Mind the (Implementation) Gap: Introducing Physical Activity into Mental Health Treatment

Research consistently shows that being active plays an important role in our mental well-being. Run, walk, dance or swim, it doesn’t really seem to matter, as long as we’re getting moving. 

While we are far from understanding exactly how physical activity supports our well-being, researchers have uncovered some key mechanisms, including: 

🧠Neurobiological changes, like the release of endorphins and other feel-good neurotransmitters (which are behind the famous ‘runners high’), as well as increased brain connectivity and decreased inflammation.

⚡Psychological changes like improved self-esteem, self-belief and resilience.

🌲Promotion of other factors linked to well-being like better sleep and – depending on the type of activity – increased social contact and time in nature. 

More than just a mood boost however, physical activity can be effective in preventing and treating mental health conditions such as anxiety and depression. In fact, experimental research has shown it to be at least as effective against depression as antidepressant medication. So could we use physical activity in mental health services?

In a given year, 1 in 4 people in the UK will experience a mental health problem. Available treatments are effective, but not for everyone. We need creative new strategies to combat poor mental health, and supporting individuals accessing mental health treatment to increase their activity levels looks promising.

But if you access support for your mental health in the UK, you’re still far more likely to be given a prescription for medication or referral to therapy than exercise. This reflects something called the implementation gap.

From the lab to the clinic: 

Service users who want support with physical activity are offered one-to-one, tailored exercise sessions from a qualified instructor, centred around activities that they can easily incorporate into their daily lives.

What we did:

Firstly, we looked at whether physical activity was effective. We examined improvement in depression and anxiety symptoms from beginning to end of treatment, comparing participants who had taken part in physical activity sessions alongside talking therapy to a group of ‘control’ participants who just had talking therapy to ask:

💡Did the physical activity group have bigger improvements in mental health symptoms than controls?

💡Was the physical activity group more likely to be classed as ‘recovered’ by discharge than controls?

We also know that participants’ experiences and views on treatments are key to their success. So secondly, we interviewed participants to gather their views on the programme, which parts of it they valued, and any aspects they thought could be improved.

What we found: 

📉On average, depression and anxiety symptoms in the physical activity group decreased twice as much over treatment compared to control participants.

❤️‍🩹The percentage of participants classed as ‘recovered’ by discharge was higher in the physical activity group (63%) than the control group (36%).

⚠️ While promising, these differences were not statistically significant. We only had 38 participants overall, and more are needed before we can confidently conclude that improvements were due to physical activity and not just chance. 

Nevertheless, interviewed participants reported that the programme helped them become more active and connected this to improvements in their physical health, mental health and self-esteem. As one participant put it:

‘It has wiped away my tears, it has taken my walking stick from me. I feel good about myself.’

They valued receiving physical activity support alongside Talking Therapies treatment, suggesting it empowered them to take an active role in their recovery and to begin to look beyond their mental health problems:

‘It’s something that has to come from inside, saying, ok, I want to get out of this and I need to do something for myself. So the physical activity helps you more in that sense. Because it’s not just talking, it’s doing things for yourself.’

‘I thought it was going to be a conversation and talking and crying like I used to do [in talking therapy sessions]. And then I went and it wasn’t like that, you know. It’s not bringing crying, it brings joy.’

The aspects of the intervention that participants found most helpful included:

• Social contact
• Instructor expertise
• Exercises that were easily transferrable outside of sessions. 

The latter two in particular helped address some of the main barriers to regular activity faced by participants: adapting activities to health conditions, time scarcity and lack of accessible sports facilities.

Participants suggested improvements could include offering the option of group sessions to maximise social benefits, and better facilities (sessions were conducted in a clinical room before the recent opening of an on-site gym facility). 

What does this mean?

As one of the first NHS Talking Therapies services to integrate physical activity into treatment, Community Living Well is trailblazing a more holistic future for mental health services. And this research suggests their efforts are paying off. We showed that:

✅ Physical activity programmes are valuable to service users.

✅ They have strong potential to improve NHS mental health care, if implemented correctly.

⚠️ Like any research, our project had limitations. Participants chose to take part in physical activity sessions (or not), so it could be that those in the physical activity group had more reason to benefit. Future research should examine whether physical activity is more effective for some people than others.

Nevertheless, one thing is clear: when we think about mental health, we should be thinking about physical activity too.