As health professionals we know we need to help motivate our patients/ service users/ clients to move more, to be more physically active. In this post, the first in a series of three, I highlight what cycling can offer over and above other physical activity and – using existing online voices – demonstrate how cycling has been beneficial to people with different mental health conditions. I wonder whether these stories might also be useful to share with our patients/ service users/ clients.
In the second post, I focus on things to consider before encouraging someone with a poor mental health to start cycling. You can find out “how to start cycling” more generally in an earlier post. In a third post, I plan to explore some NHS cycle projects.
People who experience severe and enduring mental health conditions may also experience anxiety and/or depression but their stories are only given once.
What cycling offers in addition to other physical activities
- It can be done solo or with as many people as one wishes.
- It can be done in parks, on traffic free routes as well as on roads
- in these COVID times, it is compatible with social distancing and is done outdoors
- it offers door to door transport so reducing the need to use public transport
- it is be a relatively cheap form of transport
- it can be used for exercise and leisure
- if someone has poor balance they can use a non-standard cycle.
Anxiety & Depression
Cycling: “a gift for recovery”
In the mid-2010s, Mandy, 53 from Chelmsford, was diagnosed with clinical depression following a difficult work situation. She resigned from work and believes cycling was key in her recovery, despite having osteoarthritis.
“The gift of cycling has proved a life-changing experience. I travelled everywhere by bike as a child but the only cycling I had done in the last 30 years was at the gym. It hadn’t occurred to me to get back on a bike, even though I had one at home that my brother had given to me.”
She had got her old bike out to start cycling again but her first attempts were not successful. Then she discovered the CyclingUK group.
“Prior to joining the group I had been a fair-weather cyclist and would never go out in the rain. I was also unsure about what to wear and not feel stupid.
Weekly cycle lessons and Tuesday group rides of about 10 miles helped build Mandy’s confidence, building up the speed and distance she could travel.
“Cycling combined with weight loss has been of great benefit to me. Getting around on a bike has had a positive effect – it has made me feel mentally well and I feel fitter, too.
“I can’t walk any distance as I suffer from osteoarthritis, so cycling gets me into town and therefore puts less pressure on my knees and hips. It is perfect for getting from A to B. If I didn’t have my bike I probably wouldn’t do most of the things I do now.”
Coping with bereavement: when cycling I’m ‘feeling not a care in the world’
Londoner Karmen experienced 2 close family bereavements within 3 ½ months causing her depression and, in 2015, attempted suicide. She gave up running, which she’d loved for over 30 years. It took her trainer 6 months to get her running again but even competing and winning was not enough. Three and a half years after the family bereavements she attempted suicide.
Cognitive behavioural therapy (CBT) did not work but 1-1 counselling helped her get back on her feet. She says part of her recovery was also due to the “running and cycling [which] makes me feel like that 7-year-old kid again; the wind on my face and not a care in the world.” She has since gone on to compete and win again and is now the Wellbeing Lead for over 4 500 staff at her workplace.
“There’s something therapeutic about just riding along”
After Mark (not his real name) went to university, his life took a downward turn – splitting up with his girlfriend, employed in a job he didn’t enjoy, losing his independence when moving back in with his parents to save money. His depression then took over, with days spent alone in his room. Eventually he opened up and a friend suggested exercise, so he started cycling.
“There’s something therapeutic about just riding along. You’re concentrating on the bike, so you don’t have mental space for all the bad stuff going on in your life or in your head. It’s just you and the bike.
“I cycle all the time now. It took a while, but after cycling every day for a few weeks, I started to enjoy it. Now I cycle everywhere, even though the hills in my hometown are a nightmare and there aren’t always safe places to leave a bike.
“I still have bad days, but they’re less frequent now. When I’m at my worst, I imagine myself just riding along without a care in the world and it helps a little. And on my good days, I can ride long distances for hours on end without hesitating, and I’ve even started cycling to work.
“If someone asked me what my definition of happiness is, I’d tell them it is being on your bike in some wide open country and riding your way towards the horizon.”
“It’s not the cure-all for depression but it’s as close as I can get.”
Londoner Sarah rediscovered cycling in her 30s. After work and study pressures got too much for her, her GP diagnosed depression and prescribed medication.
Through her flatmate, a regular mountain biker, she started to volunteer at local ride events and eventually decided to ride too. “Although I spent the entire race repeatedly being overtaken by small children, finishing exhausted, more importantly I felt exhilarated, for the first time in a long while.”
She began to cycle for leisure, later joining a racing club. “It gave me regular exercise. It gave me a new social group and many new friends who encouraged me to try longer, harder rides. Saturdays weren’t Saturdays if I didn’t go on the club ride.”
“The thing is, even when I’m feeling crappy, if I can force myself out of the door and out for a ride I *know* I’ll return feeling so much better. When depressed, it’s trickier. This is where the social importance of cycling and depression really kicks in and keeping in touch with cycling matters via my friends cannot be underestimated.
As soon as I do get back out there on the bike I remember and the passion returns.
When I’m finding things tough I use yoga, Pilates and mindfulness to counter stress, anxiety and depression. I think I could cope without these others but I can’t imagine a life without cycling. It’s not the cure-all for depression but, for me, it’s as close as I can get.”
Mountain biking for Mental Health
Sheffield-based Katie experienced poor mental health much of her life but about 4 years ago her life took a turn for the better, partly because she bought a mountain bike. She has now set up a mountain biking group for people with mental health issues and is one of Sheffield’s MoveMore Ambassadors.
“Just giving yourself the time to be in nature and be in the moment is a great mindfulness technique. Being in the moment can free you up to notice all the beautiful things around you as you cycle along, the blossoming flowers, the call of a bird you haven’t heard before and sometimes just the silence is enough for you to let out a long sigh and relax those tense shoulders.
“In this respect getting out into nature is a good way of managing the stress that can come with mental health issues such as depression and anxiety.
“The sheer fun that nature can bring can also have a huge positive impact in someone’s life. Especially when depression is telling you that you aren’t good enough and anxiety is telling you all the ways that you can land on your face!
“I genuinely believe that most people can benefit from being in nature in some way or another, just to get out and appreciate what’s out there or to experience it whilst mountain biking and trying new things.
“Nature has a place for everyone, it won’t judge you, it won’t make out like you shouldn’t be there but it may get you muddy and send you home with a huge grin.”
To join a ride with Katie’s Sheffield group, you can visit their Facebook page.
Using traffic routes to manage my anxiety & depression
Wayne Lewis, 34, lives in the north east and loves cycling. Since 2016 he has volunteered with Sustrans, the charity which makes it easier for people to walk & cycle. He conveniently lives just one mile from Sustrans’ Coast to Coast cycle route.
“I first started with anxiety and panic attacks back in 2007, so I’ve suffered with anxiety and depression for 12 years. I’ve had counselling with psychotherapists, used to take medication to control my anxiety and received CBT.
“I use the Network to cycle, to help manage my mental health, depression and anxiety and reduce stress. I use it every day.
“Being able to cycle or walk with no worries of traffic and feeling the freedom you have, and also seeing other smiling faces on the Network is very mood-lifting. Also reducing stress and decreasing my anxiety, my depression eases too and I feel better in myself after a good ride out.
“Traffic-free sections allow us the freedom of being able to cycle or walk without any worries, it’s safer and is a great use for people who are not confident cyclists or children learning to ride. “
“Cycling put me on the road to happiness”
Londoner Charles Graham-Dixon experienced his first panic attack aged 25. For a long time, the spectre of further panic attacks meant avoiding enclosed spaces – if he felt anxious travelling by tube, he got off and walked. It was another 8 years before cycling became such a large part of his life.
“What began as a way of avoiding the tube and panic attacks has become my primary form of transport, a means to compete and my daily dose of therapy. Counselling and medication have helped but not come close to what cycling offers me. I still have episodes of anxiety/OCD, and worry sometimes takes control, snowballing small doubts and concerns into all-consuming neuroses. Whenever this happens, I go cycling. Whether a short one-hour ride or a four-hour endurance session, cycling declutters my mind and makes everything more simple and manageable.
“Key to the therapeutic qualities of cycling is its inherent mindfulness. Focusing on the physical and engaging mind and body purely on riding takes us away from negative, swirling thoughts, which take on such greater and troubling significance when we obsess over them.
“It may sound contradictory to suggest a mindful, focused activity such as cycling can de-complicate our lives off the bike. Surely if our attention is on riding, any outside issues should remain challenging? Cycling clears the mind in the present, so any problems in our non-cycling lives are far more solvable when we arrive home. “
On the Guardian website you can find Graham’s story in full plus 450+ comments, predominantly supportive of the role cycling can play in depression.
“The more I rode, the better I felt”
West Yorkshire based Lisa discovered mountain biking aged 30 whilst studying for a Master’s degree. She had low self-esteem due to the ending of a relationship and was feeling under stress; her future was looking bleak. She usually used nature as a coping strategy and this time decided to go cycling with a friend – and for the first time since a child, off road. As she writes “I feel nervous at first; frightened even. But I throw myself into it, and when I get home I feel exhilarated. Cold, wet, muddy, hungry, and aching. But exhilarated.
“And I’ve never looked back.
“The more I rode, the better I felt. Mountain biking allowed me to experience the natural environment and landscape in a completely new way. More technical rides provided me with an abundance of mental and physical challenges that demanded concentration and focus. I felt scared a lot of the time when faced with obstacles or steep descents, but I picked my line carefully, walked when necessary, and faced these challenges nonetheless. More gentle, relaxed rides allowed me to sit back in the saddle and coast around the bridleways of West Yorkshire listening to the birdsong and watching the clouds skirt along the sky. My worries, anxieties and stresses simply faded away when I rode. My confidence began to grow both on and off the bike, and my outlook became more positive and purposeful.”
Lisa is now an occupational therapist who has been researching mountain biking’s impact on psychological health. Here’s her full story on the AnxietyUK website.
Obsessive Compulsive Disorder
Cycling to break the anxiety cycle
Australian Justin Sacr, 33, (who lives in Australia) couldn’t drive as his anxiety made him think he’d knocked someone down every time he drove his car over a bump. He’d lived with anxiety and OCD for 19 years and because of his phobia, his bike was “his lifeline”.
“I cycle to work every day. It has been a blessing in disguise because exercise helps me a lot. You have to accept it [the anxiety] and learn to live with it. You can’t fight it head on because it will consume you. To be in your room for 24 hours a day thinking the thoughts consumes you.”
“It’s the one time I’m in control”
Diagnosed at 15 with OCD, a condition she’d had since birth, left Chloe and her parents receiving confirmation that yes, she was different. Accessing therapy was difficult and made everyday life difficult, with studying at university and jobs impossible to sustain. As Chloe writes “CBT didn’t have an impact, ‘talking therapy’ helped short term but gave no long-term coping mechanism and doctors just prescribed pills.”
One day though it clicked. “Any time I was playing sport, running around outside or riding bikes, OCD was miles away – a dull ache of habits that passed by. You see, it’s not just the endorphins; it’s the one time I’m in control. The one time I own my body, movements, thoughts – my mind. When you run, ride, lift, swim, sail, jump; they require a lot of attention to do, your thoughts are taken away from OCD and dedicated to the task at hand.
“But it is even more than that, you realise how strong you truly are; not just physically, but mentally. That moment you run past someone you thought unreachable, you lift a weight that felt impossibly heavy or you ride faster and higher than you thought your legs could ever take you. These moments of physical achievement require mental strength more than anything else. To put yourself in a position of unknown, move out of your comfort zone and the safety net of what you know you can do – that is strength you cannot measure.”
Riding to work by bike again
Londoner Pete (not his real name) was a busy sociable man who enjoyed cycling to work. Until the day he needed to seek medical help for his OCD.
He had become frightened of stepping on something dirty, and carrying a deadly infection around with him. Pretty soon he could only ride his bike while looking down at the ground for fear of riding through something infectious. “I love cycling, it’s all about freedom and travelling under my own steam. But it was too dangerous to ride like that and I had to stop.”
His GP referred him for counselling and CBT but the NHS CBT waiting list was years long.
He left the house only to go to work. “The commute was awful. On the tube I couldn’t sit down or hold onto the pole for fear of contamination. Stations would be full of people rushing in all directions, which seemed an impossible situation for me because I was always looking at the floor, which would sometimes seem to leap up at me like an excited dog. Sometimes I would just stop myself from dropping to the ground in the stress of it all.”
Eventually he decided to pay for private CBT and started medication to provide an interim support. Slowly he has been able to do things like have friends round to his home, shake peoples’ hands, go on holiday, and, finally, ride his bike to work again.
Post Traumatic Stress Disorder (PTSD)
“Back in control”
Steven Maclean lives in Inverness. He was badly injured in Belize, suffering Post Traumatic Stress Disorder as a consequence, and able to leave his house only to get his medication due to his need not to meet people. Fortunately, the CyclingUK project Wheelness was able to support him to go to a bike shop and buy a bike. On a bike he’s “in his own bubble, able to move in and out of situations” at his own pace so now he feels back in control. As he says “It’s great. I was out on it all day. It’s really helped me. You’re getting some exercise, you’re getting the fresh air, you’re getting out and about, when you used to be stuck in a house for 10 years. It makes a lot of difference.”
You can read more of Steven’s story on CyclingUK’s website.
Additional material: Ainsley, R. (2019, April/May). Pedalpower. Cycle.
”A vacation for the mind”
A small quasi-experimental research design was used to compare PTSD symptoms of Israelis aged 12 -16 , using a cycling and non-cycling group with otherwise similar demographics from the same area. The cycling programme was delivered once a week by trained coaches. It involved a mixture of intense and moderate cycling for a maximum of three hours a day, twice a week from October 2007 to June 2008. Demographics and data of PTSD symptoms was collected at baseline and 9 months later. The researchers discovered that the likelihood of re-experiencing symptoms was statistically significantly lower in the cycling group (13%) than in the control group (32%) after the 9 months had passed.
In focus groups, the young people said that cycling ‘took their mind off of bad feelings’ and ‘was a vacation for my mind’.
Source: Sue Lawrence RN Phd. (2018, July 16). The function of fun: cycling reduces PTSD symptoms in a group of high-risk adolescent involved in a community cycling programme. British Journal of Sports Medicine blog.
PTSD paramedic ‘owes life to cycling’
Erica was a paramedic. An experience of the death of one particular patient in her ambulance in 2011 eventually caused her to resign from her job due to PTSD. She had not dealt with the death properly and it remained with her. During counselling she was encouraged to join a cycling club and so she began track cycling.
She says “A part of PTSD is overthinking and your brain goes at a hundred miles an hour. You get on a bike and it is brilliant for switching off and being able to escape.”
You can watch Erica telling her story to the BBC on this short video (2.08 minutes).
Bipolar Affective Disorder
John (not his real name), a health & safety officer and poet, uses medication to control his Bipolar Affective Disorder but also tries “to get out for more exercise on my bike ….. all good positive stuff.”
Borderline Personality Disorder/ Emotionally Unstable Personality Disorder
Using cycling to cope with suicidal thoughts
Ruth (not her real name) writes that she has had Borderline Personality Disorder since childhood. Her early life has led her to be afraid of adults and social situations and she has been in and out of abusive relationships. Each day she experiences suicidal thoughts and a fear that she can’t live with such thoughts so uses cycling amongst other tools to cope with them.
East Lothian resident Jim, 56, experiences anxiety, depression and hallucinations (the latter since childhood) together with arthritis and chronic pain. He was referred to Health Revolutions, a joint CyclingUK and NHS project which has supported people with poor mental health. It provided cycling skills lessons, group rides and maintenance skills.
Jim has now fallen in love with cycling.
In relation to his mental health, he says “I can deal with it a lot better now, but in the past, I hated being around people and always felt like everyone was looking at me. When I got the chance to talk to a psychologist, that’s when it all… It all just came flooding out.
“I spend more time tinkering with [the bike] than what I do riding it. I just love working on things.”
The stability and regularity of events provided by Health Revolutions and Stepping Out (the mental health charity which referred him) really helped Jim get back on his feet.
“If these groups didn’t exist, all of us would probably just be back in the vicious circle. You go back out, you become ill, you go to hospital… And it’s only a matter of time before you just can’t deal with it anymore, you know, it gets too bad.
“So, that’s why these groups are so important. I still have a lot of problems, you know, with life, with things, doing things and that.”
Want to find out more?
- read Part 2 of this series on cycling for people with mental health conditions
- read Getting Started in Inclusive Cycling which provides links to for example, where to find a local cycling group/ local cycling training providers/ national cycle organisations/.
- contact CyclingUK which ran some the projects mentioned above.
And you can always contact me.