Associations between grip strength, cardiorespiratory fitness, cardiovascular risk and mental health in forcibly displaced people from a Greek refugee camp

Muscular strength represents a specific component of health-related fitness. Hand grip strength is used as a simple and dynamic marker of maximum voluntary force of the hand and to estimate overall strength. Today, little is known about the relationship between grip strength and health in forcibly displaced populations. In the present study, we examined whether grip strength is associated with various health outcomes in a sample of forcibly displaced people living in a Greek refugee camp. The present analyses are part of a larger pragmatic randomized controlled trial. In this paper, cross-sectional baseline data of 143 participants (71 men, 72 women) will be presented. In addition to grip strength, the following physical and mental health outcomes were assessed: body weight and body composition, blood pressure, total cholesterol, low- and high-density lipoprotein cholesterol, triglycerides, blood glucose levels (HbA1c), post-traumatic stress disorder (PTSD) symptoms, depressive and anxiety symptoms, pain, and quality of life. Linear regression analyses were carried out to examine how grip strength is associated with the health outcomes, separately for absolute and normalized grip strength scores. Grip strength was positively and strongly associated with percentage muscle mass (normalized grip strength: Stand. B = 0.58, p < .001), whereas a negative association existed for percentage body fat (normalized grip strength: Stand. B = − 0.58, p < .001). No statistically significant associations occurred between grip strength and the other cardiovascular risk markers. In contrast, we found that participants with higher normalized grip strength reported higher levels of PTSD (normalized grip strength: Stand. B = 0.36, p < .05) and depressive symptoms (normalized grip strength: Stand. B = 0.29, p < .05). No significant association occurred between grip strength, anxiety, pain and quality of life. Measuring grip strength in forcibly displaced people can be a useful way to assess their overall muscle strength. Grip strength tests are easy to implement, and results can be used to assess the effects of specific intervention measures. Nevertheless, our results question the usefulness of grip strength as a marker of cardiovascular health and mental wellbeing in a refugee camp setting

Effects of a co-designed exercise and sport intervention on cardiorespiratory fitness and metabolic syndrome components among individuals living in a refugee camp in Greece: A randomized controlled trial.

BACKGROUND The metabolic syndrome epidemic, including in forcibly displaced individuals, requires cost-effective prevention and treatment strategies. Yet, the health needs of forcibly displaced individuals often remain underserved. Our study evaluated the effect of a co-designed exercise and sport intervention on cardiorespiratory fitness and metabolic syndrome components among individuals in a refugee camp in Greece and examined the indirect effect through cardiorespiratory fitness on metabolic syndrome components. METHODS We conducted a randomized controlled trial involving an intervention and a wait-list control group with n = 142 (52.8 % women) forcibly displaced Southwest Asians and Sub-Saharan Africans. The intervention group participated for 10 weeks in exercise and sport activities. Outcomes were cardiorespiratory fitness and single metabolic syndrome components. Effects were analyzed with structural equation modeling. RESULTS In total, 62.7 % of participants presented with low cardiorespiratory fitness levels (<40th percentile), and 24.6 % met the criteria for metabolic syndrome. In the intervention group, 73.5 % attended the exercise and sport sessions at least once a week. There was evidence for a direct intervention effect on cardiorespiratory fitness, ßdirect = 0.12, p = 0.022, but not for any of the metabolic syndrome components (p ≥ 0.192). Cardiorespiratory fitness significantly facilitated the intervention's indirect effect on abdominal obesity, ßindirect = -0.03, p = 0.012, high diastolic blood pressure, ßindirect = -0.04, p = 0.011, and elevated triglycerides, ßindirect = -0.03, p = 0.025. CONCLUSION Implementing exercise and sport activities in a refugee camp in Greece effectively reaches a wider target population and improves cardiorespiratory fitness among forcibly displaced individuals. The intervention contributes to a decrease in abdominal obesity, high diastolic blood pressure and elevated triglycerides indirectly via improved cardiorespiratory fitness

Associations between grip strength, cardiorespiratory fitness, cardiovascular risk and mental health in forcibly displaced people from a Greek refugee camp.

Muscular strength represents a specific component of health-related fitness. Hand grip strength is used as a simple and dynamic marker of maximum voluntary force of the hand and to estimate overall strength. Today, little is known about the relationship between grip strength and health in forcibly displaced populations. In the present study, we examined whether grip strength is associated with various health outcomes in a sample of forcibly displaced people living in a Greek refugee camp. The present analyses are part of a larger pragmatic randomized controlled trial. In this paper, cross-sectional baseline data of 143 participants (71 men, 72 women) will be presented. In addition to grip strength, the following physical and mental health outcomes were assessed: body weight and body composition, blood pressure, total cholesterol, low- and high-density lipoprotein cholesterol, triglycerides, blood glucose levels (HbA1c), post-traumatic stress disorder (PTSD) symptoms, depressive and anxiety symptoms, pain, and quality of life. Linear regression analyses were carried out to examine how grip strength is associated with the health outcomes, separately for absolute and normalized grip strength scores. Grip strength was positively and strongly associated with percentage muscle mass (normalized grip strength: Stand. B = 0.58, p < .001), whereas a negative association existed for percentage body fat (normalized grip strength: Stand. B = - 0.58, p < .001). No statistically significant associations occurred between grip strength and the other cardiovascular risk markers. In contrast, we found that participants with higher normalized grip strength reported higher levels of PTSD (normalized grip strength: Stand. B = 0.36, p < .05) and depressive symptoms (normalized grip strength: Stand. B = 0.29, p < .05). No significant association occurred between grip strength, anxiety, pain and quality of life. Measuring grip strength in forcibly displaced people can be a useful way to assess their overall muscle strength. Grip strength tests are easy to implement, and results can be used to assess the effects of specific intervention measures. Nevertheless, our results question the usefulness of grip strength as a marker of cardiovascular health and mental wellbeing in a refugee camp setting

Psychological well-being, mental distress, metabolic syndrome, and associated factors among people living in a refugee camp in Greece: a cross-sectional study

BACKGROUND: Forcibly displaced people face various challenges and are therefore at higher risk of being affected by mental and physiological distress. The present study aimed to determine levels of psychological well-being, PTSD symptom severity, metabolic syndrome, and associated factors among forcibly displaced people in Greece in response to WHO's call for evidence-based public health policies and programs for forcibly displaced people. METHODS: We conducted a cross-sectional study among n = 150 (50% women) forcibly displaced people originating from Sub-Sahara Africa and Southwest Asia living in a Greek refugee camp. Self-report questionnaires were used to assess psychological well-being, symptoms of PTSD, depression, generalized anxiety disorder and insomnia, perceived stress, headache, and perceived fitness. Cardiovascular risk markers were assessed to determine metabolic syndrome, and cardiorespiratory fitness was measured with the Åstrand-Rhyming Test of Maximal Oxygen Uptake. RESULTS: The prevalence of mental distress and physiological disorders was overall elevated. Only 53.0% of participants rated their psychological well-being as high. Altogether, 35.3% scored above the clinical cut-off for PTSD, 33.3% for depression, 27.9% for generalized anxiety disorder, and 33.8% for insomnia. One in four (28.8%) participants met criteria for metabolic syndrome. While the prevalence of moderate or severe insomnia symptoms and metabolic syndrome differed little from the global population, the risk of being affected by mental distress was markedly increased. In multivariable analysis, higher perceived fitness was associated with higher psychological well-being (OR = 1.35, p = 0.003) and a decreased likelihood for metabolic syndrome (OR = 0.80, p = 0.031). Participants with elevated psychiatric symptoms were less likely to report high psychological well-being (OR = 0.22, p = 0.003) and had increased odds for higher PTSD severity (OR = 3.27, p = 0.034). Increased stress perception was associated with higher PTSD symptoms (OR = 1.13, p = 0.002). CONCLUSION: There is an elevated risk for mental distress compared to the global population and an overall high mental and physiological burden among people living in a Greek refugee camp. The findings underpin the call for urgent action. Policies should aim to reduce post-migration stressors and address mental health and non-communicable diseases by various programs. Sport and exercise interventions may be a favorable add-on, given that perceived fitness is associated with both mental and physiological health benefits

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/ISRCTN1629198

Psychological well-being, mental distress, metabolic syndrome, and associated factors among people living in a refugee camp in Greece: a cross-sectional study

BackgroundForcibly displaced people face various challenges and are therefore at higher risk of being affected by mental and physiological distress. The present study aimed to determine levels of psychological well-being, PTSD symptom severity, metabolic syndrome, and associated factors among forcibly displaced people in Greece in response to WHO’s call for evidence-based public health policies and programs for forcibly displaced people.MethodsWe conducted a cross-sectional study among n = 150 (50% women) forcibly displaced people originating from Sub-Sahara Africa and Southwest Asia living in a Greek refugee camp. Self-report questionnaires were used to assess psychological well-being, symptoms of PTSD, depression, generalized anxiety disorder and insomnia, perceived stress, headache, and perceived fitness. Cardiovascular risk markers were assessed to determine metabolic syndrome, and cardiorespiratory fitness was measured with the Åstrand-Rhyming Test of Maximal Oxygen Uptake.ResultsThe prevalence of mental distress and physiological disorders was overall elevated. Only 53.0% of participants rated their psychological well-being as high. Altogether, 35.3% scored above the clinical cut-off for PTSD, 33.3% for depression, 27.9% for generalized anxiety disorder, and 33.8% for insomnia. One in four (28.8%) participants met criteria for metabolic syndrome. While the prevalence of moderate or severe insomnia symptoms and metabolic syndrome differed little from the global population, the risk of being affected by mental distress was markedly increased. In multivariable analysis, higher perceived fitness was associated with higher psychological well-being (OR = 1.35, p = 0.003) and a decreased likelihood for metabolic syndrome (OR = 0.80, p = 0.031). Participants with elevated psychiatric symptoms were less likely to report high psychological well-being (OR = 0.22, p = 0.003) and had increased odds for higher PTSD severity (OR = 3.27, p = 0.034). Increased stress perception was associated with higher PTSD symptoms (OR = 1.13, p = 0.002).ConclusionThere is an elevated risk for mental distress compared to the global population and an overall high mental and physiological burden among people living in a Greek refugee camp. The findings underpin the call for urgent action. Policies should aim to reduce post-migration stressors and address mental health and non-communicable diseases by various programs. Sport and exercise interventions may be a favorable add-on, given that perceived fitness is associated with both mental and physiological health benefits

The Effects of Acute Exercise and Virtual Reality Tasks on Children’s Memory Function and Exercise Preference

Background: It is well established that regular participation in exercise and virtual reality (VR) environments are important tools for improving or maintaining human health and cognitive function. Objectives: This study examined the effects of acute exercise and VR environments on children’s memory function and exercise preference (i.e. cycling with or without the use of VR technology). Methods: Α 2×3 factorial design was adopted with two measures (pre, post) and three study groups. Forty-five healthy children aged 9 to 13 years (Mage = 10.91±1.24 years) voluntarily participated in the study. Participants were randomly assigned into three groups receiving different treatment: (1) an exercise+VR group that cycled for 15 min in a VR environment (forest path) combined with basic mathematical problem-solving tasks, (2) an exercise group that cycled for 15 min, and (3) a no-exercise group that sat in a specific place in a lab for 15 min (the control group). Before and after the acute exercise, all the groups completed the Sternberg Memory Task. Upon completion of the intervention, the two exercise groups completed measures of enjoyment, intention and attitudes towards cycling. The exercise+VR group also completed a scale capturing the VR’s usability. Results: The results show that the exercise group scored higher on Sternberg’s Memory Task (p .05) after the acute exercise treatment (post) than before it (pre). Similarly, the exercise+VR participants scored higher on the post-intervention memory task than did the exercise and control groups (p .05). Moreover, the exercise+VR group reported higher scores on enjoyment, intention and attitude towards cycling than the exercise group, but this difference was not statistically significant (p .05). Finally, the exercise+VR participants recorded high scores on the usability of the VR system during the acute exercise programme. Conclusions: These findings are in line with those of previous studies, underlining the important roles of exercise and VR environments on youths’ cognitive function

Perceived advantages and disadvantages of organized sport and exercise activities in a Greek refugee camp: A qualitative approach

Human made conflicts and natural disasters led to a doubling of forced displacement in the past 10 years (United Nations High Commissioner for Refugees, 2022). Forcibly displaced people are generally challenged with severe mental and physical strains before, during and after their flight. Whereas forcibly displaced people show high levels of resilience (Dangmann et al., 2021), their risk of mental health struggles is markedly increased (Mesa-Vieira et al., 2022). The objective of this study was to explore the perception of regular participation in a co-designed and tailored sport and exercise intervention among adults living in a Greek refugee camp. The methodological approach relied on ethnography including informal discussions and participative observations. Data was collected and documented daily in a research diary over a period of eight months. Additionally, debrief meetings with the coaches (4 women and 4 men) were held regularly. These insights built the basis for a critical understanding and interpretation of 13 focus group discussions (n = 49, 19 women) and 38 self-recorded testimonies (17 women). Focus group discussions were conducted after a 10-week physical activity intervention period. The same participants were asked, after a 10-week follow-up, to provide a self-recorded testimony. Overall, 58 (55.8%) of the participants took part in the physical activities on a regular basis. Regular participation benefitted domains of psychological well-being, social cohesion, personal competencies, change in behavior and physiological health. However, some of the same domains were likewise negatively affected for certain participants, namely social cohesion and physiological health. The results indicate that organized sport and exercise activities have the potential to positively impact the living conditions of adults living in a Greek refugee camp. However, participation is not imperatively beneficial and only a specific target population can be addressed. References Dangmann, C., Solberg, Ø., Myhrene Steffenak, A. K., Høye, S., &amp; Andersen, P. N. (2021). Syrian refugee youth resettled in Norway: Mechanisms of resilience influencing health-related quality of life and mental distress. Frontiers in Public Health, 9, Article 711451. https://doi.org/10.3389/fpubh.2021.711451 Mesa-Vieira, C., Haas, A. D., Buitrago-Garcia, D., Roa-Diaz, Z. M., Minder, B., Gamba, M., Salvador, D., Gomez, D., Lewis, M., Gonzalez-Jaramillo, W. C., Pahud de Mortanges, A., Buttia, C., Muka, T., Trujillo, N., &amp; Franco, O. H. (2022). Mental health of migrants with pre-migration exposure to armed conflict: A systematic review and meta-analysis. The Lancet Public Health, 7(5), e469-e481. https://doi:10.1016/S2468-2667(22)00061-5 United Nations High Commissioner for Refugees. (2022). Global Trends. Forced Displacement in 2021. Retrieved from https://www.unhcr.org/publications/brochures/62a9d1494/global-trends-report-2021.htm