Health Benefits of Gardening: Cultivating Heart Health

A 2022 meta-analysis of 53 studies from 18 countries, with more than 100 million total participants, examined associations between the normalized difference vegetative index (NDVI) — which indicates the density and health of vegetation in an area — and various measures of cardiovascular and cerebrovascular health. The results demonstrated that a 0.1 increase in NDVI was associated with 2% to 3% reductions in the risk of mortality from CVD, ischemic heart disease, and cerebrovascular disease, as well as stroke risk.³

The range of proposed mechanisms underlying the beneficial health impact of green space exposure include “its ability to relieve stress, decrease air pollution, and encourage physical activity,” according to a review by Yeager et al.⁴

“Exposure to green spaces has also been linked to lower rates of key cardiovascular risk factors, including hypertension, dyslipidemia, and diabetes,” explained Liz Joy, MD, MPH, DipABLM, chief medical officer of Lore Health.⁵

In addition, research participants with higher greenness exposure have reported “better mental health and more frequent social interactions, which can benefit cardiovascular health as well,” as stated in a 2024 review published in Circulation Research.⁵

Cardiovascular Benefits of Gardening

Numerous studies have demonstrated the cardiovascular health benefits of gardening specifically, which are likely attributable to greenness exposure and some unique effects on dietary quality and other factors.

Many types of movement, including gardening, can count toward the recommended 150 minutes of weekly moderate-intensity aerobic activity, noted Carl “Chip” Lavie MD, medical director of cardiac rehabilitation and preventive cardiology and director of exercise laboratories at the John Ochsner Heart and Vascular Institute, Ochsner Clinical School-The University of Queensland School of Medicine in New Orleans, Louisiana.⁶

“Gardening is also an activity that may be more doable for patients with musculoskeletal limitations, and it can help with muscle strength and coordination,” he continued.

Along with stress-reducing effects and increased physical activity, studies have found that “gardeners consume fruits and vegetables more frequently than non-gardeners, which contributes to better cardiovascular health outcomes,” Dr Joy added.

In a 2023 study that analyzed cross-sectional data from 146,047 adults aged 65 or older in the 2019 Behavioral Risk Factor Surveillance System (BRFSS), Veldheer et al found lower odds for a range of health outcomes among gardeners compared to non-exercisers, including CVD (adjusted odds ratio [aOR], 0.60; 95% CI. 0.53-0.68), stroke (aOR, 0.55; 95% CI, 0.47-0.64), myocardial infarction (aOR, 0.63; 95% CI, 0.55-0.73), high cholesterol (aOR, 0.86; 95% CI, 0.79-0.93), high blood pressure (aOR, 0.74; 95% CI, 0.68-0.81), diabetes (aOR, 0.51; 95% CI, 0.46-0.56), and 10-year mortality risk (aOR, 0.39; 95% CI, 0.36-0.42), as well as higher odds of consuming 5 or more fruits and vegetables per day (aOR, 1.56; 95% CI, 1.40-1.57).⁷

Multiple studies have found that gardening interventions, including school-based programs implemented with low-income students, were associated with increased preference toward and consumption of fruits and vegetables,increased intake of unprocessed foods and reduced intake of ultra-processed foods, increased cooking and gardening self-efficacy, and increased knowledge about nutrition and gardening.^8-10

A small mixed-methods study published in 2023 in Hypertension examined the benefits of gardening for hypertension self-management among African American men who reported regular engagement in personal or community gardening.¹¹ In line with other research on the topic, participants “described an increase in fruits and vegetable intake and physical activity, and they viewed gardening as a way to alleviate stress that may assist in managing their hypertension,” lead author Carrie McCoy, PhD, ANP-BC, told Cardiology Advisor. McCoy is an assistant professor in the department of biobehavioral health and nursing science at the College of Nursing at the University of South Carolina in Columbia.

Additionally, a new study published in Environmental Pollution showed that greater exposure to domestic gardens may attenuate the risk for heart failure associated with exposure to air pollution, nighttime light, and noise pollution.¹²

Improvements in sleep duration and quality may further mediate the connection between gardening and cardiovascular health. In a 2024 cross-sectional study of 62,098 adults from the 2017 BRFSS, gardeners demonstrated lower odds of experiencing 2 or more sleep complaints — such as daytime sleepiness, short sleep duration, sleep apnea, and probable insomnia — compared to non-gardeners (OR, 0.58; 95% CI, 0.49-0.67) and other exercisers (OR, 0.67; 95% CI, 0.61-0.72).¹³

Finally, “Gardening is often done with others, providing for social connection,” Dr Joy said. “Social isolation and loneliness are considered major cardiac risk factors and are independently associated with cardiovascular and all-cause mortality.” Research findings have shown that community gardening is associated with lower levels of perceived loneliness and increased social support.¹⁴

“I cannot think of a greater joy than sharing the abundance from my garden with friends and family, either by inviting them over to help tend to plants together or through sharing my overflowing basket of fruits and vegetables with them,” shared gardening expert Brian Brigantti, founder of Red Leaf Ranch in Morrison, Tennessee, and author of the book, Gardening for Abundance: Your Guide to Cultivating a Bountiful Veggie Garden and a Happier Life.¹⁵ “One of the simplest and most primal ways we can foster connection with one another is through food.”

Along with the personal and social benefits, gardening can “play a crucial role in strengthening local food systems and combating food insecurity through various means, which is particularly important in areas with limited access to grocery stores or food deserts,” Brigantti noted. For example, “Participation in community gardens can reduce hunger and malnutrition and increase dietary diversity and balance.”

Patient Recommendations on Gardening

According to Dr Lavie, “No studies focused only on gardening have been large enough to confirm the clinical effects, and more research is needed to determine optimal dosing and other factors needed to maximize risk reductions.”

However, gardening can motivate patients to “engage in regular physical activity through tasks such as planting, weeding, and harvesting, thus contributing to overall cardiovascular health,” Dr Joy said.

For physicians considering recommending gardening to their patients, Dr Joy emphasized the importance of offering personalized guidance. “If patients indicate a desire to increase physical activity and fruit and vegetable intake, and they have access to a place and resources to garden, then a ‘gardening prescription’ might be a great fit.”

McCoy explained that she began gardening using planters and eventually started a backyard garden growing cucumbers, tomatoes, black-eyed peas, and bell peppers. “Gardening can be difficult but enjoyable, and it helps me stay physically active, as it can be strenuous,” she said. “I tend to eat more vegetables when gardening, which makes me want to choose healthier options when shopping at the grocery store.”

Dr Joy cautioned that older adults and patients with known heart disease should “be aware of environmental risk factors such as high temperatures and poor air quality, which can exacerbate CVD and other health conditions,” and they should be sure to “hydrate sufficiently before, during, and after outdoor activities such as gardening.”

For help developing a green thumb, Brigantti offered the following tips that can be shared with beginner gardeners or those with limited time.

• Start with low maintenance plants, such as ones that are native to your area and accustomed to your area’s unique conditions. Native plants are naturally resilient and can do a great job of taking care of themselves with minimal maintenance.
• If you don’t have time to water your plants on a regular basis, plant drought resilient plants, set up an irrigation system on a timer that will handle the watering for you, and mulch your garden beds. Mulching is essential in maintaining moisture by preventing the harsh rays of the sun from drying out garden beds too quickly. 
• Opt for easy and low-maintenance vegetables such as kale or peppers or herbs like rosemary and basil. These plants also do exceptionally well in containers if space is limited or you just want to test the waters before starting a full-on vegetable garden.

“Gardening can be intense as you want it to be, so go at a pace that you’re comfortable with and don’t be afraid to make mistakes,” Brigantti said.