A webinar hosted by Sport England’s Liz Aitken and featuring a presentation by Andy Smith and Stuart Fairclough from Edge Hill University.
Liz begins by addressing the online audience, before Andy and Stuart present, with help from Katie Scott from Sport England. The webinar concludes with a Q&A session facilitated by Rosie Sadler from Sport England.
Liz: “Hi everyone. Welcome and thank you for joining us on Mental Health Day. Apologies, just a few technical issues there to start for this webinar, where we'll be taking you through a new evidence review which has been undertaken by Edge Hill University, looking at the role of sport and physical activity on the treatment and management of diagnosed health conditions in children and young people.
“Before we progress, I just want to remind you of a few things and provide you with some general housekeeping. First, when you joined the session, both your microphone and cameras were automatically disabled. This is to ensure you're not recorded without your consent.
“The session will be recorded for future use by Sport England and for publication on Sport England's website and YouTube channel. The recording will also be shared on Sport England social media channels, LinkedIn and X, so that other interested parties may view the content.
“If you wish to provide comments, you can type these into the Q&A section and this will be read by the moderator. If you don't wish for your name to be included and recorded, please use the anonymous function. Finally, if you'd like any more information about this, please see our privacy statement, which we've posted in the Q&A section.
“So firstly, I'd like to do some introductions of who we have presenting today. I'm Liz Aitken. I work in the Children and Young Policy team here at Sport England. And later my colleague Rosie Sadler from our Insight team will be joining from Edge Hill. Both Professor Andy Smith and Professor Stuart Fairclough will be taking you through their work and their findings.
“As I've mentioned before, please do use the Q&A function. We're interested to hear all of your questions and your comments and we'll try to get to as many of those as possible after the presentation.
“Given that we have Edge Hill University with us here today, we'd really like to hear your questions and comments that are focused on the research and findings that we'll share with you. We will try our best to go through the majority of questions, but if we are left with a lot, we will follow up with a Q&A document.
“So before I hand over to Andy and Stuart, I just wanted to give you a little bit of background about why this piece of work was so important for Sport England to do. We know that children and young people's mental health challenges have increased over recent years and at the heart of Sport England’s strategy, Uniting the Movement, is the role that being active can and does play in transforming lives.
“Research from Sport England's Active Lives Survey shows that active children are more likely to be happy, healthier and more resilient. Moving more regularly is proven to help us to take good care of our mental health and well-being, which we need to live a happy, healthy and fulfilling life. And we want to help and support as many people as possible to reap the mental well-being benefits that an active lifestyle can bring.
“But not everyone finds it easy to be active and this is especially true for people aged 16+ experiencing mental health and or physical health challenges. To date, Sport England's work in this space has been predominantly adult-focused, working with and through trusted mental health charities such as Mind and Rethink.
“And in the Uniting the Movement, we really wanted to explore this further for children and young people. Despite the evidence on the positive association with being active and children and young people's mental well-being, there is less documented evidence on the role sports and physical activity can play for children and young people with a diagnosed mental health condition and those waiting for or on a mental health pathway.
“This was something that stakeholders and partners were keen for us to look at before we initiated any new work in this space. So based on feedback from a wide range of stakeholders, we identified a need to better understand the evidence base, to have this in an accessible place and a format for all sectors to use and to understand what works and where further attention may be required.
“And so came about this work with Edge Hill University, who have carried out an independent evidence review. And today we're really pleased to be able to share with you these findings. So with that, I'm going to hand over to Andy and Stuart.”
Andy: “Thank you everyone who's able to join us today for hopefully will be an important and first step in understanding the way that forced activity interventions can be used to support the mental health of children and young people, not just in England, but more broadly, I'm sure.
“And I will take you through some of the key headline findings of the report, which will be available for colleagues to download at the end of this particular webinar. So if I move on to the first slide, Katie, please.
“As Liz has just summarised very quickly, the scope of the review was before. Firstly, we were asked to look at the research which focuses on the use of sport and physical activity interventions for children and young people who in this work were defined as those aged 5 to 25 and those who had a diagnosed mental health condition.
“We also included those children, young people who were waiting for or were on a mental health treatment pathway as diagnosed by a general practitioner or a mental health specialist.
“We include a range from health conditions and including their symptoms, and that's something that we'll come back to later in the presentation, which included conditions such as depression, anxiety, eating disorders, self-harm, bipolar disorder and schizophrenia.
“And later on in the presentation, we'll take you through some of the ways in which the research is focused on different types of conditions, either singly or separately.
“Before I hand over to Stuart, we want to just identify the key review objectives. As colleagues refer to earlier, the first purpose of the review was to identify and collect the existing research, the academic research which assesses the strength of the evidence for the role of sports and physical activity on the treatments and management of diagnosed mental health conditions, including young people.
“As well as summarising the evidence base, we also sought to increase both the knowledge and the awareness of practice principles and the key ingredients or themes. We can identify the effective interventions which have been shown to positively impact the mental health of children and young people. In doing so, we sought to identify the transferable and actionable learning for the sectors.
“We also sought to summarise, translate and make the evidence accessible to better inform decision-making and influencing by Sport England and other stakeholders. Stuart will now take you through the way we approach the review and then I will come back to talk briefly around some of the key headline findings.”
Stuart: “Next slide please, Katie. Thanks Andy. So we conducted a scoping review of the evidence between the dates there and when we started to look at this, it was clear that January 24, January 2004, was the first point at which there was some relevant research published on this topic.
“So we used a scoping review. It's an appropriate method when there's a topic that's not very well defined and there's a need to clarify the key concept. So it fitted well to what we tried to do as well as the criteria that Andy mentioned which formed the focus of the review.
“We want to just make it clear that we were quite inclusive in the approach that we took here. So as long as the interventions had a physical activity and or sport component, we weren't prescriptive on content or design and similarly we included any research designs and approaches which fulfil the other criteria. Important to note as well, this evidence review includes only peer reviewed evidence published in the English language.
“So because we were anticipating quite a range of evidence information, we wanted to try and provide some indicators who have stronger evidences. So we've used this kind of traffic light adapted grade system that you can see there on the screen.
“So if we can go to the next slide please, Katie, I'll just unpack that in a little bit more detail. So we, sorry Katie, I think we need to scroll one back. That's the one. Yeah, so the strength of the evidence was based on these five criteria.
“Some of them are a little bit more self-explanatory than others, but predominantly we're interested in what volume of evidence was out there, how many studies fitted to the criteria that we set in terms of the findings from these studies, how consistent were the results? Similarly, how consistent were the types of interventions and populations of interests that were included in the studies?
“And we also wanted to consider the quality of the research that was undertaken, so we can think about that in terms of rigour. So for example, typically a higher number of participants would indicate a better-quality or more rigorous study, but also the study design.
“So we've got randomised control trials, they're up there on the screen. So that was an indicator of a rigorous study design. So when we have a randomised control trial, it's one of the best, sometimes called gold-standard research designs in the hierarchy of research evidence, which typically reduces bias in any conclusions.
“It can include a control group who were randomly selected and matched to those fulfilling the intervention. So it's recognised certainly in health and clinical studies as the gold standard for experimental designs.
“Importantly, RCTs as they are called also allow cause and effect relationships to be discussed as conclusions. And then the last elements of our criteria was how timely the evidence was and with a weighting towards stronger evidence which was published more recently in the last five years.
“So we can go to the next slide please. So this is a little bit more detail on how we assessed the strength of the evidence. So I won't read all the text on the screen, but essentially these are the descriptors for the criteria which would relate to the strong evidence.
“So in terms of accessibility and availability, we need more than 20 studies available. We have far more than that. The consistency of the findings kind of speaks for itself. Consistency of mental health outcomes, though, was an important element of relatedness.
“But also the methods or the outcome measures used to assess those mental health outcomes and how consistent they were used was also a consideration when we thought about the strength of the evidence.
“I've mentioned a little bit earlier there about rigour of the research designs and sample sizes. And then again in terms of timeliness, strong evidence was where there were studies published in the last five years. Next slide please.
“So after the literature search, which took place across seven separate databases, we extracted about 12-and-a-half thousand records. And then we went through a screening process whereby the titles and the abstracts were screened for against the inclusion criteria.
“And then following the process, as you can see on the screen, where we removed duplicates, we were left with almost 800 full text studies and we screened these across the research team. We removed the majority of those that did not meet the criteria and that took us to 165.
“And then we also removed a smaller number of 22; on closer inspection, this small number of studies were not that relevant. For example, they went over the age range, they didn't clearly define the mental health outcomes, etcetera.
“So our review consists of an analysis of 143 studies. Next slide please. So the next few slides will give some descriptive information about what these studies look like.
“So here we have the research design that was used in the evidence that we've got. So I've already mentioned the randomised control trials and we had 29% of the studies fitted that.
“So given that we've already said that's the gold standard for experimental studies, that was a real good start. We've also got a term here, systematic reviews and meta analysis, and that formed about 12% of the studies. So this is an important element of the evidence review for us.
“If you're not familiar with a systematic review and meta analysis, essentially there's clearly prescribed questions for a review, which combines studies a bit like we have done on some prescribed criteria and then it makes some summary recommendations follow from that review.
“But importantly was whether it's a meta analysis. This means that the results of the individual studies are pooled together and then we can make some generalised statements and conclusions around the overall effect of interventions for the studies included in those meta analysis.
“So when I referred early to a hierarchy of evidence, at the top of that hierarchy of evidence for research is systematic reviews of meta analysis with randomised control trials sitting just underneath that.
“So from our evidence review, 41% of the included studies were of this high-quality evidence, which is a good sign. But then on the other hand, you could look at it in a different way in that like the majority, almost 60% were of lesser, quality in terms of the research design of these designs or, sorry, of these studies, a small number, about 7% were conducted in the UK. Go to the next slide please.
“So these interventions were conducted in a variety of different settings. In many cases, though, the studies did not actually give enough information for us to categorise those settings. And that's the top bar that you can see up on the screen.
“This also includes all systematic review and meta analysis studies because they would include studies from many different settings.
“So they're kind of indeterminate, but other than that, almost over 25% of the research was conducted in hospital or healthcare settings and then almost 20%, 19% were in non-school educational settings such as universities and then a smaller number in a different mix of community-type settings. And the next slide please.
“So this is a summary of the mental health conditions that were studied across the studies that were included in the evidence review.
“So you can see that depression overwhelmingly was studied most frequently followed by anxiety. And these came through either through the individual studies and typically through the meta analysis studies that we included.
“There were some other conditions, multiple conditions, eating disorders, behavioural disorders and so on, but they were in the minority.
“The top bar says not reported or insufficient information. So in many cases, this was really unclear in the studies, they didn't provide enough information for us to really clearly understand what mental health outcomes have been reported upon. Okay, I think I'm going to hand over to Andy now on the next slide.”
Andy: “Thanks Stuart and thanks very much for taking us through the methods. Overall, the first key message from the review is that there was strong and consistent evidence that sport and physical activity interventions have positive effects on the diagnosed mental health problems of children and young people.
“This is a significant finding as we'll come on to shortly, but which doesn't need to be understood in the context of the types of conditions that interventions sought to address and the types of activity and intervention types which were typically used in those interventions.
“On the next slide, we'll talk through the most common types of interventions that were used in the existing research, which have important applied practice implications. So next slide please, Katie.
“Firstly, aerobic exercise was the most common mode of physical activity intervention, which had a moderate effect on depression in children and young people.
“This was the most common form of exercise, which can take many forms, which has important implications for the ways in which we use those types of activities to address the mental health needs of children and young people. And there was moderate evidence for the impacts of those types of interventions.
“However, when aerobic exercise was combined with resistance exercise as part of intervention designs, although those studies were less common, they had stronger effects on the symptoms of depression in children and young people.
“So there is strong evidence for the use of both aerobic and resistance exercise interventions, which are being used currently to address those symptoms in children and young people.
“This is significant because the Chief Medical Officer physical activity guidelines for children and young people also recommends that at least moderate-intensity forms of those types of exercise are also important for the mental health and well-being of children and young people. Next slide please, Katie.
“Stuart referred earlier to the strongest and highest-quality forms of evidence that we have available to us in this slide and in the subsequent view we're going to focus on some of those types of evidence.
“But in this case, the metro analysis evidence and the conclusions which we can draw from the analysis of those studies indicates that there is strong effects of randomised control trials delivered in group settings.
“In other words, active physical activity interventions which are delivered for groups of children and young people had particularly beneficial impacts on their diagnosed mental health conditions overall.
“Programmes which were delivered on a one-to-one or individual basis were also prominent and helpful, but they had more weak-to-medium effects on mental health.
“So the key message here is whilst one-to-one or individual interventions can help, what is particularly important is the group level and group types of settings that physical activity interventions are delivered in and that's for all types of conditions that didn't vary by the types of conditions that were referred to earlier. Next slide, please, Katie.
“If we're to focus particularly on depression in adolescence, given as Stuart referred earlier that many of the studies have typically focused on depression generally and have moderate to high intensity physical activity is most effective in addressing that.
“We have metro analysis which suggests that the benefits or the design of those types of interventions range from interventions which occur 4 x 30 minutes per week for at least six weeks through to 3 x 20 to 60 minutes per week for at least 12 weeks.
“So interventions varied in both the length and in their time, but between those two parameters there we begin to see some of the most beneficial impacts of interventions for adolescents with diagnosed depression. Next slides please, Katie.
Stuart: “So thanks Andy. I'll just take over the next couple of slides. So I referred earlier to we applied an adapted grade approach to summarise the strength of the overall findings. Again source 5 criteria.
“So for each of those criteria we assessed each study and we came up with a composite descriptor. So for rigour it was moderate. So although we had a relatively significant proportion of randomised control trials included, a significant proportion of the studies were also poorly reported and had quite variable quality in terms of the way they were conducted and evaluated.
“And that speaks a little bit to the consistency elements. So there was lots of variability also in the way interventions were designed and delivered, their content and their evaluation.
“And in some cases there was very limited information in terms of the dose of the intervention or the duration or the intensity or even key information like the setting and whether it was group or individual and so on. So for consistency, the evidence was relatively weak.
“However, in terms of relatedness, the evidence was very, very strong in the sense of there were consistent findings between studies and many studies used similar outcome methods or outcome measures to report on similar mental health outcomes.
“And as we've seen earlier, depression or symptoms of depression was the mental health condition which was most commonly reported upon.
“In terms of the volume or amount of evidence, again, this was strong. I think, between Andy and I and the Edge Hill team and also the Sport England team, I don't think we expected to be reporting on 134 studies for this evidence review.
“So this is strong because the amount of evidence was quite voluminous and yeah, much strong, much higher than we anticipated.
“And then in terms of timeliness, this was also strong. 57% of the included studies were conducted in the last five years. We've not shown it on the slides today, but there is this kind of linear upward trajectory of the volume of evidence published in this particular topic area since 2004 onwards. And so taken all together, the overall body of evidence was judged as moderate.
“Andy has unpacked the detail of the key findings on the slides prior to this. So it's important to kind of look at each specific element, not just that kind of moderate overall judgement. Next slide please.
“And just as Andy mentioned the RCT in a little bit more detail, I'll just say one or two words about the meta analysis evidence because it did form 12% of the included studies. So we'll just take this as well in terms of the quality of the meta analysis studies.
“And this, again, just to refresh you, is where results from individual studies were pooled together and then some conclusions were made upon those.
“So in terms of how the studies included in the meta analysis were rated for methodological quality, that was pretty low, which speaks to the rigour points I've just made earlier.
“And in terms of variability of results or heterogeneity, that varied somewhat in terms of the direction of association and often the strength of the effect as well, sometimes very strong effects, sometimes quite minimal.
“Also in the metro analysis, the mental health outcomes into consideration weren't always reported as consistently as they may have been.
“So again that the rigour across the metro analysis was somewhat wanting in places and what was apparent is that these metro analysis really did focus primarily as you might expect on what the effects of the interventions were.
“So they provided quite limited information on the kind of what works ingredients. So you know, what was the content, how were the things delivered, what was the dose, how long did they last and so on and so forth.
“And then the last point, which I think is maybe a really prominent one, and it wasn't really mentioned in any of the metro analysis, and I didn't see in any of the individual studies that I reviewed, is that the importance of the participants’ habitual or free-living physical activity levels wasn't acknowledged.
“And what I mean by that is it was not accounted for in the analysis that were undertaken. So this is what we'd call potentially a confounding influence and it could have an effect on the conclusions reached if we don't account for people's typical levels of physical activity when we're doing some kind of intervention on a structured exercise or structured intervention.
“So this could have an effect of either blunting or exacerbating intervention findings. So from a methodological perspective, this was quite a big limitation. Thank you. Next slide, Katie.”
Andy: ”Thanks, Stuart. And as we've begun to allude to, there are some important recommendations for practice from the evidence base which is developing and certainly by comparison to adults is much currently much less developed.
“Nonetheless, there are some promising sides in the literature that we can begin to use to inform both our practice, policy and investment in this particular space.
“Before we move on to some of those particular recommendations, it's important at this stage to know that while supporting physical activity interventions can be important both for supporting mental health of children and young people, it's critical that that isn't seen as the only option.
“They are part of a suite of support mechanisms for young people who experience mental health challenges, and sport and physical activity interventions are also often used as an adjunct to other types of interventions.
“And it's really important at this stage to remind ourselves that there isn't a magic bullet or silver bullet to many of the mental health problems that we observe in judging young people.
“And it's also important to note that I know, as some colleagues have rightly observed in the question and answer section, that we have to be very careful about the ways in which we promote sport and physical activity for people who experience a whole range of mental health conditions or for people who find a whole range of challenges in relation to exercise and that activity.
“And we would always caution the conclusions which are drawn, whether by this evidence review or indeed by others.
“That having been said, one of the key recommendations for practice which the evidence review has identified is clearly a need to increase access to aerobic and resistance exercise programmes.
“What's really important here is that the types of aerobic exercise and resistance programmes can take many forms.
“The evidence doesn't suggest at this stage that we're… it's important to identify any particular means by which we engage in aerobic exercise or resistance exercise.
“So it's important to recognise that we can use more inclusive, accessible forms of activity that enable people to be active where they're at in ways which they feel comfortable in settings which are appropriate for them. And that's really significant.
“Also important is that we need to consider integrating physical activity into mental health services given, as Stuart referred to earlier, that many of the studies, at least approaching a quarter of those, were conducted in those spaces.
“There is clear evidence that we can begin to derive greater mental health benefit for children and young people if we were to increase access to physical activity in a range of spaces.
“It's also clear that we need to support and invest in the development of an appropriately qualified workforce to support young children, young people in a range of settings.
“And there was much existing practice and excellent guidance which will be forthcoming, including, of course, the work provided by Sport England and also undertaken by Mind in relation to their safe and effective practice guidance, which can be usefully used to support the implementation of some of the recommendations that we can make on the basis of the evidence base that we've been able to review as part of this review.
“Because it's particularly important when designing and delivering those interventions that the people who support children and young people are appropriately qualified to do so and are able to provide them with the relevant support that they need based on the types of conditions or challenges which they encounter.
“We also need to consider that when delivering group-based interventions, these are tailored to the individual needs and preferences of the children and young people who exist in those types of programmes.
“And to talk to the earlier points which I made, it's really important when identifying the benefits of sport and physical activity interventions for children and young people that we do so in responsible ways and the messaging and promotion around those types of interventions wherever they're delivered, that responsible messaging takes precedence over other things.
“It's also important that we seek to promote the long-term engagement of children and young people in the mental health space and how that can be used to benefit them for their mental health, regardless of the particular needs and areas of interest that we have as practitioners, as possibly as funders or commissioners. Next slide please, Katie.
“Some additional recommendations which we think can be made on the basis of the existing evidence base, which can be made bearing in mind the areas of caution that Stuart rightly noted, is there's a real need for us to consider leveraging right across sector investment and resource sharing to help tackle the increasing prevalence of mental health problems among children and young people.
“That will partly be important for supporting the rising demand in health services that we're seeing among that population group. And indeed the lengthening waiting times among the other needs to be considered complex.
“It's also important that we should refer to really improve both the amount and the quality of the research evidence that is available to us. Certainly by comparison to those in the adult space there is much less evidence which exists at the moment, but nonetheless the evidence is encouraging and we need to see more of that.
“That type of research should focus increasingly on the different types of sports and activities which are being delivered as parts of interventions in real-world settings, particularly in community settings, which as we know, is particularly important both for the mission of organisations such as Sport England but many others where children are young people engage in sport and communities and in settings which are really significant for engaging young people with a range of diagnosed mental health problems.
“We also need to consider how we can include more diverse groups of children and young people in the evidence base, particularly those from more minoritised communities, children and young people with neurodiversity, and also those who may experience a range of mental health conditions beyond those which we listed earlier.
“And indeed, those young people who experience multiple forms of disadvantage, which may impact on their mental health, are also among those whose needs are not yet well understood, but which could reasonably focus on being included in the future research that we need to undertake in this particular space. The next slide, please, Katie.
“We're grateful to colleagues at Sport England and to everybody who's been able to join us for the short webinar this afternoon. Even on the evidence review which we undertook, as referred earlier, we undertook the evidence review with a range of other colleagues who are not here today.
“We'd like to gratefully acknowledge their contributions to the report, which will be made available as a result of the webinar today and I'm sure colleagues from Sport England will be able to share details of that in due course.
“On behalf of Stuart and I, we're grateful for everyone joining us today and we’ll happily take some of the questions which I know have been coming in as we've been talking over the last half an hour or so.”
Rosie: “Thank you so much, Andy and Stuart, what a brilliant summary of the findings of the review. And I'm sure everybody is dying to read the full report and ask their questions.
“So we're now going to spend the rest of the time going through your questions, some of the questions that have come in to the Q&A section already.
“So thank you to those that have already shared their thoughts, reflections, and please do continue sharing any that you might have. There's no such thing as a silly question and you are able to post anonymously if you wish.
“If we don't get around to your questions today, please don't worry. We're looking to collate these after the webinar and we'll circulate any responses to them or any elaborations on the responses along with the recording of the webinar.
“And then any thoughts or questions that relate to what next will be used as inputs into planning the next phase of this work.
“So I'm going to start with just some other questions that have come through already. So those that are kind of a bit more related to the methodology. So Stuart and Andy, I'm going to come straight back, back to yourselves.
“What were the common outcome measures that were used? Were they self-reported on symptoms or were they tested?”
Stuart: “The majority that I read, so we split the review and screening between us, were self-reported, validated surveys. That said, there were a proportion of studies as well which were mainly based on diagnoses. And Andy, do you want to add to that? It was a mix, essentially, which muddies the water somewhat when we're trying to kind of make consistent conclusions.”
Andy: “Yeah, thanks, Stuart. There is mixed evidence and practice in that respect. The evidence base whilst strong in some areas is rather mixed and there is a combination of those types of studies which do involve reports, self-reports.
“There are other types of interventions where we have clinician-defined symptoms among children and young people, so people who have received a diagnosis for example, of depression or anxiety, whether from their GP or from another medical professional in a particular mental health care setting.
“There isn't a particular dominance of practices currently that we saw particularly in the activity intervention space. There are other types of evidence which haven't been included within the scope of this particular review and which extend beyond sport and physical activity, which looks at how we begin to better understand some of those.
“So this is clearly one area where the future development of interventions and the reporting of people with symptoms, and they may be subclinical symptoms as well as those with clinician-diagnosed symptoms, are reported and feature in the evidence. Many thanks for the question, but it's one of a mixed picture at this stage.”
Rosie: “Thanks both and the following questions are more related to kind of differentiating some of the findings between groups.
“So first of all a question around kind of types of activity and sport. So is there any evidence that would indicate specific types of physical activity or sport that were beneficial? So we're kind of excluding those points that were made regarding intensity and time.”
Stuart: “My reading of that is not with any confidence. So the reference to aerobic and/or with resistance exercise were the most consistent and had the strongest effects. They were relatively common.
“Very, very few studies reported on individual sports and certainly not enough for us to make any conclusions about that.”
Andy: “Just to follow on from that, Rosie, I think that's why, as we referred earlier, at this stage, many of the types of activities, the most common forms of activities which were defined in the evidence base simply refer to aerobic exercise, for example, or resistance exercise, which as we know, can take many forms, which on a practical perspective can be beneficial because that can be everything from walking, swimming and so on.
“And it is more inclusive for people to engage in types of activities that are particularly beneficial for them. In other types of activities, and we do include this in the final report, they’re also defined as multi-sports or various activities where there are specific studies which have looked at the impacts on the diagnosis of children and young people.
“They include things like yoga. There are around 10 studies which included yoga and other mindfulness-related exercises. They were described in the evidence base.
“We've been really cautious when reporting on the activity types simply to refer to the activities and exercise that were reported by the studies.
“So we're not trying to impose our own interpretations on those, but that is certainly something that we need to better understand as we move forward in this particular space.
“In far fewer studies, in some cases only one or two studies, we do begin to see some activities including kickboxing, Tai Chi and running being used and reported on to benefit the children and young people's mental health.
“But they're given they're so few in number at this stage, it's difficult to draw firm conclusions in the manner that we were able to perhaps for more aerobic forms of exercise.
“But that's certainly one area that we can begin to better work with colleagues across the system and sector to, to begin to evidence the benefits of those.
“And it's really important at this stage, and it's a point that we emphasise in the report, just because there is an absence of evidence, that's not to say that there are some of the activities and other types of interventions that we talked about don't work or aren't beneficial. It is that the state is an absence of evidence.
“And while the key priority moving forward is to address that evidence base, that can help support colleagues across all the various systems who are working with the children and young people for mental health benefits in a whole range of settings.”
Rosie: “Thank you. And I can probably guess a similar response, but a question around the differences between kind of competitive sport and physical activity, if there's anything else that you might want to elaborate on.
“But would it be a similar kind of picture or similar response for that?”
Andy: “It is, it is very similar, Rosie. Again, one of the challenges sometimes is how the activities are also described or defined in some of the existing evidence base.
“I think you'll notice that we didn't refer directly to competitive sport. We do know in other forms of evidence that for example team sports can have protective effects for mental health and well-being. But typically some of those studies have been in children and young people who haven't received a diagnosis.
“But we didn't find firm evidence either way in in response to your question in the review, the evidence that we reviewed over that 20 years.”
Rosie: “Thank you. And then we've had quite a few questions come in around demographic groups, particularly around whether or not there are any age-specific differences in outcome measures and findings.”
“And then also whether there are any differences between other demographics such as background, ethnicity, disability and gender. So, yeah, anything around differences across different demographic groups and ages.”
Stuart: “I'll just say something about age groups in the sense of there weren't any studies which separated children and adolescents. So it was difficult to talk just to children as a subpopulation.
“There were studies which talked about just adolescents at mid or late adolescence. So we could talk to that with a little bit more confidence.
“But again, it comes back to the way the studies have been A: conducted and B: reported, which presses on limitations on how far we can go in, in making some demographic comparisons.”
Andy: “In some cases, Rosie, it was true also that some of those demographic characteristics which you've just referred to were either reported inconsistently or in some cases not at all, which makes some of those challenges that Stuart referred to even more difficult to address.
“So at this stage, the evidence which we have available to us means that we can only be talking in reasonably general terms. But there are some types of research that are beginning to emerge now which begin to address, for example, the mental health of young women in particular settings, for example, in patient settings and engagement in particular types of activity.
“But that evidence base is certainly small and is only beginning to grow at this stage. So there is much work for us to do, not just looking at individual demographic characteristics, but also the ways in which those interact with other forms of inequality, which means that some children and young people are more likely to experience diagnosed mental health conditions and challenges than others.”
Rosie: “Thank you. And again, just while we're on the kind of theme of exploring kind of the nuances across the findings, you mentioned the different settings that the research was done in. Were there any outcome differences and outcomes between whether or not the intervention was done in a clinical service and community and education settings?”
Stuart: “Should I go? We didn't look at that. It was out of scope for what we were trying to do. And primarily there wasn't enough meta analytic evidence for us to conduct that kind of analysis.
“So we don't have an answer for that one. Again, it comes back to the data available for us to make some conclusions upon.”
Rosie: “Thank you. This question is interesting. It's around kind of childhood trauma experienced by those in the study and a question from someone about whether or not there'd be any scope or any or could there be any analysis between childhood trauma experiences experienced by those in the study. So differentiating between cause and effect and the intentional design of sporting work delivered.
“I don't know if that was something that was picked out, the kind of childhood trauma experience was picked out within the studies given some of the things you've reflected on already, but I don't know if there's anything that you're able to share about that.”
Andy: “Thanks, Rosie. You might anticipate what we're about to say. Much the same as Stuart referred to earlier. We know from other settings that clearly various forms of trauma which are experienced during childhood impact children's mental health and indeed their physical health and relationships in a range of ways.
“And we probably know more outside of the sector at this point than we do in relation to the intentional use of sport and physical activity and exercise interventions to address those challenges.
“So one of the key things for us, I think, moving forward to begin to improve the evidence base and indeed to better understand the ways in which we can support children and young people, is to start looking at the different types of trauma that children and young people experience at different age points throughout the life cycle and the life stage that we reviewed here.
“And to look at the ways in which that may affect mental health at different points, sometimes in relation to the point of diagnosis. In other cases it's in relation to their ability to engage in, not just sport and physical activity, but in relation to other forms of intervention.
“So those types of analysis are important to undertake in relation to the work that addressed some of the demographic challenges that we referred to earlier. So I think there's real promise for us, for people who are working in that space to begin to look at that.”
“What I would say is that for many of those colleagues who work with children and young people who experience trauma in a range of ways, they will have real valuable knowledge and insight into how that does affect their engagement in sport and physical activity.
“And part of the role of that moving forward is to begin to better capture that knowledge and to ensure sure that that can be incorporated more clearly, consistently and at a higher level than is presently the case.”
Rosie: “Thank you. Interesting question recently come in, in the chat. Did you find any risks associated with using physical activity as a tool for managing mental health issues?”
Stuart: “I don't recall reading any studies which reported on unintended consequences or risks. Certainly it's not something we've collated evidence on in the review.
“I don't know, Andy, if you came across any specific studies which spoke to that.”
Andy: “No. And I think that's why we're appropriately cautious in the claims which we're making in the report. And it's one of the reasons why I referred earlier to not only the responsible messaging around, you know, how much and, and how often and what types of activities are encouraging people to engage in.
“Because we do know from other settings, there are a whole range of unintended risks of engaging in activity, not just for people who've experienced diagnosed mental health challenges, but the population more widely.
“So we always need to balance both the risks of engaging in those types of activities with some of the potential benefits and the associated costs or benefits costs or benefits that can identify there.
“That certainly hasn't been studied widely, certainly in the research that we were asked to do. But certainly should be part of that the ongoing development of work in this area as an area that is relatively immature at this stage in terms of its development by comparison to others mentioned earlier.”
Rosie: “Okay, thank you. And then we've got a few questions that relate to kind of capturing or measuring the, whether it be the physical activity element or the mental health outcomes.
“So broadly speaking, what were the consistent mental health outcomes that were measured across the evidence base? Have you got any examples of some of the surveys that were used to capture those?”
Andy: “I'll kick off certainly around the some of the measures that are often commonly used. And again, this is very similar that you see in other settings.
“So for example, in relation to depression and anxiety, some of the common measures may include things like general anxiety disorders instruments as well as patient health questionnaire data.
“It does very much depend sometimes on the context of the research and where the research is undertaken. So in in the US, but not always in the US, DSM5, the Diagnostic Statistical Manual 5 is often used sometimes to use some of those criteria and some of the diagnoses are made or not in some cases for their children and young people. So it does very much reflect whether studies are undertaken.
“And again, in relation to some of the outcome measures, they do vary quite substantially between both the types of, in some cases, the study design, but also the spaces where the research is undertaken.
“Stuart, did you want to come in on anything related to outcomes beyond what I've mentioned?”
Stuart: “I'll just have to play a straight bat on this one, Andy, I've got really nothing to add. I think just the variability comes through for me. There wasn't like one measure which seemed to be really prominent or one methodology which seemed to be really prominent.
“And given that there were a range of mental health outcomes reported upon that's, I guess, to be expected. I guess just we're in a kind of physical activity and measurement hat.
“I think one of the other complications with this is trying to really assess the impact and dose of interventions on the mental health outcomes.
“So we've mentioned in the some of the slides about intensity and duration and so on. But although some studies did speak to intensity of physical activity, very, very few documented how they assess that.
“So they could verify that the interaction programme was eliciting that physiological response in the children and young people in the first place.
“So I think on both sides in terms of the exposure and the outcome, there's a lot to be done in terms of intervention design and delivery from a methodological perspective, notwithstanding the content of such interventions.”
Rosie: “Thank you. And then I think we've got time for one more question and this relates more to kind of how interventions were designed.
“So across the research, were there any differences or did the research highlight how their interventions were designed around collaboration, co-production with service users and doing the interventions with rather than doing to. So I just wondered if you could speak to any of the kind of detail around the how.”
Andy: “Thanks, Rosie. Yeah, they're all really important principles that to varying degrees were present in some of the research co-production, for example. And the use of those types of principles for intelligent design were evident.
“We can't, I don't think we could say that they dominated much of the intervention design, important though they are.
“And actually some of the evaluation of some of those types of interventions also referred briefly to kind of co-evaluated types of interventions.
“But those principles that you've referred to that many of colleagues on the call I'm sure will be familiar with in practice don't or haven't always translated yet, I don't think, into some of the reporting of the interventions.
“That's not to say that they don't always exist, but they do in some cases where their report is often into some of the qualitative designs and the qualitative studies where colleagues have reported on smaller-scale programmes and they may include programmes which are undertaken in communities or in blue spaces and other settings.
“So I think that there's some evidence that is beginning to feed through to the evidence base. But certainly a more consistent approach to the report, that gives a little of the other demographic evidence that we referred to earlier, is an important next step in evolving this particular evidence base.”
Rosie: “Absolutely. Thank you, Andy. I think it just shows the complexity of this space and the excitement across everybody here to kind of dive into this even more.
“I'm going to hand over to back over to Liz. Thank you both for answering some of these questions. And Liz, over to you.”
Liz: “Thanks, Rosie. Thanks, Andy and Stuart. Just before we close, just to remind you that we will be sending the report out to you. I did put a link in the Q&A onto our website.
“So it's up already for you to have a read. We will also be sending around a recording, so the link to the recording of this webinar, so you can watch it back and also share it with any other colleagues you think might be interested.
“As Rosie said, we will review the questions. There are some we didn't get around to, so we will produce an FAQ and also circulate that to everybody.
“And just as a next step, we're really keen to keep this discussion going. And so we’re planning to hold several follow-up sessions which will be open to anyone that's interested in exploring the role that we can all play to progress this work further.
“For example, discussing whether there's any resources that you might need to help your work, considering the recommendations from the report and what we can do next, and prioritising where we might want to collectively take some action. So we'll follow up with you and let everyone know the dates in case you're interested.
“But thank you again for your time and for your questions. We really appreciate them. We hope you found this useful and have a good rest of the day. Thank you.”
