Physical activity and sport: Helping people experience well-

being

Confidence and well-being in motion ConferenceGlasgow

2nd September 2009

Professor Ken FoxExercise, Nutrition and Health

SciencesUniversity of Bristol

The British IsleToo much reliance on the car?

Gorseland School, Ipswich

UK Chief Medical Officer’sReport on Physical Activity And Healthwww.dh.gov.uk/publications

US Health and Human Services(2008)

Physical activity and mental health

Physical activity and health outcomes:Overall picture

www.dh.gov.uk/publications

PREVENTION THERAPY

Evidence Effect Evidence EffectCHD High Strong Medium ModerateStroke High Moderate Low WeakObesity Medium Moderate Medium ModerateCancer Medium Moderate - -Diabetes High Strong Medium WeakMusculo-skeletal Medium Moderate Medium ModerateMental health Medium Moderate Medium Moderate

Wellness and mental illness

MENTAL WELL-BEING

MENTALILLNESS

DISEASE RISK

Prevention

Treatment Promotion

Physical activity and risk of dementia

risk ratio.1 .5 1 1.5

Combined

Yoshitake (1995)

Wang (2002)

Simons (2006) Female

Simons (2006) Male

Rovio (2005)

Ravaglia (2008)

Podewilis (2005)

Laurin (2001) Female

Laurin (2001) Male

Larson (2006)

Hebert (2000) Female

Hebert (2000) Male

Fabrigoule (1995)

Carlson (2008) Male

Andel (2008)

Abbott (2004) Male

Fox, Khandpur, & Taylor, unpublished

Common mental problems presenting in primary health care

• Depression• Anxiety• Alcohol and drug use disorders• Sleep problems• Chronic tiredness• Unexplained somatic complaints

– aches, pains, nausea, digestion, rashes etc.

• Schizophrenia, bipolar and obsessive disorders

Components of mental well-being

• Self-esteem and self-perceptions• Subjective well-being• Life satisfaction• Emotional adjustment• Mood and affect• Stress• Cognitive function• Sleep

So what is self-esteem?

Self-definitions• Self-concept

The individual as known to the individual• Self-esteem (self-worth)

Awareness of good possessed by self• Identity(ies)

An integration of self-description, values, and behaviours

• Self-acceptance

Recognising and integrating strengths and weaknesses

The mediating role of the self

Self ExerciseWell-being

What is the self?How does it affect feelings?How does it influence motivation?How does it change?

What happens when it goes wrong?

The self-system:Self-direction

• Objective self “The I”

Chief executive/manager

• Subjective self - “The me”

Self affairs, abilities and roles

The self-system:Self-direction tasks

Self-enhancement• Personal growth strategies

– investing in high growth areas

– discounting low yield areas

– self-serving bias and attributions

– self-affirmation and verification

– self-publicity

– maximising social approval and support

• Self-consistency

The self-system:Self-direction tasks

Self-consistency versus change• Personal stability

– maintaining the status quo– retaining familiar patterns– cementing identity – developing uniqueness– stable self

Characteristics of low self-esteem

• Neutral rather than negative (not positive)

• Less defined self-knowledge

• Responsive to external cues

• Simpler self-concepts (fewer eggs)

• Protective, defensive, conservative

• More discrepancies

Multiple dimensions of self

Physical self

SELF-ESTEEM

Self-esteem and the physical selfThe Physical Self-Perception Profile

(Fox & Corbin, 1989)

SELF-ESTEEM

PHYSICAL SELF-WORTH

Sport Competence Strength Conditioning

Body image

Levels of specificity of self-perceptions

SELF-ESTEEM

Physical Self-Worth

Sport competence Attractive Body

Soccer competence Feeling fat

Shooting competence Feeling hips too fat

Feeling able to score Feeling hips too big for dress

Physical self-perception profiles of college students versus obese

patients

6

8

10

12

14

16

18

20

SPORT COND STR BODY PSW

MalesFemalesObese MObese F

PSPP change scores after 13 weeks in obese females (n=168)

0

2

4

6

8

10

12

14

16

SPO CON STR BODY PSW

Pre13 weeks

Self-esteem and the physical selfThe Physical Self-Perception Profile

(Fox & Corbin, 1989)

SELF-ESTEEM

PHYSICAL SELF-WORTH

Sport Competence Strength Conditioning

Body image

Mental well-being

Self-esteem and self-perceptions (Fox, 2000, 2001)

• Exercise can improve self-esteem, but the relationship is fairly weak and inconsistent

• Exercise does improve physical self-perceptions including body image, strength, fitness and sports competence. About 70% of studies show these changes

• Evidence from two studies that improvements in physical self-worth has an effect on well-being independent of self-esteem

• Improvement in all populations but most likely in those who are initially low in self-perceptions

Self-esteem needs

The need to feel: • Competence • Autonomy and control (self-determination) • Several meaningful resources• Significance and importance• Love and regard• Affiliation and belonging(Baumeister, 1993; Cloninger, 1999; Deci & Ryan, 1995, Epstein, 1973,

Rogers, 1951)

LIFELONG PHYSICALACTIVITY

LIFELONG PHYSICALACTIVITY

ACTIVE IDENTITY“Can I do it?” “Is it worth it?” Perceptions of Attitudes, beliefs,competence/control rewards, values

ACTIVE IDENTITY“Can I do it?” “Is it worth it?” Perceptions of Attitudes, beliefs,competence/control rewards, values

Long termobjective

Psychologicalobjectives

Primaryobjectives

Physical Physical Health Skills Fitness Skills

Physical Physical Health Skills Fitness Skills

Fox & Biddle, BJPE, 1987

Diversity among young people

Am I bovvered?Look at my face!

• Feeling incompetent• Feeling stupid• Feeling left out• Desperation? • Defensive strategy?

Feeling can stay with us for a long time and affect our behavioural choices

Competence style

• Be mastery and task orientated

Focus on your own improvement and don’t worry about how good others are

• Develop self-determination

Take responsibility for your achievements. It’s the only way to feel good about yourself.

(Lloyd & Fox, 1992; Goudas, Biddle, Underwood & Fox, 1995)

Helping youngsters stay motivatedCreating an ego environmentPost scores publiclyPointing out who is the best in classUsing overt competition to motivateEncourage kids to compare and look aroundCreating a mastery environment Concentrate on effort and trying bestFocus on completion of tasksDiscourage comparison with others and look for personal

improvement(Lloyd & Fox, 1992; Goudas, Biddle, Underwood & Fox, 1995)

I exercise/play sport because….• my mates play Social • I want to be a great player Achieve

• other kids tell me I am a good player Social • my body feels better Affect

• it’s a great crowd to be with Social • it’s a lot of fun Affect• the coach/teacher is great Social

• It puts me in a better mood Affect• It makes me feel good about myself Achieve

A Pragmatic Randomised Controlled Trial to Evaluate Physical Activity as a Treatment

for Depression

Primary Care, Social Medicine, Exercise, Nutrition and Health Sciences, University of Bristol and Exeter

Feeling low/down/distressed/ill

Lowered motivation

Reduced activity

Worsen how I feel

Fatigue/Tiredness

Reduced activity of things that lead to fun/pleasure/sense of achievement

1

2

3

4

The spiral of inactivity and depression

Physical activity facilitation for depression

• Face to face and phone contact• Adoption of motivational interviewing

principles• Self-determination and confidence building• Personal preferences rather than

prescription• Develop independence and discourage

dependence

•Depression and anxiety (Van de Vliet et al.)

•Alcohol abuse (Mutrie & Donaghy)

•Arthritis (McSween et al. )

•Schizophrenia (Carless & Fox )

•Older adults (Davis, Fox et al.,)

•Wheelchair athletes (Ferreira & Fox)

•Obesity and weight management (Fox)

•Congenital heart disease in adolescents (Dua et al)

Physical self research in rehabilitation/therapeutic settings

Self-esteem needs

The need to feel: • Competence • Autonomy and control (self-determination) • Several meaningful resources• Significance and importance• Love and regard• Affiliation and belonging(Baumeister, 1993; Cloninger, 1999; Deci & Ryan, 1995, Epstein, 1973,

Rogers, 1951)

Physical inactivity and its effect on social well-being

• Breakdown of community? • Reduced social interaction and support?

– Shopping malls v local shops– car v walking or cycling – TV v shared entertainment– video v theatre/cinema– less outdoor play for children– absorbtion v creation in leisure– more ‘virtual’ than real interaction

“Cocooning of life”

Source: Appleyard D, Lintell M. Am Inst Plan J 1972;38:84-101

Traffic is associated with social interaction in neighbourhoods

Home zone scheme – less traffic, more play and social life?

Win back the streets

National Prevention Research Initiative

National Prevention Research Initiative

Older People and Active Living: Older People and Active Living: Project OPALProject OPAL

AndThe Avon Network for Physical Activity

Promotion for Older People

Maintaining functional capacity help with independence and quality of life

GP practice recruitment

Recruited GP surgery

Montpelier 25

Easton 4

Merrywood 8

Brentry 22

Bedminister 19

Brislington 31

St George 19

Sea Mills 22

Henleaze 27

Clifton 21

Stockwood 21

Fishponds 22

IMD

High

Med

Low

Amenity access Low High

n=241

males = 125 (52%),

females = 116 (48%)

Physical activity recommendations for mental health?

• Aerobic, rhythmic exercise of moderate intensity• Resistance exercise• Team and individual sports• Expressive activity such as dance• Daily movement – walking or cycling to work• Green gyms • Adventurous activity – outward bound? • Rambling, health walks, nature walking?

Currently no generic guidelines for exercise for mental health

Summary

• The self is central to human motivation• The self is central to mental health• Physical activity can improve self-perceptions and

self-esteem• Successful approaches rely on a mastery and self-

determination approach to building competence and confidence

• Physical activity has great potential to improve self-esteem and well-being through social engagement

Relevant and recent books

• Biddle, S. J. H., & Mutrie, N. (2008). Psychology of physical activity: Determinants, well-being and interventions. London: Routledge.

• Faulkner, G., & Taylor, A. H. (Eds.). (2005). Exercise, health and mental health: emerging relationships. London: Routledge

• Fox, K.R. (Ed.) The physical self: from motivation to well-being. Champaign, IL: Human Kinetics

• www.bris.ac.uk/enhs/staff/fox