Being diagnosed with cancer is associated with increased risk of a second cancer, as well as other health problems like cardiovascular disease. Exercising regularly and eating healthily can reduce these risks while also improving well-being in other ways and, for survivors of early-stage cancer, potentially reducing risk of recurrence.
The American Cancer Society recommends that cancer survivors, like members of the general population, get 150 minutes of moderate or 75 minutes of vigorous exercise per week and eat at least five servings of fruits and vegetables a day. Most cancer survivors do not meet these recommendations.
In an effort to change that, researchers at the University of Alabama at Birmingham (UAB) and their collaborators have devised a program that aims to encourage physical activity and vegetable consumption at the same time. Through the program, called Harvest for Health, cancer survivors are paired with trained gardeners, who help them plant and tend three seasonal vegetable gardens over the course of a year.
An initial study of the program, published June 22 in Cancer, indicates that mentoring breast cancer patients to start gardens is feasible and promotes increased physical activity.
The researchers randomly assigned 82 interested breast cancer survivors, most of whom had had localized breast cancer, to either receive the gardening intervention immediately or to be waitlisted and serve as the control group. (The waitlisted participants received the gardening intervention the following year.) Four participants did not complete the study for various reasons, none related to adverse effects of the gardening intervention.
The mentors were certified Master Gardeners, meaning they had gone through training and passed a gardening exam. Master Gardeners are certified through programs available at land-grant institutions—usually public universities—in all 50 states. Further, Master Gardeners are required to do community service to maintain their certification, and mentoring cancer survivors is one avenue for that community service.
The primary goal of the study was to test whether the gardening program would be feasible, which it proved to be. A year after the study ended, 86 percent of the participants from the gardening group were still gardening, and all the breast cancer survivors who participated in the gardening program said they would “do it again” if they could.
Unlike more traditional exercise interventions, vegetable gardening produces a tangible, edible result. Study participants took satisfaction in that, says study author Jennifer Bail, a registered nurse and postdoctoral fellow in UAB’s Department of Nutrition Sciences. Growing a successful garden can also increase people’s feelings of self-worth, she says, adding, “Anytime that we can help to improve [patients’ and survivors’] self-esteem and their self-worth, that can greatly impact their quality of life.”
Not only can people eat the vegetables themselves, but they can also share them with neighbors, which participants liked, says Bail. “Now you’re also helping other people eat healthier, too.”
Susan Rossman of Chelsea, Alabama, who was diagnosed at age 48 with stage I breast cancer in 2009, planted a vegetable garden as a participant in the study. She’s still gardening now, four years later. “If I don’t have anything in my boxes, I feel like I’m wasting time, or resources, I should say,” says Rossman, referring to her two raised beds.
In addition to testing feasibility, the researchers collected data about vegetable consumption, physical activity, physical performance and other measures of health and well-being both before and after the intervention. The gardeners had increased their vegetable consumption by nearly a serving per day, though this increase was not significantly greater than that observed in the controls.
Rossman certainly began eating more vegetables thanks to gardening, she says. For one thing, gardening introduced her to new vegetables, like kale, which she learned to sauté on its own or add to soups, she says.
According to reports of the participants themselves, their levels of moderate physical activity had also increased by the end of the year of gardening. Improvement in the gardening group was significantly higher than that in the control group. However, data from accelerometers, which participants wore for one week before and after the intervention, revealed no significant changes in physical activity over the course of the study.
At the end of the study, the gardening group exhibited statistically significant improvements on six out of seven tests of physical performance. On two of these tests, the improvements in the gardeners were significantly greater than those exhibited by the control group.
“Finding creative ways to help [breast cancer survivors] increase or improve upon these health behaviors is very important,” says cancer epidemiologist Alpa Patel of the American Cancer Society in Atlanta. “This may be yet another channel through which breast cancer survivors may increase those health behaviors.” Patel, who was not involved in the study, researches the influences of physical activity and obesity on cancer prevention and development.
Bail and her colleagues are currently enrolling participants in an Alabama-wide study of the same intervention that will include 426 survivors ages 65 and up, representing multiple types of cancers. The study focuses on older survivors because, with the aging of the baby-boom generation, their numbers are increasing, Bail says. Further, older survivors are more likely than younger survivors to have physical function limitations, which gardening could help alleviate, Bail adds.
The study is not open to patients with metastatic cancer because the researchers wanted to increase the likelihood that participants would survive the two-year study, Bail says. In the future, the researchers hope to expand the study to include people with metastatic disease.
Eventually, Bail and her colleagues hope to extend Harvest for Health nationwide.
Meanwhile Rossman is harvesting tomatoes. Both she and her husband, who has heart problems, have improved their health since Rossman participated in Harvest for Health, Rossman says. In addition to gardening, they also raise chickens now and collect their own eggs. “We’re more aware of an organic lifestyle than we were before all this happened. So it kind of—it is a study, and it is one thing, but after the study ends, the effects kind of ripple out into a lot of other awarenesses and making good choices.”
August 07, 2018