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- Title
Vegetable Gardening and Health Outcomes in Older Cancer Survivors: A Randomized Clinical Trial.
- Authors
Demark-Wahnefried, Wendy; Oster, Robert A.; Smith, Kerry P.; Kaur, Harleen; Frugé, Andrew D.; Cole, W. Walker; Locher, Julie L.; Rocque, Gabrielle B.; Pisu, Maria; Bail, Jennifer R.; Cohen, Harvey Jay; Moellering, Douglas R.; Blair, Cindy K.
- Abstract
This randomized clinical trial investigates whether vegetable gardening improves vegetable and fruit consumption, physical activity, and physical function outcomes among Medicare-eligible cancer survivors. Key Points: Question: Does vegetable gardening improve health outcomes in older cancer survivors? Findings: In this randomized clinical trial including 381 cancer survivors aged 50 years or older across Alabama, a vegetable gardening intervention did not significantly improve a composite index of diet, physical activity, and physical function; survivors assigned to the intervention had significantly increased vegetable and fruit consumption and, compared with waitlisted survivors, experienced significant improvements in physical performance. Meaning: Vegetable gardening improved some health outcomes among cancer survivors, warranting further study in pandemic-free times. Importance: Cancer survivors experience accelerated functional decline that threatens independence and quality of life. Previous studies have suggested that vegetable gardening may improve diet, physical activity, and physical function in this vulnerable population, which comprises more than 5% of the US population. Objective: To assess whether diet, physical activity and functioning, and other outcomes improved in older cancer survivors assigned to a vegetable gardening intervention compared with a waitlist. Design, Setting, and Participants: From May 11, 2016, to May 2, 2022, a 2-arm, assessor-blinded, crossover-designed, intent-to-treat, randomized clinical trial was conducted at cancer survivors' homes across Alabama. Medicare-eligible survivors of cancers with 5-year survival of 60% or more were registry ascertained and screened for suboptimal vegetable and fruit consumption (<5 servings per day), physical activity (<150 moderate-to-vigorous minutes per week), and physical function (36-Item Short Form Health Survey [SF-36] subscale score ≤90). Consented participants underwent baseline assessments, were randomly assigned to intervention or waitlisted arms, and were reassessed at 1-year follow-up. Intervention: One-year, home-based vegetable gardening intervention providing gardening supplies and mentorship by cooperative extension–certified master gardeners to plant and maintain spring, summer, and fall gardens. Waitlisted participants received the identical intervention after 12 months. Main Outcomes and Measures: The main outcome was a composite index of improvements in self-reported vegetable and fruit consumption, physical activity, and physical function corroborated by plasma α-carotene levels, accelerometry, and physical performance assessments, respectively. Results: Of 381 enrolled participants (mean [SD] age, 69.8 [6.4] years; range, 50-95 years; 263 [69.0%] female), 194 were assigned to the gardening intervention and 187 were waitlisted (attrition rates, 7.2% and 7.0%, respectively). Intent-to-treat analyses did not detect a significant improvement in the composite index of vegetable and fruit intake, moderate-vigorous physical activity, and physical function (intervention arm vs waitlisted arm, 4.5% vs 3.1%; P =.53) or between-arm differences in vegetable and fruit intake (mean difference, 0.3 [95% CI, −0.1 to 0.7] servings per day; P =.10). The intervention arm experienced a significant improvement in vegetable and fruit intake (mean increase, 0.3 [95% CI, 0.0-0.6] servings per day; P =.04). Significant improvements also were observed in the intervention arm vs waitlisted arm in physical performance (mean difference for 2-minute step test, 6.0 [95% CI, 0.8-11.2] steps; P =.03; for 30-second chair stand, 0.8 [95% CI, 0.1-1.5] repetitions; P =.02), perceived health (8.4 [95% CI, 3.0-13.9] points on a 100-point scale [higher scores indicate better health]; P =.003), and gut microbiome alpha diversity (84.1 [95% CI, 20.5-147.6] more observed species; P =.01). The COVID-19 pandemic significantly moderated effects (eg, odds of improvement in self-reported physical functioning were greater before vs during the pandemic: odds ratio, 2.17; 95% CI, 1.12-4.22; P =.02). Conclusions and Relevance: In this randomized clinical trial including older cancer survivors, a vegetable gardening intervention did not significantly improve a composite index of diet, physical activity, and physical function; however, survivors assigned to the intervention had significantly increased vegetable and fruit consumption and, compared with waitlisted survivors, experienced significant improvements in perceived health and physical performance. Further study in broader populations and during pandemic-free periods is needed to determine definitive benefits. Trial Registration: ClinicalTrials.gov Identifier: NCT02985411
- Subjects
ALABAMA; LIFESTYLES; MOTOR ability; RESEARCH funding; STATISTICAL sampling; LOGISTIC regression analysis; QUESTIONNAIRES; RANDOMIZED controlled trials; DESCRIPTIVE statistics; CROSSOVER trials; ODDS ratio; HORTICULTURE; VEGETABLES; QUALITY of life; CANCER patient psychology; CONFIDENCE intervals; DATA analysis software; CANCER patient rehabilitation; ACTIVITIES of daily living; DIET; OLD age
- Publication
JAMA Network Open, 2024, Vol 7, Issue 6, pe2417122
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2024.17122