Challenges Associated with the Implementation of an Exercise and Sport Intervention Program in a Greek Refugee Camp: A Report of Professional Practice

A sport-for-protection program reduces anxiety and depression in youth affected by displacement: A randomized controlled trial of the Game Connect program in Uganda

INTRODUCTION

Youth affected by displacement are at risk for anxiety and depression. Supervised sport programs are a potentially effective strategy, however trials from displacement contexts are lacking.

METHODS

Displaced youth and youth from host communities in five humanitarian settings across Uganda aged 15 to 24 years, and with at least mild anxiety and/or depression, were randomized to a 16-week sport-for-protection program or a wait-list control condition. The Generalized Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-9, adolescent version (PHQ-9-A) were assessed pre- and post-intervention. Linear mixed modelling was conducted.

RESULTS

834 young people were randomized (421 in the experimental and 413 in the control condition; median age = 19.0 years; 46.9 % boys; 14.7 % with self-reported or observed disability; 29.5 % from host community and 70.5 % displaced youth). Large effect sizes were found for the anxiolytic (Cohen d = 1.21, 95%CI = 1.06-1.36) and antidepressant (Cohen d = 1.32, 95%CI = 1.17-1.47) effects of sport-for-protection in comparison with a wait-list control condition. In subgroup analyses, large effect sizes were observed in displaced youth (Cohen d GAD-7 = 1.15, 95%CI = 1.0-1.32; Cohen d PHQ-9-A = 1.33, 95%CI = 1.16-1.51) and youth from host communities (Cohen d GAD-7 = 1.34, 95%CI = 1.06-1.61; Cohen d PHQ-9-A = 1.30, 95%CI = 1.03-1.58); in boys (Cohen d GAD-7 = 1.23, 95%CI = 1.03-1.43; Cohen d PHQ-9-A = 1.36, 95%CI = 1.14-1.58) and girls (Cohen d GAD-7 = 1.11, 95%CI = 0.89-1.33; Cohen d PHQ-9-A = 1.26, 95%CI = 1.05-1.47); and in those with (Cohen d GAD-7 = 0.99, 95%CI = 0.61-1.37.; Cohen d PHQ-9-A = 1.53, 95%CI = 1.12-1.94) and without disability (Cohen d GAD-7 = 1.24, 95%CI = 1.08-1.49; Cohen d PHQ-9-A = 1.28, 95%CI = 1.12-1.44).

CONCLUSION

Sport-for-protection is an effective stand-alone or adjunctive intervention to reduce symptoms of anxiety and depression among young people affected by displacement within humanitarian settings.

Effects of an exercise and sport intervention among refugees living in a Greek refugee camp on mental health, physical fitness and cardiovascular risk markers: study protocol for the SALEEM pragmatic randomized controlled trial

BACKGROUND

Due to ongoing political and social conflicts, the number of international refugees has been increasing. Refugees are exposed to severe mental and physical strain, as well as traumatic experiences during their flight. Therefore, the risk of psychiatric disorders is markedly increased among international refugees. International organizations have criticized the lack of early interventions as a key problem, because untreated mental disorders are often difficult to cure at a later stage. Today, exercise and sport have been successfully employed to treat a wide range of psychiatric disorders. With patients with post-traumatic stress disorders (PTSD), very limited empirical evidence exists, and studies carried out with international refugees are nearly non-existent.

METHODS

We intend to implement a pragmatic randomized controlled trial (RCT) with an exercise and sport intervention group (n = 68, 50% women) and a wait-list control group (n = 68, 50% women) in the Koutsochero refugee camp, located close to the city of Larissa (Greece). During the RCT, exercise and sport will be offered five times per week (60 min/session) for 10 weeks. Participants will be asked to participate in at least two sessions per week. The programme is developed according to the participants' needs and preferences and they will be able to choose between a range of activities. PTSD symptoms will serve as primary outcome, and several secondary outcomes will be assessed. Qualitative data collection methods will be used to gain a more in-depth appraisal of the participants' perception of the intervention programme. In the second year of study, the programme will be opened to all camp residents. A strategy will be developed how the programme can be continued after the end of the funding period, and how the programme can be scaled up beyond the borders of the Koutsochero camp.

DISCUSSION

By moving towards the primary prevention of chronic physical conditions and psychiatric disorders, a relevant contribution can be done to enhance the quality and quantity of life of refugee camp residents in Greece. Our findings may also strengthen the evidence for exercise as medicine as a holistic care option in refugee camps, by helping camp residents to adopt and maintain a physically active lifestyle.

TRIAL REGISTRATION

The study was registered prospectively on the 8 February 2021 with ISRCTN https://www.isrctn.com/ISRCTN16291983.