Promoting Physical Activity for Better Mental Health in Norfolk

1. Getting more people moving more often in NorfolkShelley Ames, Physical Activity Development Manager

2. Introduction

3. Format • About Active Norfolk • Physical activity and mental health • Recommending physical activity • Resources and services • Addressing barriers

4. What isActive Norfolk? • One of 45 County Sports Partnerships, since 2006 • Strategic lead for sport and physical activity • Funded (mainly) by Sport England • Hosted by Norfolk County Council • Wide range of partners

5. Mission Working in partnership to harness the power of sport and physical activity to improve lives in Norfolk

6. Strategic objectives • To increase participation in sport and physical activity • To improve health and wellbeing by reducing physical inactivity • To improve lives by establishing and increasing sport and physical activity’s contribution in creating stronger, more sustainable and prosperous communities

7. Physical Activity & Mental Health Emma Howard Pure Training and Development

8. Depression

9. 25% of the UK population experience a mental health problem at some point • 1 in 6 people will have a mental health problem at any one time • Disorders have significant impact on public health - £77 billion per annum

10. Unipolar depression is most common (persistent low mood) • Bi-polar is second kind (extreme fluctuations in mood) • WHO ranked it as leading cause of long term disability worldwide • Women twice as likely as men to suffer from depression • Men more likely to turn to substance abuse to help them cope and to commit suicide (Washington Uni, 1998)

11. Loss of interest or enjoyment in daily activities and pleasures • Lack of energy • Chemical imbalance of neurotransmitters in the brain • Low self esteem and self confidence

12. ‘Moving on up’ identified benefits of exercise as a mental health condition intervention: • It is cost effective compared to pharmacological and psychological interventions • It is more readily available • Can help prevent and manage co conditions • Potentially sustainable self managed intervention • Promotes social inclusion • Popular with patients compared to others interventions

13. Anxiety

14. Excessive worrying and agitation over a period of 6 months or more, occurring on most days.

15. Signs & Symptoms include: • Lethargy, • Dizziness, • Palpitations, • Muscles aches, • Difficulty in falling or staying asleep, • Restlessness/ apprehension • Feeling on edge, • Difficulty concentrating, • Easily distracted, • Irritability, • Impatience

16. Stress

17. The way someone feels when they perceive a situation to be applying an abnormal pressure on their internal and external resources.

18. Signs & Symptoms: • Irrational thoughts, • Mental fatigue, • Self criticism, • Anger • Increased eating, drinking or/and smoking • Increased HR and breathing rate, sweating and shaking

20. What happens? http://www.rcpsych.ac.uk/healthadvice/treatmentswellbeing/physicalactivity.aspx

21. Benefits of exercise • Improved mood • Improved self esteem and confidence • Increased physical self worth (a sense of achievement) • Improved body image and cognitive function • Less anger, frustration and tension • Opportunity for social interaction • Improved sleep patterns & appetite • Reduce risk of CHD • Reduce risk of co-morbidities

22. PA for prevention • Evidence shows that there is a link between being physically active and good mental wellbeing. (NHS, 2016) • Evidence suggests it can protect you against anxiety and other conditions • Exercise releases endorphins, endorphins work to: • Reduce levels of pain • Release positive feelings like morphine

23. PA for prevention • Regular activity helps with positive mind-set so events can be coped with better • Provides a social atmosphere for social interaction

24. PA for management • Many studies have found a range of beneficial results for regular exercise • Symptoms reduced compared to control groups • Long term lasting benefits • Running has been found comparable to psychotherapy in terms of benefits (Craft et al, 2004) • Provides social interaction and enjoyment • Helps manage co-morbidities • Develops self confidence, esteem and competence over time

25. Dementia

26. Introduction • ‘Dementia’ refers to symptoms which include memory loss, difficulties with thinking, problem solving or language • Umbrella term • Caused when the brain is damaged by disease • It is progressive condition • There are different types of dementia, most common two are • Alzheimer's disease • Vascular dementia

27. Alzheimer’s Disease • Most common • 520,000 people • Symptoms include: • Difficulty with word finding • Difficulty remembering names and places • Difficulty with planning and organising • Poor judgement may effect decision making • May not see or understand views of others.

28. Proteins build up in the brain forming plaques and tangles • Loss of connection between nerve cells occur • Progresses to death of nerve cells and brain tissue

30. Vascular Dementia • Second most common type • Caused by impaired supply of blood to the brain (due to diseased blood vessels) • Lack of oxygenated blood causes cognitive issues • Approx. 135,000 in UK

32. Physical ActivityBenefits • Improve cognition • Improve cardiovascular health • Improve strength, flexibility and endurance • Improving ability for daily activities • Improve sleep • Social interaction • Reduce risk of falls • Maintain independence • Improve confidence & self esteem • Improve mood!

33. Physical Activity for Prevention • PA and exercise could potentially reduce risk of dementia • Suggested to delay the onset • Research is still needed as it’s inconclusive with discrepancies • All points in the direction that a healthy lifestyle, good nutrition and regular physical activity would prevent onset of disease

34. Physical Activity for Prevention Why can it prevent disease? • Important for maintaining adequate blood flow to the brain • Potentially stimulates brain cell growth and survival • Exercise reduces likelihood of other co-morbidities

35. Physical Activity for Prevention Evidence • Studies suggest: • People who exercise experience a slower loss of brain tissue as they age (National Institute on Aging) • Aerobic exercise can improve thinking and memory and reduce risk of dementia (Colcombe et al, 2006; Heyn, 2004; Kirk-Sanchez et al, 2014) • Regular aerobic exercise of at least 30 minutes has been beneficial for cognitive health (Alzheimer's Australia, 2015)

36. Physical Activity for Management • Improve circulation • Challenges co-ordination and balance • In supporting studies, all exercises were functional and aimed at maintaining mobility. • Exercises included gentle stretching, strength training, balance and endurance training. (Teri et al, 2008) • Help them maintain independence & QOL • The large focus was around exercise that is accessible and pleasant (if people don’t enjoy exercise then it is not sustained)

37. Physical Activity for Management • Prevents muscle weakness, mobility problems and other medical conditions • Promotes a day-night routine • Improves mood and social participation • Reduces stress and depression • Repetition motions i.e. reduce anxiety due to no decisions needing to be made • Boosts immune system health

38. Physical Activity for Management • Fewer than 20% of people aged over 65 engage in adequate physical activity – those with dementia is even less • If a programme can be incorporated in early stages it is more likely to be maintained • Moderate to late stages of dementia – support from all is essential • Must be individualised and person centred

39. Recommending physical activity

40. Benefits of physical activity • Reduced risk of diseases – including coronary heart disease, diabetes, colon & breast cancer • Reaching/maintaining a healthy weight • Reduced risk of falls in later life

41. Benefits of physical activity • Higher levels of energy to enjoy life • Improvements in quality & quantity of sleep • Improved mental wellbeing • Opportunities for new learning experiences • Less risk of depression & anxiety • Social opportunities • Reduced risk of dementia

42. The risks Direct relationship between your activity levels and your risk of: • Health condition risk factors. • Diseases and disorders • Premature mortality

43. Key Points • Among modifiable risk factors, physical inactivity is the fourth leading cause of death globally • Inactivity is now a greater risk to health than obesity & being sedentary is as dangerous as smoking • Getting inactive people to become more active has greater health benefits than getting active people to do more activity

44. How much? Adults: • 150 minutes moderate physical activity per week • OR 75 minutes of vigorous intensity activity • Physical activity to improve muscle strength on 2 days per week • Minimise the amount of time spent sitting

45. Tip An activity that is of relatively moderate intensity causes adults to feel warmer, breathe harder, and their heart to beat faster. At this level your patient can talk, but cannot sing. Using this ‘talk test’ is useful for people to gauge their own level relative to their current fitness.

46. How much? Adults over 65: • 150 minutes of moderate intensity physical activity per week • Physical activity to improve muscle strength on at least 2 days a week • Those at risk of falls should aim to improve balance & coordination • Minimise the amount of time spent sitting

47. How? • Doesn't have to be in one block! • Accumulation of 10 minute blocks of moderate intensity activity through the week. • Taking the stairs, gardening, walking to work, dancing – it doesn't have to be in the gym!

48. Tip The intensity recommended should be relative to the person’s current level of fitness. A slow walk to the shops may be moderate intensity for an older person, but low intensity for a fit person.

49. Recommending Physical Activity Choosing the right activity will require careful thought. Answers to the following questions can help your patients/clients choose realistic activities that they can sustain: • Have I been inactive for a while? (If so I should start gently) • Do I want to do this on my own or with others? • How much does my activity cost? • Do I prefer indoors or outdoors? • Home or gym?

50. Recommending Physical Activity Is the activity…? • Local? If it is too far away then it is harder to maintain. • Enjoyable? Activities that excite the patient will keep them going back for more. It may be that the activity is a means to an end rather than the end itself. So playing with grandchildren in the park is a great experience but it is the grandchildren rather than the activity that are more likely to make it enjoyable. • And • Practical? If it can’t be done easily, it won’t last.