The mind-body-activity connection
“When you’ve done a workout you feel better."
Leon, service user
"Patients are using the TGO outdoor gym to effectively manage emotions, yielding huge benefits for both mental and physical health."
Mary Yates, Nurse Consultant and Smoke-Free Lead, South London and Maudsley NHS Foundation Trust
The key question:
What’s the link between mental resilience, long-term physical health and accessible outdoor activity?
The heart of the challenge:
In 2018, the South London and Maudsley NHS Foundation Trust (SLaM) come to TGO with a set of health priorities for their patients at the world-renowned Bethlem Royal mental health hospital. Integral to SLaM’s physical health strategy is the idea of movement as medicine, benefiting both the body and the mind.
SLaM asks TGO to enhance their lovely garden at the Bethlem Royal Hospital, already the home to a beautiful renovated orchard. Can TGO create an outdoor fitness space to complement the setting, helping patients to manage difficult emotions, encouraging smoking cessation and promoting long-term health beyond discharge?
TGO’s answer:
Inspired by the brief from SLaM, we study the latest evidence around the relationship between mental health and physical health.
We’re already big fans of the 5 ways to wellbeing, which highlight physical activity, presence of mind and connection to others as three of the best ways we can care for our mental health. TGO outdoor fitness spaces are always designed to break down barriers to exercise – encouraging communities to come together for inclusive activities, whilst enjoying the natural environment.
We’re most struck, however, by a 2018 report entitled ‘From One to Many’, produced by Guy’s & St Thomas’ charity. The research explores people’s progression from one to multiple long-term health conditions. With over 15 million people in the UK living with one long-term health condition and three million with three or more, the report highlights the mean age of diagnosis for the most common chronic illnesses. On average, severe mental illness is diagnosed at 37 and depression at 38, almost two decades earlier than the most prevalent physical health conditions – including diabetes (53) and chronic pain (54). Notably, the report finds that depression and severe mental illness are often a precursor to diabetes, morbid obesity and chronic pain – the first diagnosis in a chain of debilitating, yet preventable, health conditions.
This evidence confirms how important it is to prevent and treat mental illness in ways that also promote physical health. It’s not only an investment in our society’s mental wellbeing, it’s one of the keys to prevent the most burdensome physical illnesses including diabetes, which Diabetes UK say costs the NHS £14 billion per year to treat. Furthermore, better long-term physical health supports long-term mental health too – helping people with mental health conditions to maintain their recovery and preventing relapses associated with the stress and hardship of chronic physical disease.
With all this in mind, we’re clear that the SLaM TGO Gym design has to be immediately welcoming to patients of all fitness abilities. From complete beginners to physical activity to people with prior experience, we create a space to encourage Bethlem Hospital patients to take positive steps whilst in hospital, to build towards a lifetime of activity.
All TGO’s equipment is designed for maximum inclusivity, exceeding Inclusive Fitness Initiative standards – but we select the most intuitive and popular TGO pieces for Bethlem Royal Hospital, which over a decade of research has shown to inspire even the most inactive groups.
The TGO Hand Bike, Cross Trainer and Recumbent Bike offer Bethlem Hospital patients a choice of cardiovascular activities, which are key to prevention of heart disease, many cancers, type 2 diabetes and obesity. We include our most accessible cardio piece, the TGO Hand Bike, which can be used by wheelchair users, people with lower limb issues and able-bodied people.
We also include TGO equipment to increase strength over time – including our Leg Press/ Bench double unit. For longer-term inpatients, there are ways to increase muscle strength and tone, building up sets of more challenging activities.
Finally, we set out the Bethlem Hospital TGO Gym adjacent to the trees, so patients and staff can enjoy the green space around them as they get active in the fresh air.
SLaM’s feedback:
Leon, service user, says: “When you’ve done a workout you feel better – your yearnings are suppressed."
The Maudsley Charity write that following the installation, service user Leon has been using the Bethlem TGO gym two to three times a week. In the space of a few months, he has lost 7kg and is further along the path to quitting smoking. Leon also inspired a couple of his friends to join him at the gym. Leon's favourite pieces are the leg press and recumbent bike, but during each of his hour-long sessions he likes getting an all over body workout.
Read more on the Maudsley Charity website.
Mary Yates, Nurse Consultant and Smoke-Free Lead at South London and Maudsley NHS Foundation Trust, says:
“The outdoor gym facilities in Bethlem Royal Hospital have dramatically changed the way our outdoor space is used. In the secure services where patients are restricted for long periods access to this robust, yet attractive facility has proved revolutionary – instead of smoking in the ward garden, the new norm is to get moving on the TGO Recumbent Bike or Leg Press. Old school mental health service providers would have taken patients outside for a smoke if they were upset, anxious or angry. Instead they are using the TGO outdoor gym to effectively manage these emotions, yielding huge benefits for both mental and physical health.
“Getting everyone to move more is a key priority in our physical health strategy. We have noted that people who develop confidence in using the TGO outdoor gym whilst in hospital are more likely to use local community facilities after discharge. Modern mental health services should be places where health and wellbeing can flourish. Providing TGO facilities is one option to ensure people have the best opportunity to engage with positive behaviour change during their admission.”
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