Growing Hope: Horticultural Therapy and Restorative Gardens

When Susan Rossman began her participation in a horticultural research study for cancer survivors, she didn’t anticipate becoming so passionate about gardening and healthy eating. During the study, she worked with a master gardener who set up raised beds planted with a variety of vegetables.

"Not only did I increase my physical activity, I also became aware of how the foods I eat affect my health. I enjoyed introducing more superfoods into my diet, including vegetables I had never tried before such as kale," Rossman says. (Superfoods, such as blueberries, salmon and broccoli, are whole foods high in nutrients.)

Rossman and other cancer survivors who participated in the Harvest for Health pilot study at University of Alabama at Birmingham (UAB) weren’t afraid to get their hands dirty to improve their overall health and quality of life. Results of the initial small study were published last August in Acta Oncologica, “Harvest for Health Gardening Intervention Feasibility Study in Cancer Survivors,” concluding that mentored gardening intervention may offer a promising strategy to improve fruit and vegetable consumption, plus physical function and activity in cancer survivors.

“We have received additional funding from two sources and are evaluating the gardening intervention that was described in the pilot study on larger scales,” says study researcher and registered dietitian Wendy Demark-Wahnefried, professor in the Department of Nutrition Sciences and associate director for Cancer Prevention and Control at the UAB Comprehensive Cancer Center.

One study is through the Community Foundation of Greater Birmingham (Women’s Breast Health Fund) where they are implementing the intervention among more than 80 breast cancer survivors in Jefferson, St. Clair, Blount, Shelby and Walker counties in Alabama. The other study, funded by the National Cancer Institute, targets 46 older survivors of more general cancers in various counties in Alabama.

"We hope this is an intermediate step and that we will find confirmatory data to support an intervention on a statewide level and eventually the nation," says Demark-Wahnefried.

There are several ways patients and survivors could potentially include gardening in their daily lives. Horticultural therapy uses plants and plant-based activities to achieve specific clinical treatment goals.

Patients can work with a professional horticultural therapist individually or in a group setting. One option is to sit or stroll in passive restorative gardens which provide emotional, spiritual and physical sanctuary. There are several cancer survivor gardens and parks across the country, and any public greenspace that helps patients and survivors feel nourished and uplifted would also provide the same effect. The third approach is do-it-yourself indoor or outdoor gardening in your home, with enabling gardening adaptations if needed.

“Horticultural therapy is a client-centered treatment modality that provides an opportunity to gently build endurance, strength, balance and mobility after chemo and surgery,” says Karen L. Kennedy, a professional horticultural therapist in private practice in Concord, Ohio.

“My personal observation, based on my 10 years experience working with cancer survivors, is that as clients cultivate and nurture plants, they discover new ways to nurture themselves and be in touch with their own healing process,” says Kennedy, who is also a faculty member of the Horticultural Therapy Institute in Denver.

Katrina Fairchild, a horticultural therapist who works with cancer survivors, took advantage of the practice herself during treatment for angiosarcoma in her breast in 2011. "At the time of my diagnosis, I was obtaining my HT certificate from the Horticultural Therapy Institute," she says. "While in the hospital recovering from the mastectomy, my husband brought me some pruners so I could salvage the fading flowers I had received to recreate another arrangement."

With this simple activity, she says she gained physical and emotional benefits. It helped her increase her standing tolerance and arm use; the colors and fragrance of the flowers helped boost her mood; and the act of caring for the flowers aided in fighting off depression, and served as a form of spiritual meditation for her. Fairchild later shared the flowers with another patient.

"Once I was home, I continued my own HT sessions in my garden, which included planting ‘seeds of hope’," she says. “When seeds are planted, I’m anticipating and hoping for the seeds to sprout successfully and then grow into the wonderful plants I envision them to become.”

“I'll go so far as to declare a personal intent and attach it to a seed. For example, ‘As you grow, little sunflower seed, you will also make me healthier and stronger.’ Of course, this is where selecting easy-propagating seeds becomes critical.”

Horticultural therapy can be used singularly or in conjunction with other therapy modalities such as physical (PT), occupational (OT) and speech (ST). Fairchild says that prior to beginning a horticultural therapy session, a patient or survivor should undergo an in-depth assessment taking into account energy levels, physical strength, disease advancement, personal preferences as well as the emotional or psychological state.

“My horticultural therapy goals for patients will be based on those set forth by their PT/OT/ST,” says Fairchild, who practices in Buford, Ga. “I also do my own assessment and work in collaboration with the other therapists toward the same primary goals.”

Fairchild recommends patients ask themselves what they want to get out of horticultural therapy. “What’s my purpose in doing this? My goal? What aspect of this makes me feel good?”

“Knowing such answers will help patients understand the value of using nature for therapy, bringing focus to the outcome rather than just the act of planting, for example,” she adds.

Even if you don’t have immediate access to horticulture therapy or a garden, you can still use gardening to improve your overall wellness and health, according to Fairchild. “Start small and simple,” she says. “Get two-inch indoor plants and transplant them into nice quart-size pots. Or buy annual flower seeds that are easy to propagate such as marigolds or parsley.”

Patients may also want to discuss gardening with their medical team to rule out the possibility of developing medical issues, such as lymphedema. This condition can result in long-term swelling, typically in the arms or legs, due to removal or damage to lymph nodes as part of cancer treatment. It can be exacerbated by infection that enters the body through cuts or punctures.

“We recommend good garden gloves for women with breast cancer who might be prone to lymphedema and encourage them to also prepare themselves with progressive resistance training," says Demark-Wahnefried.

Even after the pilot study, Rossman continues to garden. Today, she considers herself a diehard gardener and an enthusiast about the many benefits reaped from her horticultural therapy experience. She maintains a positive focus by tending to living, growing things which require daily care.

“I absolutely recommend horticultural therapy to other cancer survivors as a way to rejuvenate and focus on current blessings,” Rossman says. “It’s important to live life to its fullest, whether or not you have cancer. Your life should never be about disease, but about living.”