Overcoming barriers to physical activity

The benefits of physical activity for mental health are well-established, but for some people there are barriers to getting more active. Here, Dr Claire Wicks presents the findings of a green exercise intervention developed for women living in Colchester.

In England, 61.5% of people with symptoms of a common mental health disorder are not receiving treatment. This ‘treatment gap’ may occur because people don’t identify their difficulties as needing medical treatment; or they may be concerned about being given pharmacological treatments. The benefits of physical activity for mental health are well-established and physical activity is recommended in treatment guidelines both nationally and internationally. There are, however, several things that prevent people taking up physical activity, such as the cost of gym membership, opening hours, feeling uncomfortable or intimidated by gym environments and anticipated lack of enjoyment. Fatigue, loss of interest in activities, low self-esteem and social anxiety, which often occur with depression or anxiety, create additional barriers.

Benefits of green exercise

Green exercise (physical activity undertaken in the natural environment) may help to overcome some of these barriers. Freely available green space avoids costs and access issues linked to gym membership and special clothing. However, people may have concerns around personal safety in poorly lit, unkempt, or isolated natural spaces.

Working with Essex Wildlife Trust, Colchester City Council, Community 360, Essex Sport and local women, a self-guided green exercise intervention called “Flourish” was developed for women living in Colchester. The programme included informative and motivational materials along with a recommended exercise routine. Women were assigned to different green exercise routines of either 90, 120 or 150 minutes a week. The programme was designed to be flexible to fit around individual preferences and lifestyles.  Women were also encouraged to notice aspects of nature (such as flora and fauna, wildlife, scents) during green exercise.

A pilot study of Flourish, partially funded by the Active Essex Local Delivery Pilot initiative, was undertaken with 14 women. The study explored how the women experienced the programme and its effect on their mood, anxiety, wellbeing, quality of life, self-efficacy and sense of connection with nature. Participants completed online questionnaires before, during (every two weeks) and after the programme and took part in focus groups and interviews.

Overcoming barriers to activity

The pilot study found that Flourish enabled women to plan green exercise, including identifying potential barriers and developing strategies to adapt and overcome them. The women also adapted the Flourish exercise programme to meet their own needs and preferences, for example incorporating a short period of sitting to notice nature and finding moments to notice nature throughout their day not just during green exercise. As little as five minutes of green exercise were reported to be beneficial and was described by one woman as like a ‘little spa’ break. Noticing nature was experienced as a form as mindfulness, offering space and respite from daily worries.

Sounds and sights became familiar to one of the women who preferred to walk the same route and she found pleasure in observing small changes in nature. Another woman who felt she was not a ‘nature-y’ person described the joy of singing aloud when alone in a country park. Support from friends and family could enhance or detract from the experience of green exercise depending on individual needs and causes of low mood. A woman experiencing loneliness recalled avoiding an open green space as she felt the remoteness of nature would exacerbate her feeling of loneliness. She sought company and reported feeling freer to engage with nature when enjoying it with others. Other women used green exercise as time for themselves and felt company diminished their experience.

Mental health improvements

Although the number of women taking part in the pilot was low, questionnaire scores suggested that women scoring in a clinical range on a depression questionnaire before they started the programme experienced clinically significant improvements in their symptoms by the end of the programme. In addition, the average score on an anxiety questionnaire decreased, and on average, scores on nature connection, wellbeing, quality of life and self-efficacy questionnaires increased.

While these findings suggest most women benefitted in some way, not all women benefitted, highlighting that there is no ‘one size fits all’ approach to tackling poor mental health. Yet the Flourish pilot suggests that green exercise may provide an alternative to medical treatments that may be beneficial to some people and has potential as an alternative to standard treatments to help reduce the treatment gap.