Feeling the power:
Reviewing the physical and
psychological benefits of
Boxercise for individuals
with mental health
difficulties
Kate Hefferon, Rebecca Mallery
Chloe Gay, Simeon Elliot & Joan Painter
Background
  The evidence supporting the binary (physical and psychological) benefits of engaging in physical
activity is aplenty (for a review, see Hefferon & Mutrie, 2011, 2012; Biddle & Mutrie, 2008)
  Physical activity hailed as a stellar positive psychological intervention as it focuses on producing
well-being within individuals rather than simply reducing negative states (Hefferon & Mutrie, 2012)
  Positive psychology has begun to consider the needs of those with mental health difficulties, in
addition to its zero to plus five remit (Sin & Lyubomirsky, 2009)
  Increased need for activity engagement in populations who experience mental health difficulties
(Crone et al., 2005; Holly et al., 2011) [e.g. Depression (Camacho et al, 1991; Bluementhal et al.,
1999; Babyak et al., 2000; Mead et al., 2009); obsessive compulsive disorder; anxiety/stress disorder;
psychosis, psychotic depression and schizophrenia (Gorczynski & Faulkner, 2010; Ellis et al., 2007)]
  There is a growing trend to diversify physical activity interventions used with mental health
populations (Carless & Douglas, 2004)
  Boxercise has been found to increase the binary benefits within the normal population (Mackay &
Neill, 2010)
  Boxercise is an unexplored physical activity intervention in mental health: cardiovascular component
(exercise machines, skipping), skills work (punch bags, pad work) and strength work (resistance
exercises)]
Aims
  To address the lack of focus on activity for the promotion of mental health
and well-being, rather than the alleviation of mental illness
  To include positive psychological measurement tools within exercise
psychology (Hefferon & Mutrie, 2011)(Holley et al., 2011; Carless, 2008)
  To address lack of investigation into the actual motivations and expectations
of physical activity participation within this participant pool (Holley et al.,
2011; Carless & Douglas, 2004)
  To utilize a multi-method approach to understanding exercise and mental
health
  To employ qualitative research as it has been identified as the most suitable
methodology for studying the experience of physical activity by people with
mental illness (Carless & Sparkes, 2008; Holley et al., 2011)
  To be the first study to look at posttraumatic growth in mental health
patients as well as the use of activity to facilitate growth in mental health
patients (Hefferon et al., 2008, 2009, 2010; Hefferon and Sparkes, Under
review; Hefferon, in prep; Sabiston et al., 2008)
Design
  Pragmatic approach (concurrent mixed methods)
  Qualitative (Inductive thematic analysis and Interpretative
phenomenological analysis)
  Quantitative (paired samples t-test and split plot ANOVA)
  4 phase study:
1)  Pre and post focus groups focused on the motivations and
expectations as well as the actual experiences of Boxercise
2)  Pre and post Boxercise Rosenberg self esteem scores
3)  Control group comparison with additional measurements
4)  In-depth follow up interviews 6-12 month post intervention
Boxercise intervention
  6 week course of weekly training sessions lasting 2 hours
  Funded by the local Mind Association who run a project aimed at increasing
people’s well-being through physical activity
  Sessions held at a local gym and were led by a former multiple world champion
boxer*
  Sessions included cardio and skill training as well as time in the boxing ring
(sparring)
Participants and recruitment
  Methods of referral included: Community Mental Health Teams, Mind in Croydon
services, other voluntary organizations, local supported housing organisations,
self-referral and family members
  Mild to severe mental health difficulties across a variety of diagnoses (anxiety,
depression, psychosis)
Study 1
(Hefferon, Mallery, Gay & Elliott, In press)
  Study 1 consisted of one preintervention focus group (n=8)
and one post intervention
focus group (n=4)
  Pre
intervention
results
yielded three main themes
and several subthemes
  Post-intervention
results,
focused
on
the
actual
experience of the programme,
yielded three main themes
and several subthemes
Main Theme
Subtheme
Gone off track
Loss of physical self
Loss of confident self
Endeavour
Social re-integration
Free to ‘Be’
Class constituents
Wayne
Evoke power
Main Theme
Subtheme
Praise of class
A focused challenge
Healthy escape
Camaraderie
Wayne
Superstar status
Proxy Efficacy
Wayne's gym
Path to Metamorphosis
Lost and found
Somato-psychic principle
in practice
Heightened awareness
of health
Participants quotes (Pre and Post)
‘I think as well there’s some emotions due to numerous reasons that also feel I need to
get out, and I think boxing is one of those sports that can help do that.’ (Andrea)
‘Yeah, I am [looking forward to] hitting that bag. Just getting all my frustrations out
you know.’ (Becca)
‘[It] takes your mind off things. Em, especially as you’re kind of learning a new skill.
It’s kind of- like the speedball for instance-You zone in on looking at that little ball and
you just totally forget everything. Or like focus pads. Yeah. Because it’s so- don’t
know, everything to think about. [So you] Just totally zone out.’ (Andrea)
‘Yeah I feel that way as well. I feel as though em, don’t know, just achieved, a big life
changing, kind of [Life changing?] Yeah. Yeah. Yeah…no it’s just that I’ve come to a
fork in the road and this has taken me in the right direction. Instead of, keep em, in
the wrong direction. Like trying to drag everything back from wrong- wrong direction
and putting it on the right road.’ (Becca)
‘It’s very interesting […] I’m not really an emotional person. Well not in public anyway.
Em…like I mentioned before, it has given me a lot more confidence to approach
different situations-situations, in a more controlling, em, collected way.’ (Peter).
Study 2
  Study 2 employed a quantitative approach including data
analysis of self-esteem scores (RSE) of attendees of the
programme (n=59)
  Convenience sample (already collected data over 5 years
prior to our working with them)
  Mean age: 29.09; 55% male 45% female
  The data were analysed with a Paired sample t-test with Pre
v Post RSE scores as factors
  There was a significant difference in the scores from time
1(M=14.033, SD=6.88) and time 2 (M=15.76, SD=6.23)
conditions; t(58)=-2.200, p = .032
Study 3
  Results of study 2 led us to utilize a control group
  Cook and Taste (similar class time and structure= 6
weeks, 2 hour weekly sessions on healthy eating)
  Addition of several
positive psychology scales
[Satisfaction with Life Scale (SWLS), Resilience Scale
(RS), Posttraumatic Growth Inventory (PTGI) and a
depression scale (CES-D)]
  Interested in possibility of PTG in mental health
recovery and these groups as potential facilitators
  Ongoing data collection
Results: Rosenberg Self-Esteem
  N= 59 (Boxercise) vs. 11 (C&T)
  Mean age: 47; 55% male, 45% female
  The data were analysed with a 2x2 split-plot ANOVA with condition (Boxercise
v Cook) and Prepost (Pre v Post) as factors
  The main effect for condition did not achieve significance, but a significant
main effect was found for Prepost (F(1,68) = 10.017, p<.01) with higher selfesteem scores being found in the Post condition (mean = 18.49) than in the
Pre condition (mean = 10.017)
  A significant interaction which was obtained between Condition and Prepost
(F(1,68) = 4.089, p<.05)
  The mean self-esteem scores for Pre and Post in the Cook condition were
13.182 and 21.182 respectively, whereas in the Boxercise condition they were
14.034 and 15.797 respectively
  The results would appear to indicate that both activities had a beneficial
effect on Self-Esteem, but this effect was strongest for the Cook activity
  Interpretation should be treated with caution as at this stage as at this stage
there is a sharp disparity in participant numbers between the two activities,
i.e. 59 in the Boxercise Group and 11 in the Cook group
Results of other measures
  N= 15 (Boxercise) vs. 9 (C&T)
Satisfaction With Life Sacle (SWLS)
  The data were analysed with a 2x2 split-plot ANOVA with condition (Boxercise v
Cook) and Prepost (Pre v Post) as factors. The main effects and interaction did not
achieve significance. CES-D   The data were analysed with a 2x2 split-plot ANOVA with condition (Boxercise v
Cook) and Prepost (Pre v Post) as factors. The main effects and interaction did not
achieve significance.
Resilience Scale
  The data were analysed with a 2x2 split-plot ANOVA with condition (Boxercise v
Cook) and Prepost (Pre v Post) as factors. The main effects and interaction did not
achieve significance.
Results: Post-traumatic Growth Inventory
  The data were analysed with a 2x2 split-plot ANOVA with condition
(Boxercise v Cook) and Prepost (Pre v Post) as factors
  The main effect for Condition and the interaction did not achieve
significance
  However, a significant effect was found for Prepost, with participants
scoring significantly higher in the post condition (mean = 66) vs. the Pre
condition (mean = 51)
  This would appear to indicate that both activities had a beneficial effect
on Post-Traumatic Growth
  This is the first study to show potential for PTG following mental health
indicating a huge development in theoretical understanding of PTG
  Again, however, caution should be exercised as participant numbers are
low (Boxercise N = 15, Cook N= 9)
Study 4
  Attenuate for the issues with Study 1 and explain results
of Study 2 and 3
  Follow up study on the experience of growth from
participation in boxercise and mental health difficulties
  Interpretative Phenomenological analysis (IPA)
  Currently in progress (data collected, analysed and due
to submit for publication October, 2012)
  Preliminary data support the previous qualitative
studies focus group findings on the issues of power and
catharsis hypothesis
Conclusions
  Control group raises questions on the social elements of the
group
  Issues with sample sizes (small, uneven, different ages) and
adherence (pre/post)
  Overall, the 4 studies have shown positive physical and
psychological benefits from the participation in a structured
Boxercise programme for people with mental health difficulties
  Furthermore, both qualitative studies found that the unique
‘power’ (boxing) component of the class to be of particular
benefit to the participants
  First pilot study to show links between PTG and mental health
  Continuing data collection plus follow up data (3 and 6 months)
Thank you!
[email protected]
www.uel.ac.uk
www.katehefferon.com