Therapeutic outcomes of gardening can enhance participation in work, home maintenance, or leisure. The following evidence from practice highlights:

Gardening for recovery and wellness is well supported by research that informs occupational therapy practice (York and Wiseman 2012, Wang and MacMillan 2013). Gardening offers moderate physical exercise (Park 2007), stress reduction (Van Den berg and Custers 2010, Hawkins et al. 2013), social interaction (Fieldhouse 2003), social inclusion (Simo-Algado 2013), and spiritual experiences ­(Unruh and Hutchinson 2011).

Creative and leisure activities are used more in mental health than in physical health practice (Müllersdorf and Ivarsson 2012). The research that reports on ­occupational therapy gardening reflects this bias. A single-blinded randomized control trial for people with severe mental health needs participating in a horticultural program found statistically significant less depression, anxiety, and stress using the Depression Anxiety Stress Scale 21 (Kam and Siu 2010). Experience of success and failure helped clients with stress-related disorders to feel free to try new things and those who had gardened increased their occupational repertoire (Eriksson et al. 2010). Women with burnout experienced enjoyment , competence, and space for ­reflection and recovery (Eriksson et al. 2011). People with Huntington’s disease expressed being happy when doing and being in the garden. They also enjoyed related activities, such as garden-focused television and painting pictures of the garden (Spring et al. 2013). Occupational therapy outpatients with neurological conditions experienced beneficial feelings of joy, improvement in physical abilities, and pride and satisfaction in production of tangible results. They valued choices that voluntary participation offered, and confidence was fostered by succeeding at complicated tasks. They also noted the problem of access for wheelchairs and those participants with poor balance on uneven ground (Jonasson et al. 2007). Furthermore, being a gardener indicates reduced risk of mortality (Eckel et al. 2012).

Parkinson et al. (2011) highlight that the benefits of engaging in horticultural activity in a mental health service are not automatic. The external environment provides challenges, which can be graded to maximize the therapeutic benefit, providing physical exercise and enhancing sensory experience. Personal interest was rated as the most important factor in participation. Problematic factors included awareness of pollution, hay fever, and inclement weather, and access to toilets, kitchens, and comfortable seating . The work of Simo-Algado (2013) exemplifies advocacy to reduce social exclusion though gardening.

The effectiveness of occupational therapy gardening activities was strongest in research relating to groups of people with mental health needs. Experimental research strongly supports the acute stress-relieving effects of independent gardening (Van Den Berg and Custers 2010). Hawkins et al. (2013) explored mechanisms by which this stress reduction occurs, reporting that both the “doing” and the “being” in the environment are important, and time alone is an essential feature of this benefit. Overall, this research clarifies the importance of quiet, solitary, contemplative time, as well as enjoyment of the vigorous active and social elements of the activity that participant’s value.

Gardening is used within the process of recovery to encourage nurturing and self- nurturing. OTs can grade and adapt gardening to develop the participants’ physical, emotional, cognitive, social, spiritual, and occupational capacities. Research has shown that gardening is a way to gain confidence, self-esteem , and develop positive roles and identity. People learn new skills, gain qualifications, and developed work-type roles in less stressful and aesthetically pleasing environments that reduce the pressure to perform. People express pride in achievements , creating tangible and edible outcomes. People describe having a sense of belonging (York and Wiseman 2012).

Gardening outcomes are important too, and the success of the projects undertaken will be experienced by participants. If the gardening is managed well, and the tasks provide a challenge that is appropriate, then there will be the opportunity to enjoy achievements in the beauty of the garden and taste of its produce. The special element of gardening as an occupation is that it deals with living plants that are imbued with a form of agency (Bhatti and Church 2004), and they demand care and attention , increasing the levels of activity, and this care results in the miracle of creating living, growing plants which can foster a spiritual connection.

Gardening is a simple ubiquitous activity, but facilitating gardening as therapy requires commitment, imagination, excellent skills in activity analysis, grading and adaptation, and the motivation to learn for and with clients. Important aspects of gardening that an OT can highlight are choice in how to enjoy free time, connection with the miracle of life, the experience of joy, and measured risk—that means, participants can have wonderful achievements or even failure and feel braver as a result. A little magic in the world is easily swamped by the complexity of human relations; gardening affords an opportunity to pause and appreciate the little miracles in order to connect with a world of hope and wonder.