Used pet bottles filled with sand become dumbbells…
Interview with Prof. Markus Gerber (Department of Sport, Exercise and Health) 8.9.2020
Dear Prof. Gerber, your project “Effects of an exercise and sport intervention among refugees living in a Greek refugee camp: A randomized controlled trial” is one of eight projects funded by the “Swiss Network for International Studies” (SNIS) 2020 out of around seventy submissions. Congratulations! Can you tell us more about the background and aims of the project?
Thank you. Yes, we are very happy about the financial support from the SNIS. It was worth making the investment, and making our passion for the project visible in the application. The broad support of the cooperation partners and the highly motivated team were certainly central to the success of our application. – Our project is based on a completed pilot study by Florian Knappe, which included an eight-week exercise and sport intervention in a refugee camp in Greece. In this pilot study, we tested the hypothesis whether exercise and sport can help to alleviate symptoms of mental disorders in this place of hopelessness and counteract them preventively. The fact that probably more than half of the refugees already suffer from post-traumatic stress disorder upon arrival in the camps shows the necessity of early intervention. We make such an intervention possible on site through sport, which is a novelty. After screening to determine the mental health of the refugees, results are generated by a randomized controlled trial. This means that one group of refugees will regularly engage in endurance or weight training activities and play sports, whereas the control group will remain without coordinated sports activities. Using a wide range of measurements, psychological and physical parameters are evaluated, and compared before, during, and after the intervention period. If the project confirms the expected effect of sport on the mental health of the refugees, we will make efforts to empower the refugees to implement the standardized training sessions on their own. This ensures the sustainability of the project, which is very important to us.
Sustainability and societal impact are the new ‘life sciences’ - a trend in research funding that is certainly more than justified in view of current developments. Do you think that the project could have a longer-term impact on the health of refugees in Greek camps?
The dissemination strategy is an integral part of the project. During the second year of the project, our university teams will be delivering sport and exercise programs to all refugees wishing to participate. At the same time, seminars on the implementation of sport and exercise programs will be offered to interested parties – sport students of the participating universities, employees working at the camp, coaches, fitness instructors and, of course, refugees. Participants of the intervention and the wait-list control groups will be offered to continue their participation in the exercise and sport program, once the official intervention has come to an end. Based on qualitative interviews with participants, we will strive to improve the intervention material on a regular basis, and develop a program that is attractive to participants, both male and female. We will also develop a strategy for scaling-up the program beyond the borders of the Koutsochero refugee camp. The results of the study will be communicated to the respective health, education and administrative authorities in Greece and Switzerland, as well as NGOs and the managements other refugee camps in Greece. At the moment, we are setting up the project. Together with our Greek project partners, we are establishing contacts with authorities and NGOs in Greece and expect the project to be approved by the Ethics Committee Northwest and Central Switzerland (EKNZ).
What are the specific ethical challenges in this project?
Since refugees are a particularly vulnerable population, it must be shown that ethical research standards can be met during the research. Open communication is key. Questionnaires and declarations of consent in various languages and local translators ensure that all participants know what is at stake and that everything is voluntary. No disadvantages result from non-participation or withdrawal from the program. The safe handling of the blood samples must be guaranteed, as must the Covid protection concept. We are experienced in such matters. Of course, the project is also subject to an ethical review in Greece.
What specific exercise and sport activities are offered to the refugees in the camp and will the participants be divided into sample groups (age, physical condition, gender, etc)?
We focus on activities that are standardized and therefore repeatable. We also have to take into account the climatic conditions for exercise and sport activities in Greece in general. In order to take into consideration the heterogeneous needs and preferences of the refugees, different activities are offered each day, so that the participants have a certain choice. The training setting should be implemented with the simplest possible means. Thus, used pet bottles filled with sand become dumbbells and water canisters become step platforms or kettlebells. As already mentioned, the fun factor should not be missing. Football is already being played without our help. The offers are separated according to gender, because we want to meet religious and cultural requirements. For women, endurance sports are often less interesting, but they can be motivated to take part, for example, by dancing. Female instructors work with the women, male instructors with the men. – Practically no project funds will go into ephemeral infrastructure. This is an important aspect, especially for sustainability.
Your intervention in Greece is the result of the pilot project mentioned above. Is it not surprising that such an intervention was not made earlier, considering how long the refugee crisis has been going on?
This is a very interesting question. The fact that exercise and sport interventions in refugee camps were not implemented earlier is certainly due to the challenging environment and its possible impact on a research project. For instance, the camp in which our pilot study was carried out was closed only two months after we have completed our follow-up data assessment! Also, in terms of methodology, there are many traps lurking. Last but not least, this work requires leaving the comfort zone and being prepared to swap laboratories for unpredictable field work. Furthermore, the question always arises as to whether and how research projects, some of which are to be carried out far away from home, can be financed. The taxpayer may not be aware of any direct benefit. – Nonetheless, we can now say that we are the first team that will be able to initiate an exercise and sport intervention on site and that it is no longer necessary to wait for refugees to come to countries where they will apply for asylum in order to start such a therapy. The topic of our research project is of high social relevance as currently the situation is explosive (as seen in the Moria camp on Lesbos), especially as the borders to the European Union are closed. As a consequence, many refugees are stuck and will most likely have to spend more time in a camp.
The fact that sport not only leads to a better shape, but also helps to reduce stress is probably known to most hobby athletes. Can you tell us more about the mechanisms that lead to this effect?
It has been known for a long time that exercise and sport have a positive impact on our physical health. With other words, exercise and sport have the potential to prevent or at least reduce our risk of cardiovascular diseases, diabetes mellitus, or even certain types of cancer. The effects of exercise and sport on mental health is a newer topic. However, during the last 20 years, our knowledge base has increased steadily and meanwhile a lot of empirical studies have been carried out. Potential underlying mechanisms are for example that exercise and sport distract from everyday worries, strengthen self-confidence, create social networks and increase one's own resistance to stress. Effects on the hormonal level can be observed, as can a promotion of neurotransmitter activity. Various “happiness hormones” are released, which normally makes people feel better after they have exercised.
Are there some exercise and sport activities that are better suited than others for the treatment or prevention of mental diseases?
It is difficult to answer this question, because in sports interventions, standardization is an important issue to enable a replication of conditions. It can be observed, however, that different endurance and strength training activities have similar positive effects. Also, it makes little difference whether a person engages in traditional continuous endurance training or, for example, performs a high intensity interval training (HITT). Less intensive exercise and sport activities like Nordic walking, swimming or yoga also show beneficial effects. Finally, it is important to find a certain fit between what is considered healthy and what the person enjoys. Having fun and feeling good during exercise and sport activities are strong motivators that promote sustainability.
Thank you for this interesting interview. We wish you and your team - and above all the participants in the study - every success!
