Harvest for Health, a Randomized Controlled Trial Testing a Home-Based, Vegetable Gardening Intervention Among Older Cancer Survivors Across Alabama: An Analysis of Accrual and Modifications Made in Intervention Delivery and Assessment During COVID-19

Bail, Jennifer R.; Blair, Cindy K.; Smith, Kerry; Oster, Robert A.; Kaur, Harsimarjit; Locher, Julie L.; Frugé, Andrew D.; Rocque, Gabrielle Betty; Cohen, Harvey Jay; Demark‐Wahnefried, Wendy

doi:10.1016/j.jand.2022.05.005

Cited by 5 publications

(11 citation statements)

References 74 publications

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“…We followed the Consolidated Standards of Reporting Trials (CONSORT) reporting guideline. The study period spanned May 11, 2016, to May 2, 2022, with detailed methods and recruitment results published previously …”

Section: Methodsmentioning

confidence: 99%

“…Assessments occurred at baseline (before randomization) and 12 months and included anthropometric measures (height [baseline only], weight, and waist circumference), physical performance testing (Senior Fitness Battery), accelerometry (7-day collection via GTPX3 accelerometer [ActiGraph]), the Community Healthy Activities Model Program for Seniors (CHAMPS) Physical Activity Questionnaire for Older Adults, blood collection via venipuncture (after ≥4 hours of fasting), and collection of toenail clippings and a fecal wipe. Plasma and serum samples and fecal wipes were stored at −80 °C and toenails at room temperature and then batch-analyzed following published methods for α-carotene, cortisol, fecal microbiome, and inflammatory biomarkers . A remote protocol was implemented in April 2020 due to the COVID-19 pandemic.…”

Section: Methodsmentioning

confidence: 99%

“…22 A remote protocol was implemented in April 2020 due to the COVID-19 pandemic. It omitted grip strength, arm curl, and gait speed measures from the performance battery because of cost or failure to prove reliability, 22,34 and dried blood spots (found valid and reliable for interleukin-6…”

Section: Assessmentsmentioning

confidence: 99%

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Vegetable Gardening and Health Outcomes in Older Cancer Survivors

Demark-Wahnefried,

Oster,

Smith

et al. 2024

JAMA Netw Open

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ImportanceCancer survivors experience accelerated functional decline that threatens independence and quality of life. Previous studies have suggested that vegetable gardening may improve diet, physical activity, and physical function in this vulnerable population, which comprises more than 5% of the US population.ObjectiveTo assess whether diet, physical activity and functioning, and other outcomes improved in older cancer survivors assigned to a vegetable gardening intervention compared with a waitlist.Design, Setting, and ParticipantsFrom May 11, 2016, to May 2, 2022, a 2-arm, assessor-blinded, crossover-designed, intent-to-treat, randomized clinical trial was conducted at cancer survivors’ homes across Alabama. Medicare-eligible survivors of cancers with 5-year survival of 60% or more were registry ascertained and screened for suboptimal vegetable and fruit consumption (&lt;5 servings per day), physical activity (&lt;150 moderate-to-vigorous minutes per week), and physical function (36-Item Short Form Health Survey [SF-36] subscale score ≤90). Consented participants underwent baseline assessments, were randomly assigned to intervention or waitlisted arms, and were reassessed at 1-year follow-up.InterventionOne-year, home-based vegetable gardening intervention providing gardening supplies and mentorship by cooperative extension–certified master gardeners to plant and maintain spring, summer, and fall gardens. Waitlisted participants received the identical intervention after 12 months.Main Outcomes and MeasuresThe main outcome was a composite index of improvements in self-reported vegetable and fruit consumption, physical activity, and physical function corroborated by plasma α-carotene levels, accelerometry, and physical performance assessments, respectively.ResultsOf 381 enrolled participants (mean [SD] age, 69.8 [6.4] years; range, 50-95 years; 263 [69.0%] female), 194 were assigned to the gardening intervention and 187 were waitlisted (attrition rates, 7.2% and 7.0%, respectively). Intent-to-treat analyses did not detect a significant improvement in the composite index of vegetable and fruit intake, moderate-vigorous physical activity, and physical function (intervention arm vs waitlisted arm, 4.5% vs 3.1%; P = .53) or between-arm differences in vegetable and fruit intake (mean difference, 0.3 [95% CI, −0.1 to 0.7] servings per day; P = .10). The intervention arm experienced a significant improvement in vegetable and fruit intake (mean increase, 0.3 [95% CI, 0.0-0.6] servings per day; P = .04). Significant improvements also were observed in the intervention arm vs waitlisted arm in physical performance (mean difference for 2-minute step test, 6.0 [95% CI, 0.8-11.2] steps; P = .03; for 30-second chair stand, 0.8 [95% CI, 0.1-1.5] repetitions; P = .02), perceived health (8.4 [95% CI, 3.0-13.9] points on a 100-point scale [higher scores indicate better health]; P = .003), and gut microbiome alpha diversity (84.1 [95% CI, 20.5-147.6] more observed species; P = .01). The COVID-19 pandemic significantly moderated effects (eg, odds of improvement in self-reported physical functioning were greater before vs during the pandemic: odds ratio, 2.17; 95% CI, 1.12-4.22; P = .02).Conclusions and RelevanceIn this randomized clinical trial including older cancer survivors, a vegetable gardening intervention did not significantly improve a composite index of diet, physical activity, and physical function; however, survivors assigned to the intervention had significantly increased vegetable and fruit consumption and, compared with waitlisted survivors, experienced significant improvements in perceived health and physical performance. Further study in broader populations and during pandemic-free periods is needed to determine definitive benefits.Trial RegistrationClinicalTrials.gov Identifier: NCT02985411

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Vegetable Gardening and Health Outcomes in Older Cancer Survivors

Demark-Wahnefried,

Oster,

Smith

et al. 2024

JAMA Netw Open

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“…Harvest for Health, a mentored gardening program for cancer survivors, demonstrated high acceptability and retention as well as increased vegetable and fruit accessibility and consumption, improved physical function, enhanced social support, and attenuated central adiposity among older cancer survivors in Alabama [ [35] , [36] , [37] ]. Remote study delivery of Harvest for Health, necessitated by COVID-19 pandemic, has been successful with standardized protocols [ 38 ]. Harvest for Health and the remote delivery has been successfully adapted for New Mexico, and also showed high rates of acceptability, retention, and increased vegetable intake [ 39 , 40 ].…”

Section: Introductionmentioning

confidence: 99%

Adaptation and study protocol for harvest for health together Arizona: A mentored community garden intervention for survivors of cancer

Skiba,

Miller,

Stratton

et al. 2024

Contemporary Clinical Trials Communications

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“…Harvest for Health (H4H), a mentored gardening program for cancer survivors, demonstrated high acceptability and retention as well as increased vegetable and fruit accessibility and consumption, improved physical function, enhanced social support, and attenuated central adiposity among older cancer survivors in Alabama [29][30][31]. Remote study delivery of H4H, necessitated by COVID-19 pandemic, has been successful with standardized protocols [32]. H4H and the remote delivery has been successfully adapted for New Mexico, and also shown high rates of acceptability, retention, and increased vegetable intake [33,34].…”

Section: Introductionmentioning

confidence: 99%

Adaptation and Study Protocol for Harvest for Health Together Arizona: a Mentored Community Garden Intervention for Survivors of Cancer

Skiba,

Miller,

Stratton

et al. 2023

Preprint

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Background Current health behavior recommendations for skin cancer prevention, treatment, and survivorship are the same for survivors of other cancers; they include eating a healthy diet, being physically active, maintaining a healthy weight, and minimizing ultraviolet (U.V.) exposure. Harvest for Health is a home-based mentored gardening intervention for cancer survivors and was successful in Alabama and New Mexico. We adapted Harvest for Health for implementation in Arizona as a community-based intervention and will pilot test for feasibility, acceptability, and appropriateness. Methods Harvest for Health Together Arizona (H4H2-AZ) is a six-month single-arm intervention of mentored community-based vegetable gardening. H4H2-AZ will be piloted among 30 skin cancer survivors. Participant cohorts are aligned with the start of growing seasons (e.g., Spring, Monsoon, Fall). Primary outcomes will be feasibility, acceptability, and appropriateness of the intervention. Secondary outcomes are to explore the effects on cancer preventive health behaviors (dietary quality, physical activity, sedentary time, U.V. exposure, and sun protective habits) and health-related quality of life (HR-QOL). Stakeholder-informed adaptations for Arizona included updating intervention materials to be relevant to the arid desert environment, emphasizing the importance of sun safety in cancer survivorship, and shifting from a home-based to a community-based delivery model. Participants were matched to an individual 30 square foot community garden plot and Master Gardener Mentor. Original intervention components retained are: 1) Master Gardeners deliver the intervention providing one-to-one mentorship and 2) gardening materials and supplies provided. Discussion This pilot single-arm intervention will determine feasibility, acceptability, and appropriateness of an evidence-based adapted mentored community gardening intervention for survivors of skin cancer. If successful, the intervention could be widely implemented throughout existing Master Gardener programs and community garden networks for survivors of other cancers. Trial registration: ClinicalTrials.gov identifier: NCT05648604. Trial registered on December 13, 2022.

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Harvest for Health, a Randomized Controlled Trial Testing a Home-Based, Vegetable Gardening Intervention Among Older Cancer Survivors Across Alabama: An Analysis of Accrual and Modifications Made in Intervention Delivery and Assessment During COVID-19

Cited by 5 publications

References 74 publications

Vegetable Gardening and Health Outcomes in Older Cancer Survivors

Vegetable Gardening and Health Outcomes in Older Cancer Survivors

Adaptation and study protocol for harvest for health together Arizona: A mentored community garden intervention for survivors of cancer

Adaptation and Study Protocol for Harvest for Health Together Arizona: a Mentored Community Garden Intervention for Survivors of Cancer

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