Tag: Depression

Part I of this interview discussed findings about general health and exercise habits of American Birkebeiner participants compared to the general public. You can catch up on that piece here.

When the Birkie Health Study launched in 2014, the role of social support in forming and keeping healthy habits was a big a question for researchers – and their high-profile supporters.

“Why people choose to get out in the first place, and what keeps them staying active, especially when we’re talking about the social aspect of it which is super huge for girls and women – I’m interested to look at the results and glean some things from it that we can apply to Fast and Female so that we can continue to make our programming more effective, and really work towards achieving our mission of keeping girls and women involved in sports for their whole lives,” World Champion skier Kikkan Randall said at the time.

Researchers Paul Anderson and Ralph Bovard received survey responses from more than 5,000 people who had participated in the American Birkebeiner, a cross-country ski marathon held every year in Wisconsin.

While the survey asked about exercise, general health status, and behavior, it also sought to understand why people exercised. Their results were published in BMJ Open last year (and can be read free of charge here).

Among survey respondents – typically middle-aged, married men with a four-year education and a full-time job – nearly 80% had been introduced to skiing by family or friends, and 96% said that they were “highly motivated to exercise by signing up for races like the Birkie.”

“I think that the masters athlete movement in America and worldwide has been a terrific incentive to many people,” Bovard wrote in an email. “It lets adults know that it is okay to move and revel in their bodily movement. It is okay to aspire to race and challenge one another in physical activity even if you’re 65 or 85 years old. We hosted the national masters swim meet and Minneapolis in early August… [One older] swimmer said: ‘I can still swim because I’m healthy. But I’m only healthy because I swim.’”

What does “social support” mean, though?

The survey asked a series of questions to find out how skiers interacted with other people regarding exercise.

Maybe most obviously, that meant finding out whether skiers trained with other people. They did. For instance, 35% of respondents said that they most often exercised with other people, and 71% of respondents said that they trained with others at least once a week.

But other behaviors are also considered social support, and some of them are so simple and basic that a skier might not realize they are doing it. An example is simply talking about exercise with a friend, family member, or co-worker. The survey asked whether family and friends talked about their own exercise, encouraged the respondent to exercise, or simply “discussed exercise with me.”

That last was the most common social support interaction among all of the choices.

“Among individuals who are training together or are interested in fitness, verbal processing of training challenges and successes builds connection, reinforces the value of physical activity, and provides a strong context for the positive meaning of an active life,” Anderson wrote in an email. “This is not surprising since language is one of the predominant forms of human connection in virtually all the important aspects of life.”

Simply talking about a workout might seem trivial, but survey respondents with high “social support scores” were more likely to spend more time exercising, get more sleep, eat more fruits and vegetables, and suffer less from depression or low moods.

That last relationship is complex, but important. While exercise can often relieve some symptoms of depression, non-exercise specific social support also can lead to better outcomes in depressed patients. So which caused the lower rates of depression in the Birkie skiers?

“Physical activity is a well-known intervention for mood disorders and I think we observed an expected change in this metric,” Anderson wrote. “Our data doesn’t allow us to speculate about causal relationships, however… we would need to design a study to look at this question specifically if we wanted to answer this question definitively.”

Besides simply talking about exercise, other forms of social support were also prevalent. Family and friends often offered to exercise with a survey respondent, scheduled activities around the respondent’s need to exercise, or planned to exercise on recreational outings.

The authors speculated that this was a second mechanism to help survey respondents get over the motivational barriers to exercising. For adults with full-time jobs, time and energy aren’t always in abundance.

This finding also highlighted an interesting complexity in the data: most survey participants trained primarily alone, and yet training with friends was also very important to them. For instance, only 22% said that they wouldn’t do the Birkie if their family or friends didn’t sign up as well. Yet 75% said that exercising with family or friends motivated them to sign up for races like the Birkie.

“While these responses seem difficult to reconcile, it may be that on the one hand the predominance of solitary training coupled with the determination to sign up for races regardless of social support suggests a high level of self-efficacy,” the authors wrote in the paper. “On the other hand, the pattern of weekly exercise with others and the fact that skiers do sign up for races because of motivation derived from others suggests that any pre-existing self-efficacy may be reinforced by regular doses of exercise-specific social support.”

In other words, even those who are highly self-motivated benefit from getting social support.

“I think a big part of the argument of Paul’s research is that the social aspects of physical activity participation can be life changing,” Bovard wrote. “When I lived in Arizona I joined a master swim group. I did not know any of those people before I went there but they quickly became good friends… I think the essence of this is that people develop a shared, camaraderie that is life enhancing. I always say that I do not hang out with the people I work with, rather I hang out with the people I work out with.”

Bovard, however, was already looking for a swim group to join: he had pre-existing motivation, and so it was probably relatively easy to fold into a community in a new place. Many skiers have likely experienced the same thing when they move to a new area and sign up for a race or join a training group.

The question remains of whether such behavior can simply maintain exercise and training habits, or start them off. Can the same social support systems that keep Birkie skiers exercising be used to get a non-exercising member of the public to start being more active?

“Exactly how this would work between a fitness-minded individual and one who isn’t currently active highlights the complexity of initiating a new behavior,” Anderson wrote in an email. “It would be interesting to study whether or not language (talking) was the strongest factor leading someone to initiate physical activity or if the was another form of social support that was more influential.”

The survey results generated lots of new ideas and Anderson is looking forward to studying Birkie skiers in more detail. But even these first results give some hints at strategies to improve public health.

“Those wanting to initiate, maintain or increase physical activity regimens should receive guidance that emphasises the importance of physical activities in groups, especially family of friend groups connected to larger fitness cultures that often surround community races or large national or international competitive events,” the study concluded.

Interested in this study? Anderson wrote, “We are also very interested in learning what Birkie skiers wonder about and doing some studies that answer their questions too. They should feel free to email me at Paul.J.Anderson@HealthPartners.com with their ideas.”