Water-based physical activity improves the physical and mental health of people with serious mental disorders

Water-based physical activity substantially improves the physical and mental health of people with a serious mental disorder. This is the conclusion of two studies undertaken by a research team from the Sant Joan de Déu Health Park with the support of Fluidra, Fundació Fluidra, and the Obra Social Sant Joan de Déu charity organization. The studies assessed over 100 participants across two years. The overall research, part of the Thalassa project, found that water-based physical activity is an effective rehabilitation tool for people with serious mental disorders, encouraging the remission of symptoms and reducing specific needs depending on the type of disorder. In addition to the two studies, the Thalassa project has led to the publication of the first Intervention Guide to Improve Coordination in Sports Activities in Public Pools and won further funding in partnership with 10 health institutions from across Spain.

Differences by sex and diagnosis

The study Benefits of Water-Based Physical Activity for People with Mental Disorders concluded that both swimming and water aerobics significantly improves self-esteem among people diagnosed with a mental disorder, reduces their perception of social stigma, anxiety, and depression, improves the subjective perception of their general health and positively impacts personal care and activities of daily living. Physical activity in a community-based sports center further promotes the benefits derived from social relations and societal engagement.

The study involved 87 people and found different benefits in men and women: men reported a reduction in their perception of social stigma and an improvement in social relations and engagement in society. In women, the improvements were around self-esteem and social relations.

Depending on the diagnosis, the study also found that water-based activity has specific benefits that can help improve problems in the different population groups. People with depression saw an improvement in self-esteem and reduction in their perception of self-stigma. They reported improvements in personal care and daily activities of living. People with a schizophrenia diagnosis, by contrast, saw improvements in the perception of their health status, social relations, daily activities of living, and engagement in society.

 “Water-based activities produce improvements across many areas for people with mental health problems, and early study results identified significant differences by sex and diagnosis,” remarked Dr Susana Ochoa, a researcher with the Joan de Déu Health Park Research Unit and the study coordinator. She highlighted that the starting point was different for a person with depression or psychosis, but in both cases the results were promising since they pointed to clearly identifiable improvements that could meet the care requirements of each group.

Water aerobics and metacognitive training, key in the treatment of psychosis

The study Efficacy of the Combination of Water Aerobics and Metacognitive Training (MCT) on Psychological and Physical Health Variables and their Relationship with SP1 and SP4 Biomarkers in People with Psychosis looked at a total of 23 patients distributed across three groups: those who had undergone a psychological intervention (metacognitive training), those who had simply done water aerobics, and those who had been given access to a combination of the two. According to Dr Ochoa, the study ultimately showed that “combined water aerobics and metacognitive training boosts the positive effects of the improvements across different areas of the population with a diagnosis of schizophrenia or other psychotic disorders”.

Specifically, the therapy was found to reduce delirium and hallucinations and significantly impact motivation and engagement. The study also recorded a reduction in depressive symptoms, an increase in awareness around the disorder, an improvement in cognitive function, and an enhanced capacity for adaptation and social and personal interaction. Together this produced a perception of improved quality of life and self-esteem and a reduction in perceived self-stigma. The study also proved that water aerobics led to a significant increase in other physical activities, such as walking. These benefits could see it becoming an integral part of therapy for people with these diagnoses going forward.These benefits could see it becoming an integral part of therapy for people with these diagnoses going forward.

Intervention Guide to Improve Coordination in Sports Activities in Pools

As a result of the Thalassa project, the Sant Joan de Déu Health Park, in partnership within partnership with Fluidra, Fundació Fluidra, and Obra Social Sant Joan de Déu, has published the Intervention Guide to Improve Coordination in Sports Activities in Pools. The guide will initially be distributed in health centers and sports facilities involved with the project and includes recommendations for water-based sports to ensure that participants engage in safe and effective exercises and movements under the supervision of trained professionals. A further aim is to raise awareness of the benefits of this activity among the general public and among vulnerable groups. 

For now the activity is being developed in nine municipalities across the Barcelona area (Barcelona, Vilanova i la Geltrú, Viladecans, Esplugues de Llobregat, Cornellà de Llobregat, el Prat de Llobregat, Sant Boi de Llobregat, Cerdanyola del Vallès, and Ripollet) with the involvement of 12 sports facilities (the Colom, Can Ricard, Espanya Industrial, Parc del Garraf, Atrium, La Plana, Sagnier, Pau Gasol and Can Xarau municipal sports centers, the Esportiu La Piscina sport and health center, the Can Mercader Water and Sports Complex, and the Ripollet Municipal Multisport Center). A total of 16 activity groups have been formed, of which seven are mixed (customers of the mental health network and other sports facility users).

In total, there are 435 participants in the activities, 357 of whomwhom are people seen by the mental health network and 78 of whomwhom are sports facility users. A total of 59% of participants are women. Both participants and managers have identified a diverse range of benefits from the activity.

Gender perspective and emotional wellness –– areas of continuity

Considering the proven benefits of water-based physical activity in the population with mental health problems, the Thalassa project is proposing crosscutting continuity of the research with the aim of creating a research area focused on further exploring the gender influence when defining the benefits obtained. The study will also analyze which activities are most suitable for each mental disorder and which benefits each population group obtains.

Thalassa has been promised ongoing funds from the Health Ministry's FIS Health Research Fund to do further work on the efficacy of the combination of water aerobics and metacognitive training among people with a schizophrenia diagnosis or other psychotic disorders. Thalassa has been promised ongoing funds from the Health Ministry's FIS Health Research Fund to do further work on the efficacy of the combination of water aerobics and metacognitive training among people with a schizophrenia diagnosis or other psychotic disorders. With a commitment to improve care for people with schizophrenia, the research team will implement a second phase of the clinical trial started at the Sant Joan de Déu Health Park together with 10 Spanish centers from the Spanish Metacognition Group, a body that has been running research projects to develop effective treatments for people with psychosis for over 15 years. The centers that have signed up so far are: Parc Taulí University Hospital (Sabadell), Marqués de Valdecillas University Hospital (Santander), the Les Corts Mental Health Center (Barcelona), Mataró Hospital, El Mar Hospital (Barcelona), Jaen University Hospital, San Carlos Clinic Hospital (Madrid), the Pere Mata Institute (Reus), Son Llàtzer Hospital (Mallorca), and the Sant Joan de Déu Health Park (Sant Boi).

Sant Joan de Déu: a health and social benchmark

The Thalassa project is part of the Sant Joan de Déu Health Park’s commitment to use healthcare research to improve the lives of patients from all areas. It is based on the mental healthcare recovery model and a community approach, which are both driving values of the Sant Joan de Déu Health ParkPark.