Physical activity and recovery from disaster - transcript

Hello everyone, my name’s Leanne Humphreys and today we’re speaking with Simon Rosenbaum.

Simon is an accredited exercise physiologist and scientist, Associate Professor in the School of Psychiatry, University of New South Wales. He has extensive clinical experience designing, delivering and evaluating physical activity programs for people with mental illness and he’s worked with a variety of groups including youth, veterans, emergency services workers and refugees. And today, because this is the Disaster Mental Health Hub we’ll be talking about the role of physical activity and supporting people in the aftermath of disaster.

So welcome Simon, I’m really delighted that you’re here with us today. Such an interesting area to talk about, you’ve very kindly overseen the development of our disaster recovery toolkit on the role of physical activity and recovery from disaster so this conversation is more of a taste test to alert people to this really interesting emerging area of research and practice. So we would really encourage viewers to take a deeper dive into the toolbox materials, but that said, Simon what are the key messages you’d like our viewers to take away from this very brief conversation?

Simon: Yes, I guess the key thing to think about is that we know that physical activity is an evidence-based strategy for improving mental health outcomes, reducing symptoms of depression, symptoms of anxiety, symptoms of PTSD and also things like psychotic symptoms, there’s some good evidence based around that as well.

Now the evidence is so strong, that really the argument is that physical activity should be considered as a routine part of care. It’s not something, it’s not one or the other and we don’t put them head to head because really they’re targeting different things and so saying that usual care should be considered, we should be adding these interventions to usual care. And there’s a couple of reasons, one is the the mental health outcomes but two is also the physical health outcomes and actually protecting and promoting physical health. And we know that people living  with PTSD and with other major depression, the physical health becomes a big issue and there’s higher risk of things like obesity and diabetes.

Leanne: Absolutely, absolutely. Simon how do you consider the role of physical health in terms of prevention of mental health difficulties?

Simon: Yes, so it’s really interesting we have some good data around showing the preventative effects as a couple of reviews published in the American General Psychiatry from a few years ago showed, we take that evidence together if we shifted the population to increase their activity levels by as little as 60 minutes per week we would prevent somewhere between 12 and 17 percent of incident cases of depression in the general population and that’s regardless of culture, it’s regardless of language and regardless of age.

So it speaks to this idea that sport and activity is this transcultural strategy that actually people naturally turn to anyway communities turn to particularly when we talk about the aftermath of trauma or major incident you know we see things like sporting clubs actually being a real key part of community recovery. So it’s not just the players and the individuals. Similarly, we know that maintaining physical fitness and maintaining physical health, there’s a bi-directional relationship with mental health outcomes as well.

So there’s a few opportunities there for practitioners and one of them as well is around
this idea of stigma and the fact that sport and physical activity could be a gateway into more traditional mental health services particularly among groups that are highly stigmatised or that they have highly theorised views around seeking mental health care.

Leanne: Simon that’s really interesting.  I guess I, as you were talking I was alerted to that, that concept of 60 minutes you were talking about increasing by 60 minutes and how do you see that fitting with the, the current recommendations about levels of physical activity that people should be engaging with?

Simon: Yes, it’s a great question we’ve got to be careful about those physical activity guidelines.
So we have Australian guidelines, we also have guidelines from the World Health Organisation and those guidelines typically recommend around 150 minutes of what we call moderate to vigorous physical activity per week. So a little bit of huffing and puffing or a little bit of, a little bit of sweating.

But we’ve got to be really careful when we talk about the mental health benefits of activity, it’s actually you can get those mental health benefits from a lot less and so really those physical activity guidelines weren’t designed with mental health in mind they were designed purely based on cardiovascular mortality based outcomes.
If we had guidelines for mental health, the guidelines would simply say something is
better than nothing.

Leanne: Right.

Simon: And really it’s about someone’s level of activity at the start and so if we think about, for example, a highly traumatized individual or someone who’s really unwell, experiencing high levels of symptoms you know maybe not even getting out of bed. We know that in those people getting up out of bed, you know, walking around the house or whatever it might be, can be beneficial and can help trigger a cascade of events that can help with recovery long term.

Leanne: Absolutely, absolutely. So Simon if you had to give our viewers just two or three
really practical things to take away from this conversation – health professionals.
What would you recommend they be doing differently in their work with disaster impacted individuals and communities?

Simon: Yes, it’s a good question. Firstly I’d say, think about their own activity and their own health, and part of that is a way of self-care. The other part to it is we know that health professionals who engage in these sort of behaviours themselves, their views and attitudes towards it changed and we know that their sort of prescribing practices and the way they work with their patients actually changes as well.

So it’s really important that health professionals that, you know, set the lead and we actually ensure that you know we’re active.

A couple of other points. One is to separate the idea of aesthetics that’s linked to exercise and particularly weight loss and this is really problematic for a couple of reasons. One because we know that when we ask people why do you want to exercise the number one reason is weight loss but unfortunately the the data around the role of exercising contributing to weight loss is pretty minimal in the absence of dietary change.

Leanne: Yes.

Simon: The reason this is problematic is that it sets people up to fail, because we then have people that we’re trying to encourage to exercise, they might start exercising, they might feel better, they might be fitter, they might be more able to lift their grandkids or whatever it is but the scales haven’t changed and that can be hugely demotivating for
people. So it’s really important that we separate that and we talk about why we want people to be active which is because of their mood, because of their sleep, because of their symptoms and really you know being open about that.

And I think we’re seeing a change in the general public around this awareness and people saying you know I exercise for my mental health. That’s you know key. And I think COVID has been really interesting with that as well, when we’ve taken away those opportunities so that’s probably one thing. You go, you jump in.

Leanne: I was going to say you’re actually recommending that our view of what a mental health practitioner looks like is actually a very different view.

Simon: Absolutely, I mean given the evidence we have, we’d be arguing and we know that in terms of exercise interventions that the people who stand to benefit the most, are probably the most unwell. They’re also the least likely to have access to the level of support required to help them engage in activity.

Leanne: Yes.

Simon: So what that means is, if we know the evidence base, we know the effect that this can have, but yet we’re not matching the level of services and the support, we’re not matching that to the individual need then we’re missing a big opportunity there.

And one of the key things when we I think, think about integrating exercise and physical activity in mental health care is thinking that it’s not the sort of, it’s not a secondary issue.

And often we work with health professionals you say look that’s fine we know this is important but we have to deal with the mental health symptoms first. But actually that’s not what the evidence tells us. The evidence says that we can do it together and actually by doing it together it’s likely to help both the mental health and the physical health outcomes. So, training for mental health practitioners could change our view of what a mental health practitioner is can really broaden, and what we offer as health professionals can, can really change as well.

Leanne: Definitely.

Simon: So we’re doing a lot of work with training exercise physiologists, physiotherapists, those traditional exercise based practitioners in mental health so that they’ve got the skills in terms of mental health first aid and so that what they can deliver, what we call mental health informed physical activity programs, but likewise
we need mental health professionals to you know basic training in exercise prescription, physical activity promotion and how those professionals can actually work together. Not one versus the other but actually simultaneously.

Leanne: Thanks Simon. So if I’m thinking about the disaster context specifically, and I’m thinking about communities that can be destroyed as a result of disaster and the idea that perhaps that there’s social disconnection, lack of access to usual kind of sporting facilities so if we’re thinking about low resource environments. Do you see that as a barrier to implementing strategies to increase participation and physical activity.

Simon: Ah no, I think it’s actually the opposite. Rather than being a barrier I think it’s an opportunity and I think that physical activity in those contexts is you know one of the most powerful strategies that we have and the most feasible.
I’ve done a lot of work in Bangladesh with the Rohingya community and driving through those camps you’ll see kids playing soccer with you know garbage bags that are tied together.

Leanne: Yes.

Simon: You know some of the work that we did there, we’ve got stories of women that would wake up early morning and they went on a walk together around the camp before the men were awake and this was something that they did because, when we sort of asked about why they told us it was about releasing their tension which is the idiom of distress and anxiety.

So really this is, it’s a natural thing that humans turn to in terms of moving our body, but also the social connection that this brings.

Leanne: Yes, yes.

Simon: But again, I think where we’re missing the opportunity, is that it’s we’re not reaching the most vulnerable, we’re not reaching those that stand to benefit the most. So, for example, in the camps when we talk about sport the, the – you know the agencies that are there they say ‘yeah we organize football tournaments for the young men.’
Now you know that’s great, but yes that’s not who needs the support. Those able-bodied young men are going to play, they’re going to find ways to play no matter what. But actually, if we think about the disadvantaged groups, you know people with disability, you know women in that context, the ones that maybe are experiencing symptoms or anxiety issues whether they’re not prepared to engage. They’re the ones that we need to focus the services on, and actually think about how can physical activity be used as a strategy to not only engage these people to then provide an intervention that can help physical and mental health, but also again, as a gateway to more traditional mental health services.

And we see that here in Sydney as well. If we, you know, if you exercise is not – you know it doesn’t carry the same stigma as other services can.

Leanne: Absolutely, absolutely Simon. That’s all incredibly interesting so thank you very much for that. That’s really given us a lot to think about and as I mentioned earlier, this conversation is just a very brief introduction to the materials that you’ve overseen for us on the Disaster Hub. So for those of you who are interested in understanding more about physical activity and its role in supporting individuals and communities in the aftermath of disaster I’d really encourage you to explore the materials and resources on
the page. Thanks very much Simon.

Simon: Thanks a lot.