Researchers say that people experiencing homelessness and addiction should not be excluded from exercise interventions

Research tells us that people who are homeless generally have poor health and premature aging compared to the general population and have traditionally been excluded from mainstream health promotion services.

A new study from a multi-disciplinary team of researchers at Trinity College Dublin has explored the feasibility of an exercise intervention with protein supplementation to target physical functioning and frailty in people experiencing homelessness and addiction. It is the first study of its kind, and published in the journal PLOS One.

Physical rehabilitation programs can target problems such as decreased fitness and strength, which are common, but how these programs work in practice for people who are socially excluded is not understood.

This unique study set out to find out if an exercise program for people experiencing homelessness would work well in practice. A flexibly designed 16-week ‘drop-in’ exercise program with protein supplementation took place in Merchants Quay Ireland (MQI) in Dublin City Center.

Participants were using services in MQI, with almost 70% currently homeless and the remaining participants were vulnerably housed or had a history of homelessness and almost half reported to have a substance abuse disorder.

The program feasibility was evaluated by recruitment and retention rates, adherence to the exercise sessions and protein supplement, adverse effects, program feedback and characteristics of non-returners, sporadic and frequent attenders. The secondary aim was to evaluate changes in outcomes of grip strength, muscle mass, lower extremity physical function, pain, frailty, and risk of malnutrition.

Findings and recommendations

• Prior to program engagement, most participants had poor strength and low physical activity levels.
• A targeted exercise program was safe, feasible and positively received by people who are homeless, with a proportion returning frequently.
• This group do value and engage with health-promoting services when they are designed in a way which makes them accessible. Health promoting services such as exercise programs should be available and offered to those experiencing homelessness and can have a positive ripple effect in terms of outcomes.
• Almost half returned, and that a proportion who were older, female and were more stable in addiction returned frequently and engaged very positively with the program.
• There was a low return rate from people who were experiencing more active addiction issues. Although the program should be offered to all, researchers recommend that people who are homeless require their immediate needs to be looked after, including stability in housing, before they can engage optimally in a health promotion program such as this.
• Researchers believe a more intensive program may be needed to change parameters such as strength and fitness but there were many positive benefits reported by participants such as mental health benefits and better sleep.

Dr. Julie Broderick, discipline of physiotherapy, School of Medicine, Trinity College Dublin and principal investigator, said, “Everyone, regardless of their circumstances, should have an opportunity to improve their physical health by taking part in suitably designed exercise programs.

“We ensured the program was fun and enjoyable, with music playing and as much light-hearted banter as possible. It was a positive focus for participants, and the benefits were far reaching. Anecdotally, it was reported that some participants ‘used’ less substances or started using later in the day, and that engaging in this program was a small positive step as part of their recovery journey.

“If nothing else, exercise can be a positive distraction from daily life struggles and is a behavior to be encouraged where possible.

“Providing a flexibly designed drop-in exercise program in Merchants Quay Ireland meant it was accessible and reduced barriers to entry. Showing how meaningful the program was, one participant said ‘it’s like a free drug’ and another said ‘you feel you have done something for the day.”

The research team has already built on the first program, with a second, more intense program that has already taken place. The team are currently analyzing the results of this program. A specific ‘women’s only’ program for women in homelessness is currently underway.