Andrew Sheppard and Noelle Fitzgerald

Physical fitness and mental wellbeing

Health needs of Young People

Social and emotional needs of Young People

Addressing these needs

The Fresh Start “Get fit for life” programme

Developing a Fitness Therapy and Nutritional Guidance Programme for Looked After Young People: A pilot study

Results, Conclusion and summary

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What is fitness?What is fitness?

Fitness or cardiovascular fitness is defined as capability of the body of distributing inhaled oxygen to muscle tissue during increased physical effort. Demonstration.Demonstration.

The World Health Organization (WHO) defined health in its constitution of 1948 as "a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity".

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The link between fitness and mental wellbeing for YP’s The link between fitness and mental wellbeing for YP’s

Extended physical activity can have a positive effect on the self-image and physical and psychological well-being of adolescents (Kirkcaldy et al. 2002)

High BMI and increased levels of sedentary behaviour correlated with depression in a study of YPs (Anton et al. 2006) and there is evidence to support that physical activity is a significant predictor of levels of depression in adolescence (Annesi 2004; Terwiliger 2008; Hong et al. 2009).Sport and physical activity has been found to play a positive role in self-esteem and perceived competence of YPs (Kalogiannis 2006) and exercise has a protective effect on stress and has been shown to reduce anger (Roemmich et al. 2008).

Many YPs entering residential care have experiences of physical and emotional trauma, abuse, neglect, and/or destructive relationships (Christian 2003).

These experiences have a detrimental effect on YPs’ development and heighten the risk for developing physical, emotional, social, and behavioural problems.

Almost one-third of looked after YPs suffer from physical health problems which limits participation levels or types of activities in which they engage (Gay et al. 2011).

Many YPs entering residential care have experiences of physical and emotional trauma, abuse, neglect, and/or destructive relationships (Christian 2003).

These experiences have a detrimental effect on YPs’ development and heighten the risk for developing physical, emotional, social, and behavioural problems.

Almost one-third of looked after YPs suffer from physical health problems which limits participation levels or types of activities in which they engage (Gay et al. 2011).

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Physical fitness has a powerful effect on health for all YPs. It combats cardiovascular disease, increases skeletal infrastructure, and increases self-worth, self-esteem and self-perception and decreases depression (Ortega et al. 2007).

One study on environmental determinants of activity reported that only 26% of children in residential care recalled playing a sport during the previous 4 weeks (Gay et al. 2011). Another study found that only 4% of looked after children in the UK are enrolled in schemes for excelling in sport, art, and learning (Browne & Lynch 1999). These studies indicate low levels of physical activity for looked after YPs.

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YPs in residential care struggle with poorer mental health and are at higher risk to develop mental disorders through their experiences of risk factors such as neglect and/or abuse (Zetlin et al. 2006).

10% YPs within the general population will experience a mental disorder (Green et al. 2005), however figures for looked after YPs are much higher, approaching 50% for those living in foster care and rising to 70% for those in residential care (Golding 2010)

Many looked after YPs do not have access to extra-curricular learning and activity opportunities that could help combat this (Vacca 2006). The Department of Health (2011) in UK emphasised the importance of physical activity, healthy eating, emotional health, and well-being on the mental health of looked after YPs.

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Four maladaptive coping mechanisms have been identified and are used by looked after YPs (Goodwin 2006):

Emotional coping

Substance use

Aggressive behaviour coping

Physical activity

The former three coping behaviours resulted in a likelihood of increased depression in YPs whereas physical activity was linked with lower levels of depression

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In a move to combat this trend and enhance the level of health and wellbeing of YPs in their care, Fresh Start Fitness Exercise Therapists created the “Get fit for life” health programme.

The “Get fit for life” programme is a comprehensive health package specifically tailored to meet the needs of young persons in residential care.

Fresh Start Fitness Exercise Therapists carry out a unit based personal training session with each young person a minimum of once per week and deliver a seminar on Nutrition Once every six weeks.

We also run an Activity day every two months for all our young people to promote the fun element of exercise while encouraging peer and social interaction.

The program concept and design, different to PT

Social and peer interaction through exercise groups

Nutritional guidance

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Tracking progress through Fitech V5 and session reports/monthly reports

Links with Occupational Therapist

The benefits of being physically activeThe dangers of a sedentary lifestyle: Heart Disease, Diabetes, cancer etc.

What is Healthy Eating?Functions and R.D.A of carbohydrates, proteins, fats, vitamins & minerals

Fats and Sugar in the diet (Functions, dangers, visual exercise with sugar and fat)

The dangers of smoking, alcohol and substance abuse. Exercise as a beneficial adjunct.

Program layout

Nutritional Nutritional GuidanceGuidance

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Participants – 8 young people* ranging 14 to 16years living in residential care homes

Measurements (3,6,9 months)Fitech V5: Physical Fitness & Quick Stress Survey

Physical Fitness: Body Mass Index/ Resting Heart Rate / Lung Capacity / Aerobic Capacity / Flexibility / Lower Body Strength

Quick Stress Survey (Well-being): Tension / Anxiety / Anger / Depression

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  Baseline 3 months p value

Resting Heart Rate

(b/m)

81.4 74.6 .011*

Lung Capacity (l/min) 382 520 .001*

Aerobic Capacity

(ml/kg/min)

40 48.5 .025*

Flexibility (cm) 37 45.3 .026*

Lower Body Strength 34.4 52.6 .003*

  Baseline 3 months 6

months

9

months

p value

Resting Heart

Rate

83.3 76.8 76.8 73.8 .006*

Lung Capacity 363 490 495 612 .048*

Aerobic Capacity 41.8 49.1 53 54.2 .001*

Flexibility 32.5 39 47.8 54.5 .012*

Lower Body

Strength

32.5 48 56.3 69.8 .003*

Mean scores and significant values of 8 young people after 3 months

Results of 4 young people across 9 months of physical activity programmes

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  Baseline 3 months 6

months

9

months

p value

Tension 4.15 2.6 2.25 1.5 .002*

Anxiety 4.65 2.8 2.5 1.75 .000*

Anger 4.5 3.6 2.6 2.55 .005*

Depression 4.1 3.45 2.5 2.15 .034*

Means and significance values for 4 young people over 9 months.

- Initial insight into how regular fitness therapy programmes with nutritional guidance can be appropriate and popular for looked after YPs and benefit both their physical health and mental wellness.

- Mild integration into the fitness therapy programme was a major strength and allowed for greater participation levels.

- Limitations: Does not account for other interventions limiting inferences to associations for fitness therapy and does not allow for direct causal interpretations.

- This study did not have scope for using a control group and any inferences made from the data cannot be directly attributed directly to the fitness therapy programmes.

- Suggestions: Include a focus on more physically active and healthier environments & fitness directors within care services and/or designated staff members for physical fitness to be part of the structural environment within residential care homes.

Thank you!