Horticultural Therapy, Part One - An Interview with Dr. Candice Shoemaker

In the first part of this two part episode on horticultural therapy, Sam and Lara talk to Dr. Candice Shoemaker, Professor Emeritus of Horticulture and Human Health at Kansas State University. Dr. Shoemaker talks about the varied and winding path that eventually led to her career in horticultural therapy, explains the basics and history of the field, and describes the benefits of receiving horticultural therapy versus therapeutical horticulture. She discusses the training needed in both horticulture and therapy in order to practice horticultural therapy.

You can find more on Dr. Shoemaker's work in the ASHS Journals HortScience and HortTechnology at http://ow.ly/CXHl50OAfu2.

Learn more about the American Society for Horticultural Science (ASHS) at https://ashs.org/.
HortTechnology, HortScience and the Journal of the American Society for Horticultural Science are all open-access and peer-reviewed journals, published by the American Society of Horticultural Science (ASHS). Find them at journals.ashs.org.

Consider becoming an ASHS member at https://ashs.org/page/Becomeamember!

You can also find the official webpage for Plants, People, Science at ashs.org/plantspeoplesciencepodcast, and we encourage you to send us feedback or suggestions at https://ashs.org/webinarpodcastsuggestion.

Podcast transcripts are available at https://plantspeoplescience.buzzsprout.com.

On LinkedIn find Sam Humphrey at linkedin.com/in/samson-humphrey. Curt Rom is at https://www.linkedin.com/in/curt-rom-611085134/. Lena Wilson is at https://www.linkedin.com/in/lena-wilson-2531a5141/.

Thank you for listening!

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Transcript

Lara Brindisi: 0:10

Welcome to Plants, People Science, a podcast by the American Society for Horticultural Science where we talk about all things horticulture. Hey Sam, how's it going?

Sam Humphrey: 0:20

It's going well. I'm having a good morning Lara. How about you?

Lara Brindisi: 0:23

Good, I don't know exactly where we left off last time, but I believe our last episode was before I left for my travels abroad to the Federated States of Micronesia and Taiwan.

Sam Humphrey: 0:39

Before you went off to have all those adventures and become like the wisest person I'll ever know? Yeah, so how was?

Lara Brindisi: 0:45

it. I definitely can't take that much credit, but I mean it was amazing. I've never been to the Pacific Islands like that before and the cultures were so rich and the people were so kind, and I would love to go back at some point, though we'll see if that's in the cards.

Sam Humphrey: 1:07

Oh, that does sound fun. So you went for the food and the people. Is that all you did? Food?

Lara Brindisi: 1:11

people, plants, culture, I mean, they had everything. I don't know exactly what I talked about last time, but in Micronesia I was working on a project related to food policy and food security which is a little bit outside of my wheelhouse, so it was great to get some experience there. And then in Taiwan I actually had a really great internship at the World Vegetable Center, working on pepper genomics. What have you been doing at home while I've been away?

Sam Humphrey: 1:45

At home. I've mostly been working in Phytotron. My school has this building called Phytotron that is just full of dozens of growth chambers that have different plant experiments, and so I've basically been living there and I started my strawberry experiment, so I'm really excited about that.

Lara Brindisi: 2:06

I'm so jealous that you have access to a Phytotron. I mean, can you explain for our audience what the difference between a regular greenhouse or growth chamber is versus a Phytotron?

Sam Humphrey: 2:18

I might not be able to explain it very well. It's like a facility that is fully dedicated to plant research. Like I said, a building that has all these growth chambers. It also has greenhouses on the top of it, but these greenhouses are like they have an air conditioning system that is closed to the outside so they can be used for BSL3 type experiments. And, yeah, the facility is just really amazing and the staff too are very dedicated to keeping the plants alive, so it's not just me sitting there alone with my plants. I can get the help that I need when I need it. So really wonderful experience.

Lara Brindisi: 3:01

Yeah, that is so important. I could not do any of the work that I did in my PhD without all the people that helped with the plant maintenance and greenhouse upkeep. It makes your life easier to have good people around you, for sure.

Sam Humphrey: 3:17

Yeah, and the lab support too. But you come from a really a pretty big lab, right? Did you feel like you had the social support you needed?

Lara Brindisi: 3:26

Oh yeah, socially. And my colleague I'll give her a shout out Arian Vasalates, made a really great comparison of us to the Weasley family how we're all a great mix of family but kind of filling in niches and competing for resources.

Sam Humphrey: 3:52

If I ever come across your twin, lara, your Weasley twin, my life will be complete. I want to meet, like Lara, number two.

Lara Brindisi: 4:04

Shall we get into it.

Sam Humphrey: 4:06

Yeah, let's do it. So for this episode we met up with two wonderful guests in the horticultural therapy field that we're dividing into two different episodes. The short series will share what horticultural therapy is, how it began and the benefits of receiving it, and what it's like to work as a professional in the field. Today will be part one, where we interview Dr Candice Shoemaker, who shares some of the research behind receiving horticultural therapy that she learned throughout her career as a professor. Part two will be with Abby Jaroslo, who practices horticultural therapy and walks us through her day to day as a professional in the field.

Lara Brindisi: 4:43

For those of you who have never heard the phrase horticultural therapy, it is defined by the American Horticultural Therapy Association as the participation in horticultural activities facilitated by a registered horticultural therapist to achieve specific goals within an established treatment, rehabilitation or vocational plan. Horticultural therapy is an active process which occurs in the context of an established treatment plan, where the process itself is considered therapeutic activity rather than the end product. It is different than community gardening and garden therapy, so we just want to make that clear.

Sam Humphrey: 5:24

Now a little more detail about our first guest. Dr Candice Shoemaker is professor at Amaritis of Horticultural and Human Health at Kansas State University. She earned her BS in Floriculture at Michigan State University, her MS in Horticultural Therapy at Kansas State University and her PhD in Environmental Floriculture at Michigan State University, after which she completed a postdoc at Virginia Tech and taught ornamental horticulture at Berry College while serving as the first director of the School of the Chicago Botanic Garden. A lifelong passion of hers is human issues in horticulture, which led her to start the interest group in the American Society for Horticultural Science.

Lara Brindisi: 6:05

If this interview resonates with you, I highly recommend renewing your membership and joining the American Society for Horticultural Science so you can be part of interest groups like this one. Let's get into it. So I understand you're from a family who owns a dairy farm and an orchard. What made you want to enter Floriculture as an undergraduate? You didn't want to continue the family farm.

Dr. Candace Shoemaker: 6:32

Yeah, I actually changed my major every year. I was an undergrad, so if you look at my transcripts, I'm in a different college every year. So I started in education and actually very quickly realized that wasn't where I wanted to be, which is kind of funny. Where I ended up right, and then I went into engineering because that's what my older brother did and he was in civil engineering, and so I thought, oh, I'll do that. Well, I didn't even know what it was, and when I found out what it was, I was like I don't want to do that. And then I landed in the architecture or landscape architecture. So I was in that college and I stayed in that college the longest.

Dr. Candace Shoemaker: 7:19

But while I was studying landscape architecture which I did for two years I discovered or realized that I liked Horticulture the courses I was taking in Horticulture, more than the design courses, the architecture courses and so I went and talked with someone in Horticulture and they went over all the different options that were available and the one that just resonated the most for me even though I grew up on a dairy farm and we had orchards and my great grandpa actually had his whole living with an orchard, an apple orchard I didn't go that direction. I liked flowers and so I just picked and I really liked production and greenhouse production. So that's where I started was in floriculture and greenhouse production, with my hope that I would someday and maybe this will still happen someday have my own greenhouse business. That was what I had planned to do when I graduated.

Sam Humphrey: 8:18

Very cool. So how did you transition, how did you segue from floriculture and horticulture into horticulture therapy?

Dr. Candace Shoemaker: 8:26

Yeah, so I was living out in. So I grew up in Michigan, but I had done my internship for my I had a bachelor's degree at a greenhouse outside of Seattle Washington and then I ended up staying out there. I just loved it and I found a place to live. It was a home for handicapped children, a foster home, and I lived in a treehouse, which was really fun, and in exchange for my room and board, I took care of the orchard and gardens and the landscape. I also helped with the kids at night. I did a lot of cooking. The woman who ran the place, she was a nurse and she was a gourmet cook and she had this amazing kitchen in the home for the kids. So it was really fun to cook.

Dr. Candace Shoemaker: 9:22

And anyway, there was a couple little boys, but one in particular his name was Danny and he was eight years old and he always wanted to be with me when I was outside and he wanted to garden and just be with me and he had a pretty significant cerebral palsy and I didn't I mean, I didn't really know at all what to do with him. And so the owner of the place, she suggested that I go and talk with her teacher, his teacher, and so I went to see the teacher and then she scheduled for me to visit with a physical therapist that would work with him. And so one of the things with his condition is that he was, he was very spastic and he also his muscles were all tightening up, and so the physical therapist really was just trying to maintain the amount of movement that he had and not lose it. So she said, anything that you could do with him to especially work with his hands so that he can continue to have control with his hands, because then he could still feed himself and have some independence would be good. So I would do that. So we'd be out in the garden and he would be laying down because he couldn't sit up, and we'd be pulling weeds and he would just have the biggest smile on his face. He was so happy out there.

Dr. Candace Shoemaker: 10:52

And and then at the same time it just I mean talk about just the way things happen, right, the same time there was an article in the Seattle Times, the local newspaper, about this thing called horticulture therapy, and a friend of mine gave it to me and said, hey, this sounds like what you're doing with Danny out in the garden. And I had. I had actually heard about horticotherapy when I was an undergrad at Michigan State because they were starting an option in that and one of the academic advisors was really interested in that and she had talked to me about it. But it would have taken me longer to, and I was interested in that because I I think because of the education piece of you know, and even with landscape architecture you get to work with people I had that interest in people but but I just didn't. I didn't want to take extra time, I wanted to be out as soon as I could.

Dr. Candace Shoemaker: 11:53

I was done with college, I wanted to do other things, and so, but in that article it mentioned Kansas State University and that was the only university you could get a degree in horticulture therapy. There were other universities where there were options, but that was the only university that had a degree, and so I was going home in the summer for my older brother's wedding and so I thought, oh well, I'm in Michigan, I'll just drive down to Kansas now it's further away than I thought, but it was closer than in Seattle and meet with a professor who ran that program his name is Dr Richard Mattson, and I was lucky because it happened to be when he was doing his annual conference on horticulture therapy. So I attended that conference and then and but I kept wanting to talk with him but he was really busy and you know I'd see him and I say, can I talk to you now? Because really what I wanted to do was just go to K-State and take all the horticulture therapy courses because I already had my degree and you know. So I just wanted to study horticulture therapy. So at the end of the conference he said, well, I have time for you now.

Dr. Candace Shoemaker: 13:07

And there was another woman her name was Joan that was with him and we were in the student union and they were asking me just some of the craziest questions like did I like to speak in front of people? When was the last time I did a talk in front of people? And and what was my writing? Like, did I like to write? And I'm like you know what in the world are these questions for? You know well, but I learned about horticulture therapy and you know I had something to think about and went back to Seattle and and well, I went back to Michigan for a while and then I finally got back to Seattle and and there was a letter from Dr Mattson and he said in the letter that he wanted me to be his graduate student and that he had an assistantship for me and at the graduate school was still waiting for my application. And I show this letter to my roommate and I'm like, okay, this is really weird, but I think I think he's gonna pay me to go to graduate school because, you know, I had no plans. In fact I clearly I had my.

Dr. Candace Shoemaker: 14:15

When I was taking plant propagation, my lab partner we were juniors she already knew she was gonna go to graduate school and was she was talking to me about it and I just thought that was, I mean, like that was the only time I ever talked about and I can remember about graduate school as an undergrad and I remember saying I would never go to graduate school, I couldn't wait to get out of college, you know, and get out with my life, and so I do nothing about graduate school and I didn't know anything about this thing called an assistantship and that they would pay you money to go to school.

Dr. Candace Shoemaker: 14:50

And my roommate says, yeah, I think that's what the letter is saying and she had a friend that was in graduate school at the time. So we called him and asked him and he said yes, and he explained it to us and stuff. So I thought, well, okay, I guess I'll go to graduate school and get my master's degree in horticulture therapy, so so it's kind of a long story, but that's sort of how I landed and got to study, really lucky, you know, dr Mattson was one of the the leaders and founders of this profession and I got to work with him. So yeah, pretty exciting yeah, that's amazing.

Lara Brindisi: 15:26

I mean I love hearing your path because one night really resembles my own. I never went into plant biology expecting to become plant biologists and end up in my PhD in this. I really did this roundabout way that kind of resembles yours, where I doubled in engineering and landscape architecture and all of these similar pathways and ultimately ended up in in horticulture. So I love hearing that. But I also really love hearing how you took each opportunity as they came along and really, really sees the day, instead of letting them pass by you. And here you are as a you know, a very impressive person in horticultural therapy. And so I guess quickly for the audience who might have never heard what horticultural therapy was, could you quickly define this term? Sure?

Dr. Candace Shoemaker: 16:15

so horticultural therapy is the use of horticulture, horticulture activities, in a therapeutic way, working with people that are in treatment, and the activities themselves are used for the, for the health outcomes that are you're striving for in treatment, and so. So that's very focused right, and I think when people hear the word horticultural therapy they're actually thinking about probably something a little bit more broad, and so sometimes, especially in the profession, you'll hear people talk about horticultural therapy and therapeutic horticulture. So therapeutic horticulture is, again, you know, health and wellness through horticulture. So those horticulture activities, but it may not be that necessarily that you're working with clients and that activity is targeting the, the health issue for that client, but it's more just you know they're gonna feel better and that might then help them with their issues in other ways. So a lot of times, like in in hospitals, especially rehabilitation hospitals, the Hort Therapy program is really a time for the patients to get a break. Because if you're in in the hospital and you're, for example, recovering from a stroke or from a heart attack and you're building strength and you know you're in physical therapy a couple times a day and you're in occupational therapy a couple times and maybe you're in speech therapy for an hour every day and so on. Right, it's a lot of work because they want you in and out pretty quick, right and. But you need time to just kind of renew yourself, and a hospital is a stressful time anyway, right. And so the Hort Therapy Program may be just a time when you're on a break from all the other therapies and it gives you a time to renew and refresh so that when you go back into the other allied health therapies you can do better. And so that's really therapeutic horticulture.

Dr. Candace Shoemaker: 18:37

Other terms that are used to kind of recognize the variety of health benefits that we get from horticulture and from plants and nature can be social horticulture, community horticulture, community gardening there's a lot of health and wellness benefits from that and, as I said, therapeutic horticulture, garden therapy. So there's a lot of terms, and that's also one of the reasons why the profession has struggled, because I think too many people think like when you and I go out and garden when my daughter was young and I would be grumpy, I'd get home from work and I'd be grumpy. My daughter would say, mom, you need to go pull some weeds for a while because then you're happier. She recognized how much gardening she helped me, but that wouldn't be horticulture therapy, right. I mean in terms of, if you want hortic therapy to be a profession, right, then you need professionals that are trained both in horticulture and in therapy and how to bring those two things together for targeted health outcomes.

Sam Humphrey: 19:55

Yeah, that's a really good thing to keep in mind. I was not aware of that before. So I think of how people have been pulling weeds for probably millions of years at this point, before we were even people, I'm sure. But the start of horticultural therapy as a practice how did that begin?

Dr. Candace Shoemaker: 20:17

Yeah, so well, actually from the founding of our country. So Dr Benjamin Rush he's considered the father of American psychiatry and he actually signed was one of the signers of the constitution. He recognized in mental health hospitals so think about hundreds of years ago and the founding of this nation what those hospitals might have been like. But he recognized many of them were out in the country and for people who couldn't pay for care they would work on the farms. They were quite often working farms and he actually noticed that those who got outside that worked in the farms got better and those who could afford to pay and stay inside quite often didn't get better. So even early on some of his writings were about that.

Dr. Candace Shoemaker: 21:12

But where the really the profession emerged was after, during and after World War II, so especially in the 1950s. But what happened is rehabilitation medicine really became its own separate entity of medical practice during World War I and World War II, especially World War II, because more soldiers were surviving the battlefield and coming home with pretty severe injuries and had to be taken care of for a long time in the hospital before they could go home, and occupational therapy at the same time was working closely with rehabilitation medicine, and so these soldiers were recovering for a long time and the doctors and the occupational therapists were looking for lots of things to keep them occupied especially the occupational therapists, while they were recovering and getting strong enough where they could go home. And at the same time the American Gardening Association had as one of their mission areas to volunteer in their communities. So they would volunteer at the hospitals and started doing gardening activities with these soldiers as you're covering soldiers and there were both physicians and occupational therapists who really saw some distinctions when it was gardening versus other things that could keep us occupied. So you think about music therapy, art therapy, horticulture therapy those all came really at the same time out of, especially after World War II, and so that's really how it began to be distinguished as its own profession.

Dr. Candace Shoemaker: 23:04

And then some work at universities and I'm proud to say at Michigan State University, my alumni or alum, where I graduated from, was one of those places that was doing some work and it was the Horticulture Department and a physician and an occupational therapist and a social worker that were doing that in the 60s and then in the 70s the National Professional Association, which is now called the American Horticultural Therapy Association, was founded. At that time it was called the National Association for Therapy and Rehabilitation through Horticulture, so it was a little complicated, so that was smart. When they changed it to the American Horticultural Therapy Association, so it was really in the 70s when the definition of it as a profession in fact that's what Dr Mattson was working on he had gotten a big National Institute for Health grant to really define horticulture therapy and that's when I got to work with him. So that was pretty exciting yeah.

Lara Brindisi: 24:11

Great. And so when you're talking about seeing patients improve, what kind of benefits are physicians and horticultural therapists and social workers or anyone involved in this process? What kind of benefits are they noticing?

Dr. Candace Shoemaker: 24:28

Yeah, you know, I just in fact, last fall I gave a talk at the American Horticultural Therapy Association annual conference. That was on the research findings that we now have, and I started that talk by, like you know where do you go when you want to learn anything new? You go to Google, right? So if you do a Google search benefits of horticulture therapy you get, you know, millions of hits right and even if you look at like the CDC, you can find the benefits of gardening and. But if you remember I just talked about horticulture therapy as a profession versus health and wellness, that we get, any of us get through horticulture right. So there's actually, I'm pleased to say, from when I started in the late 70s, there's more and more research being done looking at and understanding the health benefits from gardening and from horticulture therapy. There's more on the health benefits of gardening, which is what my research was in than there is on our understanding of the health benefits from horticultural therapy. So if you think about it as a profession in the healthcare field, right, if we're taking a pill to feel better from the flu or something, it's a certain dosage for a certain amount of time that from research we know for most people will make us feel better, right. So in that regard we've got a long ways to go in terms of horticultural therapy. But if we look at it, there's been enough research now that there's actually publications, probably the last five or six years, that are meta-analysis of the research that's been done. Looking at particularly with older adults, there's a lot of pretty good research now on horticultural therapy programs, and probably the biggest one we have with older adults in treatment is with cognitive impairment. So we know that horticultural therapy programs can help sustain or maintain cognitive health. So in terms of people with dementia, it's a really good way to help with that problem. Depression is another one. That's we've got, I think, pretty good research now that shows that it can help positively improve depression, anxiety. So those mental health aspects, right. We also know that and this is from some of my research as well that gardening is a physical activity, so we can have physical improvements, it can help with strength and general physical health as well. So both mental and physical health benefits, and then and then we can look at social benefits as well. So, and again, a lot of the research has been with older adults, and so we know that gardening activities, horticultural activities can foster more social interaction and I quite often tell a story when I was getting my PhD, which was in floriculture, I really wanted to do it in human issues in horticulture, but that didn't work out.

Dr. Candace Shoemaker: 28:01

But I connected with a medical school at Michigan State University, again for my PhD. I connected with the medical school and they had just started while I was getting my PhD. They called it a cognate through the medical school but it was like a master's degree in gerontology. So while I was getting my PhD I did this gerontology cognate and I had to do a research project and I had to do a practicum and I did those at a nursing home and so I ran a horticultural therapy program for a full year. As for my practicum and one of my because that's what the facility wanted was they wanted the people to to socialize more and kind of build friendships in the institution, which is hard. So that was one of my goals, for my horticultural therapy program was to foster socialization.

Dr. Candace Shoemaker: 29:07

So I would plan, you know, each week these activities and think about how I could get them to talk. Right, well, they would talk to me. I had about 12 residents that came to my garden club and they would all talk to me, they would answer my questions, but they weren't talking to each other. Well, one week in the Botanic Gardens on campus they had pruned all the roses and they just bags of roses, you know, and spent roses, right. So I took these bags and and brought them to the to the facility and I just dumped all these roses on the table, was just covered in red roses and I said all we're gonna do today is pull the petals off the the roses, because then we're gonna dry them and we'll just leave them on these tables and we'll dry them and the next week we can make pulp vreep. So it wasn't a hard activity, right.

Dr. Candace Shoemaker: 30:04

And we're just sitting there and we're, and of course it smells heavenly, right. They started talking to each other and more people come in and they want to join because it smells good. And they're talking to each other and they're sharing stories about, you know, when, the first time their husband gave them roses when they were dating? Or you know the rose bush, that was next to their front porch and the hub every summer when it would start blooming. They would remember that. I mean it. And they're sharing these stories with me, not with me with each other. You know it was just, it was amazing, but I didn't plan that, you know, for that to happen, but it worked. So socialization we've. We know from the research that that's also another good health outcome.

Lara Brindisi: 30:52

Yeah, you're gonna open up a new can of worms about aroma therapy, but that's a whole separate discussion Exactly exactly.

Sam Humphrey: 31:02

Wow. So you have talked, then, about many of the health benefits of gardening and you've done a lot of research in this area yourself. Can you talk a little bit about the work that you've done?

Dr. Candace Shoemaker: 31:15

Yeah. So I focused on, of course, older adults because I had studied gerontology while I was getting my PhD and then I also did some school garden projects as well, research projects as well, and so with the the, actually with both of them, it was to really look at two primary things one was nutrition and then the second one was physical activity. So we all know, we're, you know, used to well, it is again now five servings of fruits and vegetables a day for a healthy diet. You know, actually while I was doing my research the CDC had changed it to nine and then they changed it back because we're not even meeting the five. So then why change it to nine when we're, you know we can't even do the five a day? So it's five a day. And then our, you know, recommendation for physical activity, for health maintenance for all of us is at least 150 minutes of moderate intensity physical activity a day.

Dr. Candace Shoemaker: 32:22

So my question with older adults is if you're a gardener, does that make a difference? And can gardening kind of a bigger question is can gardening with older adults help with their health, their physical health? And then with youth it was more about can we design a program that can help? And we targeted eight, nine and 10 year olds. So, like fourth and fifth grade, right before they're going into middle school or junior high, can we come up with a program using gardening that can help them start thinking about healthy lifestyle choices, right? So sedentary behavior, drinking water, screen time, right, and then of course, physical activity and healthy eating.

Dr. Candace Shoemaker: 33:18

And so those were the two avenues that my whole research career was in, and we would do a variety of different things, different interventions, and we would do all kinds of different ways of measuring the outcomes. So we would do observation, so I would train undergraduate students and they would have a check sheet and, like with older adults, they would go to the older adults' homes and just observe them gardening, and it was specific things that we would have them mark as they watched them. So they were just. It was kind of like, you know, in see-true research, right. Of course we did a lot of surveys. Some of them were things that we wrote ourselves, especially like the demographics information we needed to gather, but then also things like, especially with the kids.

Dr. Candace Shoemaker: 34:19

All of my interventions were designed using social cognitive theory, and so with social cognitive theory, some of the things that you target are self-efficacy and outcome expectancies. So we would do. We would use survey instruments that were already shown to be reliable in measuring those behaviors in kids. There's standard eating behavior survey instruments. We would use those. And then we also would measure metabolic things. So we would measure things like heart rate, oxygen consumption. We'd have both the adults and the kids wear accelerometers to measure their movements, and so it was a real mix of things that we would do to measure, to understand how they garden right and how long they garden, and so on. So it was just a real mix of things that we would do.

Lara Brindisi: 35:19

Great, so what did you?

Dr. Candace Shoemaker: 35:20

find so with our older adults. Okay, so these are community dwelling. Most of my research was with community dwelling older adults and one of the standardized survey instruments that we used was a leisure time physical activity assessment. That, basically, was quite a comprehensive survey instrument, but it would, based on the results, you could calculate how much time they spent in leisure time, physical activity, and if it was low intensity, moderate intensity or high intensity, and gardening was one of those items on that thing. So it was really great because we could look at gardening versus walking, versus golfing versus vacuuming, just all different kinds of things right.

Dr. Candace Shoemaker: 36:19

So we took our study population and we designated them as gardeners or non-gardeners based on the results of that survey. And then we looked at all these health parameters, both from self-report surveys that we did, as well as heart rate and oxygen consumption and so on, and what we found, what we learned, was, first of all, both in terms of the metabolic measurements that we took as well as the self-report measurements, that they have better physical health. So if you're a gardener, or if you've ever been a gardener, as you approach older age, you might want to think about starting gardening again. If you're not a gardener, because it helps you. It can help you sustain good physical health, mental health was actually similar across all of our population. So what we found, what we kind of concluded there was we did this research in Manhattan, kansas that older adults in Manhattan campus are mentally healthy, and then probably one of the biggest findings that we took and then we did some horticulture therapy type research, was we found that gardeners had stronger hand strength and better finger dexterity, which is really important. I mean, I notice already, I can notice that my hand strength is changing as I'm aging and so I really want to get out and garden Minus three here today, so I'm not going to be gardening today, but anyway. So that finding. We actually then designed a 12-week horticulture therapy program and we worked with the rehabilitation unit at our local hospital and worked with occupational therapists and we recruited people that were in outpatient care, still doing therapy, who had had a stroke but were still in therapy to improve their hand strength, and so we had a control group that was in their traditional OT care and then we had a treatment group that got our 12-week horticulture therapy treatment and we did plant propagation for an hour twice a week for 12 weeks and our treatment was as effective as the OT treatment. So that was really a fun finding to find out. So that's kind of globally what we found out with our older adult research With our kids.

Dr. Candace Shoemaker: 39:16

So the grant I got a really big grant. That was a four-year project and the biggest thing on that was that we had to measure BMI. So basically weight right, and what we found which of course sounds like it was a non-finding was that there was no change in BMI and what you want to see is a reduction. Well, our kids weren't overweight to begin with, so why would we want it to go down? Because they weren't overweight? We ran an after-school gardening program. We built high tunnels at the schools so that they could garden through the winter in Kansas, which was really fun because they'd come out of the school running to the greenhouse in their winter coats through the snow and then they'd come in and they would harvest strawberries and we'd have strawberries in December or spinach in January. So it was fun.

Dr. Candace Shoemaker: 40:15

I think and this is more anecdotal, but I would say that with my school projects that I think that the biggest thing was that having the gardening program was just a fun way for the kid, the young people to think about healthy lifestyles. Right, and a non-threatening not through health class, where it's boring, you know, it was just, it was fun. And probably the biggest finding which there's quite a bit of research that supports this is that they were more likely to try new fruits and vegetables. We would always have a snack, because it was right, after school. So they would start the after-school program with a snack, and it was a healthy snack, a fruit or vegetable. And if we could find something different that maybe they never had before, we would buy that and everyone had to try it. And so that's a big thing, like I just know with my daughter at that age. You know she wasn't into trying new things. So even just, it was just the culture of our club we're all going to try it, we might like it, we might not, and the volunteer adults, you know that were our leaders. They didn't, you know they would say I don't like that and I'd say, well, you have to try it and don't say you don't like it in front of the kids until after they've all tried it. And so they were game, it was fun, and a story I like to share about this is.

Dr. Candace Shoemaker: 41:53

So at the end of one school year we did a field trip and we took all of our student farmers to meet our college student farmers. So we took them to our student farm on campus and they got to meet the college students. They were really excited. And that day on the student farm on campus they had harvest spinach and they had big bags. I mean just big bags, like if it was potato chips it'd be like the super size of potato chips, of the spinach. It was all washed and ready to sell to farmers market.

Dr. Candace Shoemaker: 42:28

But they told the kids when they were leaving they had big boxes on them. They said if you want a bag of spinach, you can take a bag of spinach. Well, these kids were so excited and they're all grabbing bags of spinach and they're saying Dr Schumacher, dr Schumacher, can we open it up and start eating it? And I said, well, of course, if you want, it's washed, it's safe. And we had parents who had come along to help us because we had two bus loads of kids. And these parents are coming up to me saying how in the world did you do that? And it was so much fun, it was just, it was so neat to see. And I mean, but you guys probably know I mean fresh spinach right out of the garden. It's really good. So anyway, that's just so. That's probably the biggest finding that we had from the youth gardening. It's just their willingness to try.

Lara Brindisi: 43:18

Right, and that's huge because a lot of those early tendencies can become static and become your adult tendencies. Right, and I personally don't know any children that have been that excited about spinach, so that's great. So this is a follow-up question to your results. You're reporting reaching levels of moderate activity that's required by the CDC, or willingness to try new foods and stay active. Have there been any reports of self-reported happiness or other emotional benefits?

Dr. Candace Shoemaker: 43:56

Yeah, so we didn't measure that in our studies. I went back and looked just to refresh my mind and so we just looked at general mental health in our studies. I do know of studies, especially with children, where the happiness scale is a really simple scale. It's a scale of one to 10, and it's just different faces, so really you can use it with any population. It's even used with older adults with dementia and it's been found to be an effective tool to understand their happiness score.

Lara Brindisi: 44:37

When you're saying different faces, you mean like a very happy face versus like a very sad face, and then maybe some intermediate faces for a scale Exactly exactly, yeah, yeah, and the biggest one is typically 10 faces.

Dr. Candace Shoemaker: 44:53

Some of them are only six, but yeah, it's just called a face happiness scale Emojis. Yeah, and that's exactly that's what it is Exactly it's emojis. Yeah, in fact, every time I wanna put an emoji and I see all those choices, I'm like, oh, I can make a new scale.

Lara Brindisi: 45:12

Yeah, this is the one with the big teeth smile. This is the one with just like the little line smile Exactly straight across that's neutral, right?

Dr. Candace Shoemaker: 45:21

Yeah, it's just emojis, exactly exactly, so it's very easy. So there's been some research that's looked at that and in general I can say that the gardening activities, especially if you do like a pre-post from one activity. In fact, last year at that conference I just mentioned, there was a group that reported on a program that they were doing with veterans that had PTSD and they did a pre-post and one of the scales that they used was that scale and they would just look at when they arrived at the garden they would do it and quite often at that time it showed that they were not happy and then before they left they got back on the bus to go back to the VA hospital. So just during that one hour, one and a half hours that they were at the garden, when they left, they were happy and so, yeah, it is used and it shows, especially that pre-post, during that experience itself, that we feel better. Yeah, yeah, and this is all self-reported scales.

Lara Brindisi: 46:43

This is just yeah.

Dr. Candace Shoemaker: 46:44

And the thing when you're using it, when you're doing human subjects research, right, one of the challenges is the burden on them, and if the burden is too great, then you're gonna get dropouts. And so if you can find a scale that has had research done on it, that has shown that it's valid and reliable with the population that you are working with, and it's simple, but it's reliable and valid and it's answering the question you have, then that's just use it. And so, yeah, the happen to scale. Doctors use it, mental health professionals use it. Yeah, it's an effective scale, okay, great.

Lara Brindisi: 47:32

And so let's say, one of our listeners is hearing you talk about horticultural therapy and they're so inspired to become a horticultural therapist. How do they get training? Do they need to be certified? Yeah, so there is a professional registration that's available to the public.

Dr. Candace Shoemaker: 47:51

There is a professional registration. That's available. It's through the American Horticultural Therapy Association. At this point you do not need to be professionally registered or certified as a horticultural therapist to practice horticultural therapy. So, just like AESHS has the professional certification for horticulturists, you don't have to have that, but it certainly gives you a leg up right and so quite often, especially if you wanna work in a healthcare facility, you need to or you should have that professional registration. To become professionally registered, it's a combination of coursework and a work experience. So you need it for 180 hours of supervised work experience and horticultural therapy and then you need credit hours in horticultural therapy and health and human sciences.

Lara Brindisi: 48:59

Okay, great, and I know a lot of universities have programs, like I know Rutgers, my university has a program, and the ones that you have frequented also, of course, have those programs. Yes, yeah yeah.

Dr. Candace Shoemaker: 49:12

So there's probably I would say maybe about 10 universities that offer the horticultural therapy coursework. Of course there's a lot more universities where you can then get the horticulture in the health and human sciences coursework. So, like introduction to psychology, developmental psychology, social sciences, I think pharmacology is a good course, aging youth development there's a lot of good courses to take.

Dr. Candace Shoemaker: 49:42

And I think I haven't looked at the requirements from HTA for a while, but they might have actually specific courses that they require. Now that you have, I'm not sure. So I would just recommend that you go to the American Horticultural Therapy Association it's just ahtaorg and look at professional registration and it'll show you. There's some public gardens also that offer the coursework. And then there's the Horticultural Therapy Institute, which is located in Denver, colorado, and they actually deliver their program across the country. So I know a lot of people take their program.

Lara Brindisi: 50:27

It's very good yeah, oh, okay, great. And so, on the other side, if people are listening that wanna receive Horticultural Therapy and they wanna incorporate it into their lives, but maybe don't have access to formal therapy sessions, how would they go about incorporating it into their life?

Dr. Candace Shoemaker: 50:45

Yeah, you know, I think that's a good question and I think you know, if you think about mindfulness, I think that's a really good way to approach it. So when you're out in nature, be mindful of nature. When you're at the farmer's market, be mindful of the produce that you're looking at. And even if you have only one houseplant in your apartment or your home and you're watering it, be mindful while you're there watering it. Smell the difference, because when you're watering you're gonna smell that soil, right, and if you don't smell it anymore, it's time to put fresh soil in there. But I think it's related to being mindful.

Dr. Candace Shoemaker: 51:45

You know, and I think my dad had an orchard and a big garden and the garden got bigger and bigger when he retired and of course I would talk to him about don't you feel better when you're out there? And of course he was a World War II veteran. I mean he was a guy and he was just like chuckle, you know, but as he got older and like he had knee problems and his doctor told him to go walk in the mall, which like he's not gonna do that. I mean he probably never even been in the mall, you know, and he'd mentioned that to me one time and I said well, dad, instead of driving your tractor around all the time when you're out in the orchard, why don't you walk? And or at least, if you take the tractor out with your wagon with all your tools in it, think about walking for many trees before you move the tractor. And he went oh yeah, I can do that.

Dr. Candace Shoemaker: 52:55

And I think I just saw with my dad that he became more aware of how he was feeling good when he went out in the orchard, cause he didn't have to be out there. I mean, this was Michigan, right, so he wasn't out there every day year round. And when there would be periods of time when he wasn't out there and then he'd go out there, I think he started just going. You know what I do feel better when I'm out here. Even when he would just walk around the orchard to look at the trees and make a note of what had to be done next, he was feeling better. So I think for all of us just being mindful and if you have a garden and you're just like you know, I gotta go out there and work maybe that's how you start. But once you get out there, just be mindful, smell, listen, feel with your plants. I think that's the way to do it.

Lara Brindisi: 53:49

Yeah, and that's the true theme of therapy, right? I feel like all therapies come back to being mindful. So that's how I know you're the real deal. Yeah, and then I guess the last couple of questions I have for you is you know, what do you want the public to know about horticultural therapy and then horticultural therapists to know about your research?

Dr. Candace Shoemaker: 54:12

Yeah, well, I mean, I think you know, first of all, it's really easy for us to think well, we all feel better when we're around, especially if we're horticulturists, right, if most of the people that are listening to this are horticulturists, they're just gonna go. Well, yeah, you know, and they provide us, you know, I mean, there's so many benefits from plants, right, our oxygen, they provide shade. You know, they modify the environment. I mean, there's just, you know, water management, there's just a whole lot of things, right, and so it's easy for us to take plants for granted. And so I think the first thing is to just go yeah, there's a lot of benefits from plants, from gardening, from horticulture.

Dr. Candace Shoemaker: 54:57

But when we talk about horticultural therapy, versus all the other many, many, many, many benefits that we have from horticulture, it is a distinct profession that have trained professionals selecting specific horticultural tasks or activities that are known to help with the health issue that that person is in treatment for.

Dr. Candace Shoemaker: 55:29

And so I think that's really what I'd like people to start really recognizing versus, you know, therapeutic horticulture or garden therapy or social horticulture, where we have all these benefits. You know, if you think about, for example, someone who runs a community garden, right, someone who runs a community garden is gonna talk about an awful lot of benefits beyond the tons of produce that they produce every year. Right, there's social benefits, there's public health benefits, there's, you know, there's activist benefits, you know they save neighborhoods sometimes because of a community garden. So, but that's not horticulture therapy, because those are community dwelling people that are coming together to have produce or flowers and socialize, maybe to change the environment and abandon lot and an inner city to something beautiful, right, but they're not there in treatment being led by health professional. And so that's really what I think, what I wanna say about horticulture therapy versus all the other benefits that we get from horticulture.

Lara Brindisi: 56:43

Got it. So you wanna make sure that everyone knows horticultural therapy. Is this distinct, very specific field meant for treating people through horticulture, whereas you know gardening and all of these other activities? They could be really, really beneficial, but it is a separate field and a separate categorization. Yeah, yeah, okay, great. Well, thank you so much for this interview, dr Shoemaker. It's been a pleasure to have you on.

Dr. Candace Shoemaker: 57:09

I've really appreciated it's fun. Yeah, yeah, yeah.

Sam Humphrey: 57:15

To find Dr Candice Shoemaker's research. You can find some of her work in HORT Science and HORT Technology, which are open source peer-reviewed journals published by the American Society for Horticultural Science. Links to these articles will be provided in the show notes.

Lara Brindisi: 57:30

If you'd like more information about the American Society for Horticultural Science in general, you can go to ashsorg Sam. If people wanna follow your work, that's the best way.

Sam Humphrey: 57:41

You can find me on LinkedIn at Samson Humphrey Lara. And what about you?

Lara Brindisi: 57:45

You can follow me on Instagram at theplantphd, or on LinkedIn with the tag Lara Brindisi.

Sam Humphrey: 57:52

Thanks for joining us. Stay tuned for our next podcast.

Lara Brindisi: 57:59

ASHS podcasts are made possible by member dues and volunteerism. Please go to ashsorg to learn more. If you are not already a member of ASHS, we invite you to join us. Ashs is a not-for-profit and your donations are tax deductible. This episode was hosted by Sam Humphrey and Lara Brindisi. Special thanks to our audio engineer, Alex Fraser, our research team, Lena Wilson and Andrew Comatz, our ASHS support team, Sarah Powell and Sally Murphy, and our musician, John Clark.