Author Archives: Nichola Kentzer

Examining physical activity and informal carers

By Jo Horne

I recently published an article in collaboration with Open University colleagues, including Dr Nichola Kentzer also from the Sport and Fitness team, and two Anglia Ruskin University academics. The article, in the Journal of Physical Activity and Health, is a systematic review of the prevalence of physical activity, and barriers and facilitators to physical activity, in informal carers in the UK. Examining existing UK based research, we sought to answer:

What are the barriers that limit or prevent carers engaging in physical activity, and what factors might facilitate their engagement?

Why is this an important area to study?

Informal carers provide unpaid care, usually to family members. There were estimated to be 8.8 million informal carers in the UK in 2019, which equates to 17% of the adult population (Carers UK, 2019). The majority of informal carers report that they are not able to engage in as much physical activity as they would like.

Research has shown that caring negatively impacts on the physical health (including sleep disturbance, fatigue, pain, loss of strength, loss of appetite and weight loss) and mental health (including anxiety, depression and stress) of informal carers (Girgis et al., 2013; Stenberg et al., 2010; Loi et al., 2015; Loi et al., 2016). Importantly, physical activity is shown to be beneficial to both of these aspects of health (Reiner et al., 2013; Warburton et al., 2006).

So, it’s important that we understand what barriers informal carers face in engaging with physical activity and what factors facilitate them to do so. This is particularly important at the current time, as the Covid-19 pandemic and restrictions are likely to have not only increased the number of individuals providing informal care, but also reduced the formal and informal support systems available to such carers, which further impacts on access to physical activity.

What did the systematic review find?

We found no UK research reporting the prevalence of physical activity of informal carers in the UK, and only three studies reporting on barriers and facilitators (Forbes et al., 2007; Malthouse & Fox, 2014; Farina et al., 2020). The studies tended to focus primarily on the health / physical activity status of the individuals being cared for, with the carers of those individuals being a secondary focus. Their findings are summarised here:

What are the next steps?

Due to the very limited amount of research in this area in the UK, we are now undertaking two international reviews: one on the prevalence of physical activity in informal carers; and the other on their barriers and facilitators to physical activity. The search process did reveal a much higher level of research internationally, particularly in the US, Canada, and Australia. We can examine this in order to learn and apply to the UK carer population. In addition, we are carrying out a pilot study looking at the effectiveness of online dance classes in increasing levels of activity in informal carers, and improving their physical and mental health.

It is expected that the combined findings from these studies will enable us to develop further resources for enabling informal carers to engage with physical activity in ways that are effective in improving their physical and mental health.

Reference

Horne, Joanna, Kentzer, Nichola, Smith, Lee, Trott, Mike, & Vseteckova, Jitka. (2021). A Systematic Review on the Prevalence of Physical Activity, and Barriers and Facilitators to Physical Activity, in Informal Carers in the United Kingdom. Journal of Physical Activity and Health. Advance online publication. https://doi.org/10.1123/jpah.2020-0526.

Read more:

We have a series of Open Learn articles which explore the impact of the Covid-19 lockdown on the physical activity of informal carers.

Jo Horne is an Associate Lecturer on the OU S&F module E235. She is also a Staff Tutor in Psychology in the OU’s Faculty of Arts and Social Sciences. You can find out more about her here.

The importance of psychological resilience in extreme environments

By Dave Harrison

In extreme environments there are many things that can cause stress for people operating and performing in them. These stressors, such as isolation, danger, and risk (Smith & Barrett, 2019), would be the same for everyone at that given time but it is how an individual perceives and digests these stressors that is important to their overall experience. Indeed, extreme environments are complex, and the array of demands and stressors can give a perceived lack of control to people within them (Leach, 2016).

Resilience can help us to function more effectively under conditions within extreme environments. This short article will examine why understanding resilience is important to those functioning in extreme environments and reflect on what we can learn from emerging research in this area.

Why is it important to study resilience in extreme environments?

Psychological resilience has been described as the ability to use personal qualities to withstand pressure and maintain functioning (Fletcher & Sarkar, 2016), and there are two key components; a stressor (or adversity) and a subsequent positive adaptation (changes of a positive nature). This sounds simple enough, but it is important to remember that people are affected differently in the same environment at varying intensities and for different durations. This means resilience, like extreme environments, is complex, and can be influenced by factors such as your past experiences. For example, the past experiences you have had in the extreme environment as well as the personal qualities you have, such as motivation and confidence can help you to respond positively to the given demands of the situation.

However, if a cluster effect (where many different stressors come together) occurs in a particular order, intensity or timeframe you might struggle regardless of the amount of experience you have or personal qualities at your disposal. For example, you might be able to deal with a rainstorm for a short time but if it persisted, and the sky went dark and you had no shelter you might be less able to function. Resilience is a process that helps individuals deal with this complexity and there are also numerous anecdotal accounts of the importance of resilience within these environments.

Emerging research on resilience in extreme environments

An interest in how people perform in extreme environments led me to pursue my PhD studies in this area, and I have investigated the challenge of an extreme environment and what impact it can have on resilience. For example, the environment plays a significant role on a person’s resilience in relation to the amount of challenge (risk and adversity) and support (from others) present. This makes extreme environments the ideal setting to investigate psychological resilience because there is usually an increased and inherent element of risk and or adversity. For example, during my first piece of research the extreme environment was the mountains of the UK, where team members had to deal with difficult terrain under foot and severe and everchanging weather.

In this research we observed that these demands and stressors can group together in a cluster effect. This is where the grouping of stressors within the environment can potentially have a greater negative effect on performance as opposed to if individuals were exposed to individual stressors (Smith & Barrett, 2019), and there is the potential to for stressors to cascade over time. People operating in an extreme environment have to deal with specific clusters of stressors before moving on to deal with the next set of stressors and this can take time. But time is not always a luxury afforded in these environments. For example, you might be out on the mountain for 15 hours before returning to basecamp tired with wet and dirty kit but you are back out on the mountain in a couple of hours. You would literally have no time to deal with these stressors before facing the next day’s stressors as seen in my research.

Also, people will identify different environments as extreme at different times. This is due to how they perceive their skills, qualities and support needed to perform within them so any environment that pushes an individual outside of their comfort zone can be considered extreme (Galli and Vealey, 2008). A 5km Parkrun might be considered an extreme environment for some but not for an experienced runner.  Therefore, people operating in extreme environments need to get experience of these stressors – to lessen the impact of them individually and within a cluster. These stressors are still present and in certain situations will still have (sometimes a major) effect but experience provides opportunity to learn what skills and qualities are needed first to maintain function and then for positive adaptation to potentially occur.

Adopting a challenge mindset

Increasing the time spent and getting the right experience in an extreme environment allows you to evaluate the risk associated with these stressors and links to something called a challenge mindset. A challenge mindset is the ability to see situations as a challenge and it is important that this is adopted and then maintained within an extreme environment to buffer against the potential negative effect of the cluster effect of stressors and allow individuals to function. This mindset allows individuals to focus on stressors as a challenge and not threatening. This is done by increasing their awareness of specific stressors, their importance and the potential consequences of not attending to them. Increasing your experience allows you to slowly build up exposure to stressors in the extreme environment and works to slowly inoculate you to the potential negative effect of stressors. So, you could consider your current situation is not as ‘bad’ as previously experienced and more of a challenge that needs to be overcome to be successful. For example, this current storm isn’t as bad as previous storms I have experienced, and I made good progress then and I can now.

This previous experience also allows you to develop the necessary skills and qualities to ‘protect’ yourself from the demands and stressors of the extreme environment which forms an important part of showing resilience. Fletcher and Sarkar (2016) highlight that individuals must positively evaluate the demands of the environment as a challenge and themselves (e.g. their own skills, thoughts and emotions). So, it is more your reaction to the environment (showing resilience) rather than the environment itself that is important. The question is therefore, do you have the experiences, skills and qualities to successfully deal with what the environment can throw at you to complete the task in the required time?

What can we take from this?

Extreme environments are not too dissimilar to other sporting environments. Each is different and individualised with clusters of stressors that are perceived differently by different individuals. There is risk and adversity albeit to a lesser extent than within an extreme environment where there is a potentially a greater risk of injury or death. So, how can ways in which individuals develop and use resilience in these extreme environments be applied to us in everyday life and in our own sporting pursuits?

  • Resilience is a complex and individualised process that changes over time and can be essential to maintaining function in our everyday lives, including our participation in sport and exercise.
  • Sporting environments, and life in general, can produce a cluster effect of stressors that can potentially cascade over time that individuals need to deal with.
  • Gaining experience of the environments/situations in which you will train/work/compete can help ‘protect’ against this cluster effect by developing the challenge mindset.

References

Fletcher, D. & Sarkar, M. (2016) Mental fortitude training: An evidence- based approach to developing psychological resilience for sustained success. Journal of Sport Psychology in Action, 7(3), 135-157.

Galli, N. & Vealey, R.S. (2008) “Bouncing Back” from adversity: Athletes’ experiences of resilience. The Sport Psychologist, 22, 316-335.

Leach, J. (2016) Psychological factors in exceptional, extreme and torturous environments. Extreme Physiology & Medicine5(1), 7–7.

Smith, N. & Barrett, E.C. (2019) Psychology, extreme environments, and counter-terrorism operations. Behavioral Sciences of Terrorism and Political Aggression, 11(1), 48-72.

 

Dave Harrison is an AL on the OU S&F modules E235 and E313. He also works at Sheffield Hallam University as a Lecturer in Sport Coaching and is currently undertaking a part time PhD on Psychological Resilience in Extreme Environments at Nottingham Trent University. You can find him on Twitter: @sheffclaret 

Bernal’s ‘amazing engine’: how do endurance athletes’ hearts differ?

By Nichola Kentzer

Many will remember the 2019 Tour de France for its premature finish caused by hailstorms and landslides, rather than the incredible achievements of the endurance athletes. To complete the 21 stages spanning 3,480 kilometres is an extraordinary feat – but what is it about these athletes that allows them to do it? The physiology of a Tour de France rider has been examined in depth by scientists (e.g. Santalla and colleagues in 2012), but in this short article we will be focusing on just one aspect, the heart.

The heart of the matter

Chris Froome described Egan Bernal, the 2019 Tour champion, as having ‘an amazing enginereferring to Bernal’s heart, the muscular pump, that drives blood around the body to perform essential functions. Located in the left-hand side of the chest and typically about the size of a clenched fist, Bernal’s heart’s ability to pump the required oxygen to his working muscles to complete the mountain climbs and long distances, is the key to his success.

We can make such statements because, on examination, as the athlete trains their hearts get bigger and stronger meaning they can pump more blood per beat. Indeed, athletes often have a larger than usual left ventricle, developed through conditioning the body to be as efficient as possible. Referring to these adaptations to training, Bradley Wiggins was described as have a heart ‘like a bucket’ after his 2012 Tour victory.

Because of this increased efficiency, and the trained heart’s ability to pump more blood per beat, a key indicator of an endurance athlete’s heart efficiency is their resting heart rate. Where an average adult’s resting heart rate might be between 60-90 beats per minute (bpm), a Tour de France cyclist can have readings of lower than 40 bpm. Physiological tests carried out on Chris Froome by Team Sky to quash doping allegations after his Tour successes, showed that his resting heart rate dropped as low as 29 bpm.

Cycling is not the only sport that produces these super athletes. Biathlon, combining cross country skiing with precision target shooting, is widely recognised as one of the most challenging winter endurance events. Indeed, the two activities seem unlikely partners with one requiring strength, speed and endurance and the other requiring concentration and a steady hand (while your heart is still thumping from the exertion!).

Top French biathlete, Martin Fourcade, winner of over 20 World Championship medals, over 120 World Cup medals and seven Olympic medals posted his own resting heart rate readings on his Instagram account in 2017. He reported an incredible 25 bpm. Although this reading is his own, and biathletes do specifically train to lower their heart beat to enable more accurate shooting, the value is incredible considering the lowest resting heart rate on record is 27 bpm.

This level of efficiency can also be examined through a second measure: cardiac output the amount of blood ejected from the left ventricle in one minute. It is calculated by multiplying the person’s heart rate by their stroke volume (amount of blood pumped from the left ventricle in a single heart beat). Therefore, with the trained endurance athlete’s larger left ventricle and lower resting heart rate, they can pump out more blood per beat and their heart needs to beat less frequently to achieve the same cardiac output.

And for those of us who are not elite endurance athletes?

Comfortingly for us mere mortals, and important knowledge for those working in the sport and fitness industry, regular exercise (not necessarily long-distance cycling!) improves heart health and increases cardiac output. This enables us to reduce our resting heart rates and for our bodies to become more efficient, even if not to the extreme levels of the athletes discussed above. So instead of sitting at your desk during your lunch break take a brisk walk, opt for the stairs, and park a few hundred metres further from the supermarket entrance, as these small changes can all improve your heart and most importantly your health.