight management and healthy eating ......................................... 14
5.1 Background ............................................................................................................ 14
5.2 Benefits for fruit and vegetable consumption ......................................................... 14
5.3 Benefits for physical activity ................................................................................... 15
5.4 Benefits for Body mass index (BMI) ....................................................................... 16
6. Helping people cope with other serious health problems ......................................... 17
6.1 Cancer ..................................................................................................................... 17
6.2 Allergies, asthma and intolerances ........................................................................ 18
6.3 HIV/AIDS ................................................................................................................ 19
References .......................................................................................................................... 20
Appendix: Benefit matrix of gardening and food growing for health and wellbeing .. 27
Cover image: Sydenham Gardens, South London
Page 8: Grow2Grow, Kent
Page 13: Sydenham garden sow and grow group
The Benefits of Gardening and Food Growing for Health and Wellbeing 3
Foreword by
Professor Tim Lang
We can all benefit from gardening and community food-growing projects. It is widely recognised
that regular contact with plants, animals and the natural environment can improve our physical
health and mental well-being. When we grow food and flowers, we are engaging with the natural
world at a pace that provides a welcome antidote to the stresses of modern life.
For the large number of people in our society – children and adults – who live with challenging
physical or mental health problems, gardening and community food growing can be especially
beneficial. Such activities can relieve the symptoms of serious illnesses, prevent the
development of some conditions, and introduce people to a way of life that can help them to
improve their well-being in the longer term. And even if you are feeling fine, gardening is… well,
just a very nice thing to do. It sets a different pace to what makes life: seasons, weather, soil.
Gardening and community food growing therefore deserve the attention of health professionals,
spatial planners and other policy makers who are well placed to make it possible for people to
participate in beneficial horticultural activities, wherever they live. People in a mass urbanised
society like Britain don’t have easy access to land.
Green space and food growing spaces need to be created and protected in the environments
where we live, to make it easy for people to participate in gardening, allotments, community
food growing and horticultural therapy. This is a job for local authorities and their planning
departments, as well as for land owners such as housing developers. Meanwhile, action already
piloted by local GPs and health authorities to ‘prescribe’ gardening and food growing to those
with physical or mental health conditions should be recognised and replicated throughout the
NHS.
All this might seem obvious. However, with tight budgets and many calls on their time and
services, policy-makers often require scientific evidence to prove what we generally take to be
common sense, and to make the case for such work to be prioritised and provided with
appropriate facilities and funding. This helpful study therefore reviews the extensive scientific
literature that exists, examining the benefits of gardening and community food growing for both
physical and mental health.
As a result, this study presents a compelling case for action by health professionals and the
NHS; local authority planners and Government planning policy specialists; and by communities
themselves, to create the circumstances in which gardening and community food growing can
thrive, for the benefit of everyone.
Professor Tim Lang, Centre for Food Policy at City University London; Fellow of the
Faculty of Public Health; President of Garden Organic; and keen vegetable grower
The Benefits of Gardening and Food Growing for Health and Wellbeing 4
Summary highlights of the literature review
This review of the scientific literature set out to demonstrate the strength of evidence for the
benefits of gardening and food growing for physical and mental health and wellbeing. It shows
that:
..to improve physical health, regular involvement in gardening or community food
growing projects, or formal horticultural therapy, can:
Increase overall levels of physical activity and fitness, burn more calories and hence
contribute to healthy weight management and reducing the risk of obesity.
Increase healthy fruit and vegetable consumption, for adults that grow food, and among
schoolchildren participating in food-growing activities at school – as well as improving young
people’s attitudes to healthy eating.
Reduce physical pain, and help with rehabilitation or recovery from surgery or other medical
interventions.
Help people cope with physically challenging circumstances, such as intensive cancer
treatment or learning how to live with chronic conditions such as asthma or severe allergies.
..to improve mental health, for people with acute or persistent mental health problems, or
especially difficult personal circumstances, regular involvement in gardening or
community food-growing projects, or formal horticultural therapy, can:
Contribute to improved social interactions and community cohesion.
Reduce the occurrence of episodes of stress, and the severity of stress and associated
depression.
Reduce reliance on medication, self-harming behaviour, and visits to psychiatric services,
whilst also improving alertness, cognitive abilities and social skills.
Alleviate symptoms of dementia and Alzheimer’s disease, such as agitation and aggressive
behaviour, which can in turn improve circumstances for carers.
Provide productive manual activity and beneficial social interaction for people tackling drug
and alcohol dependency.
Help people manage the distress associated with mentally challenging circumstances, such
as making the end of life more peaceful, sociable and enjoyable for hospice patients.
The Benefits of Gardening and Food Growing for Health and Wellbeing 5
1. Introduction and approach
It is increasingly recognised, by individuals and health professionals alike, that gardening and
food growing is good for our health and wellbeing. Whilst much of the evidence for these
benefits is anecdotal, there is a large, and growing, body of evidence published in the scientific
literature. The aim of this review was to draw together some of the published evidence so that it
can be used to support decision making and to encourage health professionals to actively use
gardening and food growing as part of the health care service provision.
The aim was to focus on the health benefits provided by community gardens and the
activities of gardening and food growing. The literature relating to the health benefits
associated with people’s engagement with nature, green spaces and the outdoors more
generally has already been summarised by Pretty et al. (2011) as part of the UK National
Ecosystem Assessment (UK National Ecosystem Assessment, 2011). Therefore, the aim of this
study was to focus more specifically on community gardens and food growing. Pretty et al.
(2011) concluded in their review that the evidence was that “observing nature and participating
in physical activity in green spaces play an important role in positively influencing human health
and wellbeing”. They also concluded that ecosystems provide direct positive effects on both
mental and physical health and indirect effects by facilitating nature based activity and social
engagement, which positively influence health and provide a catalyst for behavioural change in
terms of encouraging the adoption of healthier lifestyles (Pretty et al., 2011). We note that these
conclusions are also valid in relation to the health benefits of community food growing.
In our study we were particularly interested in gathering evidence of the benefits of gardening
and food growing in relation to specific health and wellbeing issues, concurring with some of the
major health issues that face our society at present, including obesity, diabetes, cardiovascular
diseases, cancer, mental health and wellbeing, dementia, stress, depression, substance
misuse, and harmful behaviours associated with some of these conditions. However, although
we searched specifically for studies where the health impact had been evaluated in relation to
these specific health issues we found that in most papers the focus of the study was not that
specific.
The methods used for the review were mainly literature searches using online tools like Google
Scholar, Coventry University’s online library services and publicly available search engines.
Full-text scientific papers were accessed were appropriate. Searches were made for health
conditions listed above then followed up peer-reviewed and grey literature in the English
language. For example, we used the term ‘allergy treatment’ and ‘gardening’ or ‘horticulture’ or
‘community gardening’ or ‘community food growing’ or ‘horticultural therapy’ with ‘active
involvement in gardening’ to find any documentation on allergy and gardening as treatment.
Papers and reports were also found via suggestions made from academics and experts working
in this area including member advisory groups for the project. The review did not included non-
English language publications.
The Benefits of Gardening and Food Growing for Health and Wellbeing 6
2. General benefits of community gardening
There is a growing body of literature on the general benefits of community gardening. Many of
them mention health and wellbeing benefits, however most do not address the benefits for the
treatment or prevention of specific diseases. Many of the English language scientific
publications assessed are reporting from the USA, Canada, Australia and New Zealand
(Kingsley et al., 2009, Draper and Freedman, 2010). Quayle (2007) summarised this qualitative
research on the general benefits of community gardens and city farms for the UK. Most of such
evidence is qualitative research and although benefits for community cohesion, the local
economy, the environment are well documented, direct benefits regarding mental health are in
the subject of only a few studies (Quayle, 2007).
One publication (Calleau, 2005) reported health benefits for volunteers with mental health
issues at a garden nursery; after attending the nursery, volunteers’ visits to psychiatric hospitals
reduced. In addition, self-harming behaviour stopped or reduced and half of the volunteers had
their medication reduced or removed (Calleau, 2005). The other study (Velde et al., 2005)
describes how animals can be used by occupational therapists, resulting in improved alertness
and cognitive ability in clients with chronic and persistent mental illness. This outcome allowed
clients to focus and remain attentive for longer periods of time.
Recently there have been more studies on the benefits of community gardens regarding social
benefits, as well as nutritional benefits, and physical activity (Barnidge et al., 2013, Zick et al.,
2013). Studies on the impact of community gardening on direct health outcomes are, however,
rare. One example is a Canadian study on the specific health impacts of community gardening,
using Toronto, Ontario as a case study (Wakefield et al., 2007). The research project collected
data on the perceived health impacts of community gardening through participant observation,
focus groups and in-depth interviews. The research method used was referred to as community-
based research (CBR) and can be defined as research with a substantial level of community
participation for the purposes of community improvement and social change. The observations
were carried out involving participants who helped out with the 2004 growing season and
attending garden meetings. Ten focus groups were held and each was 1-2 hours long. Overall
55 people participated in the focus groups and 13 in-depth interviews were held. All focus
groups and interviews, were possible, were tape-recorded and transcribed verbatim by
professional transcribers.
Results from the study suggested that community gardens were perceived by gardeners to
provide numerous health benefits, including improved access to food, improved nutrition,
increased physical activity and improved mental health. Community gardens were also seen to
promote social health benefits and social connections. The mental health benefits are described
by gardeners as more general i.e. helping to be more mentally (and physically) active or to
reduce stress e.g. “sometimes when you are stressed out…when you go to the garden, you feel
different”.
The Benefits of Gardening and Food Growing for Health and Wellbeing 7
3. Social and therapeutic horticulture
Therapeutic horticulture and/or formal horticultural therapy, have been widely promoted over the
past few decades, although they certainly have a longer history than this. Whilst the terms are
often used interchangeably horticultural therapy is the use of plants by a trained professional as
a medium through which certain clinically defined goals may be met. Therapeutic horticulture is
a perhaps less formal process by which individuals may develop wellbeing using plants and
horticulture either by active or passive involvement. Although many publications have been
produced, many have not provided measured evidence of its effectiveness (Sempik et al.,
2003), perhaps because of the subjective or qualitative nature of many of the outcomes.
3.1 Horticultural therapy
Engaging people in horticulture as a formal clinical therapy is well documented in the scientific
literature. By this definition persons suffering or recovering from illness (mental or physical) are
engaged in horticultural tasks as a means to ease their clinical suffering or as an aid to promote
longer-term recovery or cure. To that end, and strictly speaking, a horticultural therapy ought to
offer a defined treatment procedure focusing on horticultural or gardening activities that is aimed
at treating a diagnosed problem in a patient. This in turn implies that the treatment has a goal
that can be measured and evaluated and that the treatment is overseen and delivered by a
suitably qualified professional.
KSU (2010) provides a good overview of horticulture therapy research and the areas in which it
can provide benefits. These include:
Reducing physical pain: gardening can be part of a programme that aims to reduce chronic
pain or discomfort in patients (e.g. Park et al., 2008). Unruh (2004) reports on a study that
showed that gardening helped people with serious health problems cope with their situation
when comparing groups of people with and without cancer.
Rehabilitation and recovery: gardening can be part of a rehabilitation programme aimed at
improving motor skills, speech skills, and/or cognitive skills after debilitating illness or
traumas such as strokes. Söderback et al. (2004) review horticultural therapy in the
rehabilitation hospital setting in Sweden but the general principles will apply more widely.
Horticultural therapy as a holistic therapy is also used for patients to recover from life-
challenging illnesses like cancer survivors (Eunhee, 2003).
Dementia: is a growing problem in more developed economies and horticultural therapy is
seen as a way of alleviating the symptoms, providing a higher quality of life and improved
cognitive functioning (e.g. Yasukawa, 2009).
Hospice care: may provide gardens and gardening activities, which aim to provide some
combination of the above therapies. Sadler (2007) provides some background information
to the use of gardens in hospice settings including a history and principles.
Rice and Lremy (1998) studied the impact of horticultural therapy on psychosocial functioning
among urban jail inmates and found that horticultural therapy treatment effects retained at
follow-up studies. They included lower depression in subjects who had emotionally detached
mothers, reduced number of substance usage and a sustained desire for help.
The Benefits of Gardening and Food Growing for Health and Wellbeing 8
3.2 Therapeutic horticulture
Therapeutic horticulture is widely promoted in
the UK as a means of engaging people in
practical activities with positive outcomes. Client
groups in this case include special needs
groups who have mental or physical disabilities
that might lead to them being excluded in many
social situations or from work. In some cases it
might be more aptly described as social
horticulture in that the outcome is to involve
‘client groups’ in practical activity, which is
socially inclusive and meaningful. Such groups
include offenders, drug or alcohol dependent
persons and other socially excluded groups like
recent immigrants or refugees. Such projects
are also increasingly seen as a way of including
older people in meaningful activity.
Although it is generally seen as a good way to
promote social inclusion among vulnerable
people (e.g. those with mental ill health, learning
difficulties, older people etc.), as well as a
therapy, Aldridge and Sempik et al. (2003) suggest that the evidence for this is scanty and of
variable quality, perhaps because most studies focus on therapy.
Areas where therapeutic horticulture have been practised with some effect include:
Mental health: gardening and related activities have long been advocated in mental health
programmes (Spurgeon and Underhill, 1979).
Physical health: health problems centred around sedentary lifestyles, obesity and even old
age have been alleviated or tackled with gardening programmes.
Substance misusers: therapeutic and manual work is increasingly being used to include
drug and alcohol dependent people and aside from horticulture projects Care Farms are
also being increasingly used to meaningfully occupy this client group in the UK.
Excluded groups (refugees etc.): once again horticulture projects are increasingly seen as a
way of generating meaningful activity for excluded groups like refugees.
In a recent UK study (Sempik et al., in preparation) the effects of social and therapeutic
horticulture on four social behaviour scores were assessed: ‘social interaction’, ‘communication’,
‘motivation’ and ‘task engagement’. This was an observational study using daily assessments
of 143 clients by horticultural therapists at the charity Thrive’s Trunkwell and Battersea gardens
in Berkshire and London, UK. Results showed a significant increase of ‘social interaction’ after
90, 180 and 365 days, but not after 30 or 60 days. The effect sizes for ‘communication’ and
‘motivation’ were similar to ‘social interaction’, while only small effects were found for ‘task
engagement’. From this it can be concluded that social and therapeutic horticulture can provide
the opportunity for social interaction, although this may take several months to show as a
significant score. Therefore the horticultural intervention may promote social inclusion among
vulnerable and isolated groups.
The Benefits of Gardening and Food Growing for Health and Wellbeing 9
4. Mental health and wellbeing
4.1 Background
The Department of Health (2010) has stated that, “Mental health and wellbeing can positively
affect almost every area of a person’s life: education, employment, family and relationships. It
can help people achieve their potential, realise their ambitions, cope with adversity, work
productively and contribute to their community and society. Promoting mental health and
wellbeing has multiple benefits. It improves health outcomes, life expectancy, productivity and
educational and economic outcomes and reduces violence and crime.” Estimates from 2006 put
the wider economic costs of mental health problems at over £110bn/year. The UK Department
of Health guidance and the Cross-government framework for wellbeing (Department of Health,
2010) defined wellbeing as “a positive state of mind and body, feeling safe and able to cope,
with a sense of connection with people, communities and the wider environment”. The guidance
document recommends promoting mental health and wellbeing across the whole population.
This UK public mental health framework identifies five key areas for action to promote wellbeing;
‘a life course approach’, ‘a positive start in life’, ‘healthy later years’, ‘build strength safety’ and
‘resilience and develop sustainable, connected communities’ (Department of Health, 2010).
4.2 Benefits of gardening and food growing for mental health
and wellbeing
Gardens, as well as the activity of gardening, have been shown to have a positive impact on
peoples’ health and wellbeing, the result of both the physical activity and the use of the garden
as a space for mental relaxation and stimulation. In 2013 the UK charity Mind published a report
on the outcomes of their 130 ecotherapy projects across England (Mind, 2013). They described
“ecotherapy as an intervention that improves mental and physical health and wellbeing by
supporting people to be active outdoors; doing gardening, food growing or environmental work”.
Based on a number of external evaluations (Bragg et al. 2013, New Economics Foundation,
2013) of their projects they concluded ecotherapy services can help people to look after their
mental wellbeing, support people who may be at risk of developing a mental health problem and
help the recovery of people with existing mental health problems (Mind, 2013).
Gardeners appear to be aware that gardening is good for their mental health; in a USA study
gardeners involved with the Philadelphia Gardening Programme were asked why they gardened
(Blair et al., 1991). Interviewing a total of 144 gardeners Blair et al. found that recreation (21%)
was the most important reason followed by health benefits including ‘mental health’ (19%),
‘physical health and exercise’ (17%) and ‘produce quality and nutrition’ (14%).
Besides the activity of gardening, viewing green space and being in green space has also been
shown to have positive effects on mental health and stress. For example Lohr et al. (1996)
report that views over ‘green space’ in the form of plants at work can already improve
performance. According to Pretty et al. (2007) “less green nature means reduced mental
wellbeing, or at least less opportunity to recover from mental stress”. Sugiyama et al. (2008)
reported in a review that perceived neighbourhood greenness was positively correlated with
mental health (together with walking and social cohesiveness), and in this case more so than
physical health.
The Benefits of Gardening and Food Growing for Health and Wellbeing 10
More widely the theory that access to restorative spaces (e.g. gardens) helps to restore
people’s directive attention on tasks and thereby improve mental acuity (Berto, 2005) has been
developed. This has also been expressed as attention restoration theory (ART), which has been
studied and reviewed in the cognitive benefits of interacting with nature (Berman et al., 2008).
Children are purported to perform better mentally when they have access to green space
(Wells, 2000) and students when their view is dominated by plants rather than buildings and
pavement (Tennesson and Cimprich, 1995). Symptoms of attention deficit hyperactivity disorder
(ADHD) are also relieved by green space (Kuo and Taylor, 2004).
‘Life satisfaction’ is harder to define objectively than physical or mental health. Life satisfaction
loosely describes a person’s ongoing state of mind and contentment with their unfolding life but
has no strict clinical definition. For example ‘happiness’ is a state of mind that most people strive
to attain without perhaps needing to strictly define exactly what it is. There is good evidence that
physical activity positively influences moods and state of mind and that gardening (as described
above) is beneficial in this respect.
Gardening when carried out in an uncompetitive manner can engage people in many different
ways and when carried through lead to feeling of achievement or having succeeded. Simply
completing a physical task can also lead to feelings of contentment and relaxation. Certainly the
rhythm of the gardening year and recycling of resources can help to ground people in natural
cycles and this seems to promote a more general feeling of wellbeing. Blair et al. (1991) found
that ‘those who are involved in gardening find life more satisfying and feel they have more
positive things happening in their lives than those who are not’.
The theory of ‘biophilia’ was first put forward by Wilson (1984), which contends that humans
have a ‘tendency to focus on life and lifelike processes’ and that knowledge about the natural
world (especially plants and animals) contributed to the survival of the human race and is thus
innate. In practical terms this implies that people feel most comfortable in settings where they
can identify with life processes (Gullone, 2000).
The evidence that suggests that optimal physical health and psychological wellbeing are linked
to positive emotional environments and the natural environment are by Haviland-Jones et al.,
2005, Pretty et al., 2007, a review by Maller et al., 2008, and by Schultz, 2010). It has been
suggested that these feelings are grounded in our evolutionary psychology as a species. For
example, it has been suggested that the reason we find certain landscape features aesthetically
pleasing is that we are attracted to those that have enabled the survival of our species (Gullone,
2000). This includes features such as bodies of water, plants, animals and trees, all elements
that are found in pleasing gardens. Even elements of gardening have the ability to trigger
emotions in people. For example, ‘flowers are a powerful positive emotion inducer’ and have
immediate and long-term effects on emotional reactions, mood, social behaviour and even
memory in both males and females (Haviland-Jones et al., 2005).
The Benefits of Gardening and Food Growing for Health and Wellbeing 11
4.3 Benefits of gardens and gardening for stress and
depression
Stress and stress-related illnesses have increased dramatically in Western societies and indeed
are increasing worldwide. Stress is expressed physically through increased muscle tension,
increased blood pressure, increased pulse, increased sweat gland production, increased
production of adrenalin and hydrocortisone, and reduced digestive system activity. Long-term
stress causes and aggravates many illnesses. These include cardiovascular diseases, high
blood pressure, depression, anxiety, thrombosis, digestive problems, chronic fatigue, aches and
pains, allergies and increased risk of infection. Prolonged stress can be a symptom of, or result
in, underlying mental illness.
Gardens seem to be able to reduce stress in several ways:
1. By simply allowing views of a green space or a (semi-) natural scene. Numerous
studies have shown that simply viewing a green space through a window can relax people
and reduce stress levels and this is expressed by, for instance, decreased recovery times
from illness and fewer stress related incidents. Good studies of this effect are provided by
Ulrich (1984) and Kaplan (2001) and are reviewed by Maller et al. (2005), while Day (2007)
provides a more critical view on the evidence and the limits of empirical evidence.
2. By allowing immersion in a natural scene. A range of studies has shown that by simply
allowing people to immerse themselves in a natural setting can reduce stress and increase
relaxation and improve recuperation (Cooper Marcus and Barnes, 1999, Ulrich, 1999). This
is certainly true of gardens as witnessed by the number of people who simply like to sit in
their gardens at the weekend, because it allows them to feel connected to nature; the role of
connectedness to nature as Mayer et al. (2008) put it.
3. By actively engaging people in a natural setting. Perhaps the most effective way to
reduce stress is to combine the effects of work (or exercise) in a natural or green setting
and exercise in such a setting certainly seems to have greater effects than exercise alone
or exercise in ‘unnatural’ or even unpleasant settings (Pretty et al., 2007)
Van den Berg and Clusters (2011) tested stress-relieving effects of gardening in a field
experiment with 30 allotment gardeners in Amsterdam either gardening or reading on their
allotment for 0.5 hour. Both, gardening and reading had cortisol decreases during the recovery
period, however decreases were significantly stronger following gardening. Positive mood was
fully restored after gardening, but further deteriorated during reading. The authors highlight that
these findings provide the experimental evidence that gardening can promote relief from acute
stress (van den Berg and Clusters, 2011) and building on the author’s earlier work on 12
different allotment sites across the Netherlands (van den Berg et al., 2010).
Research carried out in Sweden found that people with access to a garden had significantly
fewer stress occasions per year (Stigsdotter and Grahn, 2004, Stigsdotter, 2005). They reported
that people living in apartment blocks with no balcony or outdoor area had an average of 193
stress occasions per year. This was reduced to 126 stress occasions if respondents had a
balcony. Those with a small garden had 86 stress occasions, while the least stress was
reported by those with a large leafy garden, who only reported an average of 65 stress
occasions per year. They also found that the more often people used their gardens, the fewer
stress occasions they suffered per year. In comparing gardens with other urban green spaces
they found that while both were important for health, but having a private garden was more
important (Stigsdotter, 2005).
The Benefits of Gardening and Food Growing for Health and Wellbeing 12
Hawkins et al. (2011 and 2013) have recently added to this by studying allotment gardening in
Cardiff, Wales, UK. Their results found a similar significant difference in perceived stress levels
between the activity groups of ‘indoor exercise’, ‘walkers’, ‘allotment gardeners’, and ‘home
gardeners’. Allotment gardeners reported significantly less perceived stress than participants of
indoor exercise. There second study Hawkins et al. (2013) had an older adult sample of
community allotment gardening with a particular emphasis on stress recovery and again results
indicate that allotment gardeners appreciate both ‘doing’ the gardening as well as ‘being’ in the
garden/allotment landscape with a wide range of benefits to their health and wellbeing.
Therapeutic horticulture in clinical depression was studied by Gonzalez et al. (2010) in Norway.
The data for the study was collected before, during and immediately after a 12-week therapeutic
horticulture programme on 4 farms near Oslo to assess if a change in depression severity,
perceived attentional capacity and rumination (brooding) in individuals occurred. Results
showed a clinically relevant decline of depression (‘Beck Depression Inventory’) in 50% of the
participants and the participants maintained their improvements in ‘Beck Depression Inventory’
scores at 3-month follow-up.
4.4 Benefits for sufferers of dementia and Alzheimer’s disease
Dementia is a long-term condition with a high impact on a person’s health, personal
circumstances and family life. Alzheimer’s disease is the most common form of dementia and is
generally diagnosed in people of over 70 years of age. Early-onset dementia refers to the onset
of symptoms before the age of 65. As well as having profound impact on the individual,
dementia can also have a high impact on family members and friends. Dementia results in a
progressive decline in multiple areas of brain function including memory, reasoning,
communication skills and those skills needed to carry out daily activities. Alongside this decline,
individuals may develop behavioural and psychological symptoms such as depression,
psychosis, aggression and wandering, which complicate care.
The UK’s National Dementia Strategy, published in 2009, aims to ensure that improvements are
made to dementia services across three areas: improved awareness, earlier diagnosis and
intervention, and a higher quality of care (Department of Health, 2009). The Alzheimer’s Society
statistics show that there are currently 800,000 people living with dementia in the UK, and it is
predicted that this number will rise to over one million people by 2021. It is estimated that
dementia currently costs the NHS, local authorities and families £23 billion per year and this
may grow to £27 billion by 2018 (Kane and Cook 2013). The Alzheimer’s Society notes that the
Welsh Assembly in its framework action recognises that low-level support services such as
gardening clubs are vital within the dementia strategy. They reduce the need for more intrusive
and costly care solutions (Kane and Cook, 2013).
The UK National Institute for Health and Care Excellence (NICE) recommends that care plans
should address activities of daily living that maximise independent activity, adapt and enhance
function, and minimise need for support (NICE, 2011). The garden and the activity of gardening
provides a non-pharmacological approach to address these goals and horticultural therapy can
be utilised to improve the quality of life for the aging population and yielded high level
patient/carer satisfaction, possibly reducing costs of long-term, assisted living and dementia unit
residents (Detweiler et al., 2012, Gitlin et al., 2012).
A number of studies have shown the benefits of therapeutic gardens and horticultural activities
for patients with dementia. In a review of the literature of the evidence to support the use of
therapeutic gardens for the elderly, Detweiler et al. (2012) concluded that many preliminary
studies have reported benefits of horticultural therapy and garden settings in reduction of pain,
The Benefits of Gardening and Food Growing for Health and Wellbeing 13
improvement in attention, lessening of stress, modulation of agitation, lowering of as need
medications, and antipsychotics and reduction in falls.
Jarrot and Gigliotti (2004) studied whether planting, cooking, or craft activities engender
differential responses from adult day service participants with dementia, and in a later study the
same author team (Jarrot and Gigliotti, 2010) evaluated responses to horticultural based
activities for randomly assigned groups in eight care homes and compared with responses to
traditional activities. They showed that horticultural activities reached groups of participants who
would often be difficult to engage in activities and resulted in higher levels of adaptive behaviour
and in active and passive engagement. Similarly, Yasukawa (2009) showed improvements in
communication, engagement, behaviour and cognitive abilities in a group of patients with
Alzheimer’s who participated in horticultural activity over a period of three months.
In a study investigating the use of horticultural therapy to prevent the decline of mental abilities
in patients with Alzheimer’s type dementia, D’Andrea et al. (2007) reported participation in
horticultural activities resulted in maintenance of memory and sense of wellbeing and an overall
higher functional level than the control group. Connell et al. (2007) compared outdoor and
indoor activity programmes on sleep and behaviour in nursing home residents with dementia
and showed that the outdoor activity group experienced significant improvements in sleep
patterns and also a decline in verbal agitation. Luk (2011) studying horticultural activities in a
nursing home in Hong Kong found no significant effect on the reduction of agitation among the
home residents with dementia, however a significant decrease in aggressive behaviour.
Hewitt et al. (2013) evaluated the impact of therapeutic gardening for people with young-onset
dementia, measuring outcomes for both participants with dementia and their carers. The
conclusion from their preliminary study suggested that structured gardening over a 12-months
period had a positive impact on the wellbeing, cognition and mood of people with young-onset
dementia. Specific attention was drawn to the relationship between the wellbeing of participants
and their cognition as the results of the study suggested that wellbeing can be maintained
despite the presence of a cognitive deterioration. Self-identity and purposeful activity were
reported as common themes as benefits of the gardening group, participants felt useful and
valued and had a sense of achievement.
The Benefits of Gardening and Food Growing for Health and Wellbeing 14
5. Obesity, healthy weight management and
healthy eating
5.1 Background
The Government’s obesity strategy ‘Healthy Lives, Healthy People; a call to action on obesity in
England’ has identified that “overweight and obesity represent probably the most widespread
threat to health and wellbeing” (Department of Health, 2011). 61% of adults are overweight or
obese, and 23% of 4-5 year olds and 33% of 10-11 year old. The level of obesity in England,
along with the rest of the UK, ranks as one of the most obese nations in Europe. It is the
consequence of overweight and obesity that makes these statistics so serious, as excess
weight is a major risk factor for diseases such as type 2 diabetes, cancer and heart disease.
Alongside the serious ill-health it provokes, overweight can reduce people’s prospects in life
affecting self-esteem and mental health (Department of Health, 2011).
Excess weight gain is the result of eating more calories than needed and/or undertaking
insufficient levels of physical activity to match the calorie intake. Although this energy imbalance
is driven by complex environmental, physiological and behavioural factors, changes in diet to
reduce energy intake along with increasing physical activity are key to achieving and
maintaining a healthy body weight. The National Institute for Health and Clinical Excellence
(NICE) clinical guideline on obesity includes advice for people to eat at least five portions of fruit
and vegetables each day in place of foods higher in fat and calories, and lower in beneficial
nutrients, and to make enjoyable physical activities part of everyday life. Engagement in
gardening and food growing can address both of these recommendations and gardening is
indeed recognised as moderate-intensity physical activity that adults are advised to undertake
30 minutes or more of on five or more days of the week (NICE, 2006).
5.2 Benefits for fruit and vegetable consumption
Reviews of academic studies from the UK and abroad, concluded that food growing
programmes in schools can have positive impacts on pupil nutrition and attitudes towards
healthy eating, specifically related to the willingness to try new foods and taste preferences
(Draper and Freedman, 2010, Nelson et al., 2011). For example, a study carried out in the USA,
with 8-11 year old students involved in hands-on school gardening programmes found a more
positive attitude towards vegetables and increased snack preference for fruit and vegetables
amongst the children Lineberger and Zajicek (2000). Ratcliffe et al. (2011), also in the USA,
studied 11-12 year old students involved in food growing over a four month period and found
that students were more willing to taste, and ate, a greater variety of vegetables than those in
the control group. In urban areas those benefits may even outweigh any risks like those from
contaminated land in an overall risk assessment (Leake et al., 2009).
The evaluation of the Food for Life Partnership (FFLP) programme in the UK (Orme et al., 2011)
showed significant associations between healthy eating and FFLP related behaviours including
participation in cooking and growing at school or at home. Orme et al. (2011) showed that
following their participation in FFLP programme the proportion of primary school-age children
eating five or more portions of fruit and vegetables increased by 28%. An evaluation of the
school fruit and vegetable scheme in the UK found that, in schools running food-growing clubs,
children ate more vegetables and intake was higher if parents were involved in the initiative
The Benefits of Gardening and Food Growing for Health and Wellbeing 15
(Ransley et al., 2010). In schools that achieved a high total score (derived from five key types of
initiatives to promote fruit and vegetables in school) children ate more vegetables, 123 g/day,
compared with those that did not 98·g/day. They concluded that gardening, parental
involvement and other activities promoting fruit and vegetables to children in schools may be
associated with increased intake of vegetables but not fruit. Nelson et al. (2011) reported details
of a number of studies in the UK and internationally demonstrating that pupils engagement in
food growing activities resulted in increased consumption of vegetables. They also noted that
most of the studies only considered whether pupils consumption habits had changed as an
immediate effect of their involvement in growing, and highlighted the lack of longitudinal
evidence research confirming whether such programmes can change eating habits longer term
(Nelson et al. 2011).
For adults, Alaimo et al. (2008), reported that household members who participated in
community gardening consumed 40% more fruits and vegetables per day than those that did
not; they were 3.5 times more likely to consume the recommended 5 portions a day of fruits and
vegetables. In the UK, the low-income diet and nutrition survey (Nelson et al., 2007) showed
that men and women living in households that grew food consumed more fruit and vegetables
that other men and women.
The evaluation of the Garden Organic ‘Master Gardener Programme’ in the UK showed that
new food growers ate an average of 4.5 portions of fruit and vegetables per day after being part
of the programme for 12 months, and 4.9 portions per day after being part of the programme for
36 months. This is above the national average for adults aged 19-64 (Kneafsey et al., in
preparation).
5.3 Benefits for physical activity
Gardening is a physical activity and there is a range of garden tasks that uses the upper and
lower body such as digging, turning compost or raking (Park et al., 2008). They offer moderate
intensity physical activity, whilst other tasks that use primarily the upper body in standing or
squatting postures offer low intensity physical activity. Such garden tasks are for example hand
weeding, mixing soil, filling containers with soil and transplanting seedlings (Park et al., 2008).
Calorie calculators provide estimates of calorie expenditure for different gardening activities,
indicating that garden work burns around 250 - 500 calories per hour, depending on the level
intensity of the activity (e.g. Boots Diet online calorie burn calculator, 2014).
The ‘Growing a Healthier Older Population’ project in Wales, UK measured the impact of being
a gardener on aspects of physical and psychological health and wellbeing, comparing
gardeners on an allotment plot or at a community garden with people same age group who were
on an allotment waiting list (Hawkins et al., 2013). In this study, 68% of gardener participants
reported exercise frequencies that met physical activity recommendations, compared to only 25
% of adults in the same age group in the Welsh population in general. Similarly, Park et al.
(2008) concluded that healthy older gardeners in their study met their physical activity
recommendation through gardening and that this may be a factor leading to better physical and
mental health.
The evaluation of the Garden Organic ‘Master Gardener Programme’ showed that a common
theme from interviews with new food growers participating in the programme was “growing more
vegetables means more exercise and time being active and the opportunity to get fresh air” and
results showed that 48% of the new growers spend 1-2 hour/week growing food and 50% spend
The Benefits of Gardening and Food Growing for Health and Wellbeing 16
more than 2 hours/week, including 7% that spend 8 or more hours/week (Kneafsey et al., in
preparation).
In their review of studies relating to the impact of food growing programmes in schools, Nelson
et al. (2011) noted that a common perception of those involved in the studies was that food
growing contributed to making young people more physically active. However, only a few
studies reported actual results of physical activity levels. For example, Herman et al. (2006) and
Phelps et al. (2010) showed that children involved in after-school gardening programmes self-
reported a significant increase in physical activity levels, while Harris et al. (2009) report on a
meta-analysis showing that encouraging physical activity in schools was only partially
successful in improving children’s health and unlikely to reduce obesity in itself and concluded
that gardening needs to be part of a more concerted programme of physical activity to
encourage children to be more active. As such incorporating gardening into the larger school
playground or green space is likely to enhance the benefits of this space which already
encourages open ended children’s activities (Dyment and Bell, 2008). The physical tasks of
food growing, such as digging and weeding, can contribute to a broader understanding of the
various ways of staying active and teachers report that children and young people take greater
responsibility for their own health (RHS, 2010).
5.4 Benefits for Body mass index (BMI)
Recently, Zick et al. (2013) published results including 3 different comparison groups from their
study evaluating the potential weight control benefits of community gardening. Using unique
administrative data from Salt Lake City Utah, they examined body mass index (BMI) data from
community gardening participants in relationship to BMI data for 3 comparison groups
(neighbours, siblings, and spouses). In the comparisons, the data was adjusted for gender, age,
and the year of the BMI measurement. Results showed that both women and men community
gardeners had significantly lower BMIs than their neighbours who were not in the community
gardening programme. Similarly significantly lower BMIs were observed for women and men
community gardeners compared with their sisters or brothers. The third comparison with their
spouses showed no statistically significant differences and the authors hypothesise that
spouses would likely enjoy the dietary advantages of the community garden and might also help
with the physical demands of gardening.
In summary, Zick et al. (2013) concluded that “health benefits of community gardening may go
beyond enhancing the gardeners’ intake of fruit and vegetable” and “community gardens may
be a valuable element of land use diversity that merits consideration by public health officials
who want to identify neighbourhood features that promote health”. These data are only from one
city, but because of the robustness of the sampling and comparison there is little doubt that the
evidence of community gardening activities towards adult obesity is more universal then just for
one USA city. Future research with controlled, randomised field studies across a range of
communities is needed to advance the understanding of gardening and healthy lives. According
to the authors this is the first study published worldwide comparing health benefits of community
gardeners with non-gardeners in a robust sample Zick et al. (2013).
The Benefits of Gardening and Food Growing for Health and Wellbeing 17
6. Helping people cope with other serious
health problems
Our literature review suggested that gardening and food growing can help people to cope with
the symptoms or treatment of other serious health problems. This included studies of people
with specific diseases or conditions; those at the end of their life in hospices or other care
situations; and also people learning to deal with drug and alcohol dependency (the latter
covered in our chapter on ‘general benefits’). To provide useful insights on this theme, we
looked specifically at the literature associated with horticultural activities for people with cancer;
allergies, asthma and intolerances; and the sexually transmitted disease HIV/AIDS.
6.1 Cancer
Unruh’s study “The meaning of gardens and gardening in daily life: a comparison between
gardeners with serious health problems and healthy participants” in Canada showed that
gardening helped people with serious health problems cope with their situation when comparing
groups of people with and without cancer. The study revealed important benefits of gardening
on physical, emotional, social, and spiritual wellbeing, and highlighted a key role of gardening as
a coping strategy for living with stressful diseases such as cancer (Unruh, 2004). The study
revealed the personal and subjective ways in which interest in gardening might change in
response to the person's own situation and needs. The study used a phenomenological method
were 27 women and 15 men were interviewed about the meaning of gardens and gardening in
their daily life. The gardens were located in small towns or rural areas of Nova Scotia, Canada
and 18 participants were diagnosed with cancer. The majority of the participants were aged 45 -
65 years. Semi-structured interviews were done 4 times per year during the growing season.
There is further evidence for breast cancer based on a literature review of 29 articles by
Kirshbaum, 2007) that whole body exercise (including active gardening) has benefits during and
after treatments for breast cancer. Kirshbaum (2007) found that many early studies had limited
validity while recent studies were more robust. Consistent support for all types of aerobic
exercise was most evident in studies of patients during chemotherapy and radiotherapy
treatments against cancer, compared with post-treatment studies. The evidence, which
suggested that aerobic exercise limits, cancer-related fatigue was particularly strong.
One Canadian study specifically included gardening exercise as a type of physical activity
(Blanchard et al., 2003), conducting a comparison of physical activity of post treatment breast
cancer survivors and non-cancer controls. This study investigated whether after breast cancer
treatment, the survivors were meeting the Centre for Disease Control and Prevention/American
College of Sports Medicine recommendations for physical activity. Results showed that breast
cancer survivors engaged in as much moderate, vigorous, and combined physical activity as the
controls. However, further analyses showed that survivors engaged in more garden and yard
work than the controls. The frequency and the total time of stretching were significantly higher in
breast cancer survivors, suggesting that breast cancer survivors engage in as much physical
activity as controls do, but that the groups differ in specific activities (e.g. more active gardening
work in the breast cancer survivor group.
Anther link between gardening work and cancer and stress was found by Fitch et al. (2003).
They were studying the patient perspectives while waiting and travelling for radiation cancer
The Benefits of Gardening and Food Growing for Health and Wellbeing 18
treatment in the USA and found that waiting for treatment and putting domestic activities like
gardening on hold added to the patient stress.
Our general knowledge and understanding regarding the benefits of gardening towards cancer
treatment is however still weak and the Kirshbaum (2007) review therefore suggests additional
studies with high methodological quality for specific patient subgroups like older people, those
with advanced cancer and the disadvantaged. The author concludes that it is important for all
healthcare professionals to be “aware of the evidence surrounding the benefits of exercise
(including gardening) and to encourage patients to increase physical activity and improve their
overall health and wellbeing ”.
In the UK the charity Macmillan Cancer Support has offered gardening packs to encourage
people to ease into physical activity after cancer treatment. The initiative was part of the
charity’s Move More campaign (Macmillan, 2012). Macmillan Cancer Support and the National
Gardens Scheme (NGS) have conducted a survey among 148 NGS gardeners showing that
75% of gardeners living with cancer said that gardening during and after treatment helped them
manage feelings of depression and sadness. In another online survey of 41 gardeners living
with cancer found that 80% say that gardening helps reduce stress and anxiety, and helps take
their mind off treatment. Gardening also had a positive impact on the cancer patients’ physical
wellbeing. Over 50% say that it helps to give them more energy while one in three say that it
helps manage fluctuations in their weight as a result of treatment. The sample size of these two
studies is small and they are not peer reviewed, nevertheless they give a good indication of the
relationship of gardening and physical activity regarding to cancers.
6.2 Allergies, asthma and intolerances
Avoiding triggers, such as allergens, can prevent symptoms of asthma, a chronic inflammatory
disease of the airways. Horticultural therapy has been used in Japan (Sadako, 2002, Kamata,
2008) to treat for asthmatic children. Sadako (2002) carried out horticultural therapy three times
a week for children with intractable bronchial asthma who were hospitalised, and they were
asked questions. The therapy seems to be useful for them to recover their confidence through
experience in growing plants from the beginning while feeling a sense of the seasons, a feeling
of freedom from an ordered life in a ward and communicating among each other. Kamata (2008)
provided horticultural therapy was for long-stay asthmatic children as a supplemental holistic
treatment to complement other treatments at the Osaka Prefecture Medical Centre for
Respiratory and Allergic Disease. Children aged form four to fourteen. The horticultural therapy
had the following three aims: interacting with nature, involvement with others, and learning to
grow plants. Results showed that asthmatic children, who have not previously experienced
nature, relaxed and harmonised with others. They learned teamwork skills and expressed their
own feelings towards nature and towards other people.
The effects of gardening and food growing on allergies and food intolerances (non-allergic food
hypersensitivity) can be indirect through a reduction of general stress levels, as allergies and
food intolerances are linked to stress through the general adaptation response (Gaby, 1998).
Patients often experience short-term relief after ingesting foods, which are later, demonstrated
to be the cause of their chronic symptoms.
The Benefits of Gardening and Food Growing for Health and Wellbeing 19
6.3 HIV/AIDS
HIV/AIDS and malnutrition are prevalent in many parts of the world, especially in sub-Saharan
Africa. There are well-established links between HIV/AIDS and poor nutrition and food
insecurity. HIV, which causes weight loss and wasting, specifically affects nutritional status by
increasing energy requirements, reducing food intake, and adversely affecting nutrient
absorption and metabolism. It is generally recognised that nutrition is important for people living
with HIV/AIDS (including pregnant women) and HIV-exposed children.
There are multiple studies for these effects including gardening and food growing for the
prevention of HIV/AIDS. They are almost exclusively in Sub-Saharan Africa like Uganda (Weiser
et al., 2010), South Africa (O’Hara Murdock et al., 2003) or Zimbabwe (Mubvami and Manyati,
2007).
Mubvami and Manyati (2007) highlight the benefits of food growing at family or community level
for HIV/AIDS. The benefits are indirect, but substantial, and include improved nutrition of
HIV/AIDS affected families, savings on food expenditures, added income from the sale of
surpluses, and community mobilisation to respond to HIV and AIDS. This can also include the
integration of former commercial sex workers from HIV/AIDS affected families (Mubvami and
Manyati, 2007).
The link between HIV/AIDS and gardening and food growing is therefore indirect, via the
provision of healthy, fresh and vitamin rich nutrition. Gardening has a mitigating and a
prevention effect on these two sexual transmitted diseases, and this is even more important as
a specific cure for the diseases is not widely available.
Currently the academic literature on sexual transmitted diseases and gardening is mainly
concerned with sub-Saharan Africa and HIV/AIDS. We did not find gardening discussed as a
prevention or mitigation strategy for any other sexual transmitted diseases like Herpes or
Syphilis. Gardening without washing hands or wearing gloves can, however, be an infection risk
for sexual transmitted diseases under certain conditions (Kaplan et al., 2010).
The Benefits of Gardening and Food Growing for Health and Wellbeing 20
References
Adhémar, A. J. (2008) Nature as clinical psychological intervention: Evidence, applications and
implications. Master Thesis, Institute of Psychology, University of Århus, Denmark
Alaimo, K., Packnett E., Miles R., Kruger D. (2008) Fruit and Vegetable Intake among Urban Community
Gardeners. Journal of Nutrition Education and Behavior, 40(2), 94- 101
Alzheimer’s Society (2012) Dementia 2012. A national challenge Devon House, London
www.alzheimers.org.uk
Alzheimer’s Society (2013) Dementia 2013. The hidden voice of loneliness. Devon House, London
www.alzheimers.org.uk
Anderson, B. J. (2011). An Exploration of the Potential Benefits of Healing Gardens on Veterans with
PTSD. All Graduate Reports and Creative Projects. Paper 50
Annerstedt, M. (2011) Nature and Public Health. Aspects of Promotion, Prevention and Intervention. PhD
Thesis, Swedish University of Agricultural Science, Alnarp, Sweden
Annerstedt, M. and P. Währborg (2011) Nature-assisted therapy: Systematic review of controlled and
observational studies. Scandinavian Journal of Public Health, 39, 371–388
Armstrong, D. (2000) A survey of community gardens in upstate New York: Implications for health
promotion and community development. Health & Place, 6, 319-327
Barnidge, E. K., P. R. Hipp, A. Estlund, K. Duggan, K. J. Barnhart and C. R. Brownson (2013) Association
between community garden participation and fruit and vegetable consumption in rural Missouri.
International Journal of Behavioral Nutrition and Physical Activity, 10, 128
Barton, J. and J. Pretty (2010) What is the Best Dose of Nature and Green Exercise for Improving Mental
Health? A Multi-Study Analysis. Environmental Science and Technology, 44, 3947-3955
Berget, B., Lidfors, L., Pálsdóttir, A.M, Soini, K., Thodberg, K. eds. (2012) Green Care in the Nordic
countries – a research field in progress. Report from the Nordic research workshop on Green Care in
Trondheim, June 2012 , Ås, Norwegian University of Life Sciences
Berman, M.G, Jonides J., Kaplan S. (2008) The Cognitive Benefits of Interacting With Nature.
Physiological Science, 19(12), 1207-1212
Berto, R. (2005) Exposure to restorative environments helps restore attentional capacity. Journal of
Environmental Psychology, 25(3), 249- 259
Blair, D., Giesecke, C. G. and Sherman, S. (1991) A Dietary, Social and Economic Evaluation of the
Philadelphia Urban Gardening Project. The Journal of Nutrition Education, 23, 161- 167
Blanchard, C. M., Cokkinides, V., Courneya, K. S., Nehl E. J., Stein K. and Baker F. (2003) A comparison
of physical activity of post treatment breast cancer survivors and non cancer controls. Behavioral
Medicine 28, 140–149
Boots Diet (2014) Calorie burn calculator. www.bootsdiets.com/calories_burned [accessed Dec 2013]
Bowler, D. E., L. M. Buyung-Ali, T. M. Knight and A. S. Pullin (2010) A systematic review of evidence for
the added benefits to health of exposure to natural environments. BMC Public Health, 10,456, 1-10
Bragg. R et al. (2013) Ecominds effects on mental wellbeing: An evaluation for Mind. Mind, London, UK
Brawley, E. C. (2001) Environmental design for Alzheimer's disease: a quality of life issue. Ageing and
Mental Health, 5 (1), 79-83
Bringslimark, T., T. Hartig and G. G. Patil (2009) The psychological benefits of indoor plants: A critical
review of the experimental literature. Journal of Environmental Psychology 29, 422–433
Brymer, E.G., T. Cuddihy, and V. Sharma-Brymer (2010) The role of nature-based experiences in the
development and maintenance of wellness. Asia-Pacific Journal of Health, Sport and Physical
Education, 1(2), 21-27
Calleau, J. (2005) The benefits of volunteers attending Cherry Tree Nursery. GrowthPoint - The Journal of
Social and Therapeutic Horticulture, 101, 20-22
Calories per hour.com (2013) Calories per hour online calculator. Demand Media, Inc. U.S.A.,
www.caloriesperhour.com/index_burn.php [accessed Dec 2013]
Catanzaro, C. and Ekanem, E. (2004). Home Gardeners Value Stress Reduction and Interaction with
Nature. Acta Hort. (ISHS) 639, 269-275
The Benefits of Gardening and Food Growing for Health and Wellbeing 21
Chen, Hui-Mei, Hung-Ming Tu, and Chaang-Iuan HoChen (2010) Exploring Dimensions of Attitudes
Toward Horticultural Activities. Hort Science 45(7), 1120-1125
Connell B. R., J. A. Sanford and D. Lewis (2007) Therapeutic Effects of an Outdoor Activity Program on
Nursing Home Residents with Dementia. Journal of Housing For the Elderly, Vol. 21, 3-4, 195-209
Coon, J. T., K. Boddy, K. Stein, R. Whear, J. Barton, and M. H. Depledge (2011) Does Participating in
Physical Activity in Outdoor Natural Environments Have a Greater Effect on Physical and Mental
Wellbeing than Physical Activity Indoors? A Systematic Review. Environmental Science and
Technology, 45, 1761-1773
Cooper, M. C. and Barnes M. (1999) Healing Gardens: Therapeutic Benefits and Design. Wiley (Series in
Healthcare and Senior Living Design): New York. 624p
D’Andrea, S., M. Batavia and N. Sasson (2007) Effect of horticultural therapy on preventing the decline of
mental abilities of patients with Alzheimer’s type dementia. Journal of Therapeutic Horticulture 2007-
2008 XVIII
D'Abundo, M. L., and Carden, A. M. (2008) "Growing Wellness": The possibility of promoting collective
wellness through community garden education programs. Community Development, 39(4), 83-95
Day L. (2007) Healing Environments and the Limits of Empirical Evidence. American Journal of Critical
Care, 16, 86- 89
Dean, J., K. van Dooren and P. Weinstein (2011) Does biodiversity improve mental health in urban
settings? Medical Hypothesis 76, 877-880
Department of Health (2009) Living well with dementia: A National Dementia Strategy. Department of
Health, London and Leeds, UK
Department of Health (2010) Confident communities, brighter futures. A framework for developing
wellbeing. Department of Health: Mental Health Division HM Government, London, UK
Department of Health (2011) Healthy Lives, Healthy People. A call to action on obesity in England.
London, UK
Detweiler, M. B., Sharma T., Detweiler J., Murphy P., Lane S., Carman J., Chudhary S., Halling M. and K.
Kim (2012) What is the evidence to support the use of therapeutic gardens for elderly? Psychiatry
Investigation. 9.2, 100-110
Douglas, I. (2012) Urban ecology and urban ecosystems: understanding the links to human health and
wellbeing. Current Opinion in Environmental Sustainability, 4, 385-392
Draper, C. and D. Freedman (2010) Review and analysis of the benefits, purposes, and motivations
associated with community gardening in the United States. J Community Pract.,18(4), 458-492
Draper, C. and D. Freedman (2010) Review and Analysis of the Benefits, Purposes, and Motivations
Associated with Community Gardening in the United States, Journal of Community Practice, 18:4, 458-
492
Dyment, J. E. and A. C. Bell (2008) Grounds for movement: green school grounds as sites for promoting
physical activity. Health Education Research, 23(6), 952- 962
Eunhee, K. (2003). Horticultural therapy. Journal of consumer health On the Internet 7 (3), 71-76
Fitch, M. I., Gray, R. E., McGowan, T., Brunskill, I., Steggles, S., Sellick, S., Bezjak, A. and McLeese, D.
(2003). Travelling for radiation cancer treatment: Patient perspectives. Psycho-Oncology, 12, 664-674
Flournoy R. L., (1975) Gardening as therapy: Treatment activities for psychiatric patients. Hospital and
Community Psychiatry, 26(2), 75–76
Folstein MF, Folstein SE, McHugh PR. (1975) Mini-mental state: a practical method of grading the
cognitive state of patients for the clinician. J Psychiatr Res., 12(3), 189-198
Friedli, L and M. Parsonage (2007) Mental health promotion: Building an economic case. Northern Ireland
Association for Mental Health.
www.chex.org.uk/uploads/mhpeconomiccase.pdf?sess_scdc=ee4428ebde41914abac0e0535f55861c
Fuller, R. A., Irvine, K. N., Devine-Wright, P., Warren, P. H. and Gaston, K. J. (2007) Psychological
benefits of green space increase with biodiversity. Biological Letters, 3: 390-394
Gaby A. R. (1998) The role of hidden food allergy/intolerance in chronic disease. Altern Med Rev. 3 (2) 90-
100
Galea, S., M. Uddin and K. Koenen (2011) The urban environment and mental disorders – Epigenetic
links. Epigenetics 6(4), 400-404
The Benefits of Gardening and Food Growing for Health and Wellbeing 22
Gitlin L. N., H. C. Kales and C. G. Lyketsos (2012) Nonpharmacological management of behavioural
symptoms in dementia. JAMA 308 (19), 2020-2029
Gonzalez M.T., Hartig T., Patil G.G., Martinsen E.W. and M. Kirkevold (2010) Therapeutic horticulture in
clinical depression: a prospective study of active components. Journal of Advanced Nursing, 66, (9),
2002–2013. doi: 10.1111/j.1365-2648.2010.05383.x
Gorgie City Farm (2011) Gorgie city farm community gardening project. Social return on investment
(SROI) report. Federation of City Farms and Community Gardens. Bristol, UK, www.farmgarden.org.uk
Grinde, B. 1. and G. G. Patil (2009) Biophilia: Does Visual Contact with Nature Impact on Health and
Wellbeing? International Journal of Environmental Research and Public, 6, 2332-2343
Gullone, E. (2000) The Biophilia Hypothesis and Life in the 21st Century: Increasing Mental Health or
Increasing Pathology? Journal of Hapiness Studies, 1(3), 293-322
Hale, J, C. Knapp, L. Bardwell, M. Buchenau, J. Marshall, F. Sancar and J. S. Litt (2011) Connecting food
environments and health through the relational nature of aesthetics: Gaining insight through the
community gardening experience. Social Science & Medicine, 72, 11, 1853-1863
Harris, K. C., L. K. Kuramoto, M. Schulzer, and J. E. Retallack (2009) Effect of school-based physical
activity interventions on body mass index in children: a meta-analysis. Canadian Medical Association
Journal, 180, 7, 719-726
Haviland-Jones, J., Rosario, H. H., Wilson, P. and McGuire, T. R. (2005) An Environmental Approach to
Positive Emotion: Flowers. Evolutionary Psychology, 3, 104-132
Hawkins, J. L., J. Mercer, K. J. Thirlaway and D. A. Clayton (2013) ‘‘Doing’’ Gardening and ‘‘Being’’ at the
Allotment Site: Exploring the Benefits of Allotment Gardening for Stress Reduction and Healthy Aging.
Ecopsychology 5, 2, 110-125
Hawkins, J., J. Mercer, D. Clayton (2013) Growing a Healthy Older Population in Wales (GHOP). Project
summary & key findings. www.uwic.ac.uk/ghop [accessed April 2014]
Hawkins, J., K. Thirlaway, K. Backx and D. Clayton (2011) Allotment gardening and other leisure activities
for stress reduction and healthy aging. HortTechnology, 21(5) 557-585
Hewitt, P., C. Watts, J. Hussey, K. Power and T Williams (2013). Does a structured gardening programme
improve wellbeing in young-onset dementia? A preliminary study. British Journal of Occupational
Therapy 76(8), 355-361
Hine, R., C. Wood, J, Barton and J. Pretty (2011) The mental health and wellbeing effects of a walking and
outdoor activity based therapy project. A Report for Discovery Quest and Julian Housing. University of
Essex, UK
Hine, R., J. Peacock and J. Pretty (2008) Care farming in the UK: Evidence and Opportunities. Report for
the National Care Farming Initiative (UK) University of Essex, Colchester, UK
Holbrook, A. (2009). The Green We Need: An investigation of the benefits of green life and green spaces
for urban dwellers' physical, mental and social health. . Newcastle: Nursery and Garden Industry
Australia, Nursery and Garden Industry Australia and SORTI, The University of Newcastle.
Jarrot, S. and C. Gigliotti (2004) From the garden to the table: Evaluation of a dementia-specific
horticultural therapy program. Acta Horticulturae, 639, 139–144
Jarrot, S. and C. Gigliotti (2010) Comparing responses to horticultural-based and traditional activities in
dementia care programmes. American Journal of Alzheimer’s disease and other dementias. 25 (8),
657-665
Jonasson, I., Marklund, B., and C. Hildingh (2007) Working in a training garden: Experiences of patients
with neurological damage. Aust Occupat Ther J 54(4), 266–272
Kamata, Y (2008) The practicability of horticultural therapy for asthmatic children: Program description.
Acta Hort. (ISHS) 790, 75-82
Kane, M. and L. Cook (2013) Dementia 2013: The hidden voice of loneliness.
www.alzheimers.org.uk/dementia2013 [accessed April 2014]
Kaplan, J., C. Benson, K. K. Holmes, J. T. Brooks, A. Pau and H. Masur (2010) Guidelines for Prevention
and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents. Division of
HIV/AIDS Prevention, Atlanta, USA www.cdc.gov/mmwr/preview/mmwrhtml/rr5804a1.htm [accessed
April 2014]
Kaplan, R. (2001) The Nature of the View from Home Psychological Benefits. Environment and Behaviour,
33(4), 507-542
The Benefits of Gardening and Food Growing for Health and Wellbeing 23
Kingsley, J.Y., Townsend M. and C. Henderson-Wilson (2009) Cultivating health and wellbeing: members’
perceptions of the health benefits of a Port Melbourne community garden. Leisure Stud., 28 (2), 207-
219
Kirshbaum, M. (2007). A review of the benefits of whole body exercise during and after treatment for
breast cancer. Journal of clinical nursing. 16 (1), 104-121
Kneafsey M., L. Bos and P. Turvil (in preparation) Master Gardener Programme Evaluation. Coventry
University and Garden Organic, Coventry, UK
KSU (2010). Horticultural Therapy Research. www.hfrr.ksu.edu/DesktopDefault.aspx?tabid=990 [accessed
April 2014]
Kuo, F. E., Taylor A. F. (2004) A Potential Natural Treatment for Attention-Deficit/Hyperactivity Disorder:
Evidence From a National Study. American Journal of Public Health, 94(9), 1580-1586
Lachowycz, K. and A. P. Jones (2011) Greenspace and obesity: a systematic review of the evidence.
Obesity reviews. International Association for the Study of Obesity 12, e183–e189
Leake, J. R., Adam-Bradford, A., Rigby, J. E. (2009) Health benefits of 'grow your own' food in urban
areas: implications for contaminated land risk assessment and risk management? Environmental
Health, 8 (Suppl 1): S6
Lebel L., Krittasudthacheewa C., Salamanca A. and P. Sriyasak (2012) Lifestyles and consumption in
cities and the links with health and wellbeing: the case of obesity. Curr Opin Environ Sustain, 4
http://dx.doi.org/10.1016/j.cosust.2012.09.005
Lee, A. C. K., R. Maheswaran (2010) The health benefits of urban green spaces: a review of the evidence.
Journal of Public Health, 33(2) 212-222
Libman, K. (2007) Growing Youth Growing Food: How Vegetable Gardening Influences Young People’s
Food Consciousness and Eating /habits. Environmental Education and Communication, 6: 87-95
Lineberger, S. E. and J. M. Zajicek (2000) School gardens: Can a hands-on teaching tool affect students'
attitudes and behaviors regarding fruit and vegetables? HortTechnology 10,3 593-597
Luk, K (2011) The effect of horticultural activities on agitation in nursing home residents with dementia.
International Journal of Geriatric Psychiatry 26, 435-440
MacKerron, G. and S. Mourato (2011) Mappiness: Quantifying wellbeing in relation to environment across
space and time. European Association of Environmental and Resource Economists 18th Annual
Conference, 29 June - 2 July, Rome
Maller, C., M. Townsend, A. Pryor, P. Brown, and L. St. Leger (2005) Healthy nature healthy people:
‘contact with nature’ as an upstream health promotion invention for populations. Health Promotion
International, 21: 45-54
Maller, C., M. Townsend, L. St. Leger, C. Henderson-Wilson, A. Pryor, L. Prosser and M. Moore (2008).
Healthy parks, healthy people. The health benefits of contact with nature in a park context. A review of
relevant literature. School of Health and Social Development. Faculty of Health, Medicine, Nursing and
Behavioural Sciences. Deakin University, Melbourne. 96pp.
Mayer, S. F., F. C. McPherson, E. Bruehlman-Senecal and K. Dolliver (2008) Why Is Nature Beneficial?
The Role of Connectedness to Nature. Environment and Behavior, 41, 607- 643
McCaffrey, R. (2007) The effect of healing gardens and art therapy on older adults with mild to moderate
depression. Holist Nurs Pract 21(2), 79–84
McCormack, L. A, Laska, M. N., Larson, N. I. and M. Story (2010) Review of the nutritional implications of
farmers’ markets and community gardens: a call for evaluation and research efforts. J Am Diet Assoc.,
110 (3), 399-408
Mind (2013) Feel better outside, feel better inside. Ecotherapy for mental wellbeing resilience and
recovery. Mind, London, UK www.mind.org.uk
Morris, N. (2003) Health, Wellbeing and Open Space - Literature Review. OPENspace: the research
centre for inclusive access to outdoor environments, Edinburgh College of Art and Heriot-Watt
University, UK
Mubvami, T. and M. Manyati (2007) HIV/AIDS, urban agriculture and community mobilisation: cases from
Zimbabwe. UA magazine 18
Nelson, J., M, B. Erens, B. Bates, S. Church and T. Bosher (2007). Low income diet and nutrition survey.
Volume 3 Nutritional status, physical activity, economic, social and other factors. London: Food
Standards Agency The Stationary Office, UK.
The Benefits of Gardening and Food Growing for Health and Wellbeing 24
Nelson, J., M, B. Erens, B. Bates, S. Church and T. Bosher (2007). Low income diet and nutrition survey.
Volume 3 Nutritional status, physical activity, economic, social and other factors. London: Food
Standards Agency The Stationary Office, UK.
New economics foundation (2011) Five ways to wellbeing. New applications, new ways of thinking. Written
by Sam Thompson and Jody Aked. Commissioned jointly by the National Mental Health Development
Unit (NMHDU) and the NHS Confederation, nef, London, UK,
www.neweconomics.org/publications/entry/five-ways-to-wellbeing
New economics foundation (2013) The Economic Benefits of Ecominds: A case study approach. New
economics foundation, London, UK
Newton, J. (2007) Wellbeing and the Natural Environment: A brief overview of the evidence. University of
Bath, UK
NHS (2014). Stress. The National Health Service, UK
www.nhs.uk/Conditions/Stress/Pages/Introduction.aspx [Accessed April 2014]
NICE (2006) NICE clinical guideline 43. Obesity: Guidance on the prevention, identification, assessment
and management of overweight and obesity in adults and children. National Institute for Health and
Clinical Excellence (NICE) London, www.nice.org.uk
NICE (2011). NICE clinical guideline 42. Dementia: Supporting people with dementia and their carers in
health and social care. National Institute for Health and Clinical Excellence (NICE). London
www.nice.org.uk
O’Hara Murdock, P. J. Lutchmiah and M. Mkhize (2003) Peer led HIV/AIDS prevention for women in South
African informal settlements. Health Care for Women International. 24, 6, 502-512
Orme, J., M Jones, R Kimberlee, D. Salmon, E. Weitkamp, N. Dailami, K. Morgan and A. Morley (2011).
Food for life partnership evaluation: full report. Project Report. University of the West of England,
Bristol. http://eprints.uwe.ac.uk/14456 [accessed April 2014]
Park, S.-A., C. Shoemaker and M. Haub (2008) Can older gardeners meet the physical activity
recommendation through gardening? HortTechnology 18, 4, 639-643
Parkinson, S., C. Lowe and T. Vecsey (2011) The therapeutic benefits of horticulture in a mental health
service. British Journal of Occupational Therapy, 74(11), 525-534
Pretty, J., J. Barton, I. Colbeck, R. Hine, S. Mourato, G. MacKerron and C. Wood (2011) The UK National
Ecosystem Assessment Technical Report Chapter 23: Health Values from Ecosystems. In: The UK
National Ecosystem Assessment Technical Report. UK National Ecosystem Assessment, UNEP-
WCMC, Cambridge
Pretty, J., J. Peacock, R. Hine, M. Sellens, N. South and M. Griffin (2007) Green Exercise in the UK
Countryside: Effects on Health and Psychological Wellbeing, and Implications for Policy and Planning.
Journal of Environmental Planning and Management, Vol. 50, No. 2, 211-231
Quayle H. (2007) The True Value of community farms and gardens: social, environmental, health and
economic. Federation of City Farms and Community Gardens. Bristol, UK, www.farmgarden.org.uk
Ratcliffe, M. M., K. A. Merrigan, B. L. Rogers and J. P. Goldberg (2011) Behaviors Associated With
Vegetable Consumption. The Effects of School Garden Experiences on Middle School-Aged Students'
Knowledge, Attitudes, and Behaviors Associated With Vegetable Consumption. Health Promotion
Practice, 12,1, 36-43
RHS (2010) Gardening in Schools: a vital tool for children’s learning. Royal Horticultural Society, London,
UK www.rhs.org.uk/schoolgardening
RHS (2011) Gardening matters: Urban Gardens. Royal Horticultural Society, London, UK.
Rice, J. S. and L. Lremy (1998). Impact of horticultural therapy on psychosocial functioning among urban
jail inmates. Journal of Offender Rehabilitation 26 (3-4), 169-191
Richardson, D. and M. Parker (2011) A rapid review of the evidence base in relation to physical activity
and green space and health. HM Partnerships for NHS Aston Leigh and Wigan, Liverpool, UK
Roberts, S. and Bradley A. J. (2011) Horticultural therapy for schizophrenia. Cochrane Database of
Systematic Reviews, Issue 11. Art. No.: CD00941311
Sadako, N. (2002) The Effects of Gardening Therapy for Asthmatic Children. Allergy in Practice, 286, 150-
153
Sadler, C. K. (2007) Design Guidelines for Effective Hospice Gardens Using Japanese Garden Principles.
MLa Thesis. Faculty of Landscape Architecture, SUNY College of Environmental Sciences and
Forestry Syracuse, N.Y. 32p
The Benefits of Gardening and Food Growing for Health and Wellbeing 25
Schandl, H. and A. Capon (2012) Cities as social-ecological systems: linking metabolism, wellbeing and
human health. Editorial overview. Current Opinion in Environmental Sustainability, 4, 375-377
Schandl, H., S. Boyden, A. Capon and K. Hosking (2012) Biosensitive’ cities - a conceptual framework for
integrative understanding of the health of people and planetary ecosystems. Current Opinion in
Environmental Sustainability, 4, 378-384
Schultz, N. (2010) Nurture nature. New Scientist, 208 (2785), 35-37
Sempik, J. (2007) Researching social and therapeutic horticulture for people with mental ill health. A study
of methodology: www.Thrive.org.uk, Reading and Centre for Child and Family Research Loughborough
University
Sempik, J. (2010) Green care and mental health: gardening and farming as health and social care: Mental
Health and Social Inclusion, 14(3),15-22
Sempik, J., Aldridge J. and Becker S. (2003) Social and Therapeutic Horticulture: evidence and messages
from research. Thrive, in association with the Centre for Child and Family Research, Loughborough
University
Sempik, J., Hine, R. and Wilcox, D. eds. (2010) Green Care: A Conceptual Framework. A Report of the
Working Group on the Health Benefits of Green Care, COST Action 866, Green Care in Agriculture,
Loughborough: Centre for Child and Family Research.
Sempik, J., Beeston, A. and C. Rickhuss (in preparation) The effects of social and therapeutic horticulture
on aspects of social behaviour. British Journal of Occupational Therapy.
Sommerfeld, A. J., T. M. Waliczek and J. M. Zajicek (2010) Growing Minds: Evaluating the Effect of
Gardening on Quality of Life and Physical Activity Level of Older Adults. HortTechnology August 2010
vol. 20 no. 4 705-710
Spurgeon, T. and C. Underhill (1979) Horticultural therapy--aspects of land use for the mentally
handicapped. A system of planning for the requirements of the mentally handicapped gardener.
International Journal of Rehabilitation Research, 2(3), 343-352
SROI Network (2012) A guide to Social Return on Investment. Written by Jeremy Nicholls, Eilis Lawlor,
Eva Neitzert and Tim Goodspeed, and edited by Sally Cupitt, SROI Network, Liverpool, UK, www.sroi-
uk.org
Stein, M. J. (2008) Community Gardens for Health Promotion and Disease Prevention. International
Journal for Human Caring, 12, 3, 47-52
Stigsdotter, U. A. (2005) Urban green spaces: Promoting health through city planning. In: Inspiring Global
Environmental Standards and Ethical Practices, The National Association of Environmental
Professionals’, NAEP, 30th Annual Conference, Alexandria, Virginia, USA
Stigsdotter, U. A. and Grahn, P. (2004) A garden at your workplace may reduce stress. In: Dilani, A (ed.),
Design and Health III – Health Promotion through Environmental Design, Research Centre for Design
and health, Stockholm, Sweden, 147-157
Sugiyama, T., E. Leslie, B. Giles-Corti, and N. Owen (2008) Associations of neighbourhood greenness
with physical and mental health: do walking, social coherence and local social interaction explain the
relationships? Journal of Epidemiology and Community Health, 62(5), e9
Teig, E., J. Amulya, L. Bardwell, M. Buchenau, J. Marshall and J. S. Litt (2009) Collective efficacy in
Denver, Colorado: Strengthening neighborhoods and health through community gardens. Health &
Place, 15(4), 1115-1122
Telles S., and R.B. Srinivas (1998) Autonomic and respiratory measures in children with impaired vision
following yoga and physical activity programs. International Journal of Rehabilitation and Health, 4,
117-122
Thompson, S., Corkery, L., and Judd, B. (2007). The role of community gardens in sustaining healthy
Twiss, J., J. Dickinson, S. Duma, T. Kleinman, H. Paulsen and L. Rilveria (2003). Community Gardens:
Lessons Learned From California Healthy Cities and Communities. American Journal of Public Health
93.9: 1435-1438.
Tzoulas, K., K. Korpela, S. Venn, V. Yli-Pelkonen, A. Kazmierczak, J. Niemela and P. James (2007)
Promoting ecosystem and human health in urban areas using Green Infrastructure: A literature review.
Landscape and Urban Planning 81, 167-178
UK National Ecosystem Assessment (2011) The UK National Ecosystem Assessment Technical Report.
UNEP-WCMC, Cambridge.
The Benefits of Gardening and Food Growing for Health and Wellbeing 26
Ulrich, R. S. (1999) Effects of gardens on health outcomes: theory and research. In: Cooper Marcus C.
and Barnes M. (1999). Healing Gardens: Therapeutic Benefits and Design. Wiley (Series in Healthcare
and Senior Living Design): New York, USA. 624pp.
Unruh, A. M. (2004). The meaning of gardens and gardening in daily life: a comparison between gardeners
with serious health problems and healthy participants. Acta Hort., 639, 67-73
van den Berg A.E. and M. H. G. Clusters (2011) Gardening promotes neuroendocrine and affective
restoration from stress. J Health Psychol., 16, 3-11
van den Berg, A. E., M. van Winsum-Westra, S. de Vries and Sonja M.E. van Dillen (2010) Allotment
gardening and health: a comparative survey among allotment gardeners and their neighbors without an
allotment. Environmental Health, 9, 74
Velde, B. P., Cipriani, J. and Fisher, G. (2005) ‘Resident and therapist views of animal assisted therapy:
implications for occupational therapy practice’ Australian Occupational Therapy Journal, 52, 43–50
Wakefield, S., Yeudall F., Taron C., Reynolds J., and A. Skinner (2007) Growing urban health: community
gardening in South-East Toronto. Health Promotion International, 22(2), 92-101
Waliczek, T. M., J. M. Zajicek, and R. D. Lineberger (2005) The Influence of Gardening Activities on
Consumer Perceptions of Life Satisfaction, HortScience August 2005 40:1360-1365
Weiser S. D., D. M. Tuller, E. A. Frongillo, J. Senkungu, N. Mukiibi. (2010) Food Insecurity as a Barrier to
Sustained Antiretroviral Therapy Adherence in Uganda. PLoS ONE 5(4) open access,
doi:10.1371/journal.pone.0010340
Wells, N. M. (2000) At Home with Nature Effects of “Greenness” on Children’s Cognitive Functioning.
Environment and Behavior November, 32 (6), 775-795
Welsh Assembly Government (2011). Sustainable Social Services for Wales: A framework for action.
Cardiff: Welsh Government
White, M.P. I. Alcock, B. W. Wheeler and M. H. Depledge (2013) Would You Be Happier Living in a
Greener Urban Area? A Fixed-Effects Analysis of Panel Data. Psychological Science April 23, 2013
0956797612464659
Wilson, E. O. (1984). Biophilia. Harvard University Press, Cambridge, Massachusetts, USA
Yasukawa, M. (2009) Horticultural therapy for cognitive functioning of elderly people with dementia. In:
International Handbook of occupational therapy interventions. Ed. by I. Soderback. Springer Dordrecht,
Heidelberg Part 4, 431-444
York, M. and T. Wiseman (2012) Gardening as an occupation: a critical review. British Journal of
Occupational Therapy, 75(2), 76-84
Zick, C. D., K. R. Smith, L. Kowaleski-Jones, C. Uno, and B. Merrill (2013) Harvesting more than
vegetables: The potential weight control benefits of community gardening. American Journal of Public
Health, 103(6), 1110-1115
The Benefits of Gardening and Food Growing for Health and Wellbeing 27
Appendix: Benefit matrix of gardening and food growing for health and wellbeing
The aim of the Benefit Matrix table in this appendix is to summarise published evidence on the benefits of gardening and food growing in relation to specific
health and wellbeing issues. We use a simple structure to make the evidence available to a wide audience beyond academia. The published evidence
considered consists of documents in the English language across the world, which are either peer-reviewed (but often not-open access), or other published
evidence which is open access (project reports, government documents).
To structure the benefit matrix table we use the following five headings:
Short
scientific
reference
Full title of the paper
or report
Location
(country,
region)
Type of documented benefits of gardening and
food growing (key results of the publication)
Main research and evaluation
methods used
The Benefits of Gardening and Food Growing for Health and Wellbeing 28
Allergies, asthma and intolerances
Reference Title of paper Location Documented benefits of gardening and food growing Research and evaluation methods
Sadako, 2002 The effects of gardening
therapy for asthmatic children
Japan Horticultural therapy was carried 3 times a week for children with
intractable bronchial asthma who were hospitalised, and they were
asked questions. The therapy seems to be useful for them to recover
their confidence through experience in growing plants from the
beginning while feeling a sense of the seasons, a feeling of freedom
from an ordered life in a ward and communicating among each other
Horticultural therapy and questioning
Kamata, 2008 The practicability of
horticultural therapy for
asthmatic children
Japan Horticultural therapy was provided for long-stay asthmatic children as
a supplemental holistic treatment to complement other treatments at
the Osaka Prefecture Medical Centre for Respiratory and Allergic
Disease. Children ages 4-14, from April 2003 to May 2004
Results showed that asthmatic children, who have not previously
experienced nature, relaxed and harmonised with others. They learned
teamwork skills and expressed their own feelings towards nature and
towards other people.
Horticultural therapy
The Benefits of Gardening and Food Growing for Health and Wellbeing 29
Cancers
Reference Title of paper Location Documented benefits of gardening and food growing Research and evaluation methods
Blanchard et al.,
2003
A comparison of physical
activity of post treatment
breast cancer survivors
and non-cancer controls
Canada The paper determines whether, after treatment, the survivors were
meeting the Centre for Disease Control and Prevention/American
College of Sports Medicine recommendations for physical activity and
were similar to the controls in physical activity. Secondly it compares
the modes of activity of the 2 groups in frequency, min/session, and
sessions/wk. Result showed that breast cancer survivors engaged in as
much moderate, vigorous, and combined physical activity as the
controls, however, chi-square analyses showed that survivors engaged
in more garden/yard work than the controls did. Independent-sample t
tests showed that the frequency and the total min/wk of stretching were
significantly higher in breast cancer survivors, suggesting that breast
cancer survivors engage in as much physical activity as controls do, but
that the groups differ in specific activities (e.g. more gardening).
Comparison of breast cancer survivors obtained
data from 335 breast cancer survivors and 6,880
non-cancer controls.
Adjusted logistic regression analyses
Unruh, 2004 The meaning of gardens
and gardening in daily
life: a comparison
between gardeners with
serious health problems
and healthy participants
Canada, Nova
Scotia
The study revealed important benefits of gardening on physical,
emotional, social, and spiritual wellbeing, and highlighted a key role of
gardening as a coping strategy for living with stressful life experiences.
The prospective nature of the study revealed the personal and
subjective ways in which interest in gardening might change in
response to the person's own situation and needs.
Phenomenological method. 27 women and 15
men were interviewed about the meaning of
gardens and gardening in their daily life.
Gardens are located in small towns or rural
areas of Nova Scotia. 18 participants were
diagnosed with cancer. The majority of the
participants were aged 45 - 65 years. Semi-
structured interviews (2 hours average) were
done 4 times per year in each season The data
analysis used a constant comparative approach
based on a construction of an emergent set of
themes and sub-themes from the interview
transcripts
Kirshbaum, 2007 A review of the benefits
of whole body exercise
during and after
treatment for breast
cancer
UK and global Many early studies had limited internal and external validity. Recent
studies were considerably more rigorous and robust. Consistent support
for all types of aerobic exercise was most evident in studies of patients
during adjuvant cancer treatments (chemotherapy and radiotherapy),
compared with post-treatment studies.
The evidence, which suggested that aerobic exercise limits, cancer-
related fatigue was particularly strong. Only one study (Blanchard et al.,
2003), as documented earlier, specifically included gardening exercise.
Additional studies with higher methodological quality are particularly for
patient subgroups (e.g. older people, those with advanced cancer and
the disadvantaged) are recommended.
Literature review with systematic search
strategy. 29 articles were retained for critical
review, appraised for quality and synthesised
The Benefits of Gardening and Food Growing for Health and Wellbeing 30
Dementia
Reference Title of paper Location Documented benefits of gardening and food growing Research and evaluation methods
Jarrot and
Gigliotti, 2004
From the garden to the
table: Evaluation of a
dementia-specific
horticultural therapy
program
USA The study considers whether planting, cooking, craft or horticultural
therapy activities engender differential responses from adult day service
participants with dementia. Two trained HT students led alternating
planting, cooking, and craft activities three times each week over a nine-
week period with 5-10 adult day service participants. Each participant
was assessed for ability to complete the activities and benefits
experienced. Most participants required some physical and/or verbal help
with each activity, regardless of the category, although variability existed
within each category.
The most common benefits were: interaction, initiation, concentration,
and activity completion. Special accommodations were rarely used, but
activities were composed of steps requiring different abilities. Thus,
individuals experienced success by performing at least one step in the
activity. Preliminary analysis indicates that the categories of horticultural
therapy activities promote cognitive, psychosocial, and physical benefits
equally.
Horticultural therapy and patient assessment
Connell et al.,
2007
Therapeutic effects of an
outdoor activity program
on nursing home residents
with dementia
USA 1-year pilot study to compare outdoor and indoor activity program on
sleep and behaviour in nursing home residents with dementia. Design: A
two-group (outdoor program, indoor program) two phase (baseline,
intervention), randomised subjects. Sleep and behaviour disturbance
were assessed over a 10-day period. Because this was a pilot study, the
significance level was set at p< 0.10.
Results showed that the outdoor activity group experienced significant
improvements in maximum sleep duration. Both groups showed
significant improvements in total sleep minutes. There also was a
significant improvement in verbal agitation in the outdoor activity group.
Sleep was assessed with wrist actigraphs with
photocells, which also allowed for monitoring of
light exposure. Behaviour disturbance was
assessed with the Cohen-Mansfield Agitation
Inventory.
D’Andrea et al.,
2007
Effect of horticultural
therapy on preventing the
decline of mental abilities
of patients with
Alzheimer’s type dementia
USA Horticultural activities (twice weekly for 12 weeks) resulted in
maintenance of memory and sense of wellbeing . The horticultural
therapy group had an overall higher functional level than the control
group (t (36)= 5.7, p < .0005). It is concluded that horticultural therapy
may be a useful alternative therapy for individuals with Alzheimer’s
disease.
HT Group of randomly selected individuals, 20
and 20 control, urban nursing home with
Alzheimer’s patients
Mini mental state examination
Yasukawa, 2009 Horticultural therapy for
the cognitive functioning of
elderly people with
dementia
Japan Horticultural activities over 3 months resulted in improvements in
communication, engagement, behaviour and cognitive abilities
Interview and Mini mental state examination
(MMSE)
The Benefits of Gardening and Food Growing for Health and Wellbeing 31
Reference Title of paper Location Documented benefits of gardening and food growing Research and evaluation methods
Jarrot and
Gigliotti, 2010
Comparing responses to
horticultural-based and
traditional activities in
dementia care
programmes
USA Compared a randomly assigned horticultural therapy treatment group with
traditional activities (TA). Horticultural therapy twice weekly at 4 treatment
sites for 6 weeks.
Results demonstrated horticultural therapy based activities are a viable
and desirable choice for dementia-care programs. They reached groups
of participants who are often difficult to engage in activities. There was no
difference on affective domains, however horticultural therapy resulted in
higher levels of active and passive engagement.
Mini mental state examination (MMSE)
Luk, 2011 The effect of horticultural
activities on agitation in
nursing home residents
with dementia
Hong Kong Horticultural activities for nursing home residents (30 min, twice weekly,
for 6 weeks) resulted in no significant reduction of agitation but a
decrease in aggressive behaviour
Chinese equivalent of Cohen Mansfield Agitation
Inventory
School of Nursing, The Hong Kong Polytechnic
University
Detweiler et al.,
2012
What Is the evidence to
support the use of
therapeutic gardens for
the elderly
USA,
Korea
Despite the history of horticultural therapy in various clinical settings, to
the best of our knowledge there are no controlled clinical trials
demonstrating the positive or negative effects of the passive or active
rehabilitation of the elderly in garden settings. Experience is suggesting
that regular time spent in a garden, results in less agitated behaviour,
improved mood and less pro re nata (PRN) medications. The quantitative
analysis of the benefits of garden settings for older individuals is overdue
and there is need for scholarly innovative studies investigating this
treatment modality.
Literature review
The Benefits of Gardening and Food Growing for Health and Wellbeing 32
Mental health and wellbeing
Reference Title of paper Location Documented benefits of gardening and food growing Research and evaluation methods
Catanzaro and
Ekanem, 2004
Home gardeners value
stress reduction and
interaction with nature
USA,
Tennessee
Respondents rated the statements “Home gardens provide a
reduction in feelings of stress” and “Home gardens provide
interaction with nature” as very important. Results suggest that
although gardeners select from a wide range of plant materials
and activities in an individualistic manner, the interaction with
nature in a nurturing environment provides a number of benefits
important to them, including mental wellbeing.
A written survey instrument was developed in 2001 and
conducted at two events: the Tennessee Green
Industries Field Day (McMinnville), and the Tennessee
State Fair (Nashville)
Stigsdotter and
Grahn, 2004
A garden at your
workplace may reduce
stress
Sweden Results show that having access to a garden has a significant
positive impact on stress. There is also a significant positive
relationship between frequency of garden visits and stress
prevention. The study also showed that the amount of verdure in
the garden is crucial to its restorative quality.
953 randomly selected persons in 9 Swedish cities
answered a mail questionnaire concerning their
experiences of their own health status and access to
and use of gardens at home. Statistical analysis with
SAS software the distribution of socio-demographic data
is representative for Sweden, meaning no statistically
significant deviation regarding socio-economic grouping,
sex or age
Stigsdotter, 2005 Urban green spaces:
Promoting health
through city planning
Sweden and
global
On the basis of the research results, urban green spaces are
viewed as a health-promoting element of city planning. The
purpose of health-promoting environments is to offer visitors rest
or activities that help to promote their health over time.
Review of literature and design theories based on the
research results
Calleau, 2005 The benefits of
volunteers attending
Cherry Tree Nursery
UK After attending the nursery, volunteers’ visits to psychiatric
hospitals reduced dramatically with some were not returning. In
addition, self-harming behaviour stopped or reduced and half of
the volunteers had their medication reduced or removed
completely.
Gonzalez et al.,
2010
Therapeutic
horticulture in clinical
depression: a
prospective study of
active components
Norway Mean Beck Depression Inventory scores declined by 4.5 points
during the intervention (F = 5.5, p = 0.002, F-test Fisher-Snedecor
distribution, p = probability value.). The decline was clinically
relevant for 50% of participants. Attentional Function Index scores
increased (F = 4.1, p = 0.009), while Brooding scores decreased.
The changes in Beck Depression Inventory and Attentional
Function Index scores were mediated by increases in Being Away
and Fascination, and decline in Beck Depression Inventory
scores was also mediated by decline in Brooding. Participants
maintained their improvements in Beck Depression Inventory
scores at 3-month follow-up.
A single-group study with a convenience sample of 28
people with clinical depression in 2009. Data were
collected before, twice during, and immediately after a
12-week therapeutic horticulture programme on 4 farms
near Oslo, Norway and at 3-month follow-up.
Assessment instruments were the Beck Depression
Inventory, Attentional Function Index, Brooding Scale,
and Being Away and Fascination subscales from the
Perceived Restorativeness Scale
The Benefits of Gardening and Food Growing for Health and Wellbeing 33
Reference Paper name Country Documented benefits of gardening and food growing Research methods
van den Berg et
al., 2010
Allotment gardening
and health: a
comparative survey
among allotment
gardeners and their
neighbors without an
allotment
Netherlands After adjusting for income, education level, gender, stressful life
events, physical activity in winter, and access to a garden at
home as covariates, both younger and older allotment gardeners
reported higher levels of physical activity during the summer than
neighbours in corresponding age categories. Allotment gardeners
of >62 years scored significantly or marginally better on all
measures of health and wellbeing than neighbours. Health and
wellbeing of younger allotment gardeners did not differ from
younger neighbours. The greater health and wellbeing benefits of
allotment gardening for older gardeners may be related to the
finding that older allotment gardeners were more oriented towards
gardening and being active, and less towards passive relaxation
Survey among 121 members of 12 allotment sites in the
Netherlands and a control group of 63 respondents
without an allotment garden living next to the home
addresses of allotment gardeners. 5 self-reported health
measures (perceived general health, acute health
complaints, physical constraints, chronic illnesses, and
consultations with GP), 4 self-reported wellbeing
measures (stress, life satisfaction, loneliness, and social
contacts with friends) and one measure assessing self-
reported levels of physical activity in summer.
Hine et al., 2011 The mental health and
wellbeing effects of a
walking and outdoor
activity based therapy
project
UK In this study, mental wellbeing was assessed using 3 outcome
measures chosen for the measurement of wellbeing , self esteem
and mood (Warwick Edinburgh Mental Well Being Scale
(WEMWBS), Rosenberg Self Esteem scale (RSE) and the Profile
of Mood States (POMS) to act as a proxy for mental wellbeing
parameters. Positive changes in all 3 wellbeing measures were
observed, with a statistically significant improvement in participant
wellbeing, self esteem and total mood disturbance for the majority
of participant.
Monitoring and evaluation programme to assess key
outcomes of the Discovery Quest project. 2 phases: first
a 6-month longitudinal study during the programme;
secondly a series of before and after activity evaluations
at regular intervals with quantitative and qualitative
analysis using, questionnaires, on-site observation and
informal interviews, and participatory appraisal
techniques
van den Berg
and Clusters,
2011
Gardening promotes
neuroendocrine and
affective restoration
from stress
Netherlands Results showed that both, gardening and reading had cortisol
decreases during the recovery period, however decreases were
significantly stronger following gardening. Positive mood was fully
restored after gardening, but further deteriorated during reading.
The authors highlight that these findings provide the first
experimental evidence that gardening can promote relief from
acute stress
Stress-relieving effects of gardening in a field
experiment with 30 allotment gardeners (allotment
complex ‘Amstelglorie’ in Amsterdam, the Netherlands)
either gardening or reading on their allotment for 0.5
hour
Hawkins et al.,
2011
Allotment gardening
and other leisure
activities for stress
reduction and healthy
aging
Wales, UK,
indoor
exercise,
walkers,
allotment
gardeners,
home
gardeners
Results show a significant difference in perceived stress levels
between the activity groups: indoor exercise, walkers, allotment
gardeners, home gardeners. Allotment gardeners reported
significantly less perceived stress than participants of indoor
exercise classes. As there were no significant differences in
reported levels of social support and physical activity. The
explanation for the allotment gardeners’ lower stress levels could
be the potential contribution of engagement with nature and
psychological restoration. The results contribute to the
understanding of the benefits of allotment gardening a health-
promoting behaviour in later life.
94 individuals aged 50 - 88 who were members of
indoor and outdoor activity groups. Participants
completed five physiological measures (height and
weight to calculate BMI, systolic and diastolic blood
pressure, lung function) and a questionnaire containing
psychometric scales of self-rated health, perceived
stress, physical activity level, and perceived social
support.
The Benefits of Gardening and Food Growing for Health and Wellbeing 34
Reference Paper name Country Documented benefits of gardening and food growing Research methods
Hawkins et al.,
2013
‘‘Doing’’ gardening and
‘‘being’’ at the
allotment site:
exploring the benefits
of allotment gardening
for stress reduction
and healthy aging
Wales, UK The study investigates the benefits to health and wellbeing of
allotment gardening in community-dwelling older adult sample
with a particular emphasis on stress recovery. Results indicate
that allotment gardeners appreciate both ‘‘doing’’ gardening
activity as well as ‘‘being’’ at the allotment landscape for affording
a wide range of benefits to their health and wellbeing .
Semi-structured interviews were used to explore
allotment gardener participants’ personal beliefs and
ideas of the benefits of their allotment gardening activity.
The sample consisted of 14 older adults with an age
range from 53-82. The transcribed interviews were
examined using thematic analysis.
The Benefits of Gardening and Food Growing for Health and Wellbeing 35
Obesity – Adult and Childhood
Adult Obesity
Reference
Title of paper Location Documented benefits of gardening and food growing Research and evaluation methods
Nelson et al.,
2007
Low-income diet and
nutrition survey
UK Men and women living in households that grew food
consumed more fruit and vegetables than other men and
women (fruit: men 95g vs.56g, women 86g vs.67g,
vegetables: men124g vs.100g, women123g vs.99g).
3,728 people from 2,477 households were included in the
survey (15% of the population in terms of most material
deprivation). Used a doorstep survey and four 24-hour
recalls of diet on random days
Alaimo et al.,
2008
Fruit and vegetable
intake among urban
community gardeners
USA, Michigan Adults with a household member who participated in a
community garden consumed fruits and vegetables 1.4 more
times per day than those who did not participate, and they
were 3.5 times more likely to consume fruits and vegetables
at least 5 times daily. Household participation in a community
garden may improve fruit and vegetable intake among urban
adults
766 adults in a cross-sectional random phone survey
conducted in 2003. A quota sampling strategy was used to
ensure that all census tracts within the city were
represented. Behavioural Risk Factor Surveillance System.
Generalised linear models and logistic regression models
assessed the association between household participation
in a community garden and fruit and vegetable intake,
controlling for demographic, neighbourhood participation,
and health variables
Park et al.
2008
Can older gardeners
meet the physical activity
recommendation through
gardening?
USA, Kansas The objective was to investigate if older gardeners meet the
Centers for Disease Control and Prevention and American
College of Sports Medicine physical activity (PA)
recommendation of at least 30 minutes of moderate intensity
PA on most days of the week through gardening. Results
showed that gardening was a moderate intensity PA (3.8 ±
1.4 metabolic equivalents). The average gardening time
during the observational study was 53 minutes. The subjects
reported gardening an average of 33 hours in May and 15
hours in a typical week in June and July.
Results from the SF-36 indicated that the subjects were
physically and mentally healthy and it is concluded that
healthy older gardeners can meet the PA recommendation
from their daily gardening and it may be a factor leading to
good physical and mental health.
The heart rate of 14 gardeners (5 women, 9 men) serving
the Kansas State University, and aged 63 to 86 years, was
continuously measured through radiotelemetry, during
gardening. Oxygen uptake and energy expenditure were
measured through indirect calorimetry using a sub maximal
graded exercise test in a laboratory. To determine how long
the subjects gardened and the kinds of gardening tasks
performed, an observational study was conducted by two
trained observers, and weekly logs were completed by the
subjects. To investigate the subjects physical and mental
health conditions, the Short-Form 36 Health Survey (SF-
36) was used.
Kingsley et al.,
2009
Cultivating health and
wellbeing: members’
perceptions of the health
benefits of a Port
Melbourne community
garden
Australia Results showed that the garden was felt by members to be a
sanctuary where people could come together and escape
daily pressures, a source of advice and social support, and a
place, which gave them a sense of worth and involvement.
Members also identified spiritual, fitness and nutritional
benefits arising from participation in the community garden.
Small qualitative study. Semi-structured questions with 10
members from an urban community garden in Port
Melbourne
The Benefits of Gardening and Food Growing for Health and Wellbeing 36
Reference Paper name Country Documented benefits of gardening and food growing Research methods
McCormack et
al., 2010
Review of the nutritional
implications of farmers’
markets and community
gardens: a call for
evaluation and research
efforts
USA In total, 16 studies were identified, 4 focused on community
gardens. It is concluded that only a few well-designed
research studies (e.g., those incorporating control groups)
utilizing valid and reliable dietary assessment methods on
nutrition-related outcomes have been completed.
Review paper of studies published between January 1980
and January 2009 were identified via PubMed and Agricola
database searches and by examining reference lists from
relevant studies. Studies included took place in the USA
and were qualitatively or quantitatively examined for
nutrition-related outcomes, including dietary intake
Draper and
Freedman, 2010
Review and analysis of
the benefits, purposes,
and motivations
associated with
community gardening in
the United States
Global Results showed sparse literature however, a large body of
qualitative data. Eleven themes related to the purposes,
benefits of, and motivations for participating in community
gardens are identified.
Review paper of the scholarly literature from 1999 to 2010
Zick et al., 2013 Harvesting more than
vegetables: the potential
weight control benefits of
community gardening
USA, Utah Results showed that both women and men community
gardeners had significantly lower BMIs (Body mass index)
than their neighbours. Similarly significantly lower BMIs were
found in the siblings comparison. The third comparison
spouses showed no statistically significant differences and
the authors hypothesise that spouses would likely enjoy the
dietary advantages of the community garden and might also
help with the physical demands of gardening.
The study used unique administrative data to examine, for
the first time, the relationship between community
gardening and a health outcome. Gardeners (423 in total)
were drawn from a pool of individuals active with a 20-year
old community garden. Data for neighbours, siblings and
spouses were drawn from administrative records, using the
Utah Population Database. A total of 375 gardeners were
linked to BMI information in the database and once linked,
driver's license records were used to build a sample of
neighbours: individuals matched for age, gender and
residential location, and Utah marriage, divorce and birth
records to identify siblings and spouses. In the final sample
data on 198 gardeners and 67 spouses were included in
the analyses, and height and weight information came from
driver's license records after they began community
gardening.
The Benefits of Gardening and Food Growing for Health and Wellbeing 37
Childhood obesity
Reference
Title of paper Location Documented benefits of gardening and food growing Research and evaluation methods
Lineberger and
Zajicek, 2000
School gardens: can a hands-
on teaching tool affect
students' attitudes and
behaviors regarding fruit and
vegetables
USA Third and fifth grade students involved in hands-on school
gardening programmes were reported to have more
positive attitudes towards vegetables and increased snack
preference for fruit and vegetables
Pupils (8-11 years old)
Hermann et al.,
2006
After-school gardening
improves children's reported
vegetable intake and physical
activity
USA Children involved in an after-school gardening programme
self-reported a significant increase in physical activity
levels.
43 completed the pre and post evaluation questions (47%
were male 53% female) There was a significant increase in
the proportion of children reporting “I eat vegetables every
day” and “I am physically active every day” after the
education and gardening program
Responses were scored as “yes” 2, “sometimes” 1, and
“no” 0. Data were analyzed with SAS and non-
parametric test. In order to conduct the data analysis the
responses “sometimes” and “no” were collapsed into
one group and labelled “no.” Significance was set at p =
0.05
Phelps et al.,
2010
Advantages of gardening as a
form of physical activity in an
after-school program
USA Children participating in an after-school gardening
programme resulted in a positive impact on childrens’
activity levels
The study evaluated the effect of an Oklahoma
Cooperative Extension Service after-school gardening
program. The ACTIVITY instrument described 3 physical
activity levels: non-moving, moving, and fast-moving. A
significant difference between pre- and post-test scores of
children's self-reported physical activity level was
observed. The results show that gardening is an effective
non-competitive way to increase children's self-reported
physical activity level in an after-school setting.
Self-reported physical activity level of children in 3rd
through 5th grade using the ACTIVITY self-report
questionnaire.
The nonparametric Wilcoxon signed rank test for a
matched sample was used to analyze the difference
between pre- and post-test scores of children's self-
reported physical activity level. Statistical significance at
p = 0.05
The Benefits of Gardening and Food Growing for Health and Wellbeing 38
Reference Title of paper Location Documented benefits of gardening and food growing Research and evaluation methods
Ransley et al.,
2010
Does nutrition education in
primary schools make a
difference to children's fruit
and vegetable consumption?
UK An evaluation of the School Fruit and Vegetable scheme
found that, in schools running food-growing clubs, children
ate more vegetables and intake was higher if parents were
involved in the initiative. In schools that achieved a high
total score (derived from five key types of initiatives to
promote fruit and vegetables in school) children ate more
vegetables, 123 g/day, compared with those that did not
98·g/day.
It is concluded that gardening, parental involvement and
other activities promoting fruit and vegetables to children in
school may be associated with increased intake of
vegetables but not fruit. Effects were independent of
deprivation status and ethnicity.
129 English primary schools
Year 2 children (aged 6-7 years, n 2530).
Cross-sectional dietary survey. Main outcome measures
were intakes of fruit, vegetables and key nutrients; and a
score for initiatives promoting fruit and vegetables in
school.
Nelson et al.,
2011
Food growing activities in
schools. Report submitted to
Defra
UK Review of academic studies (UK and international)
concluded that food growing programmes in schools can
have positive impacts on pupil nutrition and attitudes
towards healthy eating, specifically related to willingness to
try new food sand taste preferences.
Review of the literature and paper-based survey
questionnaire for senior leaders or other individuals with
responsibility for food growing activities in schools, sent
to a total of 4479 institutions with 29% response rate
Ratcliffe et al.,
2011
The effects of school garden
experiences on middle
school-aged students'
knowledge, attitudes, and
behaviors associated with
vegetable consumption
USA A study of 320 sixth grade students in the USA, involved in
food growing over a 4 month period found that students
were more willing to taste, and ate a greater variety of,
vegetables than those in the control group
Future research should explore whether effects persist
over time and if and how changes in children's behaviour
affect the their parents/guardians.
320 pupils (11-12 years old), 236 students completed
the Garden Vegetable Frequency Questionnaire and
161 complete a taste test
The Benefits of Gardening and Food Growing for Health and Wellbeing 39
Sexually transmitted diseases
Reference Title of paper Location Documented benefits of gardening and food growing Research and evaluation methods
O’Hara Murdock
et al., 2003
Peer-led HIV/AIDS prevention
for women in South African
informal settlements
South Africa Results from this social influences peer led approach
demonstrated that women residents are a valuable
resource in providing effective HIV/AIDS prevention
programs to South Africa's most vulnerable residents.
24 women trained from informal settlements to lead
HIV/AIDS education workshops for 480 residents.
reaching 1,440 residents. Focus groups
Mubvami, T. and
M. Manyati, 2007
HIV/AIDS, urban agriculture
and community mobilisation:
cases from Zimbabwe
Zimbabwe The authors highlight the benefits of food growing at family
or community level for HIV/AIDS. The benefits are indirect,
but substantial, and include improved nutrition of HIV/AIDS
affected families, savings on food expenditures, added
income from the sale of surpluses, and community
mobilisation to respond to HIV and AIDS. This can also
include the integration of former commercial sex workers
from HIV/AIDS affected families.
Case studies descriptive:
New Dawn of Hope Community Gardens, Harare;
Allotment Gardens, Bulawayo; School gardens, Harare
and Bulawayo; Household gardens, Harare; Integration
of former Commercial Sex Workers, Gweru
Weiser et al.,
2010
Food insecurity as a barrier to
sustained antiretroviral
therapy adherence in Uganda
Uganda Food insecurity was common and an important barrier to
accessing medical care and antiretroviral adherence.
Among other mechanisms research showed that while
working for food for long days in the fields, participants
sometimes forgot medication doses. Despite these
obstacles, many participants still reported high antiretroviral
adherence and exceptional motivation to continue therapy.
Open-ended interviews with 47 individuals (30 women,
17 men) living with HIV/ AIDS recruited from AIDS
treatment programs in Mbarara and Kampala, Uganda.
Interviews were transcribed, coded for key themes, and
analyzed using grounded theory (grounded theory is not
a descriptive method, it has the goal of generating
concepts that explain the way that people resolve their
concerns)
The Benefits of Gardening and Food Growing for Health and Wellbeing 40
Social health and wellbeing (social and therapeutic horticulture)
Reference Title of paper Location Documented benefits of gardening and food growing Research and evaluation methods
Sempik et al.,
2003
Social and therapeutic
horticulture: evidence
and messages from
research
UK and global Hard evidence as to effectiveness of social and therapeutic
horticulture is scant and of variable quality.
Client groups include those recovering from major illness or
injury, those with physical disabilities, learning disabilities and
mental health problems, older people, offenders and those who
misuse drugs or alcohol.
The reported benefits of social and therapeutic horticulture
include increased self-esteem and self-confidence, the
development of horticultural, social and work skills, literacy and
numeracy skills, an increased sense of general wellbeing and
the opportunity for social interaction and the development of
independence.
Literature review: >300 articles examined from ~1000
available titles. Identified by searching library databases,
references from known published work and by
consulting with researchers in the field
Waliczek et al.,
2005
The influence of
gardening activities on
consumer perceptions
of life satisfaction
USA Texas Results indicated statistically significant differences in
comparisons of the overall life satisfaction scores with
gardeners receiving higher mean scores indicating more
positive results on the LSIA. When responses to individual
statements were analyzed, results indicated statistically
significant differences on statements relating to energy levels,
optimism, zest for life, and physical self-concept with gardeners
answering more positively on all statements when compared to
non-gardeners' responses. Additionally, gardeners rated their
overall health and their physical activity levels higher than did
non-gardeners
A survey based on the Life Satisfaction Inventory A
(LSIA) was used to investigate gardeners' and non-
gardeners' perceptions of life satisfaction. The LSIA was
developed in 1961 by Neugarten and measures five
components of quality of life including zest for life,
resolution and fortitude, congruence between desired
and achieved goals, high physical, psychological and
social self-concept, and a happy optimistic mood tone.
The survey was on one of the largest online resources
for Texas Master Gardeners. During the 4 months, 402
responses were gathered. Additionally, identical
`paper/pencil' format surveys were distributed to garden,
church, social and community groups with about 400
responses received. In each group of participants,
respondents differentiated themselves as gardeners or
non-gardeners by responding positively or negatively to
the survey question, Do you garden?
Sommerfeld et
al., 2010
Growing Minds:
evaluating the effect of
gardening on quality of
life and physical
activity level of older
adults
USA Results indicated statistically significant differences in
comparisons of overall life satisfaction scores with gardeners
receiving higher mean scores indicating more positive results
on the LSIA. Four individual quality-of-life statements included
in the LSIA yielded statistically significantly more positive
answers by gardeners when compared with non-gardeners.
Other questions regarding healthful practices revealed that
personal reports of physical activity and perceptions of personal
health were statistically significantly more positive among
gardeners when compared with non-gardeners.
A questionnaire based on the Life Satisfaction Inventory
A (LSIA) was used to investigate older adult (age 50+
years) gardeners' and non-gardeners' perceptions of
personal life satisfaction and levels of physical activity.
The LSIA measures five components of quality of life:
“zest for life,” “resolution and fortitude,” “congruence
between desired and achieved goals,” “physical,
psychological, and social self-concept,” and “optimism.”
The survey was posted on a university homepage for ≈1
month. Responses were gathered from 298 participants.
The Benefits of Gardening and Food Growing for Health and Wellbeing 41
Reference Title of paper Location Documented benefits of gardening and food growing Research and evaluation methods
Sempik, 2010 Green care and mental
health: gardening and
farming as health and
social care: mental
health and social
inclusion
UK Social and therapeutic horticulture (STH) is described as a
community of vulnerable people working together on
horticultural activities in a garden or allotment, with the aim of
providing mutual support and benefit to their health and
wellbeing .
It argues that STH is an inexpensive way to treat and care for
people with mental health problems, and that there is room for
expansion of service provision.
Discussion article and literature review: history of STH
and horticultural therapy; evidence of its effectiveness
and current services and their funding
Sempik et al.,
2010
Green Care:
aconceptual
framework. A report of
the working group on
the health benefits of
green care
EU countries It is concluded that research into green care spans a variety of
different subject areas and issues. One area of specific interest
is regarding the effectiveness of green care interventions.
There is now an overwhelming body of evidence that shows
that the natural environment is beneficial to health and
wellbeing . There are opportunities where nature can be placed
within existing therapies, which will help to spread the greening
of medical, social and psychiatric services.
Literature review and conceptual framework. Report on
European COST action
The Benefits of Gardening and Food Growing for Health and Wellbeing 42
General health benefits of community gardens
Reference Title of paper Location Documented benefits of gardening and food
growing
Research and evaluation methods
Armstrong, 2000 A survey of community
gardens in upstate New York:
implications for health
promotion and community
development
USA, New
York State
The most commonly expressed reasons for
participating in gardens were access to fresh foods, to
enjoy nature, and health benefits. Gardens in low-
income neighbourhoods (46%) were four times as
likely as non low-income gardens to lead to other
issues in the neighbourhood being addressed
reportedly due to organizing facilitated through the
community gardens.
Survey of 20 community garden programs in upstate New York
(representing 63 gardens)
Twiss et al.,
2003
Community Gardens: lessons
learned from California
Healthy Cities and
Communities
USA
California
Community gardens enhance nutrition and physical
activity and promote the role of public health in
improving quality of life. California Healthy Cities and
Communities (CHCC) promotes an inclusionary and
systems approach to improving community health.
CHCC has funded community-based nutrition and
physical activity programs in several cities.
Results show that successful community gardens were
developed by many cities incorporating local
leadership and resources, volunteers and community
partners, and skills-building opportunities for
participants.
Through community garden initiatives, cities have e.g.
improved access to produce and elevated public
consciousness about public health
‘Field action report’ Description of California’s community
gardens and public health funding regime
The Benefits of Gardening and Food Growing for Health and Wellbeing 43
Reference Title of paper Location Documented benefits of gardening and food
growing
Research and evaluation methods
Quayle H., 2007 The true value of community
farms and gardens: social,
environmental, health and
economic
UK Results demonstrate the contribution to wellbeing of
individuals and communities: reconnect people,
promote local action on global environmental issues,
(recycling, composting, use of organic methods,
creation of wildlife areas), uptake of healthier diets.
22 projects (farms, gardens, allotments and stables) across
England using informal interview sessions, participatory
appraisal (PA), rapid appraisal (RA) and postal questionnaires.
Wakefield et al.,
2007
Growing urban health:
community gardening in
South-East Toronto
Canada Results suggested that community gardens were
perceived by gardeners to provide numerous health
benefits, including improved access to food, improved
nutrition, increased physical activity and improved
mental health.
Community gardens were also seen to promote social
health benefits and community cohesion.
Mental health benefits are described by the gardeners
as more general, like helping to be more mentally (and
physically) active or to reduce stress
Community-based research (CBR = research with a
substantial level of community participation). Involving
participants helping in 2004 growing season and attending
garden meetings. 10 focus groups, 1-2 hours long with overall
55 people and 13 in-depth interviews. All focus groups and
interviews recorded and professionally transcribed verbatim
Teig et al., 2009 Collective efficacy in Denver,
Colorado: strengthening
neighborhoods and health
through community gardens
USA,
Colorado
Descriptive results of social processes (like social
connections, reciprocity, mutual trust, collective
decision-making, civic engagement and community
building) and the activities supporting them. No specific
findings on health issues despite title.
Semi-structured interviews with community gardeners in
Denver. 90 minutes 15 interviews were conducted with
individuals and 14 were conducted in groups with at least 2
and up to 8 participants. Data from individual and group
interviews were pooled to generate the final dataset (67
respondents, 29 garden sites).
All coding, sorting, and comparing of the data during the
analysis process took place using NVivo 7 (QSR International
Pty. Ltd.)
Chen et al., 2010 Exploring dimensions of
attitudes toward horticultural
activities
Taiwan Five dimensions of attitudes toward horticultural
activities were extracted: increasing positive mood,
improving the environment, leisure belief, improving
social relationships, and escaping.
These dimensions of attitudes toward horticultural
activities had activity-based attributes that differed to
some extent from those of general leisure.
Two steps: First open-ended interviews were used to
conceptualise attitudes toward horticultural activities, and 7
themes and several sub themes of attitudes were induced.
Based on the results, a quantitative survey was conducted to
identify the dimensions of attitudes towards horticultural
activities and their interrelationships
The Benefits of Gardening and Food Growing for Health and Wellbeing 44
Reference Title of paper Location Documented benefits of gardening and food
growing
Research and evaluation methods
Hale et al., 2011 Connecting food
environments and health
through the relational nature
of aesthetics: gaining insight
through the community
gardening experience
USA,
Colorado
Gardeners’ aesthetic experiences generate meaning
that encourages further engagement with activities that
may lead to positive health outcomes.
The physical and social qualities of garden
participation awaken the senses and stimulate a range
of responses that influence interpersonal processes
and social relationships that are supportive of positive
health-related behaviours and overall health.
The research suggests that the relational nature of
aesthetics, can help guide community designers and
health planners when designing environment and
policy approaches to improve health behaviours.
Key-informant interviews to explore gardeners’ tactile,
emotional, and value-driven responses to the gardening
experience and how these responses influence health at
various ecological levels (n = 67 participants, 28 urban
gardens).
Anderson, 2011 An exploration of the potential
benefits of healing gardens
on veterans with post
traumatic stress disorder
(PTSD)
USA This study looks at the potential benefits of using
healing gardens in addition to traditional methods of
treatment for veterans suffering from posttraumatic
stress disorder (PTSD).
Results are descriptive and design based but state that
many PTSD practitioners at VA facilities across the
country show interest in the use of healing gardens.
However, there is also hesitation of professionals
expressing concerns regarding a number of perceived
obstacles for healing garden implementation.
Master study for landscape architecture. The study examines
the history of healing gardens, problems facing veteran
populations today, current treatment methods for PTSD, and
how healing gardens could be beneficial to veterans with
PTSD
A Veterans Affairs (VA) healthcare facility that is in the process
of implementing a healing garden was used to determine how
their PTSD patients will potentially use a healing garden space
during treatment.
MacKerron and
Mourato 2011
Mappiness: quantifying
wellbeing in relation to
environment across space
and time.
(www.mappiness.org.uk)
UK Wellbeing is a topic of increasing interest to
economists, including environmental economists,
however, available quantitative evidence remains
limited. The paper describes a new primary research
focused on individuals’ momentary experiences of their
environment.
Results show that even after controlling for other
factors (weather, daylight, activity, companionship,
location type, time, day) participants are substantially
happier outdoors in any natural or green habitat type
than in the urban environment.
Environmental economics primary research using individuals’
momentary experiences of their environment. Respondents
are ’beeped’ with questions at random moments via smart
phones, creating a GPS geo-located panel data set comprising
of 1,5m responses from 30k individuals. Using GIS to
associate response locations with environmental data, we
estimate a model relating habitat type to self-rated happiness.
The Benefits of Gardening and Food Growing for Health and Wellbeing 45
Reference Title of paper Location Documented benefits of gardening and food
growing
Research and evaluation methods
Pretty et al.,
2011
The UK National Ecosystem
Assessment technical report
chapter 23: health values
from ecosystems
UK The report concludes that observing nature and
participating in physical activity in green spaces play
an important role in human health and wellbeing.
Ecosystems provide direct positive effects on both
mental and physical health. In addition, there are
indirect positive effects by facilitating nature based
activity and social engagement, which positively
influence health and provide a catalyst for behavioural
change in terms of encouraging the adoption of
healthier lifestyles.
Literature review and ecosystem assessment
White et al.,
2013
Would you be happier living in
a greener urban area? A
fixed-effects analysis of panel
data
UK Results showed that on average, individuals have both
lower mental distress and higher wellbeing when living
in urban areas with more green space. Although
effects at the individual level were small, the potential
cumulative benefit at the community level highlights the
importance of policies to protect and promote urban
green spaces for wellbeing .
Earlier research was unable to control for time-invariant
heterogeneity (e.g., personality) and focused on indicators of
poor psychological health. The current research advances the
field by using panel data from over 10,000 individuals to
explore the relation between urban green space and wellbeing
(indexed by ratings of life satisfaction) and between urban
green space and mental distress (indexed by General Health
Questionnaire scores) for the same people over time
A Garden Organic and Sustain publication
ISBN: 978-1-903060-60-5
April 2014
Growing Health is a national project run by Garden
Organic and Sustain, which is funded by the Tudor
Trust, to see how community food growing can be
routinely used by the health and social care services as
a way of promoting health and wellbeing for a range of
individuals and population groups.
www.growinghealth.info
Garden Organic: The national charity for organic
growing, is the working name of the charity ‘Henry
Doubleday Research Association’. Garden Organic has
been at the forefront of the organic horticulture movement
for over 50 years. Through its 22,000 members and the
thousands of individuals touched by its wide-ranging
projects carried out across the UK and overseas,
Garden Organic spreads the organic growing message,
demonstrating its lasting benefits to the mental and
physical health of individuals and the communities,
schools and workplaces in which they grow.
www.gardenorganic.org.uk
Sustain is a Registered Charity No. 1018643
The benefits of
gardening and food
growing for health
and wellbeing
Health
Growing
Food growing for
health and wellbeing