Physical Activity Interventions and Adolescent Mental Health

In this Papers Podcast, Gabrielle Hale discusses her CAMH journal review paper ‘Physical activity interventions for the mental health and wellbeing of adolescents: a systematic review’ (https://doi.org/10.1111/camh.12485). Gabrielle is the lead author of the paper.

There is an overview of the paper, methodology, key findings, and implications for practice.

Discussion points include:

• The link between physical activity and mental well-being in young people, and the impact of a lack of physical activity on mental health.
• Barriers that prevent young people from participating in physical activity.
• To what extent is the relationship between poorer mental health due to a lack of physical activity and poor mental health resulting in young people not exercising bi-directional or correlational.
• Gender differences in outcomes and uptake of physical activity interventions.
• Implications for CAMH, and education, professionals, and policy makers.

In this series, we speak to authors of papers published in one of ACAMH’s three journals. These are The Journal of Child Psychology and Psychiatry (JCPP); The Child and Adolescent Mental Health (CAMH) journal; and JCPP Advances.

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Gabrielle is a PhD researcher in the School at Psychology at the University of South Wales. Her general research interests include the impact of physical activity on the mental health and well-being of children and adolescents. Her PhD project has explored the role of professional football clubs in enhancing the mental health and well-being of children and adolescents using community-based interventions that are delivered by the charitable arms of Premier League and English Football League clubs.

Transcript

[00:00:00.000] Jo Carlowe: Hello, welcome to the Papers Podcast series for the Association for Child and Adolescent Mental Health, or ACAMH for short. I’m Jo Carlowe, a Freelance Journalist with a specialism in psychology. In this series, we speak to authors of papers published in one of ACAMH’s three journals. These are the Journal of Child Psychology and Psychiatry, commonly known as JCPP, the Child and Adolescent Mental Health, known as CAMH, and JCPP Advances.

Today, I’m interviewing Gabrielle Hale, Lecturer in Psychology, in the Faculty of Life Sciences and Education, at the University of South Wales. Gabrielle is the first author of the CAMH Review, “Physical Activity Interventions for the Mental Health and Wellbeing of Adolescents: a Systematic Review.” This paper will be the focus of today’s podcast. If you’re a fan of our Papers Podcast series, please subscribe on your preferred streaming platform, let us know how we did, with a rating or review, and do share with friends and colleagues.

Gabrielle, welcome, thank you for joining me. Can you start with an introduction about who you are and what you do?

[00:01:08.120] Gabrielle Hale: Hi, Jo. So, first of all, thank you very much for inviting me onto the podcast to talk about my research. So, my name is Gabrielle, and I’m a final year PhD student, and I’m due to submit my thesis and sit my viva over the next few months. So, I’ve been completing my PhD part-time since October 2017, and during this time I’ve also worked as a Lecturer in Clinical Psychology at the University of South Wales. So, broadly, my area of research focuses on the impact of physical activity on children and young people’s mental health.

So, for my research, I’ve been evaluating programmes that are delivered by the charitable arms of professional football clubs in the UK. So, these clubs, they’re often referred to as Professional Football Club Community Trusts, and often, they will receive funding from their parent club, and they use the status of their parent club, kind of, as a hook to connect with individuals of various different ages and backgrounds, to deliver different programmes to try and address public health issues.

So, the programmes that I have specifically been interested in evaluating and looking at is programmes that are delivered by these football clubs that aim to encourage children and young people to become more physically active, by using the power of sport, but, also, aiming to enhance their mental health and wellbeing, as well.

[00:02:40.720] Jo Carlowe: Great, excellent. So, before we go into the details of your review, can you tell us what is currently known about the link between physical activity and mental wellbeing in young people? And, conversely, the impact that a lack of physical activity has on mental health?

[00:02:57.880] Gabrielle Hale: Yeah, so there’s lots of longitudinal and cross-sectional studies that highlight an association between being more active at a young age and having better mental health and wellbeing. So, specifically, young people that are more active, they tend to report lower rates of depression throughout their later life as well. And then intervention studies, they also report similar effects. So, if we assign a child to an activity programme, they are likely to report better mental health outcomes, over the course of the next few weeks or months, in comparison to children who were asked to continue with their usual physical activity levels.

And there’s several possible explanations for this link, so it’s likely due to a complex interplay between lots of different biological and psychological and social factors. So, for example, being active can provide a child or a young person with opportunities to connect with others and build those social connections, and then also boost their self-esteem as well.

[00:03:59.200] Jo Carlowe: Great. Let’s turn to your CAMH Review, so this is, “Physical Activity Interventions for the Mental Health and Wellbeing of Adolescents: a Systematic Review.” Can you give us an overview of the paper? What did you look at, and why?

[00:04:13.720] Gabrielle Hale: Yeah, so in the paper, me and my colleagues, we identified and explored physical activity-based interventions that have been delivered to young people between the ages of 11 and 18, and had evaluated the impact on outcomes that are indicative of mental health and wellbeing. So, many previous review studies have explored the impact of these types of interventions, mainly on outcomes such as anxiety, depression and self-esteem, and have found positive effects. But we wanted to look at the impact of these physical activity interventions on a broader range of outcomes that can be indicative of good mental health during adolescence.

So, for example, we wanted to look at, were there any interventions that evaluated impact on quality of life, body image, resilience, overall mental wellbeing, and perceived stress? And we was also interested in whether there were specific types of physical activities that were being used in these interventions as well.

[00:05:22.068] Jo Carlowe: And how did you go about it? Can you tell us a little about the methodology that you used for this review?

[00:05:25.320] Gabrielle Hale: Yeah, so we – so, as we conducted a systematic review, so we developed and registered our protocol with the PROSPERO database before conducting the review. So, that stands for Prospective Register of Systematic Reviews. So, this meant that we identified search terms and inclusion and exclusion criteria that we was interested in beforehand. So, for example, we wanted to keep the criteria quite broad, as we was interested in a broad range of outcomes and types of activities. So, we want to look at the impact of all types of physical activity interventions, including team sports, circuit training, water-based interventions, as well as yoga.

And then, once we had identified those potential articles, the potential articles were then screened by myself and my colleagues, using that inclusion and exclusion criteria, in order to decide whether each study could be included in our review, or not.

[00:06:24.120] Jo Carlowe: What key findings from the paper would you like to highlight?

[00:06:28.160] Gabrielle Hale: So, I think one interesting finding from the paper is that a variety of physical activity-based interventions appear to have a positive impact on young people’s mental health. So, whether that is team sports, or aerobic exercise, or age-appropriate resistance training, it appears consistent with the previous literature, it appears to be more just about becoming more active, rather than taking part in a specific type of exercise.

And another interesting thing that we found with our review was that the impact of yoga interventions was less clear. So, sometimes it appeared that the children that took part in their physical activity as usual would see greater improvements in their mental health, compared to those that were assigned to a yoga programme.

But one important thing to note with our review is that we only looked at quantitative studies that had measured mental health impact using self-report. But actually, if you look at some qualitative studies, where children and young people are asked about the perceived benefits of yoga, then actually, they do speak quite positively about the impact that yoga can have on their mental wellbeing. So, I think that’s an interesting area for future investigation, as well.

[00:07:44.868] Jo Carlowe: Was there a difference between whether the activity was team-based or done as an individual?

[00:07:47.960] Gabrielle Hale: So, because we didn’t do a meta-analysis, we couldn’t confirm whether there was a difference there, but I think it’s certainly something to explore in the future.

[00:07:58.200] Jo Carlowe: Gabrielle, in your paper, you describe how, despite there being marked benefits in engaging in physical activity, the rates of activity decline throughout adolescence. What barriers prevent young people from participating?

[00:08:12.840] Gabrielle Hale: Globally, studies they estimate that I think around 80% of young people do not meet the recommendations for physical activity, which is an average of 60 minutes of mostly aerobic activity across the week. Often, it can be a misconception that this decline will start during adolescence, but actually, a number of prospective studies show that these declines can begin as early as, like, five up to nine-years-old, and then will continue to decline.

Many factors can prevent physical activity participation during these age groups. So, factors such as just having a preference for electronic media, spending more time devoted to academic studies, as well as a lack of parental support, as well as fear of judgement from peers and bullying. And another factor that is often cited in the literature as well is “poorly resourced or unsafe communities,” that’s also been highlighted as a barrier. Which is quite interesting, ‘cause that’s one of the key factors that can, sort of, be addressed through the professional football club programmes that I’ve been evaluating as well.

[00:09:17.280] Jo Carlowe: Can you elaborate in what you mean by “unsafe”?

[00:09:21.120] Gabrielle Hale: So, sometimes it’s reported by qualitative studies, in particular, where children perhaps, if they’re living in a community where there’s, like, high levels of, like, crime rates, perhaps they feel not safe being able to go out and be active in their own community.

[00:09:34.240] Jo Carlowe: In your view, what comes first, poorer mental health due to a lack of physical activity, or poor mental health resulting young people not exercising? Or it is bidirectional?

[00:09:45.400] Gabrielle Hale: It can be difficult to establish, and I believe the relationship is often bidirectional. There’s a large – lots of research is correlational, so it can be difficult to identify. The majority of the studies, reviewed in our paper, reported significant or positive effects. So, whilst we cannot rule out publication bias, it certainly shows that there are benefits to encouraging young people to become more active through these interventions, at least for certain populations.

[00:10:17.148] Jo Carlowe: In your paper, you describe how previous reviews have noted the positive impact that physical activity interventions have on young people’s mental wellbeing, yet the results are far less clear for interventions that combined physical activity with other elements, such as health education. Gabrielle, what did you conclude from your own review?

[00:10:36.264] Gabrielle Hale: We found that most of the physical activity interventions, the majority of them, did include some sort of education session alongside with them. Unfortunately, as a meta-analysis was not possible for our review, we could not determine whether physical activity only, or physical activity combined with education, were more or less effective.

But one thing that we did find is that, often, these interventions will in – focus on health education, but less interventions have focused on mental health education. For example, often, these programmes might be teaching young people about the benefits of physical activity for their physical health, and I think one interesting area for future research would be to be including more sessions for young people, to show them, actually, the benefits that being physically active can have on their mental health, as well.

[00:11:28.360] Jo Carlowe: Did your review highlight any gender differences?

[00:11:32.480] Gabrielle Hale: Consistent with studies that have looked at barriers to physical activity, we found that female only interventions often reported higher dropout or lower adherence rates, in comparison to the male only studies. And we also found that more male only studies reported improvements in self-esteem as well, and this outcome seemed to be less clear for the females. But again, this could be due to those adherence issues that we found. Often, in the literature, females will report barriers to physical activity more often, and there’s a pathway for continued investigation and lots of Researchers in the area of physical activity and mental health are exploring this, not just with young people, but with older adults, as well.

[00:12:17.000] Jo Carlowe: But what are your views about that finding that you mentioned in terms of females – all female groups, there being this higher dropout rate?

[00:12:25.320] Gabrielle Hale: Yeah, so, I think one thing that we need to consider is the types of activities that these young people want to take part in. So, if we look at theories of physical activity behaviour, or health behaviour change, it’s about giving people that autonomy and control over being able to choose activities that they feel that they can enjoy, and that they are competent at. And I think that is one key thing that we need to consider when we are trying to encourage young females to be active, is giving them that choice, and giving them the opportunity to explore a variety of activities that they may or may not enjoy, and then helping them to find something that they feel that they can engage with long-term.

[00:13:04.880] Jo Carlowe: That’s interesting, this issue about autonomy. From your research then, so what interventions do you believe will result in the greatest engagement and best impact, in terms of improving adolescent psychological wellbeing?

[00:13:20.704] Gabrielle Hale: Yeah, so I think the key take home message really is that there isn’t one specific type of physical activity that is going to be more beneficial for adolescent mental health. And the most important factor for Practitioners to consider is encouraging young people to take part in activities that they are going to find enjoyable, feel competent at, and can participate in, either with friends or alone, depending on their own preference. I think that giving them this choice, and allowing them to take part in activities that they enjoy, will increase the likelihood of them wanting to continue to participate long-term, and that then can therefore increase the likelihood of having a positive impact on their mental health and wellbeing.

[00:14:05.108] Jo Carlowe: You may have just partly answered this already, but what are the implications of your review, for CAMH professionals, educationalists, and policymakers? What message would you like them to take from your research?

[00:14:15.400] Gabrielle Hale: Yeah, so, I think, kind of, going back to what I just said, that there is – there doesn’t seem to be one specific type of activity that is going to be more beneficial, and it’s not a one size fits all approach. I think it’s more about encouraging young children, from a very early age, to become active and showing them those benefit, and showing them that perhaps just because they don’t enjoy team sports, for example, that doesn’t mean that then they are destined to lead a sedentary lifestyle. It just means that they haven’t found an activity yet that they feel competent at, and that they find enjoyable. So, I think it’s more about encouraging young people to experiment and get involved with different activities, to find something that they want to take part in over the long-term.

[00:15:01.228] Jo Carlowe: Is there anything else in the paper that you would like to highlight?

[00:15:04.464] Gabrielle Hale: One key thing to remember is that these are – all these papers that we’ve reviewed in this systematic review have looked at quantitative studies and self-report measures. So, it’s interesting, I th – or I think it’s important to also take these findings into consideration with qualitative studies that ignore young people’s perceptions, and their barriers to activity, as well.

[00:15:24.080] Jo Carlowe: Gabrielle, are you planning any follow-up research, or is there anything else in the pipeline that you would like to share with us?

[00:15:30.640] Gabrielle Hale: As part of the PhD research, I’ve since conducted interviews and focus groups with young people that have taken part specifically in physical activity-based interventions that are delivered by professional football clubs. And once I’ve submitted my thesis, I hope to publish the findings of those studies in – within the next year or so.

[00:15:50.160] Jo Carlowe: Finally, what is your take home message for our listeners?

[00:15:53.520] Gabrielle Hale: I think I’d like to say that, as we can see that young people’s activity levels, they are declining, it’s important that we do identify ways to encourage young people to be more active. And I think it’s important to highlight to young people that this is important, not only for their physical health, but for their mental health, as well.

So, the key factor to consider is encouraging them to explore various activities, and helping them really identify something that they truly enjoy, feel competent with and want to take part in long-term. So, it’s important that they understand that just because they perhaps don’t like a particular activity that is perhaps offered to them at school, that doesn’t mean that they are destined to lead an inactive lifestyle, they just need to be supported to find something that they do enjoy.

[00:16:39.548] Jo Carlowe: Fantastic. Gabrielle, thank you ever so much. For more details on Gabrielle Hale, please visit the ACAMH website, www.acamh.org, and Twitter @acamh. ACAMH is spelt A-C-A-M-H, and don’t forget to follow us on your preferred streaming platform, let us know if you enjoy the podcast, with a rating or review, and do share with friends and colleagues.