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Mental Health

Open the conversation

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If it’s ok with you, can we spend a few minutes focusing on what you and your parents think might be some help for you?

Insight

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Setting the scene for both the child and parent/guardian allows a constructive person-centred conversation around behaviour change. With younger children the emphasis needs to be around short-term goals. The more concrete and specific – the better!

Did you know?

Toddlers and pre-schoolers should spend at least 3 hours per day in a variety of physical activities spread throughout the day including active and outdoor play.

Muscle and bone strengthening activities should be throughout the week for strong muscles and bones e.g. swinging on playground equipment, hopping and skipping for children and young people aged 5-18

Children and young people should aim to minimise the time they spend sitting for extended periods of time, including watching TV, playing computer games and travelling by car when they could walk or cycle and should replace sedentary time with light intensity physical activity wherever possible.

Real impact

Don’t focus on what you can’t do, focus on what you can.

Make sure you speak to school and your teachers, make a plan about how you can participate!

Make activity part of daily routine/normality.

Assess impact of the condition

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How does your condition affect your playtime?

Insight

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Living life with a long -term condition commonly affects physical activity beliefs and behaviours. Focusing on this can be a useful way to introduce the topic.

Young children lack experience and their goals are short term. Engaging with parents is key to establishing behaviour change in this age group.

Learning motivational interviewing can help you avoid common pitfalls that sometimes make conversations about behaviour change unrewarding and ineffective. Visit our education section to learn more.

Did you know?

Toddlers and pre-schoolers should spend at least 3 hours per day in a variety of physical activities spread throughout the day including active and outdoor play.

Muscle and bone strengthening activities should be throughout the week for strong muscles and bones e.g. swinging on playground equipment, hopping and skipping for children and young people aged 5-18

Children and young people should aim to minimise the time they spend sitting for extended periods of time, including watching TV, playing computer games and travelling by car when they could walk or cycle and should replace sedentary time with light intensity physical activity wherever possible.

Real impact

Don’t focus on what you can’t do, focus on what you can.

Make sure you speak to school and your teachers, make a plan about how you can participate!

Make activity part of daily routine/normality.

Explore current activity

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I’m curious, how much do you move about everyday?

Regular strength activity is also important so consider asking this directly:

“Tell me about things you do to make you feel strong.”

Insight

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Evaluating how active a child is, as part of a conversation to help them move more in the future, is recognised as being an important aspect of assessment.

What matters most is for the youth to engage and move!

Any activity is better than none, and there is no simple cut off or ‘threshold’ for health applying to everyone – and particularly not paediatric populations as they are constantly in motion of new development and growth. Identifying a cut-off point introduces a concept of success or failure and can be detrimental to having a person-centred conversation based on individual values, and in the case of paediatric populations, this typically centres on the parent’s values.

Did you know?

Toddlers and pre-schoolers should spend at least 3 hours per day in a variety of physical activities spread throughout the day including active and outdoor play.

Muscle and bone strengthening activities should be throughout the week for strong muscles and bones e.g. swinging on playground equipment, hopping and skipping for children and young people aged 5-18

Children and young people should aim to minimise the time they spend sitting for extended periods of time, including watching TV, playing computer games and travelling by car when they could walk or cycle and should replace sedentary time with light intensity physical activity wherever possible.

Real impact

Don’t focus on what you can’t do, focus on what you can.

Make sure you speak to school and your teachers, make a plan about how you can participate!

Make activity part of daily routine/normality.

Find out what they already know

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What do you know about the benefits children get/achieve from physical activity?”

Insight

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Children relate to other children and peers more readily – than hearing adult advise. Helping them identify how they might benefit from being more active is key. Engaging both the child and parents about what they understand about being more active, allows opportunity for you to more collaboratively share the benefits with them.

Did you know?

There is strong evidence that physical activity prevents mental illness, and improves symptoms for those who have depression and anxiety

Higher levels of activity at age 5 predicts higher levels of activity as a teenager and being healthier.

Real impact

Physical Activity helps you get to sleep at night

Physical Activity can help you feel happier about your body.

Children should be encouraged to play outdoors – embrace the rain and mud!

Share benefits

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Can I share some other things people find beneficial to see what you make of them.

Insight

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Based on your discussion so far, choose to share the benefits you judge will be most relevant and important to them. Some benefits are quite generic and others will be condition specific.

Remember the conversation won’t work if you take away their control. Ask permission and keep this a conversation not a lecture.

Did you know?

There is strong evidence that physical activity prevents mental illness, and improves symptoms for those who have depression and anxiety

Higher levels of activity at age 5 predicts higher levels of activity as a teenager and being healthier.

Real impact

Physical Activity helps you get to sleep at night

Physical Activity can help you feel happier about your body.

Children should be encouraged to play outdoors – embrace the rain and mud!

Encourage reflection

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What’s most important for you and I to talk about next?

Insight

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Children typically don’t reflect the depth of adults on their own change behaviours.

Focusing on things of particular importance to them will facilitate change in their behaviour. This will allow them to make very short -term goals, which are easier for them to adhere. Ask if they need anything clarifying and what concerns they or the parents might have about how the information applies to them.

Listen and reflect their concerns: ‘you’re worried about X’. Help them to address these issues by sharing the experience of children  ‘other people I’ve worked with have had those concerns, but what typically happens when they get started is…’  or  ‘whilst there is a small risk of X when you get started, this is outweighed by the risk reduction you experience once you have started moving more’. Ask what they think about what you have said.

Did you know?

There is strong evidence that physical activity prevents mental illness, and improves symptoms for those who have depression and anxiety

Higher levels of activity at age 5 predicts higher levels of activity as a teenager and being healthier.

Real impact

Physical Activity helps you get to sleep at night

Physical Activity can help you feel happier about your body.

Children should be encouraged to play outdoors – embrace the rain and mud!

Explore how they think activity may help

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How do you think moving more might help you?

Readiness Cycles

Using your judgment, offer to share the most relevant and important problem commonly reported issues by children with the same condition.

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  • Being active-more energized
  • Feel more energised
  • Positive distraction and less time to internalise
  • Make better choices and habits
  • Sleep better and feel more rested
  • More positive about our body
  • Being active-more energized
  • Being less active- Less energy to do things
  • Increases boredom
  • Poor sleep
  • Comfort eating and weight gain
  • More negative thoughts
  • More embarrassment due to poor body
  • Being less active- Less energy to do things
  • More physical activity
  • Physically stronger and fitter
  • Less negative thoughts, Improved self-esteem and self-efficacy
  • More social Interaction
  • Better mood
  • More physical activity
  • Less physical activity
  • Less strong and fitter
  • More negative thoughts, reduced self-esteem and self-efficacy
  • More social isolation
  • More negative thoughts
  • Less physical activity
  • More physical activity
  • Increased lean muscle mass
  • Improved energy balance
  • Improved body image
  • Increase in confidence
  • Increased Participation
  • More physical activity
  • Less physical activity
  • Reduced lean muscle mass
  • Reduced energy balance
  • Worsening body Image
  • Reduced confidence and participation
  • Increasing weight
  • Less physical activity
  • Increased physical activity
  • Increased readiness for sleep
  • Good Sleep
  • Less fatigue, more energy
  • More motivation and enjoyment
  • Better daily routine due to enhanced motivation
  • Increased physical activity
  • Reduced physical activity
  • Not physically worn out
  • Poor Sleep
  • Disrupted sleep cycle and fatigue
  • Reduced motivation and enjoyment
  • Poor daily routine due to lack of motivation
  • Reduced physical activity
  • More Exercise
  • Exercise makes Endorphins/Enkephalins – the body’s ‘natural antidepressants’
  • Feel better mentally and physically
  • Improved enjoyment and performance
  • More Exercise
  • No exercise
  • Less natural ‘feel good’ chemicals’
  • Less enjoyment, less motivation
  • Life feels greyer, you feel left out and isolated
  • Nothings fun. Why would I bother to exercise
  • No exercise
  • Moving more regularly
  • Improved physical well-being and less pain
  • Strengthen muscles, joints and bones
  • Decreased pain over time
  • Increase motivation and confidence to take part in physical activity
  • Moving more regularly
  • Moving less regularly
  • Increased weight gain and reduced wellbeing
  • Weaker muscles, joints and bones
  • Increased pain
  • Avoidance in participation of physical activity
  • Moving less regularly
  • Increase in physical activity
  • Feel motivated
  • Sense of achievement
  • Increase in self- belief
  • Increase in resilience
  • Increase in physical activity
  • Decrease in physical activity
  • No motivation
  • Decreased mood
  • Increased isolation
  • Reduced self-esteem
  • Decrease in physical activity
  • Increase physical activity
  • Improves muscle strength
  • Improve heart and lung fitness
  • Cope more easily with day to day activity
  • Feel less tired
  • Increase physical activity
  • Decrease physical activity
  • Weaker muscles
  • Heart and lungs less fit
  • Everyday activity feels harder work
  • More tired
  • Decrease physical activity
  • Increase physical activity
  • Increase heart and lung fitness and muscular strength
  • Increased confidence to participate in activities
  • More social activities
  • Greater self-esteem
  • Increase physical activity
  • Decrease physical activity
  • Decrease heart and lung fitness and muscular strength
  • Decreased confidence to participate in activities
  • Fewer social interactions
  • Lower self-esteem
  • Decrease physical activity

Insight

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The symptoms and challenges experienced by children are a real and frequently challenging part of everyday life. Understanding how physical activity can make a difference to their day-to-day life can help strengthen the parents/guardians and child’s confidence to become more active.

Did you know?

Physical activity helps social development of children by providing opportunities for self-expression, building self-confidence, social interaction and integration.

Think about sports or exercise that follow the SAAFE principles (supportive, active, autonomous, fair, enjoyable).

In the report of the commission on ending childhood obesity, the World Health Organisation (WHO) highlights one of the six key areas of action is to “promote physical activity”.

Real impact

Make it sociable. Find a buddy – friend/pet/family member

Set a family challenge, make up an obstacle course to do together, walk the dog, move more at home or in the garden, get outside more – embrace the mud and rain!

Physical activity is not just sports – have fun!

Respond to concerns

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Is there anything that makes you worried about moving more?

Insight

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Many kids with health problems – and those without – have concerns about becoming more active. When you ask them about this, saying “if you decided to” reminds them that they and their parents/guardians are the decision maker, not you, keeping the discussion open and active, focusing your supportive role.

Find a way to reflect that you understand and restate the specific struggle- ‘Yes, …… is a common concern’ Using a statement, and not a question also helps to show the child and parent/guardian you understand what they are saying. ‘You’re concerned that being more active may make your pain worse.”

Allow some space, including a pause for kids and parents to talk about and explore new information, by asking ‘what do you think about what I’ve just said?’ rather than asking ‘do you understand?’ which can shut things down. Ask if they need clarifying and what concerns they might have about how the information applies to them.

Did you know?

Physical activity helps social development of children by providing opportunities for self-expression, building self-confidence, social interaction and integration.

Think about sports or exercise that follow the SAAFE principles (supportive, active, autonomous, fair, enjoyable).

In the report of the commission on ending childhood obesity, the World Health Organisation (WHO) highlights one of the six key areas of action is to “promote physical activity”.

Real impact

Make it sociable. Find a buddy – friend/pet/family member

Set a family challenge, make up an obstacle course to do together, walk the dog, move more at home or in the garden, get outside more – embrace the mud and rain!

Physical activity is not just sports – have fun!

Make it personal

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What would be the most important reason for you to become more active?

Insight

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Help kids and parents/guardians to generate and articulate their own reasons, with short term goals in mind. This may or may not be health-related.


Did you know?

Particularly for older girls, body image concerns can reduce levels of physical activity. Enquiry and support about these concerns may facilitate future engagement in exercise.

Stopping exercise if it feels too difficult or you are too tired that day is ok. Freedom to reduce or stop the activity without consequence is important for building engagement.

Paternal Physical activity is one of the strongest predictors for physical activity in adolescents. So if parents exercise too there are benefits for themselves and the while family.

Real impact

You will get bad days. Try again tomorrow

Be realistic about what you can achieve and don’t be hard on yourself if you don’t always manage to fit exercise in when planned or if you’re exercise session doesn’t always go as well as you’d like!

Consider using mobile applications to increase your physical activity levels. Some apps can make use of augmented reality for an extra dose of fun!

Look forwards

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What things do you think could be easier if you became more active?

Children have short-term goals and may like to do more with their friends. By asking them what things they’d like to do more of can allow both children and parents to understand and consider new ways they can engage in more enjoyable physical activities that can be longer-lasting.

Insight

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Did you know?

Particularly for older girls, body image concerns can reduce levels of physical activity. Enquiry and support about these concerns may facilitate future engagement in exercise.

Stopping exercise if it feels too difficult or you are too tired that day is ok. Freedom to reduce or stop the activity without consequence is important for building engagement.

Paternal Physical activity is one of the strongest predictors for physical activity in adolescents. So if parents exercise too there are benefits for themselves and the while family.

Real impact

You will get bad days. Try again tomorrow

Be realistic about what you can achieve and don’t be hard on yourself if you don’t always manage to fit exercise in when planned or if you’re exercise session doesn’t always go as well as you’d like!

Consider using mobile applications to increase your physical activity levels. Some apps can make use of augmented reality for an extra dose of fun!

Help them build confidence

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What are the main reasons you would start becoming more active -if you chose to?

Insight

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These questions aim to get parents and children thinking about how to get active, if they tried, as this can help to increase their confidence. It also helps them to think about the concrete steps. Listen to and explore what they say: ‘are there things that would like to do which you feel you can’t at the moment, and would like to do more of?’ 

These questions can sometimes prompt children to create a personalised behaviour change plan. Continuing to explore their ideas (before you share yours) is key in this process.

Ask:

“What else might help you become and stay more active?’

Did you know?

Particularly for older girls, body image concerns can reduce levels of physical activity. Enquiry and support about these concerns may facilitate future engagement in exercise.

Stopping exercise if it feels too difficult or you are too tired that day is ok. Freedom to reduce or stop the activity without consequence is important for building engagement.

Paternal Physical activity is one of the strongest predictors for physical activity in adolescents. So if parents exercise too there are benefits for themselves and the while family.

Real impact

You will get bad days. Try again tomorrow

Be realistic about what you can achieve and don’t be hard on yourself if you don’t always manage to fit exercise in when planned or if you’re exercise session doesn’t always go as well as you’d like!

Consider using mobile applications to increase your physical activity levels. Some apps can make use of augmented reality for an extra dose of fun!

Summarise without adding anything

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If it’s OK, can I go through what we have been talking about just now?

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“Let’s pause for a second, to make sure I’m getting everything you have said.”

Insight

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Don’t be tempted to impose your own plan at this stage – kids easily fatigue and can become bored with too much conversation and may agree with you just to end the conversation. Summarise the main points of the conversation and find out what they are thinking. Consider adding breaks at this juncture in the conversation to help them refocus and engage if they are less interactive at this point.

This may sound something like: ‘Some of the things that being active would help you are X, Y and Z. You would like to do more of X and that’s where being more active may help’.

Using a summary can be a good way to demonstrate and express empathy, and allows both the child and caregivers know you are seeing the world from their perspective.

Did you know?

If you find exercise really hard, exercising at your preferred intensity and choosing activities you enjoy improves engagement whilst still helping to improve symptoms of depression.

It is easier to get moving when the whole family is involved, so look for activities that everyone will enjoy!

Children and young people (5-18) should do at least 60 minutes of physical activity spread throughout the day that leaves them slightly out of breath (moderate-to-vigorous intensity).

Real impact

Physical Activity can help you make new friends through shared interests or joining new clubs in or outside of school

There are lots of different ways to exercise; individually, with friends or a group, playing sport on your own or as a team, in public or at home. Online videos can be a useful for home exercise.

Look at people you look up to for inspiration whether that be athletes, musicians, or actors

Ask the key question

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What do you think you might try out/do next?

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“Getting more active doesn’t always have to be a chore. What are some things you all could do together to become more active as a family/together – that would be fun for all of you?”

THEN move on to planning. Continue to keep the focus on them generating their own ideas for change, rather than telling and instructing. People are much more likely to make successful changes if they develop their own plans.

Insight

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The child and the parents have heard about the benefits of physical activity for someone like them and they have had the chance to consider the benefits they would most like to experience. They have heard their ideas spoken back to them, which can help to reinforce them. Now it’s decision time.

Asking an open question ‘what do you think you will do?’ rather than a closed question, such as ‘are you going to do physical activity?’ helps remind them that they – not you – are the decision maker.

Did you know?

If you find exercise really hard, exercising at your preferred intensity and choosing activities you enjoy improves engagement whilst still helping to improve symptoms of depression.

It is easier to get moving when the whole family is involved, so look for activities that everyone will enjoy!

Children and young people (5-18) should do at least 60 minutes of physical activity spread throughout the day that leaves them slightly out of breath (moderate-to-vigorous intensity).

Real impact

Physical Activity can help you make new friends through shared interests or joining new clubs in or outside of school

There are lots of different ways to exercise; individually, with friends or a group, playing sport on your own or as a team, in public or at home. Online videos can be a useful for home exercise.

Look at people you look up to for inspiration whether that be athletes, musicians, or actors

Explore opportunities in daily routine

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How do you think you might get started?

Build activity into everyday life
Help in the garden
Help with housework
Carrying the shopping home
MM-Icons-Stand during advert breaks Doing 10 star jumps during the advert breaks
Helping to walk the dog
Cycling
Walk
Public Transport
Scooter
Walk up the stairs
PE Lessons
Join a club
Stand up when you’re chatting to your friends during break/lunch
Swimming
Exercise class
Throwing ball in the park
Playing in the park with friends
Going to sports class/lessons
Dance

Signpost the activity finder to explore local opportunities

Insight

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Useful questions to ask may include:

● What things do you think you would enjoy doing?
● What’s the easiest thing you might do?
● What kind of help might you need?
● Who might you do that with?

You may need to give some information here – about starting slow and building up, stopping if they notice any particular symptoms, etc.
Reflect back and expand on relevant points from your earlier discussion.

Did you know?

New exercises can feel difficult and unappealing but if you can stick with it, it will become achievable and enjoyable.

It doesn’t matter what activity you do from dancing in your room to going to the gym, every movement counts.  Do something you enjoy and its always more fun with getting friends and family involved!

Being active in childhood builds the foundation for an active adult life.

Real impact

Psychologically, it helps to have a goal to aim for. This helps motivation turn into habit. That goal could be to get fitter, learn a new skill or how about raising money for a charity?

There are lots of different ways to exercise; individually, with friends or a group, playing sport on your own or as a team, in public or at home. Online videos can be a useful for home exercise.

When I dance it makes me smile

Agree a plan

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There are some things that some, but not all children and parents find helpful when making a plan. Can I share with you some of these with you now and you both can let me know what sounds most interesting to do next?
We could also discuss your plan using new ideas too! Not everything works for everyone – and you both have great ideas!

If they agree, ask them which of these might suit them

Share the relevant resource from the list below with your patient

Activity Wheel

Children can pick an activities which they would like to do and brings an element of fun when choosing what to do. This can be done spontaneously and with the family.

Idea Board

This allows children to be creative and chose what activities that they may have seen on TV or in a magazine and bring them to life.

Reward Chart

The reward chart provides aprogress incentive for children to use with the support of their parents/guardians. When an activity is achieved a smiley face can be drawn or sticker will be received in the appropriate box.

Insight

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At this stage it is important to engage parents when making a plan, as they will need to facilitate any physical activity which occurs. There is not strong evidence around the following in children and a lot of this will have to actioned by parents.

Did you know?

New exercises can feel difficult and unappealing but if you can stick with it, it will become achievable and enjoyable.

It doesn’t matter what activity you do from dancing in your room to going to the gym, every movement counts.  Do something you enjoy and its always more fun with getting friends and family involved!

Being active in childhood builds the foundation for an active adult life.

Real impact

Psychologically, it helps to have a goal to aim for. This helps motivation turn into habit. That goal could be to get fitter, learn a new skill or how about raising money for a charity?

There are lots of different ways to exercise; individually, with friends or a group, playing sport on your own or as a team, in public or at home. Online videos can be a useful for home exercise.

When I dance it makes me smile

Troubleshoot

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What might get in the way of fitting these plans in next week?

Insight

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The pathway to successful behaviour change is seldom straightforward and especially for children who have not tried new changes before. Parents also may be hesitant to change or re-try activities they have been less successful in before. It is important to recognise, anticipate and prepare for setbacks and identify the individuals in both the child and parent’s life who will be able to support them through difficult periods. There is always more than one path to each destination and it is important to get support along the journey of change by encouraging conversations tailored to the possible obstacles to success, and ways around potential barriers can be helpful during the planning phase.

Did you know?

New exercises can feel difficult and unappealing but if you can stick with it, it will become achievable and enjoyable.

It doesn’t matter what activity you do from dancing in your room to going to the gym, every movement counts.  Do something you enjoy and its always more fun with getting friends and family involved!

Being active in childhood builds the foundation for an active adult life.

Real impact

Psychologically, it helps to have a goal to aim for. This helps motivation turn into habit. That goal could be to get fitter, learn a new skill or how about raising money for a charity?

There are lots of different ways to exercise; individually, with friends or a group, playing sport on your own or as a team, in public or at home. Online videos can be a useful for home exercise.

When I dance it makes me smile

Arrange follow up

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Would you like to come back and talk to someone a little more about this and tell us about all the fun things you have been getting up to?

Insight

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Ongoing support is a key factor of successful behavioural change.

Useful things to organise for people with mental health issues may include:

  • A follow up appointment with you or a colleague
  • Onward signposting

Signpost the patient information section, which contains links to physical activity opportunities regionally.

Did you know?

Exercise promotes brain development and cognitive function

Every type of movement counts as physical activity. It doesn’t matter what it is as long as you enjoy it and can do it for as long as you can. All physical activity counts towards moving more.

More active children have better psychological and physical health than less active children.

Real impact

Don’t forget to tell yourself well done!

Be realistic about what you can achieve and don’t be hard on yourself if you don’t always manage to fit exercise in when planned or if you’re exercise session doesn’t always go as well as you’d like!

Psychologically, it helps to have a goal to aim for. This helps motivation turn into habit. That goal could be to get fitter, learn a new skill or how about raising money for a charity?

Signpost support organisations

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We can also give some information which you can provide to your school, any clubs you might be interested in joining or any other family members so they can understand your condition a little more, and how being active can help

Support organisations
Mind

Mind, a national mental health charity, offer a programme to help people with mental health issues get active through specially designed physical activity projects.

Young Minds

There are free publications to download about various mental health issues from school problems to mental illness in families. There is a guide to the NHS’s Child and Adolescent Mental Health Services (CAMHS) and a Parents Helpline.

The YoungMinds resources library is full of useful toolkits, publications, reports and policy information about children and young people’s mental health

Also part of Young Minds is their sport for charity work which promotes activities for fundraising and have events that are planned and everyone can join in.

Childline

Childline is a free, confidential counselling service for children and young people for anybody under 19 years old, where anything can be discussed. They can be contacted by phone and email anytime, day and night. Childline doesn’t show up on the phone bill. A counsellor can also be contacted through a British Sign Language (BSL) interpreter.

The website also contains useful information ranging from advice about stress to bullying and abuse.

Insight

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Did you know?

Exercise promotes brain development and cognitive function

Every type of movement counts as physical activity. It doesn’t matter what it is as long as you enjoy it and can do it for as long as you can. All physical activity counts towards moving more.

More active children have better psychological and physical health than less active children.

Real impact

Don’t forget to tell yourself well done!

Be realistic about what you can achieve and don’t be hard on yourself if you don’t always manage to fit exercise in when planned or if you’re exercise session doesn’t always go as well as you’d like!

Psychologically, it helps to have a goal to aim for. This helps motivation turn into habit. That goal could be to get fitter, learn a new skill or how about raising money for a charity?