HERSHEY, Pa, — Cardiovascular disease is the leading cause of death around the world, according to the World Health Organization , and is strongly influenced by diet and physical activity. However, roughly only one in 10 American adults meet the recommended five servings of fruits and vegetables per day and about half get the recommended 150 minutes of physical activity per week, according to the Centers for Disease Control and Prevention.
Knowledge alone often isn’t enough to produce lasting behavior change, said Susan Veldheer , associate professor of family and community medicine and of public health sciences at Penn State College of Medicine. Yet most health programs focus on teaching people what they need to do to improve their health, and often the activities recommended may not be enjoyable or meaningful to the people who are trying to change their behavior.
Now, with a five-year, $3.8 million grant from the National Institute of Nursing Research of the National Institutes of Health, Veldheer and Amy Moore, assistant professor of nutritional sciences and food science at Penn State and co-principal investigator of the study, will lead a multidisciplinary team of researchers from Penn State in determining if starting with an activity that people are interested in, like gardening, can help lead to behavior change and improved health.
The grant includes a randomized controlled trial of the program, developed by the researchers and called “Growing Healthy Hearts” to test whether gardening, cooking, nutrition education, and social support can help people build healthier habits and whether these healthier habits extend beyond participants to positively influence the health of children living in their households. The program is not mean as a replacement for standard clinical care.
“Growing Healthy Hearts is grounded in behavioral science showing that enjoyment and intrinsic motivation are important for sustained behavior change,” Veldheer said. “When gardeners are asked why they garden, enjoyment is often the primary reason. They may enjoy being outdoors, spending time with their children, growing their own food or connecting with nature — reasons that have little to do with preventing disease. Yet, through gardening, they may also become more physically active, eat more vegetables and develop healthier eating habits.”
Growing Healthy Hearts takes a “food as medicine” approach, integrating food and nutrition interventions with healthcare to prevent, manage or treat chronic health conditions. The program also uses remote delivery to provide participants with the skills, resources, confidence and social support they need to help them succeed.
In a pilot study of the program, participants, who were all new to gardening, successfully harvested their produce and developed new healthy habits. Those who took part in the program ate nearly one additional cup of fruits and vegetables per day and took approximately 1,000 more steps per day than those in the control group.
With this new NIH grant, the research team will recruit 264 participants with at least one risk factor for cardiovascular disease, who eat few fruits and vegetables, who have low physical activity, who have at least one child living at home, and who are interested in learning how to garden and grow their own food. Participants will be randomized to the Growing Healthy Hearts group or a waitlist control group. Researchers will follow up with participants at six months and one year to assess diet, physical activity and biomarkers of cardiometabolic health.
“Many Food as Medicine programs focus on increasing access to healthy foods, which is an important first step, but access alone may not be enough to support lasting changes in health behaviors,” Moore said. “Knowing how to prepare and incorporate those foods into everyday meals can make that access even more meaningful. By combining gardening, cooking, and nutrition education, we're helping participants build practical skills and confidence to make healthy eating part of their daily lives. Since many families shop, cook and eat together, we're also interested in whether the changes participants make can positively influence the food choices and health behaviors of their children.”
The program will be delivered through a private Facebook group, which serves as both the intervention platform and community. Social media platforms are widely used in daily life but remain underutilized for delivering evidence-based nutrition and behavior-change programs, the researchers explained.
By using a familiar platform, the researchers will provide education, skill-building and peer support in a setting that may already be a part of people’s daily lives. The approach may be particularly beneficial for people living in rural communities, where access to health promotion programs, nutrition education and affordable fresh produce can be limited.
“Most nutrition and lifestyle programs are delivered in person in clinics, classrooms or community settings,” Moore said. “We're interested in whether social media platforms can also serve as effective learning environments. If successful, this approach could make evidence-based programs accessible to families regardless of where they live.”
Penn State Extension master gardeners and culinary nutrition experts will moderate the Facebook group, where participants will receive ongoing education over six months on growing and preparing healthy foods. Penn State Extension educators will help participants develop practical gardening and food preparation skills, offering guidance tailored to their available growing space, geographic location, and individual circumstances.
“One of the most exciting aspects of this collaboration is the opportunity to combine rigorous health research with Penn State’s land-grant mission,” Veldheer said. “By working closely with Penn State Extension, we can study not only whether Growing Healthy Hearts improves health, but also how it might eventually be delivered to families and communities across Pennsylvania and beyond.”
Additional Penn State collaborators on the grant include William Calo , associate professor of public health sciences and of family and community medicine; Jordan Kurth , assistant professor of medicine; Meg Bruening , professor and department head of nutritional sciences; and Elise Gurgevich , assistant director, food, families and communities programs at Penn State Extension.
This work is supported by the National Institutes of Health’s National Institute of Nursing Research under award number 1R01NR022295-01 . This content is the sole responsibility of the authors and does not necessarily reflect the views of the funders.