Advances in Integrative Medicine, 2026/09, 13(3):100689. doi: 10.1016/j.aimed.2026.100689, type of study: pretest posttest design

Full text    (https://www.sciencedirect.com/science/article/abs/pii/S2212958826000820)

Keywords:

anxiety [71]
gardening [1]
medical students [694]
osteopathic medicine [2109]
pretest posttest design [240]
USA [1752]

Abstract:

Objectives: Anxiety is the most common psychiatric disorder and is associated with dysregulation in the hypothalamic-pituitary axis causing elevated cortisol levels. Increased cortisol release impacts the function of brain regions and increases autonomic symptoms. Medical students are disproportionately affected by high levels of anxiety, which may increase burnout, reduce empathy, and compromise patient care. Nature-based therapies, such as gardening, offer a nonpharmacological and cost-effective approach to anxiety management. This study aimed to evaluate the potential effects of gardening as a nature-based intervention for reducing anxiety in first- and second-year osteopathic medical students. Study design and setting: Participants (n = 32) were adult medical students at Lake Erie College of Osteopathic Medicine in Elmira, NY. The intervention consisted of approximately 2 h of gardening per week over an 8-week period. Anxiety levels were assessed pre- and post-intervention using the Hamilton Anxiety Rating Scale (HAM-A) and the Severity Measure for Generalized Anxiety Disorder–Adults (SM-GAD-A). Results: All participants had a certain level of anxiety with 75% reported mild, 22% moderate, and 3% severe in the HAM-A pre-intervention survey. Furthermore, 53.1% of participants reported mild, 37.5% moderate, and 9.38% severe levels of anxiety in the SM-GAD-A pre-intervention survey. Analysis of the SM-GAD-A domain scores indicated that none of the domains demonstrated a statistically significant change from pre-intervention to post-intervention. However, HAM-A domain analysis revealed a significant (p < 0.05) reduction in autonomic symptom scores. Conclusion: These findings suggest that gardening may be associated with improvements in self-reported autonomic symptoms of anxiety and may serve as a supportive nonpharmacologic strategy for medical students. However, the absence of a control group and paired analyses limit causal interpretation, and further comprehensive studies are needed to evaluate broader effects on anxiety severity.