Up and Running

1. Up and Running The benefits of exercise on wellbeing Jane Shears and Mike Scanlan Mental Health Foundation

2. Context • One in four people will experience a mental health problem • 2020 2nd biggest global health problem • Suicide accounts for 30% of deaths in the 15-24 year age group • People with mental health problems are at a significant risk of social exclusion, stigma and discrimination

3. Primary care consultations • Between 1994 and 1998 consultations for depression rose from 4 to 9 million • Up to 30% of consultations relate to mental distress • 90% of people experiencing mental distress are treated in primary care

4. Links between physical and mental health • People with mental health problems have higher levels of physical ill health – Lawrence (2001) • Increased risk of physical illnesses including CHD, diabetes, respiratory illness, osteoporosis. • Excessive weight gain is a common side effect of many psychiatric medications

5. Does exercise actually help? Exercise reduces morbidity and mortality from: • CHD • Obesity • Diabetes • Some cancers

6. Exercise and Mental Health – The Benefits • Increased release of endorphins • Part of behavioural activation – sense of achievement and pleasure • Links in with a solution focussed approach • A positive affect on body image • Exercise can enhance self esteem maintaining wellness.

7. More Benefits • High levels of subjective well-being and improvements in mood ( Biddle 2000) • Can reduce stress and anxiety (Taylor 2000) • Antidepressant effect of exercise (Mutrie 2000) • Success as a treatment approach for mild depression ( NICE 2003) • Diversion from negative ruminations (Lepore 1997) • Exercise improves the quality and length of sleep (NELMH)

8. Up and Running 2005 • 180% increase in the number of antidepressant prescriptions since 1992 • 92% of GPs prescribe antidepressants as one of their three most common treatment responses • 5% of GPs prescribe exercise as one of their three most common treatment responses

9. Up and Running 2005 • 38% of GPs would try antidepressants as one of their top three strategies if they became depressed • 42% of GPs would try exercise as one of their top three strategies if they became depressed

10. Up and Running 2005 • Less than 1% of GPs refer to exercise programmes as their first treatment response • NICE 2004 advises against antidepressants for mild depression whilst exercise has been recommended as a treatment for mild depression

11. Up and Running 2007-2008 • Follow-up survey • Engage Pilot Sites • In depth data collection • Toolkit • Training • Dissemination

12. Book Prescribing – some lessons • Book prescribing – phenomenology • Wrong book • Hated school • Can’t read well • People with follow up do much better • Some people may feel the prescription process itself is stigmatising • Some lessons for exercise prescribing?

13. Good social prescribing practice • The consultation must be informative and collaborative • Look for where the person is on the ‘Cycle of Change’ • Offer choice – gym, green walks, swimming. What fits with the lived experience? • Use phone follow-up to motivate, to maintain, to encourage continued self management and recovery.

14. Mike Scanlan is a user of primary care mental health services.Jane Shears is a carer. Thank you.