Intro
Gillian Street and Ray James: Mentally Healthy WA Centre for Behavioural Research in Cancer Control, Curtin University
A review of current literature indicates that people who participate in sports clubs and organised recreational activity enjoy better mental health, are more alert, and more resilient against the stresses of modern living. Participation in recreational groups and socially supported physical activity is shown to reduce stress, anxiety and depression, and reduce symptoms of Alzheimer’s disease. Violent crime also decreases significantly when participation in community activities increases.1 More people undertake voluntary work for sports and physical recreation organisations in Australia (1.1 million) to support participation in sport and recreation activity, than are employed in the industry (83,008).2 Links between obesity, depression and physical inactivity are also briefly examined.
Infographic above: Being physically active: protects against mental health problems, decreases depression in older adults, reduces the symptoms of post natal depression, is as effective as medication for mild to moderate anxiety and depression, improves self-esteem and cognitive function in young people, playing sport reduces psychological distress by 34% 1-3 times a week and 46% 4+ times a week, people who participate in sports clubs and organised recreational activity enjoy better mental health.
Infographic above: Physical activity and mental health: Community sport and recreation.
Source: DSR 2017 Community Perceptions Survey
Participation in sport and recreation activities can reduce stress, anxiety and depression.3 Participation in group recreation provides a sense of value, belonging and attachment.4 According to Bandura’s social cognitive theory, behaviour is shaped by the interaction between individual and environmental factors.5 This theory emphasizes the influence of social interaction in relation to behaviour. There are both direct and indirect links between participation in group activity and mental health.
Numerous studies and reviews demonstrate associations between social interaction and mental wellbeing.6-15 The Whitehall Study in the United Kingdom found that people without good social support were five times more likely to have a mental illness than those with good support.6 There were significant associations between social isolation and low mental health scores in a cross section of the population in rural and regional Victoria.8 There were similar findings in a random sample of the population in suburban Adelaide.7 A significant association between depression and loneliness has been found in middle to older age adults in the United States, using both cross-sectional and longitudinal analyses.15 A prospective cohort study into psychosocial factors and mortality in Norway found that both social participation and social support are predictors of a long life, and social support helps in the handling of stressful life situations.9 An evidence-based intervention strategy designed for older adults in the USA advocates social participation as a means to maintain cognitive vitality.14 The Mayo Clinic in Rochester, Minnesota, USA recommends joining a community group or becoming a volunteer in order to buffer the effects of stress.16 Another benefit to community wellbeing is shown in a study by the Australian Institute of Criminology in which a ten percent increase in community participation was related to a statistically significant 1.9% decline in violent crime rates.1 A decrease in criminal behaviour can lead to a further increase in social participation as people feel safer in their community environment.17 The Australian Government promotes social participation and social capital in the Stronger Families and Community Strategy.17
Extensive evidence shows that social participation and social support increases participation in physical activity18, 19 and engagement in physical activity is strongly associated with mental health.7, 8, 20-29 Evaluations have shown that social support such as “buddy” systems increases feelings of well-being and people’s intention to begin or continue participating in physical activity.10, 18, 30, 31 A study of older adults showed that these positive effects were highest amongst subjects with high baseline self-efficacy and in those who exercised more frequently.20 However, those with lower baseline self-efficacy showed a greater upward trend over six months, which was attributed to the creation of “buddy groups” within the program. The National Heart Foundation’s ‘Just walk It’ program identified social cohesion as the main predictor of adherence to walking programs and as an important component for creating positive attitudes toward physical activity.10 The 2003 Child and Adolescent Physical Activity and Nutrition Survey in Western Australia identified one of the barriers to participation in physical activity as “no one to be active with”.32 A recent review of dog ownership literature suggests that “buddies” need not be limited solely to the human variety, as the social support gained from dogs was also shown to encourage increased physical activity.33
Recent research also indicates an association between obesity and depression.34,35 Many depressed persons are inactive and gain weight and physical activity is listed as a potential mediating variable for depression.35 Participation in recreational groups and socially supported physical activity assists people to initiate and sustain physical activity programs. Decreased physical activity amongst children and adolescents is believed to have contributed to the prevalence of overweight and obesity doubling in the past two decades.36 There is clear evidence of the benefits of physical activity in preventing and treating obesity.37, 3
Australia spent a total of $3.3 billion on mental illness in 2003, 6.6 percent of the total cost of health care.39 Depressive disorders are one of the major causes of disability in Australia affecting about six percent of the population in any one year.40 Certain population groups appear to be more at risk than others: Indigenous people, culturally and linguistically diverse (CALD) people, people with disabilities, adolescents, postnatal women and the elderly.40 The 2001 National Health Survey showed that people with mental and behavioural problems were twice as likely to be hospitalised as those without these problems.36 Strategies aimed at enhancing mental health and wellbeing in the community therefore have the potential to decrease the social and economic costs associated with mental illness. The 2000 National Action Plan for Depression includes recommendations for social support, but does not specifically address the need for physical activity or social recreation as a preventive or curative measure.40 The first objective of Key Initiative 6 of the Western Australian Mental Health Action Plan 2005-2010 is “to strengthen community capacity to promote mental health and prevent mental illness, including increasing cross sectoral collaboration and community development”.41
The Australian Bureau of Statistics reported that participation in social activities declines with age, and 4% of people aged 18-24 years report no social or sporting participation in a three month period compared with 21% of those over 75 years.17 The 2003 Survey of Disability showed that few people with profound or severe core-activity limitation (14 and 10% respectively) ever attend supervised activity programs in a safe environment.17 This includes group activities at day care centres for older people. VicHealth, the peak body for health promotion in Victoria, supports community organizations through its Active Participation Grants.42 Participation by a diverse range of organizations creates opportunities for people who would not normally be involved in traditional sporting activity. An area in which many Australians actively participate is volunteering. Much of the volunteer work undertaken relates to parent’s involvement with their children’s sporting activity.17 A recent study by the Institute of Psychiatry at Kings College London indicates that volunteering can help boost the 4 recovery of people who experience mental disorders, and help regain entry into employment opportunities.43
Physical inactivity is second only to tobacco as a contributing factor to the burden of disease and injury in Australia.44 Regular physical activity is widely recognized as protective against the overall burden of disease.37 In 2002, more than a third (37.6%) of adult Australians reported no participation in sports and physical recreation.2 Approximately half of the remainder (31.5%) participated in organized sports and physical recreation, with a further 30.9% reporting that they undertook some form of physical activity.2For both males and females, walking was the most popular form of recreational physical activity.2Approximately 40% of children do not participate in organised sporting activity outside of school.2
The relationship between participation in organized sport, recreation and mental health is shown in Figure 1. Studies and reviews cited in this review are summarised in Tables 1 and 2. A number of themes were consistent across the literature:
Research relating to the relationship between participation in organized sport and risk-taking behaviour has had mixed results. While sport participation is shown to have mostly positive behavioural effects26,47 a few studies have shown greater risk-taking behaviour such as alcohol and other substance use amongst those participating in organized sport.47, 49 Two other limitations of this review are the reliance on cross-sectional studies, which are unable to exclude confounders and prove a causal relationship, and the use of grey literature. However extensive reviews in international literature support the mechanisms for the relationships between organized sport and recreation and mental health shown in Figure 1.22, 30-32, 36, 37
Participation in organized sport and recreation can be a preventative and curative strategy to promote positive mental health and combat mental illness. The recommendations of this review support the development and maintenance of organized sport and recreational activities in the community. These programs should be socially and culturally appropriate and should take into account mediating factors that increase adherence to physical activity programs. They should Participation in organized sport and recreation Improved physical and mental health and well-being Reduction of obesity Social support Social networks Social cohesion Social capital Cognitive function 6 extend to diverse population groups including those most at risk of developing mental health problems. Valid and reliable evaluations of the programs would contribute to the international body of evidence relating to the mental health benefits of organized group activities. Government sectors must work together to support a diverse range of organized recreational activities to promote increased social support and social capital in the population as proposed in both State and Federal Action Plans relating to mental health.40, 41