Getting Active and Feeling Better

A self help guide to using physical activity to manage your mood

There is a substantial body of evidence to show a link between physical activity and reduced depression.

Mental Health Foundation

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Cautionary note, please read: Many health conditions can be helped by regular physical activity. If you are new to exercise, pregnant or have concerns about your health, it is best to check with your GP or Health Professional about the amount and type of activity which is right for you. This guide does not replace any advice that you may have already been given by a health professional, based on their knowledge of your condition.

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Are you experiencing… Depression? Anxiety? Stress?

Physical activity could help you to manage your mood and feel better.

Taking part in physical activity on a regular basis can have a positive effect on your mental health.

Studies show that regular physical activity can help to overcome depression, lift your mood, reduce anxiety, improve self-esteem and concentration.

This guide will help you to think about your own physical activity and how you can use it to improve your health and wellbeing. It gives practical guidance about how to include more activity in your life and how to overcome the barriers to being more active.

What is Physical activity?

• Physical activity includes walking, gardening and housework, as well as sport and exercise.

• Physical activity doesn’t have to mean running a marathon - even simple changes can add up to big benefits.

• Physical activity can be done anywhere – at home, at work, at leisure facilities or out and about in your local area.

• Physical activity can be done without any cost.

• Physical activity can be fun!

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What do people say about the benefits of being physically active?

Sometimes I feel too tired to exercise. It’s strange because if I can make myself do it, I actually feel like I’ve got more energy afterwards. Sometimes I feel

Walking more has

helped me to sleep

better and get back

into a healthy sleep

routine.

Swimming is a good

distraction. It stops me

getting so caught up in my

thoughts.

I feel like I’ve got something positive to focus on and it’s good to be getting fitter. I look and feel better about myself

Running is my natural

anti-depressant. When I

start feeling low I know

it’s time to get my

trainers on. I always feel

better afterwards.

Playing five-a-

side was a good

way to get back

in touch with

my friends

I don’t feel so stressed and anxious. It’s as if I’ve burnt off all my worries. I feel calmer and more relaxed.

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Physical Activity and your Body’s Chemistry

How does physical activity work for me?

• Physical activity has been shown to increase levels of the brain chemical serotonin, which can affect mood and help us to feel happier. Serotonin is also involved in the regulation of sleep, appetite and sex drive. Increases in serotonin can lead to a reduction in symptoms associated with depression.

• Physical activity may also release endorphins, chemicals in the brain which help lift your mood.

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What sort of exercise will help my mood? Exercise does not have to be extremely vigorous to make a difference to how you feel! Activities where you notice a slight increase in your breathing and heart rate, and make you feel warmer are classed as ‘moderate intensity’ exercises. You should be able to maintain a conversation whilst exercising at this rate, and feel tired rather than exhausted afterwards. Examples of moderate intensity exercise in every day life include:

� Brisk walking, or walking uphill � Climbing the stairs � Carrying shopping bags � Cleaning - vacuuming, sweeping, mopping � Gardening – raking leaves, digging, mowing the lawn � Washing the car � DIY

How much should I do? Activities that keep you moving at a constant, steady pace are best. It is recommended that you spend at least 30 minutes a day doing moderate intensity exercise. This could be made up of several short sessions of different activities. It is important to start slowly and build up your activity levels gradually. Even a little activity is better than none at all!

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What type of exercise should I do? You don’t need to be particularly sporty, own special equipment or go to the gym to become more active. There are lots of ways of increasing your level of physical activity nearer to home. Here are some examples: o Use an exercise DVD – look at what is available to rent

in your local library o Use a games console such as Nintendo Wii o Follow a tutorial on You Tube o Jog, run or cycle around your local area o Practice strength training by doing sit-ups, press-ups

and squats at home o You don’t need to buy weights to develop strength,

use bottled water or tin cans o Invest in an exercise bike that you can use whilst

watching TV o Put on your favourite music and dance o If you regularly walk the dog, or walk children to school,

try taking a longer or more challenging route o Use a skipping rope or hula hoop in the garden

Use this space to note which activities you would like to do, or highlight the activities in the list above. I would like to: ……………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………

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If you are able to visit a gym or attend an activity group: o Join a dance class – such as Zumba, Salsa, Ballroom o Take part in a gym class – like aerobics, circuit

training, or toning classes o Find a yoga, pilates or tai chi class o Participate in team sports – such as football,

volleyball, hockey, cricket, basketball o Or partner sports such as badminton, tennis, squash,

table-tennis, golf o Individual sports include diving, ice-skating and

gymnastics o Gym equipment can be used for resistance training o Look for a club to train in boxing, judo, karate, martial

arts o For exercise that creates less stress on your joints, try

swimming or aqua aerobics. There are also plenty of exercise opportunities outdoors. You could consider: o Walking, Climbing, o Horse riding, o Gardening, o Flying a Kite, Playing Frisbee, o Sailing, Surfing, o Taking your children to the park

I would like to: ……………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………

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What are the different types of exercise? Aerobic exercises such as running, involve rhythmic repetitive movements that use large muscle groups such as legs and arms. Aerobic activity helps to increase stamina and can also help to maintain a healthy weight. Strength exercises such as weight training, make your muscles work harder to make them stronger. Strength activities can also prevent thinning of bones, and help with good balance and posture. Flexibility exercises such as yoga, can maintain or improve the range of movement in a joint or in a series of joints and muscles. Being more supple and flexible can improve your sports performance, and help prevent injury from exercise.

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Common reasons for not exercising and some friendly advice… 1. “I’m too unfit” However unfit you feel, it is never too late to start being more active. Start slowly and you may be surprised at how quickly your fitness improves. Just 10 minutes of moderate intensity exercise each day is a good start. People who benefit most from regular physical activity are those who are currently inactive. Remember that a little activity is better than none and more is better than a little! 2. “I don’t have enough energy” If you have experienced anxiety or depression, you may notice feeling tired. Exercising can actually improve your energy levels, make you feel more relaxed and improve the quality of your sleep. As you get into shape, you will begin to recognise the difference between lethargy and feeling physically tired. 3. “It’s boring” Vary the types of physical activity that you do, listen to music and set yourself new challenges. Is there a sport or activity you used to enjoy and have stopped doing? Or something new which you have always wanted to try? Being active with friends and family can also make exercise fun and interesting and help to motivate you to do more.

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4. “It hurts!” If you experience pain when exercising, reduce the intensity that you are working at – slow down your pace or the length of time you are active for. You are looking to notice a slight increase in your heart rate and breathing, so don’t be put off if you are not used to feeling like this. It means you are beginning to work at a ‘moderate intensity’ level. 5. “It might make me feel worse” Physical activity can be a useful way of letting go of distressing thoughts and feelings and learning to focus your mind on something else. Try paying attention to what you are doing in the present moment. Remember to focus on the positive reasons you have for becoming more active. 6. “It’s too expensive” There are plenty of free and inexpensive ways to become more active. Look at the list on page 7 for less costly exercise suggestions. 7. “I’m not overweight therefore I don’t need to worry” As we have seen, the benefits of exercise are much wider than just managing your weight.

8. “I don’t have time”

Think about the amount of time that you spend doing ‘inactive’ activities. This might include watching television, sitting at the computer or travelling on public transport.

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9. “I don’t have anyone to exercise with”

Think about friends and family who might also want to start exercising. Look at page 23 for information on local groups that can support you in getting more active.

10. “I’m afraid that I might feel unwell”

Fear of becoming physically unwell can stop people becoming active. Exercise builds strength, flexibility and endurance, which means in most cases it is probably safer to exercise, than not to exercise. If you are worried about this, consult your GP or physiotherapist.

11. “I’m afraid that I might fail”

Make sure you set realistic, achievable goals. Be proud about what you have done, not guilty about what you haven’t done. New projects often feel overwhelming until we get started and begin to enjoy each new challenge and success. You may have other barriers to exercise. The human mind is incredibly creative! Try turning that creativity to your advantage by using it to develop a positive attitude to physical activity.

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Are you ready to make a change?

Feeling low or anxious can make it hard to think about doing something different and it may seem especially hard to motivate yourself to increase your physical activity. Looking at the balance of advantages and disadvantages can help you to make a decision or motivate yourself to get started.

Use this table to help you think about your own situation.

Advantages Disadvantages

Being more physically active or exercising

Keeping things as they are

Taking all this into account, what is your decision? Writing it here may help to clarify your thoughts. ……………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………

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How do I get started? This section aims to help you to start increasing the amount of physical activity that you are doing. It will help you decide what activities you want to do, set realistic goals and make an action plan. This will help to increase the chances of achieving your goals. Often when people are feeling depressed and anxious they also feel tired and lethargic. At times like this physical activity is often the last thing that people feel like doing. Therefore, it can be useful to use some of the strategies below to help you motivate yourself to gradually become more active. Becoming more active isn’t going to be easy, but the following approach will increase your chances of success.

Action Plan

1. Choosing what to do.

A good place to start is to think about the types of physical activity that you already do and would like to do more of.

Types of physical activity I already do:

……………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………

Next think about other types of physical activity that you used to do, but have stopped doing, but would like to start again.

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Types of physical activity I’d like to start doing again:

……………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………

Finally, are there any new types of physical activity that you would like to try? You may not be able to do these immediately, but they might be something that you work towards over the longer term.

New types of physical activity that I would like to try:

……………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………

2. Choosing which activities to start with. It is probably best to build on the activities that you are already doing by doing them for longer, more often or more energetically. Then you could resume activities that you haven’t done for a while. And finally you could introduce some new types of physical activity. It is best to start slowly and build up gradually. For example, if you’ve not done any physical activity for a while, start with a 10 minute walk each day for the first week, and gradually increase this to 30 minutes a day. It can also be useful to look at the pros and cons and different types of activity to help you decide what you can realistically achieve.

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3. Set a date to start. You may want to start today, or plan to start at some time in the future. Whichever you choose, write this date below and make a note in your diary or calendar if you use one. I will start on: ……………………………………… 4. Other things to help you get started. Talk to family and friends about what you would like to do. This will help with your motivation and you may get some useful ideas. Get other people involved. If you’re feeling down you may not want to be with other people, but exercising with other people can be more fun and can help get you motivated. To improve your chances of success choose exercises that you can do regularly, fit easily into your daily routine, you can do near to home and that do not depend on factors out of your control. Find out about where you can get active locally such as leisure centres; places to walk, run or cycle; and activity groups such as walking groups and yoga classes. If anxiety prevents you from doing group activities, consider the following options:

� go with a friend, � visit the venue or speak to the group leader beforehand � challenge any unhelpful thoughts about the activity

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Things to do before I start: …………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………… 5. Setting yourself some goals

Having some goals gives you something concrete to work towards and will help increase your chances of success. Think about what you want to achieve and why. For example: I want to go for a 5 mile walk in the countryside once a week. I feel better when I am outside in beautiful surroundings. It helps me to clear my head. It is something I can do with friends.

It is best to make your goals realistic and specific. That way you are more likely to achieve them.

Examples of short term goals:

Walk for ten minutes five times a week.Walk for ten minutes five times a week.Walk for ten minutes five times a week.Walk for ten minutes five times a week. Take the stairs instead of the lift at work.Take the stairs instead of the lift at work.Take the stairs instead of the lift at work.Take the stairs instead of the lift at work. Cycle to work once a week.Cycle to work once a week.Cycle to work once a week.Cycle to work once a week.

My short term goals:

……………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………

Examples of long term goals:

Walk to work 3 times a week.Walk to work 3 times a week.Walk to work 3 times a week.Walk to work 3 times a week. Spend 3 hours gardening every weekend.Spend 3 hours gardening every weekend.Spend 3 hours gardening every weekend.Spend 3 hours gardening every weekend. Run 5 miles every week.Run 5 miles every week.Run 5 miles every week.Run 5 miles every week.

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My long term goals with timescales:

…………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………… 6. Reward yourself Promising yourself a reward for achieving some or all of your goals can help with motivation. Try to make sure that it is a healthy reward. My rewards for achieving my goals: …………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………… 7. Maintaining the gains.

Becoming more physically active will help you to feel better in the short term, but you need to keep doing it over the longer term to maintain the gains. It’s easy to slip back into old habits, but if you do, don’t give up. The following tips may help you:

� Develop new healthy habits. The more you do something the easier it becomes.

� Develop a new routine. Try to develop a new routine such as walking to work instead of taking the bus; going running every Monday evening with a friend, or gardening on Saturday mornings.

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� Having a regular time for exercise each week, committing to a class or exercising with friends

� Enjoy exercise - you’ll find it easier to keep doing them. Try different activities until you find something you enjoy. If running is becoming a chore, you could try a change of scenery or go with friends.

� Using a diary to plan your activities in advance will remind you to do them and help to make sure other activities don’t get in the way. Using a diary to note what you have done will help you review the progress that you are making, which can increase your sense of satisfaction. If you feel you’re not making any progress, look back and see what you have actually achieved, which should help boost your confidence.

Planning Your Physical Activity Many people find writing down what they plan to do and what they have done really useful. This is especially helpful if you are feeling low and struggling to motivate yourself.

Weekly goals You can use the weekly goal section on the following pages to note the activities that you plan to do in the week ahead. It’s a good idea to refer to the long and short term goals that you noted in the previous section. Aim to build up to doing five 30 minute sessions of moderate intensity exercise each week. Activity Diary Use a diary sheet to establish what you are already doing. Compare this with your goals to highlight ways in which you could be more active. Then use other diary sheets to monitor how much you have done. Also note how you have been feeling physically and emotionally to see how exercise is affecting you.

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An Example Action Plan

Week 4444---- Example weekly goals Example weekly goals Example weekly goals Example weekly goals Briskly walk Briskly walk Briskly walk Briskly walk to the local shops x 3to the local shops x 3to the local shops x 3to the local shops x 3 Go to Zumba with Jenny on Tuesday and Thursday nightsGo to Zumba with Jenny on Tuesday and Thursday nightsGo to Zumba with Jenny on Tuesday and Thursday nightsGo to Zumba with Jenny on Tuesday and Thursday nights Go for a long walk on Saturday afternoonGo for a long walk on Saturday afternoonGo for a long walk on Saturday afternoonGo for a long walk on Saturday afternoon

Week 4444---- Example diary sheetExample diary sheetExample diary sheetExample diary sheet Day / date Activity Intensity &

duration Comments

Mon 1111stststst OctOctOctOct

Walked briskly to Walked briskly to Walked briskly to Walked briskly to shops with Bobshops with Bobshops with Bobshops with Bob

LowLowLowLow

30 30 30 30 minsminsminsmins

Found it hard work but felt Found it hard work but felt Found it hard work but felt Found it hard work but felt better for getting out of the better for getting out of the better for getting out of the better for getting out of the househousehousehouse

Tues 2222ndndndnd OctOctOctOct

Zumba with JennyZumba with JennyZumba with JennyZumba with Jenny MediumMediumMediumMedium

45 mins45 mins45 mins45 mins

Felt less anxious about going Felt less anxious about going Felt less anxious about going Felt less anxious about going this week as the instructor is this week as the instructor is this week as the instructor is this week as the instructor is really encouragingreally encouragingreally encouragingreally encouraging

Wed 3333rdrdrdrd OctOctOctOct

No physical activity No physical activity No physical activity No physical activity as sorting out billsas sorting out billsas sorting out billsas sorting out bills

SleSleSleSlept better after Zumba and pt better after Zumba and pt better after Zumba and pt better after Zumba and feeling more like eating now, feeling more like eating now, feeling more like eating now, feeling more like eating now, but felt low trying to sort billsbut felt low trying to sort billsbut felt low trying to sort billsbut felt low trying to sort bills

Thurs 4444thththth OctOctOctOct

Didn’t go to Zumba Didn’t go to Zumba Didn’t go to Zumba Didn’t go to Zumba as no money, but as no money, but as no money, but as no money, but cleaned the house cleaned the house cleaned the house cleaned the house

LowLowLowLow

30 mins30 mins30 mins30 mins

Disappointed at missing Disappointed at missing Disappointed at missing Disappointed at missing Zumba, but pleased that the Zumba, but pleased that the Zumba, but pleased that the Zumba, but pleased that the house is cleanerhouse is cleanerhouse is cleanerhouse is cleaner

Fri 5555thththth OctOctOctOct

Walked to the shops Walked to the shops Walked to the shops Walked to the shops with Jennywith Jennywith Jennywith Jenny

Low Low Low Low 15 mins15 mins15 mins15 mins

Gave me something to get out Gave me something to get out Gave me something to get out Gave me something to get out of bed forof bed forof bed forof bed for

Sat 6666thththth OctOctOctOct

Raining so didn’t go Raining so didn’t go Raining so didn’t go Raining so didn’t go for a long walk, but for a long walk, but for a long walk, but for a long walk, but walked to the shopswalked to the shopswalked to the shopswalked to the shops

LowLowLowLow 10 mins10 mins10 mins10 mins

Felt disappointed at not going Felt disappointed at not going Felt disappointed at not going Felt disappointed at not going for a long walk, and felt a bit for a long walk, and felt a bit for a long walk, and felt a bit for a long walk, and felt a bit low being stuck in thlow being stuck in thlow being stuck in thlow being stuck in the housee housee housee house

Sun 7777thththth OctOctOctOct

Good weather so went Good weather so went Good weather so went Good weather so went for a long walkfor a long walkfor a long walkfor a long walk

2 ½ hours2 ½ hours2 ½ hours2 ½ hours LowLowLowLow

Enjoyed the scenery and Enjoyed the scenery and Enjoyed the scenery and Enjoyed the scenery and spending time with Sue. Felt spending time with Sue. Felt spending time with Sue. Felt spending time with Sue. Felt more relaxed when I got homemore relaxed when I got homemore relaxed when I got homemore relaxed when I got home

Summary

Achieved most of my Achieved most of my Achieved most of my Achieved most of my weekly goals or did weekly goals or did weekly goals or did weekly goals or did equivalent activitiesequivalent activitiesequivalent activitiesequivalent activities

Similar to Similar to Similar to Similar to last weeklast weeklast weeklast week

Am doinAm doinAm doinAm doing a lot more than the g a lot more than the g a lot more than the g a lot more than the first week, and feeling better first week, and feeling better first week, and feeling better first week, and feeling better for it. I now feel ready to do for it. I now feel ready to do for it. I now feel ready to do for it. I now feel ready to do some more vigorous activitiessome more vigorous activitiessome more vigorous activitiessome more vigorous activities

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Weekly Physical Activity Goals – Week

.................................................................................................... ..................................................................................................... .....................................................................................................

Physical Activity Diary – Week

Day / date Activity Intensity & duration

Comments

Mon

Tues

Wed

Thurs

Fri

Sat

Sun

Summary

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Where can I find extra help?

If you feel that you need some extra support to help you be more active, the following organisations may be able to help you:

� Help Yourself is an online directory of voluntary, community, faith sector, health & social care organisations in Sheffield. There are over 5000 entries covering a wide range of subjects including sport and exercise. www.sheffieldhelpyourself.org.uk

� Sheffield International Venues run 17 sports and exercise venues in Sheffield including Ponds Forge, Hillsborough, Springs & Stockbridge Leisure Centres, Concorde & Westfield Sports Centres, four golf courses, and Don Valley Stadium. www.sivltd.com/

� Sheffield Mind and Body Project is a health and

wellbeing project delivered in 5 areas of Sheffield. Activities include healthy lifestyle courses, Zumba, Tai chi, Circuit training for men. www.sheffieldmind.co.uk

� Activity Sheffield offer a range of sport, play and

physical activity sessions, aiming to get more people, more active, more often! www.sheffield.gov.uk/out--about/lleisure-services---activity-sheffield.html

� Running - Park Runs take place in Endcliffe, Graves

and Concord Park. All ages and abilities welcomed! www.parkrun.org.uk/sheffieldhallam/home

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� The Ranger Service provides a service and resource for people using the parks, woodlands and countryside areas of the city. It organises a wide range of activities including guided walks and cycle rides. It also has an active and extensive volunteer programme. www.sheffield.gov.uk/out--about/parks-woodlands--countryside/rangers.html

� The Run England website includes a directory of organised runs throughout England, and other useful information on running. www.runengland.org/

You can also be referred to the following organisations by your IAPT worker or other health professional:

� The ‘Active for Life’ city wide exercise referral scheme offer a 12 week supported activity programme for people with long term conditions, including anxiety and depression. They run free community based walks and gym based activity at a reduced rate. www.zestcommunity.co.uk/

� Sheffield Health Trainers can offer one-to-one support

around changing and leading a healthier lifestyle, including exercise. There are currently 18 health trainers working in different areas of Sheffield. You can

contact them on: 0114 2930687

Please also look at the exercise pages on the Sheffield IAPT website. www.sheffieldiapt.shsc.nhs.uk

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This booklet has been written by the IAPT Exercise Strategy working group. If you have any comments or suggestions on the booklet please email them to: Iapt.info@shsc.nhs.uk Improving Access to Psychological Therapies Sheffield (IAPT) Sheffield Health and Social Care NHS Foundation Trust 38 Carver Street 1st Floor Sheffield S1 4FS Tel: 0114 22 64380