By learning to move their bodies in new ways, Canadians with mental health and addiction challenges are rediscovering their strength, resilience, and joy.

Walking in a park. Taking a moment to focus on your breath. Holding a yoga pose. These activities may seem simple — even frivolous. But they are part of a therapeutic approach that is transforming outcomes for people undergoing mental health and/or addiction treatment in Canada.

Recreational therapy improves physical, social, emotional, and cognitive functioning through leisure, recreation, and play. For people with mental health and addiction challenges, recreational therapy not only changes our bodies, but it also changes our brains on a chemical level. The result can be greater self-confidence, self-esteem, social connections, motivation, strength, and a sense of purpose — all of which support treatment and recovery.

The benefits have been proven through extensive research, and in 2016, the World Health Organization (WHO) officially recognized exercise as a proven therapy for mild to moderate depression and anxiety.

“We tend to separate ‘exercise’ from all the other ways we move our bodies, but it’s a continuum, and all movement is valuable.”

Recreational therapy is for everyone

Becoming and staying active isn’t always easy. Only one in five Canadians meet the recommended level of physical activity. People seeking mental health treatment in Canada for issues such as depression, anxiety, PTSD, or addiction often face even greater barriers to adopting an active lifestyle, including negative self-image, low energy, and physical health concerns.

In these cases, a recreational therapist can help the individual to overcome those barriers and incorporate movement and recreation into their mental health treatment options. A recreational therapist is a healthcare professional who helps individuals improve their physical, social, emotional, and cognitive functioning through recreational and leisure activities.

 Chris Seftel, strength and conditioning coach at The Residence at Homewood, an inpatient treatment facility in Guelph, Ontario, says many of his clients mistakenly believe that this type of therapy is only for people who are young and fit.

“I work with a vast range of clients, from high-level athletes to sedentary desk workers, and from people in their twenties to people in their eighties,” says Seftel. “The exercises are tailored to each person’s abilities, needs, and preferences.”

Ronnie Birkland, recreational therapist at Homewood Ravensview, a private inpatient facility on Vancouver Island, British Columbia, agrees that this type of therapy is infinitely adaptable.

“We’re all at different stages in our lives,” he says. “We have different injuries, different backgrounds, and all of these things can make us feel intimidated. My job is to break that down and modify the activities so they don’t feel overwhelmed.”

“There’s a perception that recreational therapy has to be tough or intense, but it doesn’t. It doesn’t need to be hard. It doesn’t need to feel like work.”

How recreational therapy works

Recreational therapy is part of a holistic approach to mental health and addiction treatment. At The Residence at Homewood and and Homewood Ravensview, for example, the recreational therapist is an integral part of an assessment team that also includes an occupational therapist, dietician, nurse practitioner, social worker.

The recreational therapist works closely with the individual to build a foundation of trust, explore recreational options, and build a personalized program designed to deliver immediate and long-term benefits.

Building trust

Building trust between the client and the therapist is a big part of the process. People begin the journey to recovery at a very vulnerable point in their lives, and recreational therapy asks them to take a big leap of faith.

Birkland creates connections with his clients through empathy. “I’ve been through trying times myself,” he says. “I can tell them from my own experience, ‘This is what helped me. This is my blueprint.’ I allow myself to be real and let them feel that they’re in a safe place and that we’re in this together.”

Seftel builds trust with his clients by following a rigorous, evidence-based approach that conforms to recommendations set by organizations including the World Health Organization (WHO), Canadian Network for Mood and Anxiety Treatments (CANMAT), and the Canadian 24-Hour Movement Guidelines. Knowing that his methods are based on credible research reassures people who are putting their recovery in his hands.

Exploring the options

Working with the client one on one, the recreational therapist gets to know them closely — their background, goals, and concerns, the types of activities the client has participated in and enjoyed in the past, and the level of effort the client is willing or able to make as a starting point.

“There’s a perception that exercise has to be tough or intense, but it doesn’t,” says Seftel. “It doesn’t need to be hard. It doesn’t need to feel like work. I try to talk about ‘perceived exertion’ instead of ‘high intensity.’ For someone who has been almost immobile, high-intensity exercise could look like a three-minute walk. And that’s still therapeutic.”

Birkland agrees that the experience should be more uplifting than grueling.

“More often than not, there are things the individual loves to do, but they have not connected with them for years,” Birkland says. “They used to find joy in these activities, but that got taken from them at some point. Rediscovering that joy completes the healing process.”

“I’ve been through trying times myself. I can tell them from my own experience, ‘This is what helped me. This is my blueprint.'”

Creating a program

Seftel and Birkland both focus on designing recreational programs that align with the individual’s interests, preferences, and capabilities. Depending on these considerations, the program could begin with something as gentle as a five-minute walk three times a week or something more physically challenging, including hiking, running, swimming, weight or circuit training, yoga, or pickleball.

Over a period of weeks, the therapist helps the client set and achieve new movement and fitness goals so that they can see tangible progress and experience a sense of achievement.

Following through

Ultimately, the goal is to give the individual the tools they need to make recreation and exercise a permanent part of their lives. That means finding a program that fits their lifestyle, their location, their abilities, and their budget.

“When the 24/7 caregivers, doctors, and therapists aren’t there anymore, when they’re back in ‘real life,’ they have the tools they need to care for themselves and take control of their overall wellbeing,” says Birkland.

“People start to develop some self-compassion. Rather than ruminating on the mistakes they’ve made, they’re focusing on the positive things they’ve done, the things they’ve accomplished.”

The proven impact of recreational therapy

Extensive scientific evidence shows that exercise and movement have a measurable, positive impact on people with conditions such as depression, addiction, anxiety, and post-traumatic stress disorder (PTSD).

People with depression. Aerobic exercise and weightlifting have been shown to be effective in restoring neuroplasticity and reducing the symptoms of major depression. (Neuroplasticity is the ability of the brain to form and reorganize synaptic connections.)

People with addiction. Several studies suggest that exercise participation can reduce cravings, improve withdrawal symptoms, and reduce triggers in heavy cigarette smokers.​

People with anxiety. Studies show that exercise is a viable treatment option for anxiety. Exercise increases the amount of a specific protein called brain-derived neurotrophic factor (BDNF) that protects and repairs the brain and reduces feelings of fear.

People with post-traumatic stress disorder (PTSD). Exercise decreases the activity of the sympathetic nervous system and hypothalamic-pituitary-adrenal (HPA) axis, which affect our physiological reactions to stress, including secondary conditions such as sleep apnea and migraines.

Vigorous exercise can also release natural “feel-good” chemicals such as endorphins and endocannabinoids (eCBs), which create feelings of euphoria (also known as a “runner’s high”). Research suggests that these good feelings can help to support sobriety and stave off or reduce the intensity of depression and anxiety.

Seftel says one of the earliest effects he notices is a change in energy levels for his clients. “People are amazed that after putting in the effort, they actually come away with more energy, not less. It’s this incredible sense of accomplishment.”

For Birkland, it’s the psychological changes that shine through. “People start to develop some self-compassion. Rather than ruminating on the mistakes they’ve made, they’re focusing on the positive things they’ve done, the things they’ve accomplished.”

Recreational therapy: Myths and realities

While modern therapeutic recreation has been in existence since the 1950s, it’s still not widely known in Canada as a treatment for mental health and addiction. Birkland and Seftel say it’s common for clients to feel apprehensive about starting a therapeutic program and exercise because of misinformation about this treatment modality.

These are some of the most common misunderstandings about recreational therapy and exercise.

Myth: Recreational therapy means hitting the gym.

Reality: You can move and improve anywhere. “People think of exercise as spandex and dumbbells and sweat,” Seftel says. “But there are hundreds of ways to incorporate movement into your day. Walk in your neighbourhood. Do yoga in your living room. There’s no wrong way to do it.”

Myth: Only high-intensity exercise is effective.

Reality: Any level of movement is beneficial. “Instead of ‘high intensity,’ I try to talk about ‘perceived exertion,'” says Seftel. “We tend to separate ‘exercise’ from all the other ways we move our bodies, but it’s a continuum, and all movement is valuable. Wherever you currently are is exactly where you need to be for us to start working forward.”

Myth: You need to meet a minimum fitness threshold.

Reality: People of any age or ability can participate. Research shows that people of all ages, abilities, and fitness levels benefit equally from recreational therapy. “There are always those blocks, that inner critic, the judgment inside,” says Birkland. “For so many, if they’re not good at it, they don’t want to try it. Throughout my time with them, I ask the questions that help them break down those barriers.”

“Motion creates motion”

For many people, recreational therapy starts small. But the impact is huge. Research shows that moving our bodies and pushing our physical limits — even just a little — can have a profound effect on our health and resilience. For people coping with mental health and addiction, this treatment can start a cascade of beneficial effects to aid recovery that go far beyond the physical.

“Recreational therapy opens so many doors in terms of the experiences you can have and the communities you can create,” says Seftel. “Movement is such a massive part of our lives, and motion creates motion.”