Feeling on top of the World.

 

It was during a meeting with the Crisis Service and CMHT, when my care was to be transferred to CMHT, that I was asked if I had any specific requests or needs that CMHT should consider. I gave them a challenge, which has become the case study I'm now involved in and what I'd like to focus on in this blog.

A bit of background first. I'd spent the past 10 years developing a charity working with predominantly older people, using sport as a focus for reminiscence, as this developed, we discovered that by talking about sport, we could create a safe, fun environment, where even the least active would willingly join in regular exercise and games. Being a man in his 50's (the government class 50 as the start of old age, as if!!) I'd made a conscious decision in 2018 to try to start exercising more, as I was working seven days a week and wasn't practising what I was preaching. Every time I made the effort to exercise, I immediately felt fresher and better for it, both mentally and physically.

But after the onset of my depression in late 2019, my exercise began to dwindle and by the time I was admitted to the Crisis Service in September 2020, all activity had stopped. I commenced my fourth different antidepressant in 9 months, Mirtazipine, which carries a risk of significant weight gain. Whilst I'd always been relatively slim and a healthy BMI, things changed very quickly when moving on to the new medication. 

 There's a wealth of evidence on the benefits to mental and physical health that sport and exercise bring. A good place to start exploring this is Mental health | Sport England. I connected with former colleagues who had worked in developing exercise programmes for people with SMI and searched for supporting evidence of similar in treating depression. 

Armed with the evidence base, my wife and I worked on creating a proposal for a twelve week programme proposal to put to the trust. With the support of the trust, this quickly became a case study and a wide ranging multi disciplinary team was formed. A large set of measures were identified to monitor the impact of the programme, covering various aspects of my mental health and physical health. I was also to receive two coaching sessions from a Highly Specialised Applied Clinical Psychologist. It was then all hands to the pump to get all the baseline measures completed before the official start date of the 2nd December. 

 Whilst I was looking forward to the programme starting, my mood dipped further and I was having a lot of suicidal thoughts.A further antidepressant was added, Venlafaxine, to the Mirtazapine.A combination that is apparently dubbed 'Californian Rocket Fuel'. I was also prescribed up to 10mg of Diazepam PRN and was regularly taking Paracetamol and Ibuprofen for various aches and pains. I'd not had any meaningful exercise for three months other than occasional walks. In eight weeks I put on 8kg. My self esteem was as low as my mood.

I was very fortunate to have an eldest daughter who competes in powerlifting. During the first lockdown, she invested in weights and equipment so she could continue her training at home. I was doubly fortunate that she then moved into a new flat and couldn't take the equipment with her, so I had access to much of the equipment needed. 

 Tristan Eaglen Coaching was appointed to work with me and he designed a programme that would include three coaching sessions a week, for an hour per session. I'd never lifted a weight in my life, nor ever had the inclination to join a gym. Our first session together involved me taking a Functional Threshold Power test on a turbo trainer bike. If that didn't show to TEC as we'll call him, that my baseline was pretty low, the following sessions to discover my baseline for the lifting, balance and strength exercises certainly did. The look of incredulity on his face when I asked what a plank was, after he asked me how long I reckoned I'd ever manage to hold one for, said it all. 

One of the first benefits I started to notice from the sessions was having some structure and purpose to my days. I had to be careful to limit any lifting outside of the sessions, as I still needed to learn the techniques, but I was free to train on my indoor bike as much as I wanted. This was when I discovered the virtual world of www.zwift.com, which has helped to keep me motivated and cycling far more than I ever envisaged I would.

I’ve recently completed all the final measures, including another lung bursting FTP test. We’re just awaiting blood results. There will be follow ups at 6 and 12 months. .   

 There's not been a session I've not looked forward to and we've been fortunate to have not had much interruption due to Covid, as we've been able to connect online for the sessions as and when we had to. I've had some peaks and troughs in terms of my mood, but haven't missed a session. 

 As I learned the lifting techniques and became proficient, weight were gradually increased to begin to build my strength and muscle. The strength and balance exercises increased in weight, speed and/or number of repetitions too. By week seven I found myself lifting and completing strength and balance reps an additional two days outside of the sessions. I cycle everyday and Strava tells me I rode well over 1500km over the course of the 12 weeks

 I've noticed a lot of changes to my body shape, my waist is significantly smaller, I feel stronger and can pedal for much longer periods at much higher power outputs. But those changes are secondary to what the case study's prime focus is on, improving my mental health. I feel stronger mentally, have far less bad days and any suicidal ideation has pretty much gone, bar some very fleeting moments mostly due to outside influences such as news stories. The two coaching sessions with Steve Donaldson, mid way through the programme were really helpful, introducing the ThinkOn methodology, which we used to set a goal I have for the end of March. It helped crystalise my thoughts and to review what I'd like to achieve in the short term. 

 Whilst the Californian Rocket Fuel will have certainly helped elevate and stabilise my mood, it was hardly Rocket Science that structured exercise would play its part too. Whilst I'll miss the sessions when they come to an end, I can't imagine not continuing using the new skills I've learned and the enjoyment I get from lifting and all the exercises around it. 

Now to write up the case study, learning and recommendations.

Ps. Had my Covid vaccination last week!

Best wishes

Blot