Effects of an Exercise and Sport Intervention Among Refugees Living in a Greek Refugee Camp on Mental Health, Physical Fitness and Cardiovascular Risk Markers: a Randomized Controlled Trial

What effect does a randomized controlled trial of a sport and exercise intervention among refugees living in a Greek refugee camp have on PTSD symptoms?

Project Summary

In recent years, more people have been forced to flee their home countries because of violence, hunger, and misery than in the aftermath of the Second World War. Due to ongoing political and social conflicts, this upward trend is likely to continue in the future. Refugees are exposed to severe mental and physical strain, as well as traumatic experiences during their journey. As a consequence, the risk of psychiatric disorders is markedly increased among international refugees with particularities based on gender.

International organizations have criticized the lack of early interventions as a key problem, because untreated mental disorders are often difficult to cure at a later stage. Today, exercise and sport have been successfully employed to treat a wide range of psychiatric disorders. With PTSD patients, however, very limited empirical evidence exists, and studies carried out with international refugees are nearly non-existent. 

In 2017, we have implemented a first pilot study in a Greek refugee camp using a one-group pre-test/post-test design. This study showed that an exercise and sport intervention is feasible and corroborated the potential benefits of exercise and sport on refugees’ mental health and cardiorespiratory fitness. Nevertheless, there is a great need for studies with stronger research designs. Therefore, in this project we will use a randomized controlled trial (RCT) design to examine the following questions:

  • Does a 3-month sport and exercise intervention among refugees living in a Greek refugee camp reduce symptoms of post-traumatic stress disorder?
  • Does a 3-month sport and exercise intervention have a positive impact on a series of further outcomes including perceived stress, depressive symptoms, anxiety, sleep complaints, health-related quality of life, pain, cardiorespiratory fitness, upper-body muscular strength, physical activity, cognitive function and cardiovascular risk markers?
  • How can we develop a standardised exercise and sport program that takes into account the cultural particularities of the target population?

By moving towards the primary prevention of chronic physical conditions and psychiatric disorders, a relevant contribution can be done to enhance the quality and quantity of life of Greek refugee camp residents. The findings of our study may also strengthen the evidence for exercise as medicine as a holistic care option in refugee camps, by helping camp residents to adopt and maintain a physically active lifestyle.

Academic Output

Executive Summary

Forced displacement has reached an all-time high, with 94.7 million people affected in 2021, and there has been a notable increase in forced migration to Europe through Greece. The individuals who are forced to flee their homes face numerous challenges, including legal obstacles, financial struggles, discrimination, limited access to healthcare, and food insecurity. These difficulties make it harder for them to recover from the traumas they experienced before leaving their home countries, and they are at a higher risk of developing posttraumatic stress disorder (PTSD).

To address these issues, this project was conducted to assess the mental and physical health of individuals living in the Koutsochero refugee camp. The project implemented a sport and exercise program and evaluated its feasibility and effectiveness in reducing PTSD symptoms. The study followed an approach whereparticipants were assessed at different time points, including before, immediately after, and 20 weeks after the 10-week intervention.

The exercise and sport program, which took place five times a week for three months, led to improvements in participants’ cardiorespiratory fitness. Qualitative feedback also indicated positive effects on their social connections and overall well-being, making them more resilient.

However, implementing the program faced challenges, such as limited access to sports equipment, inadequate infrastructure, and the complex social structure within the camp. In addition to camp institutional architecture, geared towards dissuasion, had an impact.

The project suggests that future studies should focus on children, explore different camp settings, and involve smaller groups of motivated participants. Additionally, involving local stakeholders in program implementation could ensure its long-term impact and sustainability.

Article

Effects of an exercise and sport intervention among refugees living in a Greek refugee camp on mental health, physical fitness and cardiovascular risk markers: study protocol for the SALEEM pragmatic randomized controlled trial

Background: Due to ongoing political and social conflicts, the number of international refugees has been increasing. Refugees are exposed to severe mental and physical strain, as well as traumatic experiences during their flight. Therefore, the risk of psychiatric disorders is markedly increased among international refugees. International organizations have criticized the lack of early interventions as a key problem, because untreated mental disorders are often difficult to cure at a later stage. Today, exercise and sport have been successfully employed to treat a wide range of psychiatric disorders. With patients with post-traumatic stress disorders (PTSD), very limited empirical evidence exists, and studies carried out with international refugees are nearly non-existent.

Methods: We intend to implement a pragmatic randomized controlled trial (RCT) with an exercise and sport intervention group (n = 68, 50% women) and a wait-list control group (n = 68, 50% women) in the Koutsochero refugee camp, located close to the city of Larissa (Greece). During the RCT, exercise and sport will be offered five times per week (60 min/session) for 10 weeks. Participants will be asked to participate in at least two sessions per week. The programme is developed according to the participants’ needs and preferences and they will be able to choose between a range of activities. PTSD symptoms will serve as primary outcome, and several secondary outcomes will be assessed. Qualitative data collection methods will be used to gain a more in-depth appraisal of the participants’ perception of the intervention programme. In the second year of study, the programme will be opened to all camp residents. A strategy will be developed how the programme can be continued after the end of the funding period, and how the programme can be scaled up beyond the borders of the Koutsochero camp.

Discussion: By moving towards the primary prevention of chronic physical conditions and psychiatric disorders, a relevant contribution can be done to enhance the quality and quantity of life of refugee camp residents in Greece. Our findings may also strengthen the evidence for exercise as medicine as a holistic care option in refugee camps, by helping camp residents to adopt and maintain a physically active lifestyle.

Other Output

Handbook For Coaches

This handbook consists of best practices from coaches who already have been working in a refugee camp.

Other Output

Self-reported physical activity and fitness, mental health, and well-being among asylum seekers in a refugee camp in Greece.

Global forced displacement has been rising steeply since 2015 as a result of wars, and human rights abuses. Forcibly displaced people are often exposed to physical and mental strain, which causes traumatic experiences and poor mental health. Physical activity has been linked with better mental health, though such evidence is scarce for refugees. The purpose of the study was to examine the relationships of self-reported physical activity and fitness with mental health indices among asylum seekers. Participants were 151 individuals (76 women, 75 men; mean age 28.90 years) displaced from their homes for an average of 32.03 months. Among them, 67% were from Afghanistan and the Middle East and 33% from sub-Saharan countries. Participants completed self-report measures assessing physical activity, post-traumatic stress disorder (PTSD), depression, anxiety, and well-being. High prevalence of mental health disorders and poor well-being were identified, with women, Asians, and people with families in the camp showing poorer mental health. PTSD, depression, and anxiety were related to perceived fitness but not self-reported physical activity. Regression analysis showed that perceived fitness and low intensity could significantly predict well-being. The findings provide useful evidence regarding the link between well-being and physical activity; nevertheless, further research examining objectively measured physical activity is warranted to complement this data and further explore the associations between physical activity and mental health.

Report

Human-made conflicts and natural disasters have led to a doubling of forced displacement in the past ten years, reaching an all-time high of 94.7 million affected people in 2021. These figures will likely continue to grow due to armed conflicts, political oppression and environmental changes. Even though most people are internally displaced or find refuge in neighboring countries, forced migration to Europe has more than tripled in the past decade. Greece has been one of the main entry points for over 1.2 million forcibly displaced people since 2015, as one of the southernmost countries in Europe and due to its close sea border with Asia.

Research Team

Markus Gerber
Coordinator
University of Basel

Roland von Känel
Co-Coordinator
University of Zurich

Marianne Meier
Principal Member
University of Applied Science North-West (FHNW)

Antonis Hatzigeorgiadis
Principal Member
University of Thessaly

Ioannis D. Morres
Principal Member
University of Thessaly

Florian Knappe
Principal Member
University of Basel

Uwe Pühse
Associated Member
University of Basel

Dominique de Quervain
Associated Member
University of Basel

Sebastian Ludyga
Associated Member
University of Basel

Flora Colledge
Associated Member
University of Basel

Harald Seelig
Associated Member
University of Basel

Yannis Thodorakis
Associated Member
University of Thessaly

Status

completed

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Regions

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