“[Physical activity] is a real support to me whilst I am contending with depression and trying to emerge from it.”
Have you ever gone on a walk and felt like all your problems have disappeared? There is some science to this. You see, physical activity plays a key role in well-being, going as far as improving mental health disorder symptoms. This raises the question, can mental healthcare use physical activity as a form of treatment? Let’s find out…
Physical activity has more benefits beyond building strength and fitness. It can improve memory, mood, sleep and reduce stress. Luckily, you don’t need to run a marathon to experience these benefits; simple movements in work, housework or school are enough! (Seriously, even 45 minutes a day of gardening helps).
Physical activity boosts positive changes in both body and brain. For example, supporting brain development – even in adulthood – and the ability to adapt to stress. ‘Feel good’ hormones (dopamine and serotonin) are also released, promoting feelings of pleasure and satisfaction and helping reduce that ‘on-edge’ feeling of anxiety.
Research shows that these effects can be therapeutic for those with mental health problems and physical activity trials have been found to be as effective as standard talking therapy or antidepressants. In some cases, physical activity on top of treatment as usual (TAU), resulted in better mental health improvements compared to TAU alone!
However, with more severe mental health cases, the positive effects of physical activity become hazy. For instance, improvements in symptoms have been found in people with schizophrenia and obsessive compulsive disorder. Yet other studies found no changes, or detrimental effects, in people with bipolar disorder and post-traumatic stress disorder. Still, research around severe mental illness and physical activity effects is rare, making it difficult to draw clear conclusions.
Nevertheless, physical activity treatments have minimal-to-no harmful effects. That being said, only six NHS Talking Therapies for depression and anxiety offer physical activity programmes. Considering the benefits of physical activity for mild-to-moderate cases of mental health, why has it not been widely adopted by healthcare services? This is because little is known about whether physical activity research findings can relate to the clinical mental health setting, which is what we sought to investigate.
Current Study: Integrating physical activity into NHS Talking Therapies.
In collaboration with a London-based service (Community Living Well), we performed an inspection on their new physical activity treatment. We aimed to explore the impact the treatment had on patient mental health, engagement with physical activity and its overall suitability.
Since Autumn 2023, Community Living Well have been running physical activity sessions for patients in addition to their TAU. Using these patients’ electronic data, we investigated the following:
1. Does a supplementary physical activity component in Talking Therapies improve mental health outcomes more than having TAU alone, and does disorder severity influence this?
2. What are patient experiences of physical activity treatment and perceptions of physical activity after treatment?
The available dataset included patient depression and anxiety scores pre- and post-treatment. It also classified mental health disorder severity as mild-to-moderate or moderate-to-severe. We took this data for eight patients who received physical activity on top of their TAU and matched them to another group of eight patients, who received TAU alone. This allowed a clear comparison, revealing any differences caused by physical activity.
Our analysis found that anxiety and depression scores improved for all groups of patients during treatment. Receiving physical activity on top of TAU or TAU only, and having a mild-to-moderate or moderate-to-severe disorder, did not lead to improvement differences. Hence, this answers our first question: a physical activity component in Talking Therapies does not improve mental health outcomes more than TAU.
The service also regularly collects patient feedback. To answer our second question, we analysed these responses for the physical activity treatment (eight responses).
Patient responses credited improvements in well-being, such as better mental health and better daily routine, to physical activity. Additionally, respondents described increases in being active alongside a motivation to maintain this. The treatment was highly accepted and described as beneficial, as seen in this patient’s response:
“Physical activity has significantly improved my well-being by boosting my mood, reducing anxiety, and enhancing overall mental clarity and to want to live.”
Potential moderators of physical activity treatment were described (in other words – things that changed how people reacted to treatment), such as confidence, motivation, physical health and a patient-therapist relationship.
“I’m not able to do much physical exercise because of my [injured] leg.”
Study Improvements
If you noticed, we only studied 16 patients. This was not a big enough number to find accurate differences in improvements between our groups. If more patients are studied, specific types of people who benefit more from physical activity than others may be found. This would allow a personalisation of treatment.
A possible team-up between NHS services may be helpful to increase participant numbers in future research.
Key takeaways
Although no extra improvements on mental health measures were found, patients provided insightful compliments on physical activity treatment. Our study showed that:
- NHS Talking Therapies are a suitable environment in providing physical activity treatment, with high patient acceptability.
- Patients attributed mental health improvements to physical activity.
- Patients’ motivation to engage in physical activity improved through treatment.
- Moderators of physical activity should be considered during treatment planning.
To conclude – yes, physical activity can and has been implemented into NHS Talking Therapies. Physical activity holds value in treating mental health problems and a potential treatment rollout on a national scale may be seen in the near future.
If you…
Work in mental healthcare or the NHS: share this article and help trailblaze the implementation of physical activity into mental healthcare.
Are a researcher: physical activity and mental health may be your next big project!
Are interested in physical activity: have you ever considered working in mental healthcare?
Are looking to improve your mental health: remember, even 45 minutes a day of gardening can bring good changes.
References on physical activity and mental health:
Community Living Well’s guidance on physical activity.
Community Living Well. (2024). How can physical activity help you? Physical Activity. https://communitylivingwell.co.uk/how-we-can-help-mental-health/psychological-therapies-kensington-chelsea-westminster/physical-activity/
Mental health benefits of physical activity.
Landers, D. M., & Arent, S. M. (2007). Physical activity and mental health. Handbook of sport psychology, 467-491. https://onlinelibrary.wiley.com/doi/pdf/10.1002/9781118270011#page=478
Why and how does physical activity improve mental health?
Matta Mello Portugal, E., Cevada, T., Sobral Monteiro-Junior, R., Teixeira Guimarães, T., da Cruz Rubini, E., Lattari, E., … & Camaz Deslandes, A. (2013). Neuroscience of exercise: from neurobiology mechanisms to mental health. Neuropsychobiology, 68(1), 1-14. https://karger.com/nps/article/68/1/1/233528/Neuroscience-of-Exercise-From-Neurobiology
NHS Talking Therapies Physical Activity 2022 Report.
NHS. (2022). Exploring how physical activity can be better utilised within NHS Talking Therapies services to help improve mental health outcomes, findings and recommendations report December 2022. Transformation Partners NHS. https://www.transformationpartners.nhs.uk/iapt-transformation/working-with-partners/sport-and-physical-activity/
Book on exercise-based treatment for mental illness.
Stubbs, B., & Rosenbaum, S. (2018). Exercise-based interventions for mental illness: Physical activity as part of clinical treatment. Academic Press. https://www.google.co.uk/books/edition/Exercise_Based_Interventions_for_Mental/KrhqDwAAQBAJ?hl=en&gbpv=0
Credits:
Cover image (exercise group with instructor) by Gabin Vallet.
989 words, 4-minute read.