In encouraging clients to engage in physical activity in order to enhance mental health outcomes, it can help to provide some psychoeducation around the various benefits of physical activity. These can include:

• Improved sleep quality
• A clearer mind for improved decision-making, planning, and problem-solving
• More stable mood
• Improved self-efficacy
• Improved relationships and social connections
• Enhanced sense of community belonging

Explain that physical activity does not replace therapy or other treatments, but works alongside them to provide a complete evidence-based intervention that presents the best chance of positive outcomes. Also explain that while a client may have to wait for access to other forms of treatment, they can commence physical activity immediately, with the likelihood of readily observable benefits, including the prevention of the typical decline in physical health that often occurs following disaster or trauma.

You get to be the bearer of good news too: the most effective forms of physical activity for mental health are associated with leisure and transport – those activities we do out of choice. Any leisure-time physical activity – from boxing to ballroom dancing – can be beneficial, as is the choice to walk or cycle to work or when doing errands. And any amount is better than none, so you can encourage your clients to start small, with manageable additions to their routine, and layer additional activities, or increase intensity, as and when they feel able to.

A small caveat is needed here: while current physical activity guidelines for health recommend aiming for 150 minutes of physical activity per week, this is not realistic for everyone, particularly those starting from little to no activity, or those with restricted mobility or poor physical or emotional health. Guidelines can be counterproductive in that they can cause some people to feel negative about not achieving enough, so it is more helpful to tailor guidance and support around an individual’s needs and capabilities. Developing intrinsic motivation is more effective than externally imposed goals, so helping your client to see the benefits and value the exercise will be more helpful than setting arbitrary targets.

Routine is key, as it provides a structure for building upon, enabling an individual to increase the amount or intensity of activity as and when they are able to. But first and foremost, routine leads to regularity, and doing exercise little and often is more effective than doing an intensive workout once in a blue moon.
The following questions will help to guide your client’s planning of their physical routine:

1. What kind of physical activity does the individual like?There’s no one ‘best kind’ of exercise an individual can do for mental health. Aerobic exercise shows benefits, of course, but there is also strong evidence for resistance training and yoga.The activity does not need to be athletic or strenuous, but it would ideally be something the individual can enjoy if they are to do it routinely.
2. How much physical activity are they able/prepared to do?It may be a good idea to suggest short windows of physical activity that are easy to integrate into a daily schedule.You can think in terms of incidental exercise, such as walking to the shops if they only need a few items they can easily carry, or in terms of short bursts of exercise, such as a set of 10 push-ups or 10 squats as a way of getting exercise while taking a short break from another task.
3. How realistic/feasible is this choice of activity in their current living context?If the answer is ‘not very’, then you can assist your client in thinking laterally to come up with a creative alternative – for example, if they want to join a yoga class, but there isn’t one nearby or they aren’t able to travel, then perhaps encourage them to browse what’s available online.

You may need to get particularly creative in the aftermath of a disaster, particularly following a natural disaster in which infrastructure and facilities have been damaged or rendered inaccessible Fortunately, research into physical activity interventions among some of the world’s most vulnerable populations, including displaced peoples in refugee camps, suggests even the most vulnerable people with the most limited access to services and resources are motivated and able to identify creative solutions when empowered to implement them.

Many of your clients will likely just need initial support to get them started, and then initial support to help monitor and motivate over time. However, some clients’ needs will be more specialized, and working at the community level presents its own set of needs.

Supporting individuals with limited access to safe or appropriate space for physical activity

Particularly after a natural disaster, and when working with displaced communities, there may be very limited access to safe or appropriate spaces for some kinds of physical activities.

While outdoor sports and activities such as running might be out of the question, it may still be possible to carry out smaller-scale indoor activities, such as yoga or stretching, resistance training such as push-ups and sit-ups, or aerobic activities such as skipping with a rope.

In cases where safe and appropriate space is available, but other resources such as equipment are lacking, the obstacles can be overcome with creativity alone. For example, kids around the world play street soccer using garbage for a ball and a couple of t-shirts positioned at either ends of an imaginary pitch to indicate where the goals are – and some of these kids have gone on to play in the World Cup.

The key is to be creative with the space available, and not limited by conventional activity types and the resources typically used to carry them out.

Supporting individuals with limited physical mobility

When working with individuals whose physical mobility is limited by factors such as ageing, chronic illness, or physical disability, a more tailored plan for physical activity may be needed. The range of activities individuals with limited physical mobility can participate in will be narrower, but can be enhanced with the inclusion of supports from an exercise physiologist, physiotherapist, occupational therapist, or some NDIS service providers offering specialized physical activity services.

There is no reason why people with limited physical mobility can’t also experience the mental health benefits of movement to the extent possible with the supports available. However, it may be necessary to supplement physical activity with access to online communities for those whose limited mobility means they are quite isolated. Social media such as Facebook provides a platform for creating secure, closed groups that are safe for engagement of this kind.

In areas where professional supports such as exercise physiologists, physiotherapists, occupational therapists, and specialized NDIS providers are unavailable, however – as is often the case in rural and remote communities – then support may need to be provided by a locally based nurse or social worker, with support from a more specialized professional provided online or by telehealth.

Supporting individuals with cognitive disabilities

When working with individuals with cognitive disabilities, if physical disability is also present or mobility is otherwise limited, it may be necessary to engage with specialized supports as suggested above, to the extent possible.

When working with individuals with cognitive disabilities alone, it will depend on the extent of impairment the individual experiences as to what kind of support they will require. In some cases you will need to engage with specialized disability service providers who are skilled in working with this population, and, where necessary, able to provide one-on-one support. And in other cases you may be able to provide adequate support yourself as you would for any other adult or child, but supplemented with additional assistance around establishing and maintaining routine, structure, and planning for improved autonomy. The largest challenge in such cases may be the need to directly facilitate engagement and inclusion.

Supporting rural, regional, and remote communities

When working with rural, regional, and remote communities, it is clear that mental health services and resources are limited at the best of times, and access to these may be completely cut off in the aftermath of a disaster. This means the community will likely benefit even more from physical activity-related interventions while awaiting access to mental health services, which in some cases may only be provided via telehealth and/or limited to those in greatest need only. Creative solutions around how to facilitate physical activity for people of varying needs across a whole community will likely play an important role in preventing and mitigating mental health decline.

In order to provide optimal support for post-disaster mental health outcomes it is important for any given service or practice to promote a culture that is supportive of physical activity as part of an integrative mental health intervention. This will look different for different services, and can range from physical health settings including counselling services to psychotherapy services including a gym on site. Integration works at the level of the service and the level of the practitioner, so a well-resourced service is also one whose practitioners are well informed about the benefits of physical activity for mental health outcomes, and able to implement or facilitate a range of approaches to suit client needs.

In addition to enhanced professional practice, a fully integrated approach to physical activity for mental health outcomes includes practitioner adoption of these principles in their own lives. The lifestyle interventions you support your clients in adopting can also assist you in maintaining your resilience as you work hard to support disaster-impacted individuals and communities, as well as improving your general wellbeing so that you are able to approach crises as they arise with the resilience necessary to prevent burnout.

Increased knowledge and skill in using physical activity to enhance mental health will always be of benefit, but perhaps of greatest benefit are the following:

• Ensuring you are aware of what’s available in your client’s community
• Ensuring you know how to facilitate access to the various supports your client may need to help them engage
• Enhancing your own creativity regarding what kind of physical activities can be facilitated with very limited resources, and for the most vulnerable individuals
• As a health professional, Incorporating physical activity in your own routine from the perspective of self-care