Despite the evidence base of the benefits of physical activity on mental health, physical activity isn't routinely a part of the NHS treatment for mental health conditions.
We’ve been working in collaboration with two NHS Talking Therapies for anxiety and depression (formerly known as IAPT) services – iCOPE( Camden and Islington NHS Foundation Trust)and Buckinghamshire Talking Therapies (Oxford Health NHS Foundation Trusts) – to explore how physical activity can best be integrated into psychological treatment pathways.
This is one of our initiatives to strengthen the connection between sport and physical activity and health and wellbeing, so that those reaching out for mental health support can also easily access physical activity opportunities and support that is right for them.
In England, there are more than 150 NHS Talking Therapies services for anxiety and depression that offer talking therapies to support adults to better manage their mental health.
Camden and Islington’s iCope and Buckinghamshire Talking Therapies carried out a three-year study to test the effectiveness of interventions that integrated physical activity into psychological treatment within NHS Talking Therapies services.
The National Collaborating Centre for Mental Health, a partnership between University College London and the Royal College of Psychiatrists, evaluated the study to understand its effectiveness.
The study ran throughout the Covid-19 pandemic, and therefore was subject to a number of challenges.
The evaluation aimed to find out whether incorporating a physical activity component into psychological treatments in NHS Talking Therapies services improved mental health outcomes for people with depression or anxiety disorders, including those with long-term physical health conditions.
The evaluation also assessed:
- the experience of service users engaging with the physical activity interventions and staff delivering the interventions
- different delivery models of physical activity and their association with different levels of (a) feasibility and acceptability and (b) engagement in physical activity.
The main interventions included in the study were:
- Physical activity incorporated into group-based cognitive behavioural therapy for depression. The CBT groups were delivered as a stand-alone intervention.
- Long-term condition (LTC) workshops for people with LTCs and depression or anxiety disorders; these workshops were undertaken alongside other psychological interventions.
A wellbeing app, Koa Foundations by Koa Health, was also evaluated. The app included a self-help module to support people to increase their physical activity.
Two other interventions, Animal Antiks at Buckinghamshire Talking Therapies and Walk and Talk therapy at iCope, were introduced later in the study when Covid-19 restrictions eased.
Due to limited data they weren't included in the main outcome analysis.
Key findings
The evaluation demonstrates that incorporating physical activity into psychological treatments is feasible and can contribute to positive effects on mental health outcomes in NHS Talking Therapies service.
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Psychological treatments that incorporate physical activity had a positive impact on depression and anxiety disorder symptoms using NHS Talking Therapies’ recommended outcome measures and metrics. These symptom changes were in line with changes seen in similar populations in the services.
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After the interventions, most people said they had become more physically active.
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Staff engaged with the physical activity interventions, and were supportive of and saw value in them. Staff said they were open to working in new ways, and that these factors helped them implement the interventions.
Other findings
- A range of physical activities were engaged in by participants in the study, typically supported by:
- increasing activity incrementally
- integrating it into their routines
- adapting it based on their condition and need.
- Staff valued physical activities and believed that it was possible to integrate them into routine clinical practice.
- Physical activities that took place outdoors were particularly valued.
- There were challenges with the measures of physical activity used, which participants found difficult to comprehend and complete.
- When developing physical activity interventions, the nature of the individual’s mental health conditions and the presence of LTCs may have an impact on the type and timing of the delivery of such interventions.
We're pro-actively sharing this learning and further enhancing the evidence base through seeking new trailblazer sites, so that more local NHS Talking Therapies services can consider physical activity as a routine part of treatment pathway.
A toolkit, which you can download below, has been developed by the pilots as a guide for mental health services who want to integrate interventions around physical activity into their clinical work.
We hope this toolkit will inspire and motivate other NHS Talking Therapies services to trial incorporating physical activity-based interventions into their work and learn from the pilot experiences.
