Gardening Intervention for Physical and Psychological Health Benefits in Elderly Women at Community Centers

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  • 1 1Department of Environmental Health Science, Konkuk University, Seoul 05029, South Korea
  • 2 2Graduate School of Environmental Science, Konkuk University, Seoul 05029, South Korea
  • 3 3Department of Sport Science, Chungnam National University, Daejeon 34134, South Korea
  • 4 4Department of Agricultural and Rural Engineering, Chungnam National University, Daejeon 34134, South Korea

The present study aimed to assess the physical and psychological health benefits of a 15-session gardening intervention in elderly women and to investigate satisfaction of the gardening intervention. Fifty elderly women (age >70 years) at two senior community centers located in Seoul, South Korea, were selected to participate in this study. Twenty-four elderly women at senior community center “A” participated in a twice-weekly gardening intervention (≈50 minutes per session) during the period Sept. to Nov. 2015; 26 elderly women at senior community center “B” comprised a control group. At the completion of the 15-session gardening intervention, physical health parameters such as body composition, physical functional ability, and hand function ability were assessed in both groups. Additionally, psychological health conditions, such as cognitive ability, depression, and sociality, were assessed. The elderly women also answered a questionnaire to assess the amount of physical activity experienced during daily life. Elderly women in the gardening intervention group exhibited significantly improved muscle mass, aerobic endurance, hand dexterity, cognitive ability, and decreased waist circumference (P < 0.05). In contrast, significantly decreased muscle mass and agility and increased depression were observed in the control group (P < 0.05). Moreover, elderly women in the gardening intervention group reported a significantly higher amount of daily physical activity compared with those in the control group (P < 0.05). Additionally, 95.8% of elderly women in the gardening intervention group reported of being very satisfied with the gardening intervention. In conclusion, the gardening intervention maintained and improved the physical and psychological health of elderly women at a senior community center, whereas elderly women in the control group experienced age-related reduced physical and psychological health conditions. More studies are needed to evaluate the effects of a gardening intervention in a larger population of elderly women; in addition, a longer intervention period would provide a better measure of health in elderly women.

Abstract

The present study aimed to assess the physical and psychological health benefits of a 15-session gardening intervention in elderly women and to investigate satisfaction of the gardening intervention. Fifty elderly women (age >70 years) at two senior community centers located in Seoul, South Korea, were selected to participate in this study. Twenty-four elderly women at senior community center “A” participated in a twice-weekly gardening intervention (≈50 minutes per session) during the period Sept. to Nov. 2015; 26 elderly women at senior community center “B” comprised a control group. At the completion of the 15-session gardening intervention, physical health parameters such as body composition, physical functional ability, and hand function ability were assessed in both groups. Additionally, psychological health conditions, such as cognitive ability, depression, and sociality, were assessed. The elderly women also answered a questionnaire to assess the amount of physical activity experienced during daily life. Elderly women in the gardening intervention group exhibited significantly improved muscle mass, aerobic endurance, hand dexterity, cognitive ability, and decreased waist circumference (P < 0.05). In contrast, significantly decreased muscle mass and agility and increased depression were observed in the control group (P < 0.05). Moreover, elderly women in the gardening intervention group reported a significantly higher amount of daily physical activity compared with those in the control group (P < 0.05). Additionally, 95.8% of elderly women in the gardening intervention group reported of being very satisfied with the gardening intervention. In conclusion, the gardening intervention maintained and improved the physical and psychological health of elderly women at a senior community center, whereas elderly women in the control group experienced age-related reduced physical and psychological health conditions. More studies are needed to evaluate the effects of a gardening intervention in a larger population of elderly women; in addition, a longer intervention period would provide a better measure of health in elderly women.

Aging is characterized by a decrease in complex functional abilities related to the physical, psychological, cognitive, and social aspects of life (Brandtstädter and Greve, 1994). In addition, muscle mass, muscle strength, and physical fitness level decline with advancing age (Rikli and Jones, 1999a). Late-life depression is a crucial public health problem because it can increase the risks of morbidity and suicide and decrease an individual’s physical, cognitive, and social functional abilities (Fiske et al., 2009). Furthermore, elderly people experience age-related losses of cognitive abilities, such as memory, attention, and learning (Driscoll et al., 2003). The effects of social changes may also affect an elderly individual’s social participation ability or social relationships (Brandtstädter and Greve, 1994).

Meanwhile, regular physical activity confers health benefits, including the prevention or improvement of chronic health problems related to the physical, psychological, cognitive, and social aspects of life (DiPietro, 2001; Weir, 2010). Despite the importance of regular physical activity, however, most elderly individuals spend 80% of their daily time in sedentary activities (de Rezende et al., 2014).

Gardening is a popular leisure time physical activity among elderly individuals (Ashe et al., 2009; Rowinski et al., 2015), especially in the United States, Canada, and some European countries (Ashe et al., 2009; Rowinski et al., 2015). In addition, urban agriculture is also increasing in popularity (Mougeot, 2006) and has been implemented in the United States, Canada, European countries, and Asian countries (Lovell, 2010; McClintock, 2010; van Leeuwen et al., 2010). Given the popularity of gardening, the present study aimed to assess the physical and psychological health benefits of gardening as a physical activity intervention for maintaining or improving the health conditions of elderly women at a community senior center and to investigate satisfaction of the gardening intervention.

Materials and methods

Recruitment and experimental design.

To recruit elderly women at senior community centers to this study, a flyer containing descriptions of the study purpose, gardening intervention, and health measurements was distributed at ≈40 senior community centers in Seoul, South Korea. Two senior community centers located in the same community, Gangnam-gu, were selected for the study and most of the elderly women (≈98% of the elderly women in each center; 24/25 and 26/27, respectively) decided to participate in this study. Therefore, a total of 50 Korean elderly women at these centers submitted consent forms to participate.

This study featured a quasi-experimental design with a nonequivalent control group. The 24 elderly women at senior community center “A” participated in the 15-session gardening intervention. An additional 26 elderly women at senior community center “B” did not participate in any gardening intervention during the study period and were considered the control group. Both groups were subjected to health assessments before and after the gardening intervention. Each participant received an incentive (equivalent to $20) at the completion of the study. This study was approved by the institutional review board (7001355–201507-HR-067).

Gardening activity intervention.

The 15-session gardening intervention was conducted during the period from Sept. to Nov. 2015 for fall gardening. This intervention was managed primarily by a horticultural therapist with three assistant horticultural therapists, all of whom were certified by the Korean Horticultural Therapy and Wellbeing Association. The intervention involved twice-weekly sessions for an average duration of 50 min per session. A garden plot (8.0 × 5.1 m) had been installed in the front yard of senior community center “A” for this project, and the intervention comprised making plant beds via tasks such as garden design and planning, making furrows in the plots, making name tags for each garden plot, planting transplants, garden maintenance (e.g., fertilizing, weeding, watering, harvesting), and other activities such as flower arrangement and garden parties involving harvested products (Table 1). The participants were allowed to take short breaks during the gardening intervention as needed to address their physical burdens.

Table 1.

A 15-session gardening intervention for the improvement of physical and psychological health conditions of elderly women.

Table 1.

The Centers for Disease Control and Prevention and the American College of Sports Medicine recommend that adults participate in at least 150 min of moderate-intensity physical activity per week to improve or maintain health (Nelson et al., 2007; Pate et al., 1995). Moreover, participation in low-intensity physical activity has been suggested to improve the daily living abilities of elderly individuals by increasing balance, flexibility, and muscle strength (Brown et al., 2000; Buman et al., 2010). Therefore, the gardening activities that comprised this intervention were selected to represent low- to moderate-intensity physical activities that would yield similar health improvements or maintenance. Previously reported metabolic cost data were used to select these gardening activities (Park et al., 2011, 2012, 2014a). Specifically, studies conducted by Park et al. (2011, 2012, 2014a) provided exercise intensity data of various gardening activities performed by older adults.

The following seasonal plants were grown in the garden plot or used for indoor horticultural activities as part of the gardening intervention: chives (Allium ascalonicum), chinese cabbage (Brassica rapa var. pekinensis), radish (Raphanus sativus), lettuce (Lactuca sativa), crown daisy (Chrysanthemum coronarium var. spatiosum), kohlrabi (Brassica oleracea var. gongylodes), beet (Beta vulgaris), onion (Allium cepa), spinach (Spinacia oleracea), crown of thorns (Euphorbia milii var. splendens), chrysanthemum (Chrysanthemum morifolium), zinnia (Zinnia elegans), rose (Rosa hybrida), golden pothos (Epipremnum aureum), and peperomia (Peperomia clusiifolia). The average weather conditions during the study period included a temperature of (mean ± sd) 17.5 ± 4.4 °C and relative humidity of 56.9% ± 10.0% (Korean Meteorological Administration, 2015).

Health assessments.

Researchers prepared rooms at both senior community centers for the health assessments conducted before and after the 15-session gardening intervention. Physical health conditions, including body composition, physical functional ability, and hand function ability, and psychological health conditions, including cognitive ability, depression, and sociality, were assessed.

To measure factors related to body composition such as body weight (kilograms), fat mass (grams), lean mass (grams), and fat (percent), participants were evaluated with a body fat analyzer (ioi 353; Jawon Medical, Gyeongsan, South Korea) after removing shoes. Height was measured using an anthropometer (Ok7979; Samhwa, Seoul, South Korea). Weight and height data were used to calculate the body mass index as the body weight (kilograms) divided by the height squared (square meters). A measuring tape (Pitting measure KMC-220; Komelon, Gyeongsan, South Korea) was used to measure the waist circumference at the area between the bottom of the ribs and the upper crista iliaca (World Health Organization, 2011) and the hip circumference at the most protruding part of the hip. The waist–hip ratio was calculated as the waist circumference (centimeters) divided by the hip circumference (centimeters).

The Senior Fitness Test was used to assess physical functional ability (Rikli and Jones, 2013). This test was developed as a tool for evaluating the functional fitness performance of older adults (Rikli and Jones, 2001) and measures physiologic parameters using functional movement tasks, such as standing, bending, lifting, reaching, and walking. This test meets scientific standards for validity and reliability (Rikli and Jones, 1999b), and age- and gender-based norms determined from more than 7000 older adults in 21 states of the United States have been published for each test item.

The Senior Fitness Test comprises six assessment items (Rikli and Jones, 2013): a chair stand test, arm curl test, chair sit-and-reach test, back scratch test, 2-min step test, and 8-ft up-and-go test. Before starting each test, the researchers provided an oral explanation and demonstration of how to perform the test to the subjects, who were then allowed to practice the test motions. For the chair stand test, which assesses lower body strength, each subject completed one test trial during which the total number of stands within 30 s was counted. For the arm curl test, which assesses upper body strength, each subject completed one test trial during which the total number of hand weight curls through the full range of motion within 30 s was counted. The 2-min step test assesses aerobic endurance; each subject completed one trial and the score was calculated as the total number of steps within 2 min. The 8-ft up-and-go test assessed agility and dynamic balance; each subject completed two test trials and the score was the shortest time to rise from a seated position, walk 8-ft, turn, and return to the seated position. The chair sit-and-reach test assessed lower body flexibility; each subject completed two repetitions of this test, and the score was the best distance (centimeters) achieved between the extended fingers and the tip of the toe. The back scratch test assessed upper body flexibility; each subject completed two test repetitions and the score was the best distance (centimeters) achieved between the extended middle fingers.

Grip strength, pinch force, and hand dexterity were measured using a digital grip dynamometer (KS-301; Lavisen, Namyangju-si, South Korea), Jamar hydraulic pinch gauge (749805; Sammons Preston, Ashburn, VA), and grooved pegboard (32025; Lafayette, Lafayette, CA), respectively. Triplicate grip strength and pinch force measurements of the dominant hand were performed, whereas duplicate hand dexterity measurements were performed. Hand dexterity (fine motor skill) is defined as the ability to coordinate small muscle movements that usually involve the synchronization of hands and fingers with the eyes (Barnsley and Rabinovich, 1970; Fleishman, 1972).

Cognitive function ability was measured using the Korean Mini Mental State Examination [K-MMSE (Kang et al., 1997)]. The K-MMSE comprises the following subscales: disorientation of time (five scores), disorientation of place (five scores), memory (three scores), attention and calculation (five scores), memory recall (three scores), language (eight scores), and composition of time and space (one score). Total scores range from 0 to 30. A score of ≥24 indicates normal ability, a score of 18–23 indicates mild cognitive impairment, and a score of ≥17 indicates severe cognitive impairment. The test–retest reliability of this instrument is 0.86 (Kang et al., 1997).

Depression was assessed using the Korean Version of the Short Form of Geriatric Depression Scale (Ki, 1996; Yesavage and Sheikh, 1986). This scale includes 15 questions related to depression in the elderly. A higher score indicates stronger symptoms of depression; specifically, a score of less than 5 indicates a normal state, a score of 6–9 indicates moderate depression, and a score of more than 10 indicates severe depression (Ki, 1996). Cronbach’s α of this instrument is 0.88 (Ki, 1996).

To evaluate the social behaviors of elderly subjects, a sociality survey developed by Song (2000) and Seok (2005) was used. Twenty-two questions addressed issues related to competence, expandability, and intimacy. Total scores range from 0 to 110 points, with a higher score indicating better social behaviors. Cronbach’s α of this survey is 0.80 (Bae, 2009).

The International Physical Activity Questionnaire-Short Form (IPAQ Research Committee, 2005) was used to determine the duration and exercise intensity of daily physical activities during the previous 7 d. Self-reported physical activities were measured in units of the metabolic equivalent (MET) of a task. Specifically, a MET-min is computed by multiplying the MET score by the minutes performed.

At the beginning of the study, demographic information, such as age, education level, marital status, and monthly income, was obtained via questionnaire from subjects in both groups. Additionally, a satisfaction survey regarding the gardening intervention (Park et al., 2015) was modified for this study and completed by participants in the gardening intervention group at the end of the 15-session gardening intervention. This satisfaction survey comprised a total of seven questions, including questions about overall satisfaction with the gardening intervention (e.g., what is your overall satisfaction for the gardening intervention?), the duration per session in the intervention (e.g., were you satisfied with the 50 min per session?), and frequency in the intervention (e.g., were you satisfied with the frequency of twice per week?). The responses were conducted based on a 5-point Likert-scale (very satisfied, satisfied, moderately satisfied, not satisfied, or very not satisfied). Moreover, a question regarding self-reported benefits of gardening intervention (e.g., what are the benefits of gardening?) was answered subjectively. Questions regarding desire to continue participating in the gardening intervention (e.g., do you wish to continue participating in the gardening intervention?) and the intention of recommending the program to others (e.g., do you recommend the gardening intervention to others?) were answered with a simple yes or no. Question regarding preference for the performed gardening activities (e.g., what was the most preferred activity in the gardening intervention?) asked participants to choose their three most preferred activities.

Data analysis.

The Wilcoxon signed-rank test and SPSS software (version 18 for Windows; IBM, Armonk, NY) were used to compare the results of pre- and post-intervention tests to evaluate physical, psychological, and cognitive health aspects in the control and gardening intervention groups. Demographic information and satisfaction with the gardening intervention were analyzed using Excel software (Office 2007; Microsoft Corp., Redmond, WA); additional analyses involving the chi-square test were conducted using SPSS software. A probability value <0.05 was considered to indicate statistical significance.

Results and discussion

Demographic characteristics.

The elderly women who participated in the gardening intervention and control groups were aged (mean ± sd) 79.4 ± 4.8 and 84.5 ± 4.7 years, respectively, and this difference was significant [P < 0.05 (Table 2)]. The average height of the gardening intervention group was taller than that of the control group (Table 2). No significant differences were observed in other variables [e.g., educational level, marital status, monthly income, and current chronic diseases (Table 2)]. Elderly women in both groups reported a low level of education (elementary school graduation or less) and a low monthly income [<$1000 (Table 2)]. The most common chronic diseases in both groups were high blood pressure and diabetes (Table 2).

Table 2.

Comparisons of demographic information of the subjects in a study for the improvement of physical and psychological health conditions of elderly women through a 15-session gardening intervention by using chi-square and Mann–Whitney U tests.z

Table 2.

Additionally, the administration type of the senior centers is similar because the two senior centers are located in the same community. The senior centers provided leisure time activities, such as stretching exercises or yoga, as well as part-time job opportunities. Most elderly attendees at the senior centers participate in sitting activities such as playing card games, which comprise a sedentary lifestyle (Dunstan et al., 2012).

The intervention attendance rate among elderly women in the gardening intervention group was 80%, and regular checkups and sickness were cited as reasons for absence.

Physical health assessments.

The elderly women in the gardening intervention exhibited a significant decrease in waist circumference from 88.0 ± 10.9 cm (pre-intervention) to 87.1 ± 10.6 cm [post-intervention, P < 0.05 (Table 3)]. Although there was no standard index value of waist circumference for elderly, the appropriate cutoff point of waist circumference for obesity for Koreans was suggested to be 90 cm for men and 85 cm for women (Lee et al., 2007). Meanwhile, there was no significant difference of waist circumference in the control group, but it showed a tendency to slightly increase. In contrast to the reduced waist circumference observed among elderly women in the gardening intervention group, waist circumference has been reported to increase with age (Ford et al., 2003). Lahti-Koski et al. (2007) reported an average 15-year increase in waist circumference of 2.7 cm among male adults and 4.3 cm among female adults. Both the waist circumference and waist–hip ratio are important indicators of the risks of cardiovascular disease and abdominal obesity (Huxley et al., 2010). Accordingly, this study suggests gardening as a physical activity intervention could reduce the risks of chronic diseases, such as cardiovascular disease, abdominal obesity, and diabetes.

Table 3.

Wilcoxon test comparisons of body compositions of elderly women before and after a gardening intervention.

Table 3.

Additionally, no differences in body weight, lean mass, fat mass, and body mass index were observed because of the gardening intervention. Elderly women in the control group exhibited significant reductions in body weight from 54.1 ± 7.3 kg (pre-test) to 53.4 ± 7.3 kg (post-test, P < 0.05), as well as lean mass from 31.1 ± 3.2 kg (pre-test) to 30.8 ± 4.2 kg [post-test (Table 3)]. Reduced lean mass was thought to explain the reduced body weight among elderly women in the control group.

The elderly women in the gardening intervention group maintained their lean mass, whereas those in control group lost lean mass over the 2-month study period (Table 3). Muscle mass maintenance during aging is important because the muscle mass decreases by 1% to 2% annually during the sixth decade of life, and the total muscle mass of the human body decreases by 50% by the ninth decade of life (Baumgartner et al., 1998; Buford et al., 2010). In addition, muscle mass is closely related to both physical and cognitive function abilities (Baumgartner et al., 1998; Burns et al., 2010; Janssen et al., 2002). Gardening activities, such as digging, lifting soil, and weeding, use the whole body and incorporate weight-bearing motions, thus helping to maintain or improve muscle strength (Park et al., 2014b; Turner et al., 2002). For example, Park et al. (2014b) described how five gardening activities—digging, raking, troweling, weeding, and hoeing—used both the upper and lower muscles. In particular, forearm muscles, such as the right flexor carpi ulnaris and brachioradialis, were used more actively than the other measured upper and lower limb muscles. Additionally, weight-bearing activities with ground and joint reaction forces, such as gardening, have been reported to effectively promote increases in bone mineral density (Bassey and Ramsdale, 1995; Kelley et al., 2013).

In the Senior Fitness Test, the gardening intervention group experienced an increase in the score of the 2-min step test for aerobic endurance from 79.4 ± 31.4 (pre-intervention) to 95.1 ± 22.5 [post-intervention, P < 0.05 (Table 4)]. However, the control group did not show any improvement in the 2-min step test for aerobic endurance. Meanwhile, the control group exhibited a significant decrease in agility, as indicated by an increase in the score of the 8-ft up-and-go test from 7.2 ± 1.4 s (pre-intervention) to 8.1 ± 1.4 s [post-intervention (Table 4)], but there were no changes in the gardening intervention group. There were no significant differences in the scores of other Senior Fitness Test sub-items (Table 4).

Table 4.

Wilcoxon test comparisons of Senior Fitness Test of elderly women before and after a gardening intervention.

Table 4.

Cardiopulmonary endurance is defined as the ability to perform aerobic exercise and to supply oxygen to the skeletal muscles to facilitate this exercise (Aaron et al., 2004; Libardi et al., 2012; Stewart, 2005). Aging causes a 5% to 10% decrease in maximum oxygen consumption every 10 years (Jackson et al., 1995; Ogawa et al., 1992; Wilson and Tanaka, 2000). The results achieved with the low- to moderate-intensity gardening intervention in the present study indicated that such regular aerobic exercise could improve cardiopulmonary endurance in elderly women. Fifty percent of elderly older than 60 years experienced decreased function for agility and dynamic balance (Chevalier et al., 2008). This occurs as a result of either reduced muscle mass and bone mineral density or increased fat mass (Fraga et al., 2011; Guzmán et al., 2011); furthermore, the decreased mass increases the risk of falling (Rockwood et al., 2000) as well as making performance of daily living activities, such as walking, climbing stairs, or standing from a chair, more difficult (Motl and McAuley, 2010; de Noronha et al., 2011).

A significant improvement in hand dexterity was observed among elderly women in the gardening intervention group as indicated by the improvement from 136.9 ± 69.3 s (pre-intervention) to 133.5 ± 113.9 s [post-intervention, P < 0.05 (Table 5)]. The control group showed a decreased tendency for hand dexterity, although there was no significant difference between pre- and post-tests. Moreover, the intervention and control groups did not differ with respect to grip strength and pinch force (Table 5). In previous studies, horticultural activity programs were found to significantly improve hand dexterity in subjects with intellectual or developmental disabilities (Lee et al., 2010; Lee and Kim, 2007; Lee and Yoo, 2010; Moon and Yoo, 2009). Various horticultural activities are known to have kinematical properties that promote improved hand dexterity. For example, the subject’s hand must approach and grasp horticultural materials and then transfer the materials to the target point (Lee et al., 2015). Accordingly, elderly women who participated in the gardening intervention repeatedly performed motions involving hand dexterity. Previous studies also showed improvements in grip strength and pinch force (Kim and Kim, 2008; Park et al., 2009; Yun and Kim, 2009). Park et al. (2009) reported that older gardeners exhibited significantly greater hand strength and pinch force, compared with older nongardeners. Indoor horticultural activity programs were found to increase grip strength in elderly subjects with stroke or dementia (Kim and Kim, 2008; Yun and Kim, 2009). In an observation of motions performed while gardening, Park and Shoemaker (2009) reported that gripping was the most frequently observed motion performed by older gardeners. Moreover, Park et al. (2013) measured muscle activation in the upper limb and hand muscles during 15 common horticultural activities and found that hand muscles such as the thenar eminence and hypothenar eminence were actively used during these activities.

Table 5.

Wilcoxon test comparisons of hand function ability of elderly women before and after a gardening intervention.

Table 5.

Psychological health assessments.

According to the K-MMSE, elderly women in the 15-session gardening intervention experienced a significant improvement in cognitive function, with an increase in scores from 22.6 ± 4.2 to 23.6 ± 2.8 [P < 0.05 (Table 6)], although both scores remained in the mild cognitive impairment range (18–23) (Kang et al., 1997). A score in the range of 24–30 indicates no cognitive impairment (Kang et al., 1997). The pre- and post-intervention scores of the control group did not significantly differ and remained in the mild cognitive impairment range. Similar to both groups in this study (Table 6), 10% of individuals older than 65 years and 50% of those older than 85 years have mild cognitive impairment (Jorm and Jolley, 1998), showing that mild cognitive impairment is common in the elderly. Previously, a program that comprised 16 horticultural therapy sessions yielded improvements in cognitive function parameters, such as attention, memory, and visuospatial perception, in 10 male and female elderly individuals with dementia, and the brain metabolic rate was also shown to have increased via positron emission tomography (Cho, 2008). The positive results achieved in this and previous studies suggest that gardening activities provide opportunities for attention and orientation through caring for plants in the garden, which requires the consideration of weather conditions and plants’ water and nutritive conditions (Bryant, 1991; Hass et al., 1998).

Table 6.

Wilcoxon test comparisons of cognitive ability, depression, and sociality of elderly women before and after a gardening intervention.

Table 6.

Notably, elderly women in the control group exhibited a significant increase in depression scores [P < 0.05 (Table 6)], with symptoms progressing from normal before the intervention period to moderate depression symptom at the end of the study. Meanwhile, the depression scores of elderly women in the gardening intervention group did not change during this period (Table 6), and the pre-test depression scores indicated a normal condition. In the elderly, depression can lead to a loss of cognitive function, decreased life satisfaction, and suicide (Almeida et al., 2006). Joshi et al. (2016) reported that elderly individuals who participate in physical activity have low levels of depression symptoms and that gardening acted to prevent depression in this population. A 12-session gardening program was previously found to improve depression symptoms and life satisfaction in an elderly population (Kim et al., 2013). The positive psychological effects of gardening can be attributed to the increased production of alpha waves in the brain as a result of the restful sensations from green plants, as determined in a previous study (Son et al., 1999).

Neither study group experienced a difference in sociality following the intervention period (Table 6). Sociality is a crucial factor associated with life satisfaction and wellbeing in later life (Carstensen, 1995; Nezlek et al., 2002). Although elderly women in this study did not experience improved sociality, previous studies have reported positive effects of gardening interventions on sociality. For example, Tse (2010) reported significantly improved social relationships among 26 elderly nursing home residents after participating in an 8-session gardening program. Moreover, 12 independently living elderly subjects who participated in a gardening intervention reported improved social support (Oh and Yoo, 2010). An expanded gardening intervention period or customized gardening program by considering the subject characteristics could be applied to improve sociality among elderly participants.

In this study, elderly women who participated in the gardening intervention experienced a significant increase in the amount of daily physical activity (Table 7). In particular, the amount of time spent on vigorous physical activities increased from 134.7 ± 515.1 MET-min/week (pre-intervention) to 976.9 ± 1290.0 MET-min/week (post-intervention, P = 0.02). In contrast, elderly women in the control group exhibited a nonsignificant tendency toward a reduced amount of daily physical activity (Table 7). Compared with indoor activities, outdoor activities such as gardening might help to motivate individuals to participate in exercise interventions and remain physically active (Department of Health, 2004; Park et al., 2008a, 2009). Seasonal variations and plant growth cycles also contribute to the motivation to participate in a gardening exercise intervention (Park et al., 2008b) because of the need to continuously care for plants in the garden and an interest in the plants’ growth cycles (Lekies and Sheavly, 2007; Park et al., 2008b).

Table 7.

Wilcoxon test comparisons of physical activity level of elderly women before and after a gardening intervention.

Table 7.

Satisfaction with the gardening intervention.

Overall, most elderly women in the gardening intervention group reported being very satisfied (87.5%, 21 respondents), satisfied (8.3%, 2 respondents), or moderately satisfied (4.2%, 1 respondent) with the gardening intervention. Participants were very satisfied (70.8%, 17 respondents) and satisfied (25%, 6 respondents) with the average duration of 50 min per session. Similarly, participants were very satisfied (91.7%, 22 respondents) and satisfied (8.3%, 2 respondents) with the session frequency of twice per week. Regarding preferences for gardening activities, planting transplants (54.7%, 1.6 points) was the most preferred activity, followed by flower arrangement (48%, 1.4 points), harvesting (40%, 1.2 points), garden parties (30.7%, 0.9 points), and making eco-friendly fertilizers (21.3%, 0.6 points). Regarding the benefits of gardening, elderly women who participated in the gardening intervention subjectively reported they enjoyed group activity (91.7%, 22 respondents), psychological relaxation (87.5%, 21 respondents), the fun of raising plants (83.3%, 20 respondents), and leisure time activity (70.8%, 17 respondents). Moreover, all participants (100%, 24 respondents) reported that they wished to continue participating in the gardening intervention and would recommend it to other elderly people.

In conclusion, the gardening intervention, as a low- to moderate-intensity physical activity, improved the physical and psychological health conditions of elderly women who participated in this study at a senior community center. The elderly women in the 15-session gardening intervention significantly reduced waist circumference and improved aerobic endurance, hand dexterity, cognitive function, and their amount of daily physical activity. On the other hand, the elderly women in the control group experienced age-related reduced physical and psychological health conditions for lean mass, agility, and depression. Moreover, satisfaction with the gardening intervention as a leisure time physical activity for health conditions of elderly women was very high. Future studies should include a larger population and longer gardening intervention period to determine the effects of the intervention and improve the health conditions of the elderly participants.

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    • Search Google Scholar
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  • Burns, J.M., Johnson, D.K., Watts, A., Swerdlow, R.H. & Brooks, W.M. 2010 Reduced lean mass in early Alzheimer disease and its association with brain atrophy Arch. Neurol. 67 428 433

    • Search Google Scholar
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  • Carstensen, L.L. 1995 Evidence for a life-span theory of socioemotional selectivity Curr. Dir. Psychol. Sci. 4 151 156

  • Chevalier, S., Saoud, F., Gray-Donald, K. & Morais, J.A. 2008 The physical functional capacity of frail elderly persons undergoing ambulatory rehabilitation is related to their nutritional status J. Nutr. Health Aging 12 721 726

    • Search Google Scholar
    • Export Citation
  • Cho, M.K. 2008 Horticultural therapy as non-pharmacological treatment for the improvement of cognitive function and BPSD in dementia. PhD Diss., Konkuk Univ., Seoul, South Korea

  • de Noronha, D.F., de Souza, R.G., Giani, T.S., Bacellar, S., Escobar, T., Stoutenberg, M. & Dantas, E.H. 2011 Correlation between static balance and functional autonomy in elderly women Arch. Gerontol. Geriatr. 52 111 114

    • Search Google Scholar
    • Export Citation
  • de Rezende, L.F.M., Rey-López, J.P., Matsudo, V.K.R. & do Carmo Luiz, O. 2014 Sedentary behavior and health outcomes among older adults: A systematic review BMC Public Health 14 333

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  • Department of Health 2004 At least 5 a week: Physical activity and health out-comes: A review of the chief medical officer. Dept. Health, London, UK

  • DiPietro, L. 2001 Physical activity in aging changes in patterns and their relationship to health and function J. Gerontol. A Biol. Sci. Med. Sci. 56 Suppl. 2 13 22

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  • Dunstan, D.W., Howard, B., Healy, G.N. & Owen, N. 2012 Too much sitting—A health hazard Diabetes Res. Clin. Pract. 97 368 376

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  • Fraga, M.J., Cader, S.A., Ferreira, M.A., Giani, T.S. & Dantas, E.H. 2011 Aerobic resistance, functional autonomy and quality of life (QoL) of elderly women impacted by a recreation and walking program Arch. Gerontol. Geriatr. 52 40 43

    • Search Google Scholar
    • Export Citation
  • Guzmán, R.A., Salazar, H.A., Cea, A., Melián, H.P., Cordier, B. & Silvestre, R.A. 2011 Correlation between the scores of “Timed up and go” test and registered joint moments of lower limb during the sit-to-stand transfer in elderly with antecedents of frequent falls Intl. J. Morphol. 29 521 525

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    • Export Citation
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  • Huxley, R., Mendis, S., Zheleznyakov, E., Reddy, S. & Chan, J. 2010 Body mass index, waist circumference and waist: Hip ratio as predictors of cardiovascular risk: A review of the literature Eur. J. Clin. Nutr. 64 16 22

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    • Export Citation
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  • Joshi, S., Mooney, S.J., Kennedy, G.J., Benjamin, E.O., Ompad, D., Rundle, A.G., Beard, J.R. & Cerdá, M. 2016 Beyond METs: Types of physical activity and depression among older adults Age Ageing 45 103 109

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  • Kim, H.Y. & Kim, D.Y. 2008 Effects of horticultural therapy on the hand functions and cognitive abilities in elders with severe brain lesions J. Korean Soc. People Plants Environ. 11 99 103

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  • Lee, A.Y., Park, S.A., Kim, J.J., So, J.M. & Son, K.C. 2015 Biomechanics analysis of horticulture activity motions for health Korean J. Hort. Sci. Technol. 33 Suppl. II 60 (abstr.)

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Contributor Notes

This paper was supported by the SMART Research Professor Program of Konkuk University. This work was supported by research fund of Chungnam National University.

These authors contributed equally to this work

Corresponding author. E-mail: drkds19@cnu.ac.kr.

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  • Buman, M.P., Hekler, E.B., Haskell, W.L., Pruitt, L., Conway, T.L., Cain, K.L., Sallis, J.F., Saelens, B.E., Frank, L.D. & King, A.C. 2010 Objective light-intensity physical activity associations with rated health in older adults Amer. J. Epidemiol. 172 1155 1165

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  • Burns, J.M., Johnson, D.K., Watts, A., Swerdlow, R.H. & Brooks, W.M. 2010 Reduced lean mass in early Alzheimer disease and its association with brain atrophy Arch. Neurol. 67 428 433

    • Search Google Scholar
    • Export Citation
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  • Chevalier, S., Saoud, F., Gray-Donald, K. & Morais, J.A. 2008 The physical functional capacity of frail elderly persons undergoing ambulatory rehabilitation is related to their nutritional status J. Nutr. Health Aging 12 721 726

    • Search Google Scholar
    • Export Citation
  • Cho, M.K. 2008 Horticultural therapy as non-pharmacological treatment for the improvement of cognitive function and BPSD in dementia. PhD Diss., Konkuk Univ., Seoul, South Korea

  • de Noronha, D.F., de Souza, R.G., Giani, T.S., Bacellar, S., Escobar, T., Stoutenberg, M. & Dantas, E.H. 2011 Correlation between static balance and functional autonomy in elderly women Arch. Gerontol. Geriatr. 52 111 114

    • Search Google Scholar
    • Export Citation
  • de Rezende, L.F.M., Rey-López, J.P., Matsudo, V.K.R. & do Carmo Luiz, O. 2014 Sedentary behavior and health outcomes among older adults: A systematic review BMC Public Health 14 333

    • Search Google Scholar
    • Export Citation
  • Department of Health 2004 At least 5 a week: Physical activity and health out-comes: A review of the chief medical officer. Dept. Health, London, UK

  • DiPietro, L. 2001 Physical activity in aging changes in patterns and their relationship to health and function J. Gerontol. A Biol. Sci. Med. Sci. 56 Suppl. 2 13 22

    • Search Google Scholar
    • Export Citation
  • Driscoll, I., Hamilton, D.A., Petropoulos, H., Yeo, R.A., Brooks, W.M., Baumgartner, R.N. & Sutherland, R.J. 2003 The aging hippocampus: Cognitive, biochemical and structural findings Cereb. Cortex 13 1344 1351

    • Search Google Scholar
    • Export Citation
  • Dunstan, D.W., Howard, B., Healy, G.N. & Owen, N. 2012 Too much sitting—A health hazard Diabetes Res. Clin. Pract. 97 368 376

  • Fiske, A., Wetherell, J.L. & Gatz, M. 2009 Depression in older adults Annu. Rev. Clin. Psychol. 5 363 389

  • Fleishman, E.A. 1972 Structure and measurement of psychomotor abilities, p. 78–196. In: S.N. Singer (ed.). The psychomotor domain. Lea Febiger, Philadelphia, PA

  • Ford, E.S., Mokdad, A.H. & Giles, W.H. 2003 Trends in waist circumference among U.S. adults Obes. Res. 11 1223 1231

  • Fraga, M.J., Cader, S.A., Ferreira, M.A., Giani, T.S. & Dantas, E.H. 2011 Aerobic resistance, functional autonomy and quality of life (QoL) of elderly women impacted by a recreation and walking program Arch. Gerontol. Geriatr. 52 40 43

    • Search Google Scholar
    • Export Citation
  • Guzmán, R.A., Salazar, H.A., Cea, A., Melián, H.P., Cordier, B. & Silvestre, R.A. 2011 Correlation between the scores of “Timed up and go” test and registered joint moments of lower limb during the sit-to-stand transfer in elderly with antecedents of frequent falls Intl. J. Morphol. 29 521 525

    • Search Google Scholar
    • Export Citation
  • Hass, K., Simson, S.P. & Stevenson, N.C. 1998 Older persons and horticultural therapy practice, p. 231–252. In: S.P. Simson and M.C. Straus (eds.). Horticulture as therapy: Principles and practice. Haworth Press, New York, NY

  • Huxley, R., Mendis, S., Zheleznyakov, E., Reddy, S. & Chan, J. 2010 Body mass index, waist circumference and waist: Hip ratio as predictors of cardiovascular risk: A review of the literature Eur. J. Clin. Nutr. 64 16 22

    • Search Google Scholar
    • Export Citation
  • IPAQ Research Committee 2005 Guidelines for data processing and analysis of the International Physical Activity Questionnaire (IPAQ)-short and long forms. 20 Mar. 2016. <http://www.ipaq.ki.se>

  • Jackson, A.S., Beard, E.F., Wier, L.T., Ross, R.M., Stuleville, J.E. & Blair, S.W. 1995 Changes in aerobic power of men ages 25–70 yr Med. Sci. Sports Exerc. 27 113 120

    • Search Google Scholar
    • Export Citation
  • Janssen, I., Heymsfield, S.B. & Ross, R. 2002 Low relative skeletal muscle mass (sarcopenia) in older persons is associated with functional impairment and physical disability J. Amer. Geriatr. Soc. 50 889 896

    • Search Google Scholar
    • Export Citation
  • Jorm, A.F. & Jolley, D. 1998 The incidence of dementia: A meta-analysis Neurology 51 728 733

  • Joshi, S., Mooney, S.J., Kennedy, G.J., Benjamin, E.O., Ompad, D., Rundle, A.G., Beard, J.R. & Cerdá, M. 2016 Beyond METs: Types of physical activity and depression among older adults Age Ageing 45 103 109

    • Search Google Scholar
    • Export Citation
  • Kang, Y.W., Na, D. & Hahn, S.H. 1997 A validity study on the Korean mini-mental state examination (K-MMSE) in dementia patients J. Korean Neurol. Assoc. 15 300 308

    • Search Google Scholar
    • Export Citation
  • Kelley, G.A., Kelley, K.S. & Kohrt, W.M. 2013 Exercise and bone mineral density in men: A meta-analysis of randomized controlled trials Bone 53 103 111

    • Search Google Scholar
    • Export Citation
  • Ki, B.S. 1996 A preliminary study for the standardization of Geriatric Depression Scale Short Form-Korea version J. Korean Neuropsychiatr. Assoc. 35 298 302

    • Search Google Scholar
    • Export Citation
  • Kim, H.W., Lee, S. & Lee, S.M. 2013 Effects of horticultural activities leisure program on mental health and life-satisfaction of the rural elderly J. Korean Soc. People Plants Environ. 16 125 132

    • Search Google Scholar
    • Export Citation
  • Kim, H.Y. & Kim, D.Y. 2008 Effects of horticultural therapy on the hand functions and cognitive abilities in elders with severe brain lesions J. Korean Soc. People Plants Environ. 11 99 103

    • Search Google Scholar
    • Export Citation
  • Korean Meteorological Administration 2015 Past Material, Korean Climatological Data. K MA, Seoul, South Korea. 10 Dec. 2015. <http://www.kma.go.kr/weather/climate/past_cal.jsp>

  • Lahti-Koski, M., Harald, K., Mannisto, S., Laatikainen, T. & Jousilahti, P. 2007 Fifteen-year changes in body mass index and waist circumference in Finnish adults Eur. J. Cardiovasc. Prev. Rehabil. 14 398 404

    • Search Google Scholar
    • Export Citation
  • Lee, A.Y., Park, S.A., Kim, J.J., So, J.M. & Son, K.C. 2015 Biomechanics analysis of horticulture activity motions for health Korean J. Hort. Sci. Technol. 33 Suppl. II 60 (abstr.)

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