“A vacation for the mind”: why cycling for people with poor mental health (Part 2)?

This post is the second in a series of 3. The first showed how cycling has helped people with a range of mental health conditions, in their own words.  In this post, I focus on things to consider before encouraging someone to start cycling. You can find out more of how to start cycling in your local area more generally in this earlier blog. In a third post, I plan to explore some NHS cycle projects.

Things to consider before encouraging someone to cycle

Risk assessment

Risk assessment is needed for any new activity. As an occupational therapist, we are encouraged to enable people to overcome the barriers that prevent them from doing the activities that matter to them, to take opportunities and not to see risk as another barrier (RCOT, 2017).

Depending on someone’s mental health, cycling not be appropriate e.g.if there is a high risk of absconding.

If someone is experiencing hallucinations then cycling may still be possible, depending on their frequency, whether there are any triggers and/ or if it is managed in some way e.g. with medication. Cycling in a park or on a motor traffic free route may be appropriate.  

People with eating or obsessive-compulsive disorders may over-exercise. However there are some forms of cycling which my mitigate against this e.g. riding a tandem (whether a traditional tandem or a side-by-side tandem) or learning to unicycle. In this way the activity is more sociable and/or fun rather than purely exercise, so reducing the risk of it becoming a competitive exercise.

And a person may have more than one health condition. If it affects balance, they may be able to use a non-standard cycle in a park or other motor traffic free area. You can find your nearest inclusive cycle hub here.

Medication may need checking with a GP e.g. tranquillisers may cause slow reactions or dizziness; lithium needs to be maintained at the right concentration in someone’s blood.

If there is high blood pressure orchest pains, a heart condition, diabetes, the person is pregnant or has recently given birth or had an injury, then they should also check with their GP.

Talking about physical activity with patients

Having conversations with patients/ service users about physical activity levels can be difficult, especially if we are not practised. As physical activity is such an important part of maintaining wellbeing though, and as healthcare professionals’ suggestions are trusted, we should try. MovingMedicine has information on how to start 1 or 5 minute or longer conversations about depression which may help. https://movingmedicine.ac.uk/consultation-guides/condition/adult/depression/

For the individual

When cycling, a person’s heart rate will usually increase. For some this may feel like a panic or anxiety attack starting so people should be told about this to reduce their concern. They should start off slowly and build up speed, and can always cycle more slowly or stop if it feels overwhelming.

If the patient/ service user is starting at a cycle group, they may like to meet someone from the group in advance and/ or observe what usually happens before they attend to cycle.  If appropriate, they may like to have the opportunity to explain what challenges they have and what if any help they need to deal with them.

The new cyclist may like to be accompanied by a friend/ supporter to the first few meetings to help deal with any anxiety about new journeys or meeting new people.

For cycle groups

There is still stigma and discrimination about mental illness which can result in individuals not feeling welcome. People in cycle groups may not be familiar with mental ill health and lack an understanding of what it can mean. To help deal with this, the charity Mind has developed Mental Health Awareness Training for Sports & Physical Activity providers in partnership with 1st4sport and UK Coaching, funded by Sport England and the National Lottery. It’s free until 31 August 2020.  https://www.mind.org.uk/about-us/our-policy-work/sport-physical-activity-and-mental-health/elearning-mental-health-awareness-for-sport-and-physical-activity/

After the first cycle session

At the first appointment after the patient/ service user’s first cycle session you should discuss how the session went & to manage any issues that may have arisen e.g. they may have started to feel obsessive or compulsive feelings.

Want to find out more?

You can:

• read Part 1 of this series on cycling for people with mental health conditions
• read Getting Started which provides links to for example, where to find a local cycling group/ local urban cycle coaching providers/ national cycle organisations/.

And you are always welcome to contact me.

References

Royal College of Occupational Therapists. (2017). Embracing risk; enabling choice Guidance for occupational therapists. London: Royal College of Occupational Therapists