Nature therapy
Gardening Therapy
Gardening Therapy is a structured, nature-based activity studied as an approach to mental wellbeing. Research has also examined whether it may support cognitive and social functioning.
Gardening Therapy is a nature-based practice with gardening as its central activity.
Overview
Gardening Therapy is a structured, nature-based activity studied as an approach to mental wellbeing. Research has also examined whether it may support cognitive and social functioning. Its evidence base includes randomized controlled trials and meta-analyses, indicating that the practice has been studied beyond preliminary observation. However, evidence strength is not the same across every outcome, and the findings should be considered individually rather than as proof that gardening reliably improves health. The research describes supervised and group-based formats, so its findings may not apply equally to every way of gardening.
Well researched: 33 studies. Last checked Oct 9, 2026.
- 19
- human evidence
- 7
- eligible
- 13
- unclassified
- 1
- animal / null result
Best-evidenced uses
- Mood ImprovementMedium · Meta-analysis
- Antidepressant EffectMedium · RCT
- Anxiety ReductionMedium · RCT
- 33
- Studies
Evidence checked Oct 9, 2026 · newest study 2026
- A
- 1
- B
- 18
- C
- 12
- D
- 2
10 community reports across 2 platforms
Coverage
- Effects
- 25
- Helps with
- 15
- Side effects
- 4
- Interactions
- 7
How to read the evidence
Evidence tier — overall strength of the evidence for the whole compound
- StrongWell established — backed by strong, consistent human research.
- ModerateSome genuine support, but mostly from small or lower-quality studies. Promising, not proven.
- PreliminaryEarly-stage evidence — a promising hypothesis, not an established effect yet.
- LimitedVery limited evidence — treat this as a hypothesis, not proof.
- InsufficientNot enough good evidence to draw conclusions yet.
Certainty — how sure we can be that the effect is real
- Very highVery sure — strong, consistent evidence
- HighFairly sure — consistent evidence from good studies
- MediumModerately sure — new studies could change this
- LowNot sure — little or mixed evidence
- Very lowVery unsure — almost no usable evidence
Source — where the data comes from
- Meta-analysisPooled analysis of many trials — the strongest evidence
- RCTRandomized controlled trial — a strong human study design
- ClinicalA human clinical study
- Reference knowledgeFrom general health-science or pharmacology references, not a study of this exact claim
- Animal researchStudied in animals, not humans
- Community reportsAggregated user reports — anecdotal signal, not evidence
- TheoreticalMechanism-based reasoning, not yet tested
Study grade — quality of each underlying study (A best, D weakest)
- AHigh-quality — strong, consistent human trials
- BGood — solid evidence with some limitations
- CModerate — limited, small, or mixed-quality studies
- DWeak — preliminary, indirect, or animal-only
Confidence — how strongly the sources back a finding
A 0–100 score from study quality and agreement
Most supplement evidence is graded C–D. Read it as preliminary signal, not proof.
These are research findings, not promises. A practice does not replace medical treatment.
What does research say?
What studies found for each claimed effect, best evidence first.
25 claims:10 some evidence11 not enough evidence3 not tested in people1 no benefit found
Mood ImprovementSome evidence it helpsSize of effect: Small
Some human studies found a benefit. More research could change this.
15 of 17 studies found a benefit; 2 found none. Strongest study: a pooled analysis of several trials. A trial found it after a single session.
A 2022 meta-analysis of randomized trials found better mental health in Gardening Therapy groups than in control groups (effect size = 0.55). A 2025 meta-analysis pooling randomized and non-randomized human studies also reported a positive mental-health effect.
Open the Mood Improvement pageAntidepressant EffectSome evidence it helpsSize of effect: Large
Some human studies found a benefit. More research could change this.
14 of 16 studies found a benefit; 2 found none. Strongest study: a pooled analysis of several trials. A trial found it after a single session. Trials that found it ran as little as 13 weeks, typically 18.
A 2024 meta-analysis pooling randomized trials involving 603 people reported improvement in depression. The studies included people with varied health conditions, so the result does not describe one specific population.
Open the Antidepressant Effect pageAnxiety ReductionSome evidence it helpsSize of effect: Medium
Some human studies found a benefit. More research could change this.
9 of 10 studies found a benefit; 1 found none. Strongest study: a pooled analysis of several trials. A trial found it after a single session. Trials that found it ran as little as 4 weeks, typically 14.
A 2024 meta-analysis pooling randomized trials involving 710 people reported an effect on anxiety. A separate 2025 meta-analysis of randomized trials involving 960 people also reported an effect on anxiety.
Open the Anxiety Reduction pageStress Resilience ImprovementSome evidence it helpsSize of effect: Medium
Some human studies found a benefit. More research could change this.
7 of 8 studies found a benefit; 1 found none. Strongest study: a pooled analysis of several trials.
Open the Stress Resilience Improvement pageCognitive Function ImprovementSome evidence it helpsSize of effect: Medium
Some human studies found a benefit. More research could change this.
9 of 11 studies found a benefit; 2 found none. Strongest study: a pooled analysis of several trials.
A 2025 meta-analysis pooling randomized trials involving 960 people reported an effect on cognition. The studies involved varied groups, including people with dementia, depression, frailty, and mild cognitive impairment.
Open the Cognitive Function Improvement pageSocial Function ImprovementSome evidence it helpsSize of effect: Small
Some human studies found a benefit. More research could change this.
All 7 studies with a clear result found a benefit. Strongest study: a pooled analysis of several trials. A trial found it after a single session.
A 2025 meta-analysis pooling randomized trials involving 960 people reported an effect on social function. A 2022 meta-analysis of randomized trials also reported better emotional functioning, well-being, subjective social functioning, and quality of life among older adults.
Open the Social Function Improvement pagePhysical FunctionSome evidence it helpsSize of effect: Medium
Some human studies found a benefit. More research could change this.
4 of 5 studies found a benefit; 1 found none. Strongest study: a pooled analysis of several trials.
A 2024 meta-analysis of randomized trials involving 655 people reported improvement in daily activities. However, a 2021 systematic review found no difference between groups in activities of daily living in a study involving 16 people.
Open the Physical Function pageFlexibility ImprovementSome evidence it helpsSize of effect: Small
Some human studies found a benefit. More research could change this.
All 2 studies with a clear result found a benefit. Strongest study: a pooled analysis of several trials.
Open the Flexibility Improvement page
What to expect
Some mood-, anxiety- and social-related changes were reported after a single session. For effects measured across programmes, anxiety-related findings came from trials lasting as little as 4 weeks and typically 14 weeks, while antidepressant effects were measured after 13 weeks at the earliest and typically 18 weeks. Some of these gains had partly faded by a 4-week follow-up; immune-related findings were measured in programmes lasting 26 to 28 weeks.
Also studied in people with 15 health conditions
How strong the evidence is in each group. This is research, not a treatment recommendation.
DepressionSome evidence it helpsSize of effect: Medium
Some human studies found a benefit. More research could change this.
All 12 studies with a clear result found a benefit.
A 2022 meta-analysis of 13 studies (6 RCTs, 7 quasi-experimental) reported reduced depressive symptoms. A separate 2025 pooled analysis of randomized trials examined depression among people with depressive disorders.
Open the Depression pageDementiaSome evidence it helpsSize of effect: Medium
Some human studies found a benefit. More research could change this.
All 11 studies with a clear result found a benefit.
A 2017 meta-analysis of randomized and non-randomized human studies reported positive affect outcomes in two studies involving people with dementia. A 2022 meta-analysis of randomized trials did not support the authors’ recommendation for this approach in older adults with dementia.
Open the Dementia pageAnxiety Disorder (General)Some evidence it helpsSize of effect: Not known
Some human studies found a benefit. More research could change this.
All 4 studies with a clear result found a benefit.
A review of randomized trials reported improvements in anxiety in nature-based intervention groups versus controls, but gave no pooled estimate. Both studies measuring anxiety in a 2022 review found decreases, including after a 15-minute single session.
Open the Anxiety Disorder (General) pageSchizophreniaSome evidence it helpsSize of effect: Not known
Some human studies found a benefit. More research could change this.
All 3 studies with a clear result found a benefit.
A 2024 meta-analysis pooling 35 randomized trials found improvements in total, positive and negative symptoms, depression, and anxiety among people with schizophrenia. A 2021 meta-analysis of randomized and non-randomized human studies also reported improvements in symptoms, rehabilitation outcomes, quality of life, and social functioning.
Open the Schizophrenia pageIntellectual DisabilityNot enough evidence
Too few or too small studies to know if it works.
The one study found a benefit.
One 2017 study involving students with intellectual disabilities reported improvements in attention and sociability.
Open the Intellectual Disability pageCancer (General)Not enough evidence
Too few or too small studies to know if it works.
1 of 2 studies found a benefit; 1 found none.
A 2023 meta-analysis of randomized and non-randomized human studies reported increased vegetable and fruit consumption and reduced waist circumference among cancer survivors.
Open the Cancer (General) pageAlzheimer's DiseaseNot enough evidence
Too few or too small studies to know if it works.
The one study found a benefit.
A 2022 systematic review reported quality-of-life improvements in four randomized trials among people with Alzheimer's disease; the conclusions were limited to this population.
Open the Alzheimer's Disease pageStrokeNot enough evidence
Too few or too small studies to know if it works.
The one study found a benefit.
One RCT found improved physical function when horticultural therapy was combined with acupuncture in people who had experienced a stroke, so the finding does not establish an effect of horticultural therapy alone.
Open the Stroke page
Before you try it
What studies and reports say about side effects and who it may not suit.
- Side effects
With weak evidence: Heat Illness, Injury Risk Increase, Muscle Strain, and Skin Rash / Irritation.
- May not suit you if you have
- History of Anaphylaxis, Wound, Iatrogenic Immunosuppression, Acute Injury, and G6PD Deficiency
- Some trials left out people with
- Hearing Loss
- Reported by users
- Joint Pain (Arthralgia) and Muscle Ache (Myalgia)
General wellness information, not medical advice. Ask a doctor before you start, especially if you take medicines or have a health condition.
How people do it
A gentle start, then what the studies used.
- Start with
- 30 minutes, weekly (Home-Based Smart Gardening)A gentle start based on the easiest variation, not on a study.
- Build up to
- 89 minutes, 2 times a week, low intensity (what the studies used)
- What the studies ran
- 135 minutes a week for 14 weeks
- Longest session studied
- 90 minutes (Community Group Gardening)Not a target and not a safe limit: past it there is no evidence either way.
- Temperature
- about 24 °C
The expert view shows every study, dose protocol and source.
Effects
25 listedStart here
Most likely to help, from the evidence we have
- →Mood ImprovementCertaintyMediumSourceMeta-analysisSmall effectlong-term16 cited studies · 2 other sources
A 2022 meta-analysis of randomized trials found better mental health in Gardening Therapy groups than in control groups (effect size = 0.55). A 2025 meta-analysis pooling randomized and non-randomized human studies also reported a positive mental-health effect.
What the sources found
16 positive · 2 neutral · 0 negativeconfidence 52/100
How big is the effect
Small effectA small but noticeable difference on average.
Who was studied
- Healthy people and patients
- Alzheimer's Disease
- Anxiety Disorder (General)
- Back Pain
- Cancer (General)
- Dementia
- Depression
- +7 more
Where the evidence comes from
- Article16
- Expert opinion1
- Community reports1
Protocol behind this outcome
5 protocolsEstimatedWhat the studies reporting this result did.
65 min · 2×/week
- Course
- 12 weeks
- Per week
- 155 min
- Intensity
- Low
- Format
- Group
- Supervision
- Instructor-led
Courses and single sessions · 3 repeated-course and 1 single-session protocols
Trials that found no benefit ran2 trials and meta-analyses
Smallest Typical Session 60 min 75 min How often 1×/week 1.5×/week Per week 60 min 120 min Course 3 weeks 15 weeks Timing
A trial found it after a single session
Open Mood ImprovementShow studies (18)
Meta-analysisApositive65% confidence2022Effect of horticultural therapy on mental health: A meta-analysis of randomized controlled trials.
The meta-analysis showed that the HT experimental groups had a significant and positive impact on mental health compared with the control groups (effect size = 0.55).
SMD 0.55Moderate effectPooled RCTsMain outcomeOpen-labelInactive controlMeta-analysisBpositiven=453575% confidence2025Effect of gardening activities on domains of health: a systematic review and meta-analysis.
the results indicated that gardening intervention is significantly effective for mental health (SMD: −0.82; 95% CI: −1.51, −0.13)
SMD -0.82 [-1.51, -0.13]Large effectTop journalStudies disagree (I² 100%)Meta-analysisBpositiven=257875% confidence2017Gardening is beneficial for health: A meta-analysis.
Wellbeing variables: effect size 0.47 (95% CI: 0.39–0.54)
SMD 0.47 [0.39, 0.54]Small effectTop journalMeta-analysisBpositiven=88450% confidence2022HT was found to be more effective for promoting emotional functioning and well-being, subjective social functioning, and quality of life among the elderly.
Top journalPooled RCTsInactive controlMeta-analysisBpositiven=41155% confidence2022Effectiveness of horticultural therapy in people with dementia: A quantitative systematic review.
significant differences were found in the effectiveness of participatory horticultural therapy on ... positive emotion
Top journalMain outcome+12 more in SourcesSystematic reviewBpositive50% confidence2026The effectiveness of nature-based interventions on mental health: A systematic review.
Seventeen studies reported significantly greater improvements in mental health, particularly depression, anxiety, and stress in NBI groups compared to controls.
Top journalSome bias concernsPooled RCTsStudies disagreeMain outcome - →Antidepressant EffectCertaintyMediumSourceRCTLarge effectlong-term16 cited studies
A 2024 meta-analysis pooling randomized trials involving 603 people reported improvement in depression (SMD = 0.646, 95% CI 0.334 to 0.959). The studies included people with varied health conditions, so the result does not describe one specific population.
What the sources found
14 positive · 2 neutral · 0 negativeconfidence 60/100
How big is the effect
Large effectA big difference on average. Check how strong the evidence is.
Rating adjusted
Lowered from High to Medium after checking study quality: journal, risk of bias, trial size and design.
Who was studied
- Healthy people and patients
- Alzheimer's Disease
- Anxiety Disorder (General)
- Dementia
- Depression
- Frailty
- Intellectual Disability
- +3 more
Where the evidence comes from
- Article16
Protocol behind this outcome
7 protocolsEstimatedWhat the studies reporting this result did.
- Intensity
- Low
- Format
- Group
- Supervision
- Instructor-led
Courses and single sessions · 4 repeated-course and 1 single-session protocols
What worked in trials5 trials and meta-analyses
Randomized trials and meta-analyses that found this benefit: the smallest and the typical amount. Not a target and not a limit.
Smallest Typical Session 88 min 89 min How often 1×/week Timing
A trial found it after a single session
Trials that found it ran as little as 13 weeks, typically 18
After stopping, the benefit partly faded (1 study) · See “When you stop”
Follow-up: 4-week follow-up after program completion
Derived from (1)
Open Antidepressant EffectShow studies (16)
Meta-analysisBpositiven=289970% confidence2024HT has moderate to large effect sizes on depression (SMD = 0.646, 95% CI 0.334 to 0.959)
SMD 0.65 [0.33, 0.96]Moderate effectWeak journalSome bias concernsPooled RCTsStudies disagree (I² 92%)Main outcomeOpen-labelInactive controlMeta-analysisBpositiven=257875% confidence2017Gardening is beneficial for health: A meta-analysis.
Reductions in depression and anxiety symptoms, stress, mood disturbance, and BMI
Top journalMeta-analysisBpositiven=202480% confidence2021SMD = −2.62, 95% CI [−3.87, −1.38], p < 0.00001
Low-quality journalSome bias concernsStudies disagree (I² 94%)Main outcomeOpen-labelInactive controlMeta-analysisBpositiven=96050% confidence2025HT significantly improved depression (g = 1.050; 95 % CI: 0.663-1.437)
SMD 1.05 [0.66, 1.44]Large effectTop journalSome bias concernsPooled RCTsStudies disagreeMain outcomeInactive controlMeta-analysisBpositiven=69875% confidence2023a significantly positive difference was found in the impact of horticultural therapy [SMD = −1.62, 95% CI (−2.56, −0.69), p = 0.0007]
SMD -1.62 [-2.56, -0.69]Large effectWeak journalStudies disagree (I² 97%)Main outcome+10 more in SourcesMeta-analysisBpositiven=60875% confidence2022Meta-analysis suggested that mean depression scores of elderly people who underwent horticultural therapy intervention were significantly lower than those who did not receive HT therapy (Hedge's g = -1.785, p < 0.001).
SMD -1.78Large effectWeak journalSome bias concernsStudies disagree (I² 96%)Main outcome - →Anxiety ReductionCertaintyMediumSourceRCTModerate effectlong-term9 cited studies · 1 other source
A 2024 meta-analysis pooling randomized trials involving 710 people reported an effect on anxiety (SMD = 0.627, 95% CI 0.364 to 0.890). A separate 2025 meta-analysis of randomized trials involving 960 people also reported an effect on anxiety (g = 0.702; 95 % CI: 0.341-1.062).
What the sources found
9 positive · 1 neutral · 0 negativeconfidence 58/100
How big is the effect
Moderate effectA clear difference on average.
Rating adjusted
Lowered from High to Medium after checking study quality: journal, risk of bias, trial size and design.
Who was studied
- Healthy people and patients
- Alzheimer's Disease
- Anxiety Disorder (General)
- Dementia
- Depression
- Intellectual Disability
- Schizophrenia
Where the evidence comes from
- Article9
- Expert opinion1
Protocol behind this outcome
4 protocolsEstimatedWhat the studies reporting this result did.
- Intensity
- Low
- Format
- Group
- Supervision
- Instructor-led
Courses and single sessions · 3 repeated-course and 1 single-session protocols
What worked in trials2 trials and meta-analyses
Randomized trials and meta-analyses that found this benefit: the smallest and the typical amount. Not a target and not a limit.
Smallest Typical Session 88 min 89 min How often 2×/week 2.6×/week Per week 180 min 231 min Timing
A trial found it after a single session
Trials that found it ran as little as 4 weeks, typically 14
After stopping, the benefit partly faded (1 study) · See “When you stop”
Follow-up: 4-week follow-up after program completion
Derived from (1)
Open Anxiety ReductionShow studies (10)
Meta-analysisBpositiven=289970% confidence2024HT has moderate to large effect sizes on anxiety (SMD = 0.627, 95% CI 0.364 to 0.890)
SMD 0.63 [0.36, 0.89]Moderate effectWeak journalSome bias concernsPooled RCTsStudies disagree (I² 92%)Main outcomeOpen-labelInactive controlMeta-analysisBpositiven=257875% confidence2017Gardening is beneficial for health: A meta-analysis.
Reductions in depression and anxiety symptoms, stress, mood disturbance, and BMI
Top journalMeta-analysisBpositiven=96045% confidence2025anxiety (g = 0.702; 95 % CI: 0.341-1.062)
SMD 0.7 [0.34, 1.06]Moderate effectTop journalSome bias concernsPooled RCTsStudies disagreeInactive controlSystematic reviewCpositiven=96070% confidence2022Both studies found significant decreases in participants' anxiety following the interventions.
Some bias concernsSystematic reviewCpositiven=1640% confidence2021Effectiveness of Therapeutic Gardens for People with Dementia: A Systematic Review.
Using the BAI, they found a 36% improvement in anxiety and depression from test to re-test.
36%Large effectLow-quality journal+4 more in SourcesRCTBpositiven=21175% confidence2024At 4 weeks, mean HADS-A was 9.55 ± 4.10 in the horticultural therapy group (n=99) and 11.02 ± 4.39 in the control group (n=92), difference statistically significant (mean difference = -1.48, 95% CI -2.68 to -0.27, P=0.017).
MD -1.48 [-2.68, -0.27]Weak journalMain outcomeOpen-labelInactive controlCompleters onlyBorderline p-value - →Stress Resilience ImprovementCertaintyMediumSourceRCTModerate effect8 cited studies
A 2017 meta-analysis pooling randomized and non-randomized human studies reported reductions in depression and anxiety symptoms, stress, mood disturbance, and BMI. A 2023 systematic review pooling human studies reported a psychological effect among 1,036 people (SMD = −0.73, 95% CI [−0.91, −0.54], p < 0.0001, I^2 = 44%).
What the sources found
7 positive · 1 neutral · 0 negativeconfidence 52/100
How big is the effect
Moderate effectA clear difference on average.
Who was studied
- Healthy people and patients
- Anxiety Disorder (General)
- Dementia
- Depression
- Frailty
- Intellectual Disability
- Mild Cognitive Impairment
- +1 more
Where the evidence comes from
- Article8
Protocol behind this outcome
3 protocolsEstimatedWhat the studies reporting this result did.
90 min · 3×/week
- Course
- 11 weeks
- Per week
- 270 min
- Intensity
- Low
- Format
- Group
- Supervision
- Instructor-led
A repeated course
Open Stress Resilience ImprovementShow studies (8)
Meta-analysisBpositiven=257875% confidence2017Gardening is beneficial for health: A meta-analysis.
Reductions in depression and anxiety symptoms, stress, mood disturbance, and BMI
Top journalSystematic reviewBpositiven=103675% confidence2023Horticultural therapy for stress reduction: A systematic review and meta-analysis.
psychological effectiveness was more significant (SMD = −0.73, 95% CI [−0.91, −0.54], p < 0.0001, I^2 = 44%)
SMD -0.73 [-0.91, -0.54]Moderate effectWeak journalStudies disagree (I² 83%)Main outcomeMeta-analysisCpositiven=1174155% confidence2023Effects of horticultural therapy on health in the elderly: A review and meta-analysis.
lower their stress -0.339 (95% CI -0.610, -0.069)
SMD -0.34 [-0.61, -0.07]Small effectStudies disagree (I² 99%)Open-labelSystematic reviewCpositiven=1655% confidence2021Effectiveness of Therapeutic Gardens for People with Dementia: A Systematic Review.
There was a significant drop in BPT from T1 to T2 (p < 0.05), while heart rates at T3 and T4 were between those at T1 and T2.
Low-quality journalRCTCneutraln=5950% confidence2018Effects of Horticultural Therapy on Asian Older Adults: A Randomized Controlled Trial.
Based on the rANOVA results, there were no significant effects of time, effects of group or time × group interactions on the levels of these four biomarkers: IL-1β, cortisol, DHEA and hs-CRP.
Low-quality journalOpen-labelInactive control+2 more in SourcesQuasi ExperimentalCpositiven=2655% confidence2026both raw and log10-transformed salivary cortisol concentrations decreased significantly after each session... r values from -0.80 to -0.87
Weak journalOpen-label - →Cognitive Function ImprovementCertaintyMediumSourceRCTModerate effect11 cited studies
A 2025 meta-analysis pooling randomized trials involving 960 people reported an effect on cognition (g = 0.816; 95 % CI: 0.302-1.331). The studies involved varied groups, including people with dementia, depression, frailty, and mild cognitive impairment.
What the sources found
9 positive · 2 neutral · 0 negativeconfidence 50/100
How big is the effect
Moderate effectA clear difference on average.
Who was studied
- Healthy people and patients
- Dementia
- Depression
- Elderly
- Frailty
- Intellectual Disability
- Mild Cognitive Impairment
- +2 more
Where the evidence comes from
- Article11
Protocol behind this outcome
3 protocolsEstimatedWhat the studies reporting this result did.
- Course
- 12 weeks
- Format
- Group
- Supervision
- Instructor-led
A repeated course
What worked in trials2 trials and meta-analyses
Randomized trials and meta-analyses that found this benefit: the smallest and the typical amount. Not a target and not a limit.
Smallest Typical How often 2×/week Open Cognitive Function ImprovementShow studies (11)
Meta-analysisBpositiven=257875% confidence2017Gardening is beneficial for health: A meta-analysis.
Increases in quality of life, sense of community, physical activity levels, and cognitive function
Top journalMeta-analysisBpositiven=96040% confidence2025cognition (g = 0.816; 95 % CI: 0.302-1.331)
SMD 0.82 [0.3, 1.33]Large effectTop journalSome bias concernsPooled RCTsStudies disagreeInactive controlMeta-analysisBpositiven=41155% confidence2022Effectiveness of horticultural therapy in people with dementia: A quantitative systematic review.
significant differences were found in the effectiveness of participatory horticultural therapy on total score of cognitive function
Top journalMain outcomeMeta-analysisBpositiven=65560% confidence2024horticultural therapy had a significant positive impact on various aspects of the patients' well-being when compared to conventional care... improve cognitive function scores
Top journalHigh risk of biasPooled RCTsMain outcomeInactive controlMeta-analysisCpositiven=1174150% confidence2023Effects of horticultural therapy on health in the elderly: A review and meta-analysis.
Cognitive(K-MMSE) 0.883 (0.631, 1.135)
SMD 0.88 [0.63, 1.14]Large effectStudies disagree (I² 99%)Open-label+5 more in SourcesSystematic reviewCpositiven=121435% confidence2023The effect of horticultural therapy on older adults in pension institutions: a systematic review.
In addition, HT improved satisfaction, quality of life, cognition, and social relationships
Studies disagree - →Physical FunctionCertaintyMediumSourceRCTModerate effectlong-term5 cited studies
A 2024 meta-analysis of randomized trials involving 655 people reported improvement in daily activities. However, a 2021 systematic review found no difference between groups in activities of daily living in a study involving 16 people.
What the sources found
4 positive · 1 neutral · 0 negativeconfidence 48/100
How big is the effect
Moderate effectA clear difference on average.
Who was studied
- Healthy people and patients
- Dementia
- Frailty
- Mild Cognitive Impairment
Where the evidence comes from
- Article5
Protocol behind this outcome
2 protocolsMeasuredWhat the studies reporting this result did.
180 min · 2×/week
- Course
- 15 weeks
- Per week
- 360 min
- Intensity
- Low
- Format
- Group
- Supervision
- Instructor-led
A repeated course
Open Physical FunctionShow studies (5)
Meta-analysisBpositiven=162935% confidence2024compared to agility, which showed a smaller effect size (g = 0.45; 95% CI, -0.90 to -0.01).
SMD -0.45 [-0.9, -0.01]Small effectTop journalMeta-analysisBpositiven=65555% confidence2024enhance daily activities
Top journalHigh risk of biasPooled RCTsInactive controlMeta-analysisCpositiven=1174150% confidence2023Effects of horticultural therapy on health in the elderly: A review and meta-analysis.
barthel index: 0.644, 95% CI: 0.352, 0.935
SMD 0.64 [0.35, 0.94]Moderate effectStudies disagree (I² 99%)Open-labelSystematic reviewCpositiven=121440% confidence2023The effect of horticultural therapy on older adults in pension institutions: a systematic review.
The effects of HT were significant in terms of physical, physiological, and psychological aspects.
Studies disagreeMain outcomeSystematic reviewCneutraln=1660% confidence2021Effectiveness of Therapeutic Gardens for People with Dementia: A Systematic Review.
The report from Pedrinolla et al. describes the only study in the present review to have examined activities of daily living (using the Barthel Index), which detected no differences between the experimental and control groups.
Low-quality journal
Medium probability(3)
- →Flexibility ImprovementCertaintyMediumSourceRCTSmall effect2 cited studies
A 2022 meta-analysis of randomized trials reported improved upper body flexibility among older adults with cancer. A 2023 meta-analysis pooling randomized and non-randomized human studies also reported an effect on physical flexibility (SMD 0.302 [0.036, 0.569]) in an analysis of 236 people.
What the sources found
2 positive · 0 neutral · 0 negativeconfidence 55/100
How big is the effect
Small effectA small but noticeable difference on average.
Who was studied
- Healthy people and patients
- Cancer (General)
- Dementia
- Frailty
- Mild Cognitive Impairment
Where the evidence comes from
- Article2
Open Flexibility ImprovementShow studies (2)
Meta-analysisBpositiven=88455% confidence2022Compared with the control group, HT can significantly improve upper body flexibility and aerobic endurance in older adults with cancer.
Top journalPooled RCTsInactive controlMeta-analysisCpositiven=1174155% confidence2023Effects of horticultural therapy on health in the elderly: A review and meta-analysis.
improve their physical flexibility 0.302 (95% CI 0.036, 0.569)
SMD 0.3 [0.04, 0.57]Small effectStudies disagree (I² 99%)Open-label - →Immune System SupportCertaintyMediumSourceRCT2 cited studies · 1 other source
A 2022 pooled analysis reported changes in several T-cell populations, including increased numbers of naive CD8 T cells compared with a waiting-list group. A 2021 randomized trial involving 59 people also found increased naive CD8+ T-cell numbers after Gardening Therapy, but not in the waiting-list control group; these are cell-marker findings, not evidence of broader protection from illness.
What the sources found
3 positive · 0 neutral · 0 negativeconfidence 50/100
How big is the effect
No study gave a number we could compare, so the size is not known.
Who was studied
- Healthy people and patients
- Alzheimer's Disease
- Cancer (General)
- Dementia
- Depression
- Frailty
- Stroke
Where the evidence comes from
- Article2
- Expert opinion1
Protocol behind this outcome
2 protocolsEstimatedWhat the studies reporting this result did.
60 min · 1×/week
- Per week
- 60 min
- Intensity
- Low
- Format
- Group
- Supervision
- Instructor-led
A repeated course
Timing
Trials that found it ran as little as 26 weeks, typically 28
Open Immune System SupportShow studies (3)
Meta-analysisBpositiven=104640% confidence2022Horticultural therapy for general health in the older adults: A systematic review and meta-analysis.
HT was associated with a reduction in the proportion of CTLA4+ TEMRAs and CTLA+CD8+ TEMRAs, and increasing the absolute numbers of naive CD8T cells when compared to waiting list group.
Weak journalHigh risk of biasOpen-labelRCTCpositiven=5960% confidence2021naive CD8+ T-cell numbers were also increased following HT but not in the waitlist control group
Top journalMain outcomeBlinded assessorInactive controlCompleters only22% dropped outExpert opinionpositive50% confidenceExposure to soil-based microbes such as Mycobacterium vaccae during gardening enhances regulatory T-cell activity and systemic immune regulation, supporting long-term immune resilience.
Expert knowledge synthesis - →Physical Endurance IncreaseCertaintyMediumSourceRCTLarge effect3 cited studies
A 2024 meta-analysis pooling randomized and non-randomized human studies reported an effect on aerobic endurance (g = 0.84; 95% CI, 0.54-1.15). A 2022 meta-analysis of randomized trials also reported improved aerobic endurance in older adults with cancer.
What the sources found
3 positive · 0 neutral · 0 negativeconfidence 38/100
How big is the effect
Large effectA big difference on average. Check how strong the evidence is.
Who was studied
- Healthy people and patients
- Cancer (General)
- Dementia
- PTSD (Post-Traumatic Stress Disorder)
Where the evidence comes from
- Article3
Open Physical Endurance IncreaseShow studies (3)
Meta-analysisBpositiven=162940% confidence2024HT appeared to have a greater impact on aerobic endurance, with a large effect size (g = 0.84; 95% CI, 0.54-1.15).
SMD 0.84 [0.54, 1.15]Large effectTop journalMeta-analysisBpositiven=88455% confidence2022Compared with the control group, HT can significantly improve upper body flexibility and aerobic endurance in older adults with cancer.
Top journalPooled RCTsInactive controlNarrative reviewDpositive20% confidence2021This research revealed that horticulture can provide physical, neurological, and psychological rehabilitation, whilst improving motor skills as well as strength and endurance.
Top journalNarrative review
Low probability(14)
- →Weight Management SupportCertaintyLowSourceRCTSmall effect3 cited studies
A 2022 meta-analysis pooling randomized and non-randomized human studies found a small reduction in BMI among older adults compared with control groups (SMD -0.30, 95% [-0.57, -0.04]; I² = 0%, P = 0.02), in an analysis of 1,046 people.
What the sources found
3 positive · 0 neutral · 0 negativeconfidence 55/100
How big is the effect
Small effectA small but noticeable difference on average.
Who was studied
- Healthy people and patients
- Alzheimer's Disease
- Cancer (General)
- Dementia
- Depression
- Frailty
- Intellectual Disability
- +2 more
Where the evidence comes from
- Article3
Protocol behind this outcome
2 protocolsEstimatedWhat the studies reporting this result did.
- Course
- 29 weeks
- Format
- Group
- Supervision
- Instructor-led
A repeated course
Open Weight Management SupportShow studies (3)
Meta-analysisBpositiven=257875% confidence2017Gardening is beneficial for health: A meta-analysis.
Reductions in depression and anxiety symptoms, stress, mood disturbance, and BMI
Top journalMeta-analysisBpositiven=104670% confidence2022Horticultural therapy for general health in the older adults: A systematic review and meta-analysis.
HT could reduce BMI of older adults compared with participants in control groups (SMD -0.30, 95% [-0.57, -0.04]; I² = 0%, P = 0.02)
SMD -0.3 [-0.57, -0.04]Small effectWeak journalHigh risk of biasOpen-labelNarrative reviewDpositive20% confidence2021found that horticultural therapy is an active, non-pharmaceutical intervention that can help people to improve their mood, reduce obesity and increase social interactions, often caused by isolation in veterans.
Top journalNarrative review - →Blood Pressure SupportCertaintyLowSourceRCTSmall effect2 cited studies
A 2022 meta-analysis pooling randomized and non-randomized human studies suggested Gardening Therapy might help maintain stable blood pressure compared with doing nothing, especially systolic pressure; reported values were 136.54±3.38/71.86±3.71 vs. 152.40±3.64/65.90±3.33 (mmHg). A 2023 meta-analysis also reported an effect on systolic blood pressure in an analysis of 184 people (SMD -0.411 [-0.704, -0.118]).
What the sources found
2 positive · 0 neutral · 0 negativeconfidence 45/100
How big is the effect
Small effectA small but noticeable difference on average.
Who was studied
- Healthy people and patients
- Alzheimer's Disease
- Cancer (General)
- Dementia
- Depression
- Frailty
- Mild Cognitive Impairment
- +1 more
Where the evidence comes from
- Article2
Protocol behind this outcome
2 protocolsEstimatedWhat the studies reporting this result did.
- Course
- 29 weeks
- Format
- Group
- Supervision
- Instructor-led
A repeated course
Open Blood Pressure SupportShow studies (2)
Meta-analysisBpositiven=104640% confidence2022Horticultural therapy for general health in the older adults: A systematic review and meta-analysis.
compared to doing nothing, HT might maintain the stable blood pressure, especially in systolic pressure (136.54±3.38/71.86±3.71 vs. 152.40±3.64/65.90±3.33) (mmHg)
Weak journalHigh risk of biasOpen-labelMeta-analysisCpositiven=1174150% confidence2023Effects of horticultural therapy on health in the elderly: A review and meta-analysis.
Blood pressure--systolic blood pressure (mm Hg) -0.411 (-0.704, -0.118)
SMD -0.41 [-0.7, -0.12]Small effectStudies disagree (I² 99%)Open-label - →Loneliness ReductionCertaintyLowSourceClinical1 cited study
A 2022 review of studies involving people with Alzheimer’s disease, anxiety, dementia, or depression reported a post-gardening-therapy reduction in loneliness; interviews conducted in the same study also supported this finding.
What the sources found
1 positive · 0 neutral · 0 negativeconfidence 55/100
How big is the effect
No study gave a number we could compare, so the size is not known.
Who was studied
- People with a condition
- Alzheimer's Disease
- Anxiety Disorder (General)
- Dementia
- Depression
Where the evidence comes from
- Article1
Timing
A trial found it after a single session
Open Loneliness ReductionShow studies (1)
Systematic reviewCpositiven=96055% confidence2022Significant post-HT reduction in loneliness was detected, which was also supported by post-intervention interviews conducted in the same study.
Some bias concerns - →Balance ImprovementCertaintyLowSourceClinical1 cited study · 1 other source
A 2021 systematic review reported that falls decreased from 288 to 200 in the year after a garden opened; the review examined people with dementia.
What the sources found
2 positive · 0 neutral · 0 negativeconfidence 53/100
How big is the effect
No study gave a number we could compare, so the size is not known.
Who was studied
- People with a condition
- Dementia
Where the evidence comes from
- Article1
- Expert opinion1
Open Balance ImprovementShow studies (2)
Systematic reviewCpositiven=1655% confidence2021Effectiveness of Therapeutic Gardens for People with Dementia: A Systematic Review.
The number of falls decreased from 288 to 200 in the year after the garden was opened.
Low-quality journalExpert opinionpositive50% confidenceGardening therapy improves balance and reduces fall risk in older adults through varied physical movements and postural control demands.
Expert knowledge synthesis - →Inflammation ReductionCertaintyLowSourceClinical1 cited study
A 2021 randomized trial in 59 healthy participants found reduced IL-6 levels during gardening therapy.
What the sources found
1 positive · 0 neutral · 0 negativeconfidence 60/100
How big is the effect
No study gave a number we could compare, so the size is not known.
Who was studied
- Healthy people
Where the evidence comes from
- Article1
Protocol behind this outcome
1 protocolEstimatedWhat the studies reporting this result did.
60 min · 1×/week
- Course
- 26 weeks
- Per week
- 60 min
- Intensity
- Low
- Format
- Small group
- Supervision
- Instructor-led
A repeated course
Open Inflammation ReductionShow studies (1)
RCTCpositiven=5960% confidence2021IL-6 levels were reduced during HT
Top journalMain outcomeBlinded assessorInactive controlCompleters only22% dropped out - →Physical Strength IncreaseCertaintyLowSourceClinicalSmall effect2 cited studies
A 2023 meta-analysis pooling randomized and non-randomized human studies involving 90 people reported a small effect on pinch force (SMD 0.368 [0.062, 0.674]).
What the sources found
2 positive · 0 neutral · 0 negativeconfidence 38/100
How big is the effect
Small effectA small but noticeable difference on average.
Who was studied
- Healthy people and patients
- Dementia
- Frailty
- Mild Cognitive Impairment
- PTSD (Post-Traumatic Stress Disorder)
Where the evidence comes from
- Article2
Open Physical Strength IncreaseShow studies (2)
Meta-analysisCpositiven=1174155% confidence2023Effects of horticultural therapy on health in the elderly: A review and meta-analysis.
Pinch force (kg) 0.368 (0.062, 0.674)
SMD 0.37 [0.06, 0.67]Small effectStudies disagree (I² 99%)Open-labelNarrative reviewDpositive20% confidence2021This research revealed that horticulture can provide physical, neurological, and psychological rehabilitation, whilst improving motor skills as well as strength and endurance.
Top journalNarrative review - →Sleep Quality ImprovementCertaintyLowSourceClinical1 cited study
A 2021 systematic review of people with dementia involving 16 people reported fewer and shorter nocturnal awakenings and naps, along with more nocturnal sleep time and better sleep efficacy (frequency: p = 0.002, duration: p = 0.011; naps: frequency: p < 0.001, duration: p < 0.001; sleep time: p = 0.002; efficacy: p = 0.006).
What the sources found
1 positive · 0 neutral · 0 negativeconfidence 60/100
How big is the effect
No study gave a number we could compare, so the size is not known.
Who was studied
- People with a condition
- Dementia
Where the evidence comes from
- Article1
Open Sleep Quality ImprovementShow studies (1)
Systematic reviewCpositiven=1660% confidence2021Effectiveness of Therapeutic Gardens for People with Dementia: A Systematic Review.
Significant improvements emerged, with a decrease in the frequency and duration of nocturnal awakenings (frequency: p = 0.002, duration: p = 0.011) and naps (frequency: p < 0.001, duration: p < 0.001), and an increase in nocturnal sleep time (p = 0.002) and efficacy (p = 0.006).
Low-quality journal - →Self-Awareness IncreaseCertaintyLowSourceClinical1 cited study
A 2021 review reported that the garden group’s overall SCQ score increased from T0 to T1, with improvement in body representation (p = 0.02), while the control group’s score decreased (p = 0.03). The finding concerned people with dementia.
What the sources found
1 positive · 0 neutral · 0 negativeconfidence 60/100
How big is the effect
No study gave a number we could compare, so the size is not known.
Who was studied
- People with a condition
- Dementia
Where the evidence comes from
- Article1
Open Self-Awareness IncreaseShow studies (1)
Systematic reviewCpositiven=1660% confidence2021Effectiveness of Therapeutic Gardens for People with Dementia: A Systematic Review.
From T0 to T1 there was an increase in the overall SCQ score for the group using the garden due to a significant improvement in body representation (p = 0.02), whereas this score decreased significantly in the control group (p = 0.03) during the same period.
Low-quality journal - →Present Moment AwarenessCertaintyLowSourceClinical1 cited study · 1 other source
In a 2022 quasi-experimental study of 111 people with anxiety or depression, the mean MAAS score increased from 55.9 at baseline to 62.7 at post-test (B = 6.296, p = 0.0035), with a small effect (d = 0.40).
What the sources found
2 positive · 0 neutral · 0 negativeconfidence 40/100
How big is the effect
No study gave a number we could compare, so the size is not known.
Who was studied
- People with a condition
- Anxiety Disorder (General)
- Depression
Where the evidence comes from
- Article1
- Community reports1
Protocol behind this outcome
1 protocolMeasuredWhat the studies reporting this result did.
180 min · 2×/week
- Course
- 15 weeks
- Per week
- 360 min
- Intensity
- Low
- Format
- Group
- Supervision
- Instructor-led
A repeated course
Open Present Moment AwarenessShow studies (2)
Quasi ExperimentalCpositiven=11160% confidence2022The Multi-Sites Trial on the Effects of Therapeutic Gardening on Mental Health and Well-Being.
The mean MAAS score increased significantly from 55.9 at baseline to 62.7 at post-test (B = 6.296, p = 0.0035), with a small effect (d = 0.40).
SMD 0.4Small effectLow-quality journalMain outcomeOpen-labelNo control groupToo small to detect itCommunity reportssubtle effectpositive20% confidenceThis effect was mentioned in 2 of 5 YouTube videos discussing it.
2 mentions - →Coordination ImprovementCertaintyLowSourceReviewnot used for recommendations1 cited study
A 2021 narrative review described horticulture as potentially supporting rehabilitation and improving motor skills. The finding is from a review, not human clinical evidence.
What the sources found
1 positive · 0 neutral · 0 negativeconfidence 20/100
How big is the effect
No study gave a number we could compare, so the size is not known.
Who was studied
- People with a condition
- PTSD (Post-Traumatic Stress Disorder)
Where the evidence comes from
- Article1
Why it isn't used for recommendations
Narrative review only, low confidence
Open Coordination ImprovementShow studies (1)
Narrative reviewDpositive20% confidence2021This research revealed that horticulture can provide physical, neurological, and psychological rehabilitation, whilst improving motor skills as well as strength and endurance.
Top journalNarrative review - →Concentration ImprovementCertaintyLowSourceReviewnot used for recommendations1 cited study
A 2021 narrative review described being outdoors in natural environments as associated with reduced stress and improved concentration and cognitive function. This is a review finding, not human clinical evidence.
What the sources found
1 positive · 0 neutral · 0 negativeconfidence 20/100
How big is the effect
No study gave a number we could compare, so the size is not known.
Who was studied
- People with a condition
- PTSD (Post-Traumatic Stress Disorder)
Where the evidence comes from
- Article1
Why it isn't used for recommendations
Narrative review only, low confidence
Open Concentration ImprovementShow studies (1)
Narrative reviewDpositive20% confidence2021being outside in the natural environment has been found to reduced stress and improve concentration and cognitive function.
Top journalNarrative review - →Grip Strength ImprovementCertaintyLowSourceTheoreticalnot used for recommendations1 other source
Digging, weeding, and pruning are proposed to support hand grip strength and dexterity.
What the sources found
1 positive · 0 neutral · 0 negativeconfidence 50/100
How big is the effect
No study gave a number we could compare, so the size is not known.
Where the evidence comes from
- Expert opinion1
Why it isn't used for recommendations
No supporting study on file
Open Grip Strength ImprovementShow studies (1)
Expert opinionpositive50% confidenceGardening activities such as digging, weeding, and pruning improve hand grip strength and dexterity.
Expert knowledge synthesis - →Biorhythm RegulationCertaintyLowSourceTheoreticallong-termnot used for recommendations1 other source
Morning and midday outdoor gardening is proposed to support sleep-wake cycle stability through natural-light exposure and the timing of physical activity.
What the sources found
1 positive · 0 neutral · 0 negativeconfidence 50/100
How big is the effect
No study gave a number we could compare, so the size is not known.
Where the evidence comes from
- Expert opinion1
Why it isn't used for recommendations
No supporting study on file
Open Biorhythm RegulationShow studies (1)
Expert opinionpositive50% confidenceMorning and midday gardening outdoors reinforces circadian rhythms through natural light exposure and physical activity timing, improving sleep-wake cycle stability.
Expert knowledge synthesis - →Gut Microbiome Health SupportCertaintyLowSourceTheoreticallong-termnot used for recommendations1 other source
Direct contact with garden soil is proposed to expose people to diverse environmental microbes that may influence gut microbiome composition and immune crosstalk.
What the sources found
1 positive · 0 neutral · 0 negativeconfidence 50/100
How big is the effect
No study gave a number we could compare, so the size is not known.
Where the evidence comes from
- Expert opinion1
Why it isn't used for recommendations
No supporting study on file
Open Gut Microbiome Health SupportShow studies (1)
Expert opinionpositive50% confidenceDirect contact with garden soil introduces diverse environmental microbes that may positively influence gut microbiome composition and immune crosstalk.
Expert knowledge synthesis
Very low probability(1)
- →Rumination ReductionCertaintyVery lowSourceClinicalnot used for recommendations1 cited study
Human evidence for a reduction in rumination is not established; the listed research concerned people with back pain.
What the sources found
0 positive · 1 neutral · 0 negativeconfidence 50/100
How big is the effect
No study gave a number we could compare, so the size is not known.
Who was studied
- People with a condition
- Back Pain
Where the evidence comes from
- Article1
Why it isn't used for recommendations
Studied, with no positive result
Open Rumination ReductionShow studies (1)
RCTCneutraln=1650% confidence2024Change in rumination [-0.5 (4.4) after handiwork and -0.3 (2.8) after HT] and catastrophizing scores [-2 (2.8) after handiwork and -1.4 (2.3) after HT] did not differ between activities (p = 0.99 and 0.22, respectively).
MD -0.2 [-2.8, 2.4]Weak journalOpen-label
What to expect
Some mood-, anxiety- and social-related changes were reported after a single session. For effects measured across programmes, anxiety-related findings came from trials lasting as little as 4 weeks and typically 14 weeks, while antidepressant effects were measured after 13 weeks at the earliest and typically 18 weeks. Some of these gains had partly faded by a 4-week follow-up; immune-related findings were measured in programmes lasting 26 to 28 weeks.
Conditions it's used for
Complaints and diagnoses people take it for15 listedMost likely to help, from the evidence we have
- →DementiaCertaintyMediumSourceRCTModerate effect11 cited studies
A 2017 meta-analysis of randomized and non-randomized human studies reported positive affect outcomes in two studies involving people with dementia. A 2022 meta-analysis of randomized trials did not support the authors’ recommendation for this approach in older adults with dementia.
How big is the effect
Moderate effectA clear difference on average.
Who was studied
- Healthy people and patients
- Alzheimer's Disease
- Cancer (General)
- Dementia
- Depression
- Elderly
- Frailty
- +4 more
Protocol behind this outcome
5 protocolsEstimatedWhat the studies reporting this result did.
90 min · 2.5×/week
- Course
- 12 weeks
- Per week
- 270 min
- Intensity
- Low
- Format
- Group
- Supervision
- Instructor-led
Courses and single sessions · 3 repeated-course and 1 single-session protocols
Open DementiaShow studies (11)
Meta-analysisBn=257860% confidence2017Gardening is beneficial for health: A meta-analysis.
Two studies included people with dementia and reported positive affect outcomes.
Top journalMeta-analysisBn=88430% confidence2022Authors recommend HT when caring for older adults with dementia; not supported by reported pooled outcome in abstract.
Top journalPooled RCTsInactive controlMeta-analysisBn=41155% confidence2022Effectiveness of horticultural therapy in people with dementia: A quantitative systematic review.
Meta-analysis of 14 studies (4 RCTs, 10 quasi-experimental) in 411 people with dementia; participatory horticultural therapy showed significant benefits on cognition, agitation, positive emotion and engagement.
Top journalMeta-analysisB60% confidence2024Reviews focusing on specific populations documented that horticulture-based therapy had a positive impact on the mental and physical well-being of people with dementia.
Top journalStudies disagree (I² 89%)Meta-analysisBn=104640% confidence2022Horticultural therapy for general health in the older adults: A systematic review and meta-analysis.
Included studies recruited participants with dementia; cohort study showed HT improved physical function and mood.
Weak journalHigh risk of biasOpen-label+5 more in SourcesMeta-analysisBn=65555% confidence2024The pooled population was older patients diagnosed with dementia; horticultural therapy was studied in this group.
Top journalHigh risk of biasPooled RCTsInactive control - →DepressionCertaintyMediumSourceRCTModerate effect12 cited studies
A 2022 meta-analysis of 13 studies (6 RCTs, 7 quasi-experimental) reported reduced depressive symptoms (Hedge's g = -1.785, p < 0.001). A separate 2025 pooled analysis of randomized trials examined depression among people with depressive disorders.
How big is the effect
Moderate effectA clear difference on average.
Rating adjusted
Lowered from High to Medium after checking study quality: journal, risk of bias, trial size and design.
Who was studied
- Healthy people and patients
- Alzheimer's Disease
- Anxiety Disorder (General)
- Cancer (General)
- Dementia
- Depression
- Frailty
- +5 more
Protocol behind this outcome
5 protocolsEstimatedWhat the studies reporting this result did.
135 min · 1×/week
- Course
- 18 weeks
- Intensity
- Low
- Format
- Group
- Supervision
- Instructor-led
Courses and single sessions · 4 repeated-course and 1 single-session protocols
Open DepressionShow studies (12)
Meta-analysisBn=453570% confidence2025Effect of gardening activities on domains of health: a systematic review and meta-analysis.
Meta-analysis showed moderate effect on mental health; sensitivity analysis significant for mental health.
Top journalStudies disagree (I² 100%)Meta-analysisBn=257875% confidence2017Gardening is beneficial for health: A meta-analysis.
Subgroup analysis showed significant positive effects for patients, including those with depression; multiple studies included patients with depression.
Top journalMeta-analysisBn=96050% confidence2025Pooled effects of HT on depression, anxiety, cognition, social function and quality of life in individuals with depressive disorders across 13 RCTs; certainty very low to low.
Top journalSome bias concernsPooled RCTsInactive controlMeta-analysisBn=69875% confidence2023Meta-analysis of 13 studies showing significant reduction in depressive symptoms (SMD = -1.62, 95% CI [-2.56, -0.69]).
SMD -1.62 [-2.56, -0.69]Large effectWeak journalStudies disagree (I² 97%)Meta-analysisBn=60875% confidence2022Meta-analysis of 13 studies (6 RCTs, 7 quasi-experimental) showing significant reduction in depressive symptoms (Hedge's g = -1.785, p < 0.001).
Weak journalSome bias concernsStudies disagree (I² 96%)+6 more in SourcesMeta-analysisBn=43555% confidence2026Pooled effect of HT on GDS depression scores in older adults with depressive symptoms (SMD = −0.52, 95% CI −0.86 to −0.18) across 7 RCTs.
SMD -0.52 [-0.86, -0.18]Moderate effectWeak journalSome bias concernsPooled RCTsStudies disagree (I² 66%) - →Anxiety Disorder (General)CertaintyMediumSourceRCT4 cited studies
A review of randomized trials reported improvements in anxiety in nature-based intervention groups versus controls, but gave no pooled estimate. Both studies measuring anxiety in a 2022 review found decreases, including after a 15-minute single session.
How big is the effect
No study gave a number we could compare, so the size is not known.
Rating adjusted
Lowered from High to Medium after checking study quality: journal, risk of bias, trial size and design.
Who was studied
- People with a condition
- Alzheimer's Disease
- Anxiety Disorder (General)
- Dementia
- Depression
- Schizophrenia
Protocol behind this outcome
2 protocolsMeasuredWhat the studies reporting this result did.
90 min · 2×/week
- Course
- 4 weeks
- Per week
- 180 min
- Intensity
- Low
- Format
- Small group
- Supervision
- Instructor-led
Courses and single sessions · 1 repeated-course and 1 single-session protocols
Open Anxiety Disorder (General)Show studies (4)
Systematic reviewB45% confidence2026The effectiveness of nature-based interventions on mental health: A systematic review.
Review reports significant improvements in anxiety in NBI groups versus controls across included RCTs; no pooled estimate reported.
Top journalSome bias concernsPooled RCTsSystematic reviewCn=96070% confidence2022Both studies measuring anxiety found significant decreases, including a 15-minute single session.
Some bias concernsRCTBn=21175% confidence2024RCT showing significant reduction in HADS-A anxiety scores in psychiatric inpatients.
Weak journalOpen-labelInactive controlCompleters onlyQuasi ExperimentalCn=11160% confidence2022The Multi-Sites Trial on the Effects of Therapeutic Gardening on Mental Health and Well-Being.
Significant improvements in depression and anxiety scores from baseline to post-test in a single-arm trial.
Low-quality journalOpen-labelNo control group - →SchizophreniaCertaintyMediumSourceRCT3 cited studies
A 2024 meta-analysis pooling 35 randomized trials found improvements in total, positive and negative symptoms, depression, and anxiety among people with schizophrenia. A 2021 meta-analysis of randomized and non-randomized human studies also reported improvements in symptoms, rehabilitation outcomes, quality of life, and social functioning.
How big is the effect
No study gave a number we could compare, so the size is not known.
Rating adjusted
Lowered from Very high to Medium after checking study quality: journal, risk of bias, trial size and design.
Who was studied
- People with a condition
- Schizophrenia
Protocol behind this outcome
3 protocolsEstimatedWhat the studies reporting this result did.
89 min · 3.1×/week
- Course
- 18 weeks
- Per week
- 276 min
- Intensity
- Low
- Format
- Group
- Supervision
- Instructor-led
A repeated course
Open SchizophreniaShow studies (3)
Meta-analysisBn=289975% confidence2024Meta-analysis of 35 RCTs showing significant improvements in total, positive, negative symptoms, depression, and anxiety.
Weak journalSome bias concernsPooled RCTsStudies disagree (I² 92%)Open-labelInactive controlMeta-analysisBn=202480% confidence2021Meta-analysis of 23 studies showing significant improvements in symptoms, rehabilitation outcomes, quality of life, and social functioning.
Low-quality journalSome bias concernsStudies disagree (I² 94%)Open-labelInactive controlRCTCn=11070% confidence2016RCT showing significant improvement in PANSS scores when horticultural therapy is added to antipsychotic medication.
Low-quality journalBlinded assessorCompleters only
Low probability(11)
- →Intellectual DisabilityCertaintyLowSourceRCT1 cited study
One 2017 study involving students with intellectual disabilities reported improvements in attention and sociability.
How big is the effect
No study gave a number we could compare, so the size is not known.
Who was studied
- Healthy people and patients
- Dementia
- Depression
- Intellectual Disability
Open Intellectual DisabilityShow studies (1)
Meta-analysisBn=257860% confidence2017Gardening is beneficial for health: A meta-analysis.
One study on students with intellectual disabilities reported improvements in attention and sociability.
Top journal - →StrokeCertaintyLowSourceRCTnot used for recommendations1 cited study
One RCT found improved physical function when horticultural therapy was combined with acupuncture in people who had experienced a stroke, so the finding does not establish an effect of horticultural therapy alone.
How big is the effect
No study gave a number we could compare, so the size is not known.
Who was studied
- Healthy people and patients
- Alzheimer's Disease
- Cancer (General)
- Dementia
- Depression
- Frailty
- Stroke
Protocol behind this outcome
1 protocolEstimatedWhat the studies reporting this result did.
- Course
- 29 weeks
- Format
- Group
- Supervision
- Instructor-led
A repeated course
Why it isn't used for recommendations
A hospital-managed condition, never self-care
Open StrokeShow studies (1)
Meta-analysisBn=104640% confidence2022Horticultural therapy for general health in the older adults: A systematic review and meta-analysis.
One RCT showed HT plus acupuncture improved physical function in stroke patients.
Weak journalHigh risk of biasOpen-label - →Cancer (General)CertaintyLowSourceClinical2 cited studies
A 2023 meta-analysis of randomized and non-randomized human studies reported increased vegetable and fruit consumption and reduced waist circumference among cancer survivors.
How big is the effect
No study gave a number we could compare, so the size is not known.
Who was studied
- Healthy people and patients
- Alzheimer's Disease
- Cancer (General)
- Dementia
- Depression
- Frailty
- Stroke
Open Cancer (General)Show studies (2)
Meta-analysisBno effectn=104640% confidence2022Horticultural therapy for general health in the older adults: A systematic review and meta-analysis.
One RCT showed no significant effect on quality of life in cancer survivors (MD 2.02, 95% CI [-0.56, 4.60], P = 0.12).
MD 2.02 [-0.56, 4.6]Weak journalHigh risk of biasOpen-labelMeta-analysisCn=1174145% confidence2023Effects of horticultural therapy on health in the elderly: A review and meta-analysis.
Studies on cancer survivors showed increased vegetable/fruit consumption and reduced waist circumference with HT.
Studies disagree (I² 99%)Open-label - →Alzheimer's DiseaseCertaintyLowSourceClinical1 cited study
A 2022 systematic review reported quality-of-life improvements in four randomized trials among people with Alzheimer's disease; the conclusions were limited to this population.
How big is the effect
No study gave a number we could compare, so the size is not known.
Who was studied
- People with a condition
- Alzheimer's Disease
- Dementia
- Depression
Open Alzheimer's DiseaseShow studies (1)
Systematic reviewCn=96070% confidence2022Four RCTs showed significant QoL improvements in Alzheimer's Disease patients, though conclusions limited to this population.
Some bias concerns - →PTSD (Post-Traumatic Stress Disorder)CertaintyLowSourceReviewnot used for recommendations1 cited study
A 2021 review discussed potential benefits of horticultural therapy for PTSD, but did not describe it as a first-line treatment.
How big is the effect
No study gave a number we could compare, so the size is not known.
Who was studied
- People with a condition
- PTSD (Post-Traumatic Stress Disorder)
Why it isn't used for recommendations
Narrative review only, low confidence
Open PTSD (Post-Traumatic Stress Disorder)Show studies (1)
Narrative reviewD20% confidence2021Narrative review discussing potential benefits of horticultural therapy for PTSD, but not a first-line treatment.
Top journalNarrative review - →Addiction (General)CertaintyLowSourceTheoreticalnot used for recommendations1 other source
Gardening therapy is proposed as a support for addiction recovery through stress reduction, purposeful activity and improved self-esteem.
How big is the effect
No study gave a number we could compare, so the size is not known.
Where the evidence comes from
- Expert opinion
Why it isn't used for recommendations
No supporting study on file
Open Addiction (General)Show studies (1)
Expert opinion50% confidenceGardening therapy supports addiction recovery by reducing stress, providing purposeful activity, and improving self-esteem.
- →Autism Spectrum DisorderCertaintyLowSourceTheoreticalnot used for recommendations1 other source
Gardening therapy is described as a way to support social interaction, communication and sensory processing in people with autism spectrum disorder.
How big is the effect
No study gave a number we could compare, so the size is not known.
Where the evidence comes from
- Expert opinion
Why it isn't used for recommendations
No supporting study on file
Open Autism Spectrum DisorderShow studies (1)
Expert opinion50% confidenceGardening therapy improves social interaction, communication, and sensory processing in individuals with autism spectrum disorder.
- →Chronic Fatigue SyndromeCertaintyLowSourceTheoreticalnot used for recommendations1 other source
Gentle, graded gardening activities are used in pacing strategies to support physical function and psychological well-being while avoiding post-exertional malaise.
How big is the effect
No study gave a number we could compare, so the size is not known.
Where the evidence comes from
- Expert opinion
Why it isn't used for recommendations
No supporting study on file
Open Chronic Fatigue SyndromeShow studies (1)
Expert opinion50% confidenceGentle, graded gardening activities are used in pacing strategies for CFS to improve physical function and psychological well-being without triggering post-exertional malaise.
- →Chronic PainCertaintyLowSourceTheoreticalnot used for recommendations1 other source
Gardening therapy is proposed to help with chronic pain through distraction, physical activity and improved mood.
How big is the effect
No study gave a number we could compare, so the size is not known.
Where the evidence comes from
- Expert opinion
Why it isn't used for recommendations
No supporting study on file
Open Chronic PainShow studies (1)
Expert opinion50% confidenceGardening therapy reduces chronic pain through distraction, physical activity, and improved mood.
- →Parkinson's DiseaseCertaintyLowSourceTheoreticalnot used for recommendations1 other source
Gardening therapy is used to support motor coordination, mood and engagement in meaningful activities among people with Parkinson's disease.
How big is the effect
No study gave a number we could compare, so the size is not known.
Where the evidence comes from
- Expert opinion
Why it isn't used for recommendations
No supporting study on file
Open Parkinson's DiseaseShow studies (1)
Expert opinion50% confidenceGardening therapy is employed to improve motor coordination, mood, and engagement in meaningful activity among individuals with Parkinson’s disease.
- →Vitamin D DeficiencyCertaintyLowSourceTheoreticalnot used for recommendations1 other source
Controlled outdoor gardening is used as a behavioral approach to support vitamin D synthesis in people with deficiency, especially alongside dietary or supplemental strategies.
How big is the effect
No study gave a number we could compare, so the size is not known.
Where the evidence comes from
- Expert opinion
Why it isn't used for recommendations
No supporting study on file
Open Vitamin D DeficiencyShow studies (1)
Expert opinion50% confidenceControlled outdoor gardening is a recommended behavioral intervention to support vitamin D synthesis in deficient individuals, especially when combined with dietary or supplemental strategies.
Side effects
4 listedHighest probability
- →Skin Rash / IrritationCertaintyLowSourceClinical1 cited study
A pooled analysis of randomized and non-randomized human studies reported contact dermatitis to Alstroemeria; this finding concerns that plant specifically.
What the sources found
0 not observed · 0 unclear · 1 reportedconfidence 45/100
How big is the effect
No study gave a number we could compare, so the size is not known.
Who was studied
- Healthy people and patients
- Alzheimer's Disease
- Cancer (General)
- Dementia
- Depression
- Frailty
- Stroke
Where the evidence comes from
- Article1
Protocol behind this outcome
1 protocolEstimatedWhat the studies reporting this result did.
- Course
- 29 weeks
- Format
- Group
- Supervision
- Instructor-led
A repeated course
Open Skin Rash / IrritationShow studies (1)
Meta-analysisBnegativen=104645% confidence2022Horticultural therapy for general health in the older adults: A systematic review and meta-analysis.
Contact dermatitis to Alstroemeria
Weak journalHigh risk of biasOpen-label - →Heat IllnessCertaintyLowSourceReference knowledge1 other source
Prolonged outdoor gardening in hot weather can cause heat illness, especially when rest and hydration are inadequate.
What the sources found
0 not observed · 0 unclear · 1 reportedconfidence 75/100
How big is the effect
No study gave a number we could compare, so the size is not known.
Where the evidence comes from
- Reference knowledge1
Open Heat IllnessShow studies (1)
Reference knowledgenegative75% confidenceProlonged gardening outdoors in hot weather can cause heat illness, especially with inadequate rest and hydration.
- →Injury Risk IncreaseCertaintyLowSourceReference knowledge1 other source
Gardening tools, thorns, and other sharp materials can cause minor cuts or puncture injuries.
What the sources found
0 not observed · 0 unclear · 1 reportedconfidence 70/100
How big is the effect
No study gave a number we could compare, so the size is not known.
Where the evidence comes from
- Reference knowledge1
Open Injury Risk IncreaseShow studies (1)
Reference knowledgenegative70% confidenceGardening can cause minor cuts or puncture injuries from tools, thorns, and other sharp materials.
- →Muscle StrainCertaintyLowSourceReference knowledge1 other source
Prolonged gardening tasks involving repetitive bending, kneeling, lifting, or carrying heavy loads can strain muscles.
What the sources found
0 not observed · 0 unclear · 1 reportedconfidence 70/100
How big is the effect
No study gave a number we could compare, so the size is not known.
Where the evidence comes from
- Reference knowledge1
Open Muscle StrainShow studies (1)
Reference knowledgenegative70% confidenceRepetitive bending, kneeling, lifting, and carrying during gardening can strain muscles, particularly when tasks are prolonged or loads are heavy.
Don't do it if
When to skip it or get medical advice first5 listedHighest probability
- →History of AnaphylaxisCertaintyLowSourceReference knowledgeTheoretical
During outdoor Gardening Therapy, insect stings or plant allergens may trigger anaphylaxis in people with a history of anaphylaxis.
Where the evidence comes from
- Reference knowledge
Confidence
confidence 80/100
Open History of AnaphylaxisRationale
Risk of insect stings or plant allergens triggering anaphylaxis during outdoor gardening.
- →WoundCertaintyLowSourceReference knowledgeTheoretical
During Gardening Therapy, exposed skin or open wounds can increase the risk of bacterial infections, including from Clostridium tetani, and fungal infections from soil pathogens.
Where the evidence comes from
- Reference knowledge
Confidence
confidence 80/100
Open WoundRationale
Exposed skin or open wounds increase risk of bacterial (e.g., Clostridium tetani) and fungal infections from soil pathogens during gardening.
- →Iatrogenic ImmunosuppressionCertaintyLowSourceReference knowledgeTheoretical
Compost and soil can contain environmental microbes such as Nocardia and Aspergillus, which may cause opportunistic infections in people with immunosuppression.
Where the evidence comes from
- Reference knowledge
Confidence
confidence 75/100
Open Iatrogenic ImmunosuppressionRationale
Immunocompromised individuals are at higher risk for opportunistic infections from environmental microbes (e.g., Nocardia, Aspergillus) present in compost and soil.
- →Acute InjuryCertaintyLowSourceReference knowledgeTheoretical
Bending, lifting, and repetitive motions during Gardening Therapy can aggravate an acute injury and delay healing.
Where the evidence comes from
- Reference knowledge
Confidence
confidence 70/100
Open Acute InjuryRationale
Physical demands of gardening (bending, lifting, repetitive motions) can aggravate acute injuries and delay healing.
- →G6PD DeficiencyCertaintyLowSourceReference knowledgeTheoretical
Fava beans or certain leguminous plants in gardens may trigger a hemolytic crisis in people with G6PD deficiency.
Where the evidence comes from
- Reference knowledge
Confidence
confidence 70/100
Open G6PD DeficiencyRationale
Exposure to fava beans or certain leguminous plants in gardens may trigger hemolytic crisis in individuals with G6PD deficiency.
Who the trials left out
Some trials of this practice did not take people with these conditions, so the studies say less about them. This is not a warning and does not show harm. Ask a clinician first.10 listed- Hearing Lossleft out by 2 trials
PubMed links (2)
Left out by one trial each (9)
- Allergies (General)left out by 1 trial
PubMed links (1)
- Cancer (General)left out by 1 trial
PubMed links (1)
- COPD (Chronic Obstructive Pulmonary Disease)left out by 1 trial
PubMed links (1)
- Coronary Artery Diseaseleft out by 1 trial
PubMed links (1)
- Epilepsyleft out by 1 trial
PubMed links (1)
- Heart Failure (CHF)left out by 1 trial
PubMed links (1)
- Liver Failureleft out by 1 trial
PubMed links (1)
- Olfactory Dysfunction (Smell Loss)left out by 1 trial
PubMed links (1)
- Strokeleft out by 1 trial
PubMed links (1)
When you stop
Rebound and withdrawal after discontinuing2 listedHighest probability
- →Antidepressant EffectCertaintyLowSourceClinicalloss of benefit1 cited study
In one quasi-experimental study of 26 people with a clinical condition, anxiety and depression levels rebounded after the program ended, so the reported improvements were not sustained.
What the sources found
0 not observed · 0 unclear · 1 reportedconfidence 40/100
How big is the effect
No study gave a number we could compare, so the size is not known.
Who was studied
- People with a condition
Where the evidence comes from
- Article1
Protocol behind this outcome
1 protocolEstimatedWhat the studies reporting this result did.
40 min · 1×/week
- Course
- 4 weeks
- Per week
- 40 min
- Intensity
- Low
- Format
- Group
- Supervision
- Instructor-led
A repeated course
Open Antidepressant EffectShow studies (1)
Quasi ExperimentalCnegativen=2640% confidence2026Following the intervention program's conclusion, anxiety and depression levels rebounded, indicating that the improvements were not effectively sustained.
Weak journal - →Anxiety ReductionCertaintyLowSourceClinicalloss of benefit1 cited study
In one quasi-experimental study of 26 people with a clinical condition, the anxiety measure rebounded to 14.00 (7.00–20.25) at follow-up.
What the sources found
0 not observed · 0 unclear · 1 reportedconfidence 40/100
How big is the effect
No study gave a number we could compare, so the size is not known.
Who was studied
- People with a condition
Where the evidence comes from
- Article1
Protocol behind this outcome
1 protocolEstimatedWhat the studies reporting this result did.
40 min · 1×/week
- Course
- 4 weeks
- Per week
- 40 min
- Intensity
- Low
- Format
- Group
- Supervision
- Instructor-led
A repeated course
Open Anxiety ReductionShow studies (1)
Quasi ExperimentalCnegativen=2640% confidence2026and then rebounded to 14.00 (7.00–20.25) at follow-up (χ2 (2) = 7.787, p = 0.020)
Weak journal
Interactions
Combine with caution
Highest severity first
- →SupplementsSt. John's WortTheoreticalCaution
St. John’s Wort is a known photosensitizer, so long hours of sun exposure while gardening can increase the risk of sunburn and phototoxic skin reactions. Covering up and using sunscreen can help limit sun exposure.
Okay to combine with
Highest probability of useful synergy
- →PracticesMindfulness MeditationCertaintyMediumSourceReference knowledgePotentiating
Combining Gardening Therapy with Mindfulness Meditation is described as supporting present-moment awareness and emotional regulation, which may amplify reductions in rumination and stress.
Where the evidence comes from
- Reference knowledge
Open Mindfulness MeditationConfidence
confidence 65/100
- →SupplementsVitamin DCertaintyMediumSourceReference knowledgeComplementary
A pharmacology reference suggests Vitamin D supplementation alongside outdoor gardening may help optimize serum 25(OH)D levels, particularly at high latitudes or in winter when sun exposure is insufficient.
- →PracticesNature WalksCertaintyMediumSourceReference knowledgeAdditive
Adding Nature Walks to Gardening Therapy increases time spent in green spaces; the proposed benefit is an additive improvement in mood and attention restoration.
- →PracticesForest Bathing (Shinrin-yoku)CertaintyMediumSourceTheoreticalComplementary
Combining Gardening Therapy with Forest Bathing (Shinrin-yoku) is proposed to deepen nature connection and strengthen stress reduction.
Where the evidence comes from
- Expert opinion
Open Forest Bathing (Shinrin-yoku)Confidence
confidence 45/100
- →PracticesOutdoor MeditationCertaintyMediumSourceTheoreticalComplementary
Meditating outdoors after Gardening Therapy is proposed to enhance mindfulness and nature’s calming effects.
- →PracticesStatic StretchingCertaintyMediumSourceTheoreticalComplementary
Static Stretching before Gardening Therapy is proposed to reduce muscle-strain risk and improve flexibility during gardening tasks.
How it works
The mechanisms this practice works through25 listed · 0 established- Physical functionPhysical activityproposed
Low-to-moderate intensity gardening activities improve physical function and alleviate depressive symptoms caused by physical health concerns.
- Attention and stress recoveryPsychologicalproposed
Horticultural activities may divert attention from symptoms, foster a sense of productivity, and enhance self-esteem.
- Attention restorationAttention Restoration Theory (ART)proposed
HT may restore attention through engagement with natural elements; shorter durations and longer intervals may compromise effects, and higher-demanding tasks may reduce attention restoration.
- BrainAnti-inflammatory and antioxidantproposed
Consuming foods with phytochemicals that cross the blood-brain barrier reduces oxidative damage and inflammation in the brain.
- CXCL12 (SDF-1α), CXCL5 (RANTES), BDNFNeuroprotectionproposed
Horticultural therapy maintained plasma levels of these biomarkers, potentially supporting hematopoietic brain support and neuroprotection.
- Direct attentional capacityAttention restoration theoryproposed
Viewing natural settings and plants may restore direct attentional capacity from fatigue and induce a feeling of being-away from stress.
- Emotional managementEmotionalproposed
Connection with nature increases sensitivity to plants, generates positive emotions, and promotes emotional management ability.
- Healthy behaviorsBehavioralproposed
Gardening activities lead to adoption of healthy behavioral practices such as increased fruit and vegetable consumption and physical activity.
- Memory and cognitive skillsReminiscence benefitsproposed
Horticultural therapy provides reminiscence benefits to promote memory and cognitive skills through olfactory and gustatory senses.
- Mental healthAttention Restoration Theory and Biophilic Hypothesisproposed
Natural exposures, such as exposure to plants, have mental health benefits including stress reduction, cognitive restoration, and emotion regulation.
- Nature connectednessPsychologicalproposed
Proximity to nature infuses feelings of connectedness with nature that promotes positive affect, lifted mood, and tranquillity.
- Nature exposureBiophilia Theoryproposed
Exposure to nature elements itself can benefit wellbeing, suggesting living plants may be an active ingredient of HT.
- Neurotransmitters (serotonin, dopamine) and inflammatory cytokinesNeurobiologicalproposed
Horticultural activities may enhance neurotransmitters and regulate inflammatory cytokines, potentially contributing to symptom improvement.
- Parasympathetic nervous systemStress reductionproposed
Exposure to nature activates the parasympathetic system, reducing cortisol, heart rate, and blood pressure.
- Sense of control, empowerment, cooperationTrauma recovery conceptproposed
Horticultural therapy establishes a sense of control, empowerment, and cooperation to satisfy the requirement of safety and stabilization from cognitive overburden status.
- Social connectednessSocialproposed
Community gardening provides a safe and relaxed context for social interaction, counteracting loneliness and social isolation.
- Social ties and sense of communitySocial interactionproposed
Gardens provide opportunities for social interaction, forging and reinforcing social ties and community networks.
- Symptoms of schizophreniaPsychologicalproposed
Horticultural therapy reduces anxiety, depression, stress, and interpersonal sensitivity, and promotes contact with real life to alleviate delusions and hallucinations.
- Vagus nerveStress responseproposed
Reducing stress through horticultural therapy may reduce overactive stress response and associated inflammatory damage.
- Voluntary attentionAttention restorationproposed
Natural environments capture involuntary attention, allowing voluntary attention to restore.
- mental fatigueAttention Restoration Theoryproposed
Leisure activities in natural settings create a sense of separation from everyday life, improving mental health and reducing mental fatigue.
- multisensory stimulationSensory Integration Theoryproposed
Mobilizes the 5 senses through multisensory stimulation, tactile input, and olfactory and gustatory experiences.
- salivary cortisolHPA axis / physiological stress responseproposed
Salivary cortisol decreased significantly after single HT sessions in both groups. The authors did not directly measure autonomic activity, so the mechanism is inferred.
- sense of coherencepsychologicalproposed
Horticultural therapy may improve SOC through empowerment and reflection processes, enhancing comprehensibility, manageability, and meaningfulness.
- social integrationsocial connectednessproposed
HT promotes social connectedness and community integration, reducing depressive symptoms caused by loneliness and lack of social interaction.
Variations
5 documentedTypical protocol
22 protocolsEstimatedAcross every study of this practice, whatever the variation.
89 min · 1.5×/week
- Course
- 14 weeks
- Per week
- 135 min
- Temperature
- 21–27 °C
- Humidity
- 60–75%
- Intensity
- Low
- Format
- Group
- Supervision
- Instructor-led
Courses and single sessions · 17 repeated-course and 2 single-session protocols
65% of the corpus contributed
Community Group Gardening
Beginner9/10supervision recommended88–90 min · 2 times a week
Community Group Gardening
Beginner9/10supervision recommended88–90 min · 2 times a week88–90 min · 2 times a week
Editorial- How often
- 2 times a week
- Intensity
- Low
- Time of day
- Morning
- Where
- Outdoors
- Research depth
- Moderate
Sessions center on shared tasks in an outdoor community plot, combining cultivation with social connection and shared responsibility for the garden. Tasks can include weeding, sowing seeds, and watering plants at a self-paced rhythm.
No equipment needed.
As studied
5 protocolsEstimatedThe protocol the studies of this variation actually used.
88–90 min
- Course
- 12 weeks
- Intensity
- Low
- Format
- Group
- Supervision
- Instructor-led
A repeated course
How it's done8 steps · 3 cues · 3 common mistakes
A general description of the practice, not instruction or medical advice.
Steps
- Gather with your group at the designated community garden plot.
- Begin with 5-10 minutes of gentle stretching, focusing on the back, shoulders, and wrists.
- Receive a simple group task for the day, such as weeding a designated bed, sowing seeds in rows, or watering plants using a hose or watering can.
- Work on the task at a comfortable, self-paced rhythm, taking breaks as needed to socialize and hydrate.
- Practice mindful observation: pause to notice the texture of the soil, the scent of the plants, and the sounds of the outdoors.
- Assist others in the group with lifting bags of soil or reaching difficult spots, fostering collaboration.
- Conclude the session with 10 minutes of cleaning tools, tidying the plot, and a brief group share of one thing you noticed or enjoyed.
- Wash hands thoroughly after finishing.
Cues
- · Bend at your knees, not your waist, when lifting.
- · Switch hands frequently when gripping tools to avoid strain.
- · Maintain a neutral spine while weeding or planting.
Common mistakes
- Overexerting by trying to finish too much in one session.
- Locking the knees while standing and bending over.
- Forgetting to drink water, especially in warm outdoor conditions.
Studied protocols5 on file
- 90 min· 3×/week· 12 weeks· n=110· A repeated coursePMID 28638192
- 90 min· 2×/week· 4 weeks· n=211· A repeated coursePMID 38909093
- 90 min· 2×/week· 3 weeks· n=16· A repeated coursePMID 39689109
- 90 min· 1×/week· 20 weeks· n=698· A repeated coursePMID 36969640
- 88 min· 3.2×/week· 25 weeks· n=2899· A repeated coursePMID 39517317
Indoor Structured Horticultural Therapy
Beginner8/10supervision recommended40–60 min · Weekly
Indoor Structured Horticultural Therapy
Beginner8/10supervision recommended40–60 min · Weekly40–60 min · Weekly
Editorial- How often
- Weekly
- Intensity
- Very low
- Time of day
- First half of the day
- Where
- Indoors
- Research depth
- Minimal
This format uses structured indoor activities such as potting, desktop planting, and plant crafts, often led by a therapist. It is intended for settings such as residential care and can include cognitive stimulation and fine motor practice without outdoor exposure.
Equipment: Small pots or containers, Potting soil, Seeds or small plant cuttings, Tray or mat, Hand mister or small watering can
How it's done8 steps · 3 cues · 3 common mistakes
A general description of the practice, not instruction or medical advice.
Steps
- Welcome and orient participants to the indoor workspace, ensuring they are seated comfortably.
- Lead the group in 3-5 minutes of seated breathing exercises to begin.
- Demonstrate the day's structured activity, such as transplanting a seedling into a small pot.
- Guide participants to fill their pots one-third full with soil, handling the texture gently.
- Carefully place the seedling in the center and fill around it with more soil, patting it down lightly.
- Mist the soil with water from a spray bottle until it is damp but not soaked.
- Facilitate a sensory exploration: encourage participants to touch the leaves gently and smell the soil or plant.
- Conclude with a group reflection on the process and clean-up of the workspace.
Cues
- · Treat the roots very gently when transplanting.
- · Keep movements slow and deliberate to avoid spills.
- · Hold the spray bottle close to the plant, not from a distance.
Common mistakes
- Over-watering, turning the soil muddy.
- Packing the soil too tightly, which restricts root growth.
- Choosing a pot without a drainage hole.
Studied protocols3 on file
- 40 min· 1×/week· 12 weeks· n=86· A repeated coursePMID 35564806
- 1×/week· 13 weeks· n=435· A repeated coursePMID 42539453
- PMID 35000249
Intensive Therapeutic Gardening
Intermediate8/10supervision recommended150–180 min · 2 times a week
Intensive Therapeutic Gardening
Intermediate8/10supervision recommended150–180 min · 2 times a week150–180 min · 2 times a week
Editorial- How often
- 2 times a week
- Intensity
- Moderate
- Time of day
- Morning
- Where
- Outdoors
- Research depth
- Minimal
This is an immersive community program built around the full cultivation cycle, from planting and weeding to fertilizing and harvesting. It is designed for people with significant mental health challenges, including schizophrenia or major depression.
Equipment: Shovels, rakes, hoes, Watering cans or long hoses, Gardening gloves
How it's done7 steps · 3 cues · 3 common mistakes
A general description of the practice, not instruction or medical advice.
Steps
- Start with a group check-in and a 10-minute warm-up of dynamic full-body movements.
- Review the seasonal garden plan for the day: this could include preparing raised beds by ridging soil with a hoe.
- Engage in the main cultivation task such as sowing new seeds, transplanting seedlings, or intensive weeding in a designated area for 45-60 minutes.
- Take a 15-minute hydration and snack break to rest and socialize.
- Proceed to the next major task, such as fertilizing plants or pruning flower bushes, working as a team.
- Perform a harvest of mature vegetables or herbs, enjoying the tangible results of the garden's productivity.
- Conclude with tool cleaning, a cool-down stretching session, and a facilitated group feedback circle to reflect on the work and personal insights.
Cues
- · Pace yourself as if this is an endurance activity, not a race.
- · Use a wheelbarrow or ask for help to move heavy loads of compost.
- · Drink water before you feel thirsty.
Common mistakes
- Attempting to lift a shovel full of heavy, wet soil with poor posture.
- Ignoring early signs of fatigue or soreness.
- Using a tool you haven't been trained on, leading to potential injury.
Studied protocols1 on file
- 180 min· 2×/week· 15 weeks· n=111· A repeated coursePMID 35805706
Nature Park Walk and Gardening
Beginner8/10supervision recommended60–90 min · Weekly
Nature Park Walk and Gardening
Beginner8/10supervision recommended60–90 min · Weekly60–90 min · Weekly
Editorial- How often
- Weekly
- Intensity
- Low
- Time of day
- Morning
- Where
- Outdoors
- Research depth
- Minimal
This variation pairs a guided, slow-paced walk with light gardening or nature-art activities, such as arranging fallen leaves and twigs. Guided observation of plants, birds, and other natural features is part of the activity.
No equipment needed.
How it's done7 steps · 3 cues · 3 common mistakes
A general description of the practice, not instruction or medical advice.
Steps
- Start with a guided slow-paced walk on a flat, accessible path in a park or garden for 20-30 minutes.
- The facilitator will point out specific plants, birds, and natural features, engaging senses of sight and sound.
- Gather in a designated garden bed area and receive instructions for a light maintenance task, like dead-heading flowers or spreading mulch.
- Perform the task with breaks, paying attention to the warmth of the sun and the breeze.
- Collect a few fallen, non-toxic leaves, flowers, or small twigs during the walk.
- Sit at a picnic table to arrange these natural items into a simple nature-art composition, or use them to decorate a plant pot.
- Share your creation and discuss the experience with the small group before walking back.
Cues
- · Breathe deeply through your nose during the walk.
- · Watch your footing on uneven paths and mulch.
- · Wear a hat and sunscreen to manage sun exposure.
Common mistakes
- Walking too fast to notice the guided observations.
- Touching or picking plants without the guide's instruction.
- Forgetting to stretch calves after the walk.
Studied protocols1 on file
- 40 min· 1×/week· 4 weeks· 21–27 °C, 60–75%· n=26· A repeated coursePMID 42325319
Home-Based Smart Gardening
Beginner7/1030–90 min · 3 times a week
Home-Based Smart Gardening
Beginner7/1030–90 min · 3 times a week30–90 min · 3 times a week
Editorial- How often
- 3 times a week
- Intensity
- Very low
- Time of day
- Any time
- Where
- Indoors
- Research depth
- Minimal
Indoor hydroponic systems use automated lights and sensors, while an app can help participants track light cycles and water levels. The format is designed for home practice with remote social support, including for people with limited mobility or outdoor access.
Equipment: Indoor smart hydroponic grower with LED lights, Seed pods or hydroponic nutrients, Smartphone for monitoring app
As studied
3 protocolsEstimatedThe protocol the studies of this variation actually used.
60 min
- Course
- 26 weeks
- Format
- Small group
- Supervision
- Instructor-led
A repeated course
How it's done6 steps · 3 cues · 3 common mistakes
A general description of the practice, not instruction or medical advice.
Steps
- Set up your smart grower near an accessible power outlet following manufacturer instructions.
- Insert the seed pods into the designated bays and add the nutrient solution and water to the reservoir.
- Use the companion mobile app to connect to the device, track light cycles, and monitor water levels.
- Spend 15-20 minutes observing and tending to your plants 3 times a week: check for germination, prune dead leaves, and refill the water.
- Take photos of your plants' growth stages and share updates to your support group or social media if part of your program.
- When a plant matures, harvest the leaves or herbs for use in your kitchen, savoring the fresh scents and flavors.
Cues
- · Clean the reservoir monthly to prevent algae buildup.
- · Keep the LED lights free of dust for optimal power.
- · Thin out seedlings to prevent overcrowding in a single pod.
Common mistakes
- Neglecting to plug in the unit correctly.
- Letting the water reservoir run completely dry.
- Placing the system in a bright window, causing double light stress.
Studied protocols2 on file
- 60 min· 1×/week· 26 weeks· n=70· A repeated coursePMID 28851276
- 60 min· 1×/week· 26 weeks· n=59· A repeated coursePMID 30096932
How to start
Community experience
Based on 10 public posts from Bluesky and YouTube.
What people report it did
2 outcomes mentioned across 10 public reports. A report often mentions several, so these counts do not add up to the total.
Reported side effects2
- Joint Pain (Arthralgia)not studied
- Muscle Ache (Myalgia)not studied
References
36 screened · 33 analysed · 34 listed below
Studies and sources cited on this page. Evidence quality varies — check the grade on each.
- Effect of horticultural therapy on mental health: A meta-analysis of randomized controlled trials.J Psychiatr Ment Health Nurs2022Meta-analysisA
- The effectiveness of nature-based interventions on mental health: A systematic review.Appl Psychol Health Well Being2026Systematic reviewB
- Dose-response efficacy of horticultural therapy for geriatric depression: a systematic review and meta-analysis of randomized controlled trials.Front Public Health2026Meta-analysisBn=435
- Effect of gardening activities on domains of health: a systematic review and meta-analysis.BMC Public Health2025Meta-analysisBn=4535
- How duration and frequency influence horticultural therapy's effect on depressive symptoms: evidence from a meta-analysis.Front Psychol2025Meta-analysisB
- Efficacy of horticultural therapy on symptoms and functional outcomes in individuals with depressive disorders: A systematic review and meta-analysis of randomized controlled trials.Complement Ther Med2025Meta-analysisBn=960
- Impact of horticultural therapy on patients admitted to psychiatric wards, a randomised, controlled and open trial.Sci Rep2024RCTBn=211
- Efficacy of Horticultural Therapy on Positive, Negative, and Affective Symptoms in Individuals with Schizophrenia: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.Healthcare (Basel)2024Meta-analysisBn=2899
- Effectiveness of Horticultural Therapy in Older Patients With Dementia: A Meta-Analysis Systemic Review.J Clin Nurs2024Meta-analysisBn=655
- Effectiveness of Horticultural Therapy in Older Adults without Dementia: A Systematic Review and Meta-Analysis.J Am Med Dir Assoc2024Meta-analysisBn=1629
Show all 34 references
- The impact of gardening on well-being, mental health, and quality of life: an umbrella review and meta-analysis.2024Meta-analysisB
- Effectiveness of horticultural therapy in aged people with depression: A systematic review and meta-analysis.2023Meta-analysisBn=698
- Horticultural therapy for stress reduction: A systematic review and meta-analysis.2023Systematic reviewBn=1036
- The effect of horticultural therapy on depressive symptoms among the elderly: A systematic review and meta-analysis.2022Meta-analysisBn=608
- Horticultural therapy for general health in the older adults: A systematic review and meta-analysis.2022Meta-analysisBn=1046
- Effectiveness of horticultural therapy on physical functioning and psychological health outcomes for older adults: A systematic review and meta-analysis.2022Meta-analysisBn=884
- Effectiveness of horticultural therapy in people with dementia: A quantitative systematic review.2022Meta-analysisBn=411
- Effectiveness of Horticultural Therapy in People with Schizophrenia: A Systematic Review and Meta-Analysis.2021Meta-analysisBn=2024
- Gardening is beneficial for health: A meta-analysis.2017Meta-analysisBn=2578
- Timing for green prescription: comparing the immediate and cumulative effects of different duration horticultural therapy programs on college students' mental health.2026Quasi ExperimentalCn=26
- Effects of horticultural therapy versus handiwork on anterior cingulate cortex activity in people with chronic low back pain: A randomized, controlled, cross-over, pilot study.2024RCTCn=16
- Effects of horticultural therapy on health in the elderly: A review and meta-analysis.2023Meta-analysisCn=11741
- The effect of horticultural therapy on older adults in pension institutions: a systematic review.2023Systematic reviewCn=1214
- The Effects of Horticultural Therapy on Sense of Coherence among Residents of Long-Term Care Facilities: A Quasi Experimental Design.2022Quasi ExperimentalCn=86
- A Systematic Review of Horticultural Therapy's Influence on Chinese Older Adults' Psychosocial Wellbeing.2022Systematic reviewCn=960
- The Multi-Sites Trial on the Effects of Therapeutic Gardening on Mental Health and Well-Being.2022Quasi ExperimentalCn=111
- Effectiveness of Therapeutic Gardens for People with Dementia: A Systematic Review.2021Systematic reviewCn=16
- Horticultural Therapy Reduces Biomarkers of Immunosenescence and Inflammaging in Community-Dwelling Older Adults: A Feasibility Pilot Randomized Controlled Trial.2021RCTCn=59
- Meta-analysis of controlled trials testing horticultural therapy for the improvement of cognitive function.2020Meta-analysisCn=286
- Effects of Horticultural Therapy on Asian Older Adults: A Randomized Controlled Trial.2018RCTCn=59
- Treatment Effect of Antipsychotics in Combination with Horticultural Therapy on Patients with Schizophrenia: A Randomized, Double-blind, Placebo-controlled Study.2016RCTCn=110
- Effectiveness of a Dyadic Technology-Enhanced Home-Based Horticultural Therapy on Psychosocial Well-Being Among People With Dementia and Their Family Caregivers: Multimethods Pilot Study.2025Pilot studyDn=38
- Horticultural therapy, nutrition and post-traumatic stress disorder in post-military veterans: developing non-pharmaceutical interventions to complement existing therapeutic approaches.2021Narrative reviewD
- Expert knowledge synthesis