Physical exercise and psychological well-being

Physical exercise and psychological well-being Steve Edwards

Department of Psychology, Zululand University, Private Bag X1001, KwaDlangezwa 3886, South Africa [email protected] This study was contextualised within a public health model of mental health promotion, with psychological well-being conceptualised as the positive component of mental health and physical exercise conceptualised as a subset of physical activities aimed at improving health and well-being. The research investigated the relationship between regular physical exercise over a period of two to six months and psychological well-being in 26 exercisers at health clubs in the Richards Bay area of South Africa. Psychological wellbeing was measured by a Well-being Profile, composed of well-being components of mood, lifestyle, satisfaction with life, sense of coherence, fortitude, stress management, coping and total well-being score. Regular exercise was defined as meeting the criterion of exercising for an average of 30 minutes a day at least three times a week. The main findings were that regular exercise was associated with significant improvements in total well-being score and especially in the well-being components of mood, sense of coherence, fortitude, stress and coping. These findings are discussed in terms of their significance for the promotion of public health in general and mental health in particular. Keywords: exercise; health promotion; mental health; mental health promotion; psychological well-being; physical exercise; public health

Enabled by the positive focus of the World Health Organization’s (WHO, 1946) definition of health as being not only the absence of illness, but also a state of complete physical, mental and social well-being, the public health approach has gained increasing viability as an alternative, complementary approach to the medical model. A health and well-being paradigm in which salutogenesis, fortigenesis and positive psychology have emerged as new perspectives, has begun to answer questions as to the origins of health, strength and well-being (Antonovsky, 1987, 1993; Edwards, 2001a, 2003a, 2003b; Kuhn, 1962; Oldenburg, 2000; Seligman & Csikszentmihalyi, 2000; Strümpfer, 1995; Wissing & van Eeden, 1998, 2002). This new paradigm © Psychological Society of South Africa. All rights reserved. ISSN 0081-2463

South African Journal of Psychology, 36(2) 2006, pp. 357–373.

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re-establishes a balanced view of both illness prevention and health promotion. For example, the salutogenic perspective begins with the commonsense observation that deviance and illness are the norm, life is an ongoing struggle to survive, and complete health, strength and well-being is an unrealisable goal (Pretorius, 1998). In general, well-being can be conceptualised as a positive component of optimal health, and psychological well-being conceptualised as a positive component of mental health. Health and well-being interventions typically involve three strategies of disease and illness treatment, disease and illness prevention, and health and well-being promotion. Following the relative success of modern public health interventions in treating and preventing disease and illness, especially in developed countries, recent years have seen the proliferation of health clubs concerned with the promotion of health and well-being (Corbin & Lindsey, 1997). Such clubs provide opportunities for social support as well as various forms of physical exercise. For example, in an extensive, sociologically orientated study with 401 participants, Hayes and Ross (1986) found that exercise and good physical health improve psychological well-being (as negatively assessed in terms of absence of symptoms of depression and anxiety) through mediation by internal mechanisms rather than through interactions or evaluations by others. While this effect was a general finding, it was more apparent in lower and middle rather than upper income groups. While mental health generally implies some experience of psychological wellbeing, in the context of the present research psychological well-being refers to a particular theoretical and empirical construct, measuring the integration of various psychological components of being well (Edwards, 2002, 2003a, 2003b). This conceptualisation was based on studies by such researchers as Conway and MacLeod (2002); Corbin and Lindsey (1997); Cowen (2000); Pretorius (1998); Repucci, Woolard, and Fried (1999); and Wissing and van Eden (1998, 2002), as well as on the following considerations: firstly, although illness and well-being are typically conceptualised as existing on a continuum, well-being is best considered as an independent dimension, distinct from illness. From the public health perspective, these dimensions are best thought of as reflecting the operation of two different systems concerned with prevention and promotion respectively. As distinct from preventing distressing experiences, well-being research and practice are concerned with the promotion of positive experiences, health, strength, resources, supplies, competencies and skills. Secondly, conceptualisations of psychological well-being in the literature are very diverse, which is understandable when one considers that it is a transient condition, which is multi-factorial in etiology, process and promotion. For example, factors that define psychological well-being will differ at different ages and in different circumstances. Thirdly, psychological well-being has multidimensional personal, transactional and environmental determinants, which become more complex as the human life cycle progresses. Environmental factors also include non-psychological factors such as housing, food and employment. Fourthly, it is better to promote psychological well-being 358

Physical exercise and psychological well-being

than to prevent factors impeding well-being. Fifthly, in as much as there are various conceptual routes to psychological wellness, there are various methods to measure and promote it. For example, Wissing and van Eeden (1998); and Conway and MacLeod (2002) have presented conceptual, empirical, methodological and clinical psychological points of view on the measurement of psychological well-being. Cowen (2000) has put forward competence, empowerment and resilience as exemplar concepts in the promotion of psychological well-being. The focus of the present research is on physical exercise. Physical exercise may be defined as a subset of physical activities that are planned and purposeful attempts to improve health and well-being. The use of exercise as a medium for health promotion is based on international research evidence for the public and mental health benefits of physical activity, exercise and fitness interventions. Research has proliferated on the duration, frequency and intensity of various forms of exercise (Edwards, 2003a, 2003b; Fox, 2000; Hayes & Ross, 1986; Morehouse & Gross, 1977; Morris & Summers, 1995; Scully, Kremer, Meade, Graham, & Dudgeon, 1998; Weinberg & Gould, 1999). For example, in the United States, the American College of Sports Medicine recommended exercise programmes based on findings that, in general, healthy adults receive cardiovascular benefits if they exercise for at least 20 to 30 minutes, three to five times a week at 60% to 90% intensity. Yet despite such health promotion and education, there is evidence that only 15% of American adults participate in such vigorous exercise activity (Weinberg & Gould, 1999). Regular, moderate intensity exercise interventions seem particularly valuable in promoting health and well-being, where the type, intensity and duration of the exercise programmes are tailored to suit the particular exercisers (Berger, 1994, 1996, 2001; Stelter, 1998, 2000, 2001). Studying desirable changes in mood and meaning in exercise programmes, researchers have emphasised regular non-competitive, activity involving rhythmic abdominal breathing of 20 to 30 minutes duration in comfortable, predictable contexts as in Tai Chi, yoga, aerobic exercise and resistance training. Various qualitative and quantitative methods have been used both to describe the experience and what it means for people, and to measure what changes result from it (Berger, 1994, 1996, 2001; Edwards, 2001a, 2001b, 2003b; Stelter, 1998, 2000, 2001). Public health interventions attempting to improve quality of life through increased exercise adherence clearly need to take such personal meanings into account, as well as the learning principle that people will repeat behaviours that are intrinsically rewarding. Many studies have clearly demonstrated the effectiveness of physical exercise in reducing stress, anxiety and depression (Fox, 2000; Morris & Summers, 1995; Scully et al., 1998; Weinberg & Gould, 1999). For example, Sinyor, Schwartz, Peronnet, Brisson, and Seraganian (1983) were able to demonstrate that aerobically trained persons were able to recover faster from experimentally induced psychosocial stress than untrained persons on physiological, biochemical and 359

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psychological measures. Various other physiologically orientated studies have demonstrated similar effects (Anshel, 1996; Scully et al., 1998; Summers, Lustyk, Heitkemper, & Jarret, 1999). Related studies by Roth and Holmes (1985, 1987) have indicated that physical fitness moderates the stress– illness relationship and that increasing fitness, through aerobic training, decreases the experience of stressful life events. This study constitutes an extension of earlier research on psychological well-being and regular exercise in samples of health club members and university students in Zululand, South Africa, in which health club members were found to be more psychologically well than students and, whether they were members of a health club or not, participants who were regular exercisers were found to be more psychologically well than irregular exercisers. Findings provided support for the vital role that health clubs and regular exercise play in the promotion of mental health and well-being (Edwards, 2002, 2003a, 2003b). The aim of the present study was to investigate the longitudinal relationship between regular exercise and psychological well-being, with the hypothesis that regular exercise would be associated with significant improvements in psychological well-being over periods of two to six months as measured on a Wellbeing Profile, which included various components of psychological well-being.

METHOD

A Well-being Profile was constructed from various questionnaires chosen, and in some cases adapted, on the basis of their relationship with the general construct of psychological well-being as conceptualised in this research and as reported in previous research (Edwards, 2002, 2003a, 2003b). Personal communication with South African colleagues Marie Wissing and Tyrone Pretorius was particularly valuable in this respect. The profile takes about ten minutes to complete. The psychological wellness components and their sources were as follows:

Mood

Respondents were required to evaluate their current feelings on a five-point scale with regard to six positive and six negative mood states. Negative moods included feeling anxious, depressed, confused, angry, fatigued and stressed. Positive moods included feeling energetic, confident, happy, healthy, being in control and strong. The scale is an adapted version based on the research of Dean, Whelan, and Meyers (1990); and McNair, Lorr, and Droppleman (1971).

Lifestyle

Respondents were required to affirm or deny seven habits associated with health (Noakes & Granger 1995). These included regular exercise, regular eating, eating breakfast, sleeping, smoking, drinking and being over- or underweight. Regular 360


exercise was defined as occurring at least three times a week for at least 30 minutes a session.

Satisfaction with life

This refers to a 5-item Likert-type scale developed and validated by Diener, Emmons, Larsen, and Griffen (1985). The scale required respondents to make cognitive judgements, rather than affective responses, as to their global satisfaction with their quality of life. In their original validation sample of 176 undergraduates, Diener et al. (1985) obtained a mean score of 23.5 and a standard deviation of 6.43. The test–retest correlation coefficient was 0.82, coefficient alpha was 0.87 and principal axis factor analysis revealed a single factor, which accounted for 66% of the variance.

Sense of coherence

This well-being component was based on 13 items, which were retained after the rigorous psychometric evaluation of Antonovsky’s full 29-item Sense of Coherence scale by Frenz, Carey, and Jorgensen (1993). These items translated into five factors described as comprehensibility, life interest, self-efficacy, interpersonal trust and predictability, with substantial loadings on the core factor labelled ‘sense of coherence’ by Frenz et al. (1993). Earlier research by Antonovsky (1987), which validated this core factor, described sense of coherence in terms of comprehensibility, meaningfulness and manageability subscales, each of which obtained coefficients alpha of 0.8 or higher. Antonovsky (1987) himself defined sense of coherence as: [A] global orientation that expresses the extent to which one has a pervasive, enduring though dynamic feeling of confidence that (a) the stimuli deriving from one’s internal and external environments in the course of life are structured, predictable and explicable; (b) the resources are available to one to meet the demands posed by these stimuli; and (c) these demands are challenges, worthy of investment and engagement (Antonovsky, 1987, p. 19).

Fortitude

The Fortitude scale was developed and standardised in South Africa by Pretorius (1998) and consists of 20 items, reflecting three subscales labelled self-appraisals, family appraisals and support appraisals with coefficient alphas of 0.74, 0.82 and 0.76 respectively, leading to a full-scale coefficient of 0.85. A principal factor analysis with varimax rotation resulted in three factors with eigenvalues greater than unity, which replicated the above-mentioned hypothesised structure of fortitude. The three factors account for 46% of the variance. The inter-correlations between the subscales were all moderate, ranging between 0.38.and 0.48, indicating that the three subscales, though related, were sufficiently independent. The correlations between the subscales and the total scale were relatively high (correlations of 0.72, 0.84, and 0.81 for the self, 361

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family and support subscales respectively), indicating that each subscale contributed significantly to the measurement of fortitude.

Stress and/or stress management

The Holmes and Rahe (1967) social readjustment scale requires respondents to indicate their current experience of stress in terms of commonly occurring life events. In creating the scale, Holmes and Rahe (1967) asked 394 respondents to complete a questionnaire that listed 43 life events drawn from earlier clinical work. Participants rated the extent to which each event would require readjustment in their lives. For example in the 43-item scale, the first rated item, death of a spouse, has a mean value of 100, marriage has 50 and outstanding personal achievement has 28. In the present research, a stress management score was also obtained by subtracting the total stress unit score from an arbitrary ceiling of 100. Persons with more than 100 stress units would score 0 for stress management.

Coping with stress

This component consisted of 15 items reflecting typical reactions to stress which respondents were required to confirm or deny (Turner 1990). For example, a typical question requiring a ‘yes’ or ‘no’ answer was, ‘Do you feel you cannot cope?’

Psychological well-being

Global psychological well-being was operationally defined in terms of a percentage score, derived by dividing the total item score obtained by the maximum possible total (373) of all the well-being components’ items and multiplying by 100. This Well-being Profile was initially administered to a total sample of 216 participants, including 106 health club members in the Zululand region of South Africa and 110 first-year psychology students at Zululand University. The health club sample consisted of 54 men and 52 women. Participants were interviewed and given feedback as to their well-being scores. Counselling was provided where requested. The average age was 30 years, with an age range from 12 to 61. There were 60 English, 21 Afrikaans, 20 isiZulu, 2 siSwati, 1 isiXhosa and 1 Sesotho speakers. The student sample consisted of 24 men and 86 women. The average age was 24 years with an age range from 17 to 47. In terms of home language, there were 1 Xitsonga, 1 isiXhosa, 4 siSwati, Xitsonga and 99 isiZulu speakers. The Well-being Profile was re-administered by the same researcher to 26 health club members, who were still exercising regularly between two and six months after the first administration. (A maximum six-month cut-off date between test and retest had been preplanned to coincide with the six-month study leave period allocated for this research.) This large, expected drop-out rate reflects established international norms of up to 25% of the general population engaging in vigorous exercise and about 50% of 362


participants dropping out of exercise programmes within the first six months (Weinberg & Gould, 1999), as well the irregularity with which exercisers attend health clubs. It was in fact a difficult and time-consuming task to obtain this follow-up data, and it was unfortunately not possible at the time to collect data on a comparative number of drop-outs or irregular exercisers, which would have been ideal as a control group measure. Future research needs to address this limitation. A minimum time period of two months was chosen on the basis of previous studies reporting some exercise effects after five weeks, with the largest effects being observed after ten to fifteen weeks (Roth & Holmes, 1987; Scully et al., 1998). During re-evaluation, participants provided updated information on well-being changes over the past two to sixth months, as well as type, amount, intensity and duration of their regular exercise. The sample consisted of 11 women and 15 men. Their average age was 31.7 years, with an age range from 16 to 52 years. In terms of home language, there were 7 Afrikaans, 15 English and 4 isiZulu speakers. Participants had been attending health clubs for an average of five years and nine months, with a range from two months to twenty years. Although 7 participants were new health club members, 2 of these new members also had previous health club exercise experience. The SPSS statistical programme was used to analyse data. Differences between means of the various well-being components were analysed with t-tests for paired samples. A total stress score rather than the derived stress management score was used for accuracy of measurement. Multiple regression analyses were performed to evaluate if any psychological well-being changes, as measured by pre-and post-test differences in total psychological well-being scores, were predicted by any biographical data, particular health club affiliation, length of membership, years of exercise experience, participants’ estimation of wellness improvement, or the type, amount, duration and intensity of exercise. In the following results, psychological well-being components are abbreviated as follows: mood, lifestyle (life), satisfaction with life (satis), sense of coherence (soc), fortitude (fort), stress, coping (cope) and well-being percentage (% well-being).

RESULTS Quantitative findings

The inter-correlations between the well-being components for the total sample of 216 participants were all positive and low to moderate, ranging between 0.09 and 0.5, indicating that the seven components, though related, were sufficiently independent. The correlations between the well-being components and the total psychological wellbeing score were all significant at the 1% level and had the following values: lifestyle, 0.19; fortitude, 0.50; satisfaction with life, 0.53; mood, 0.54; sense of coherence, 0.54; coping, 0.62; stress management, 0.76. 363

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Regression analysis revealed that all well-being components, with the exception of lifestyle, were significant predictors of total psychological well-being, with stress management being the most significant predictor, followed by fortitude, sense of coherence, satisfaction with life, mood and coping respectively. As a predictor, lifestyle only reached the 6% level of significance. This non-significant finding could be due to a relatively small sample size and the fact that, compared to the other well-being components, most of the lifestyle items are less specifically psychological with their focus on such factors as diet, sleep, alcohol intake, weight and cigarette smoking (Edwards 2003a). Analysis of variance of well-being components of health club members and university students indicated that health club members were significantly more psychologically well than students, especially due to their healthier lifestyle, decreased stress and improved coping. Whether they were members of a health club or not, regular exercisers were significantly more psychologically well than irregular exercisers, particularly with regard to mood, lifestyle and coping (Edwards, 2003b). Regular exercise was defined as meeting the criterion of exercising for an average of thirty minutes a day at least three times per week. Table 1 refers to the pre- and post-test means for well-being of the 26 regular exercising health club members over a range of two to six months. From inspection of Table 1 it is clear that there were significant improvements for the well-being components; mood, sense of coherence, fortitude, stress, coping and well-being percentage. From the means for lifestyle and satisfaction with life, it appears that, at pretest, exercisers were already living very healthily (scoring 6 out of a possible 7) and were already fairly satisfied with their lives (scoring 26 out of a possible 35). From an individual perspective, 24 of the 26 exercisers improved in well-being percentage. The decreased well-being scores of the other two exercisers reflected personal traumas each had incurred over the post-testing period. Table 1. Pre- and post-test means and t statistics for well-being components Mood

Life

Satis

Pretest

33

6.1

25.8

59.9

57.7

99.7

12

61.5

Post-test

36.6

6.3

26.6

65

62.5

60

13.2

71.7

t statistic

2.03*

0.96

Soc

0.99

4.1**

Fort

3.4**

Stress

3.1**

Cope

2.42**

Well-being %

5.4**

* indicates a significant difference at p < 0.05 ** indicates a significant difference at p < 0.01

Table 2 refers to the multiple regression analysis with health club affiliation, length of membership, age, gender, home language, years of exercise experience, participants’ estimation of wellness improvement, and the type, amount, duration and intensity 364


Table 2. Results of the Multiple Regression Analysis Model Summary Model 1

R .530(a)

R Square

Adjusted R square

Std. error of the stimate

.281

-.057

31.38472

ANOVA Model 1

Sum of Squares Regression

df

Mean Square

6544.876

8

818.110

Residual

16745.008

17

985.000

Total

23289.885

25

F

Sig.

.831

.588(a)

Coefficients Model

1

Unstandardised coefficients B

Standardised coefficients Std. Error

(Constant)

141.007

72.672

Health Club

13.148

14.950

Membership status Age

-7.046

t

Sig.

Beta 1.940

0.069

0.214

0.879

0.391

16.413

-0.104

-0.429

0.673

-1.253

0.809

-0.438

-1.548

0.140

Gender

-8.206

19.212

-0.135

-0.427

0.675

Duration

0.446

0.336

0.401

1.328

0.202

Intensity

-10.107

7.025

-0.439

-1.439

0.168

Exercise type Estimate

6.521

6.855

0.308

0.951

0.355

-0.800

0.795

- 0.288

-1.006

0.329

Dependent Variable: Well-being improvement

of exercise as predictors and the criterion dependent variable, well-being improvement, as measured by pre- and post-test differences in total psychological well-being scores This analysis indicated that well-being improvement was not significantly predicted by any of the above independent variables. Thus it could be concluded that the major factor related to the sustained improvement in well-being, as also evident in Table 1, was regular exercise of at least two months’ duration. 365

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Qualitative findings

The following case vignettes were chosen as representative of the sample’s views on exercise and well-being. Mr A was a 25-year-old Afrikaans-speaking man, who had been exercising regularly for six years, visited the health club four days a week, for about an hour to an hour and a half, doing mainly aerobic exercises and weight training at 80% intensity. He described exercise in terms of keeping fit and in shape, and well-being in terms of living a physically and mentally healthy life. He improved in well-being from 53% to 56%, a 3% increase. Mrs E, a 52-year-old English-speaking woman, who had been exercising regularly for twenty years, visited the health club every day for about ninety minutes and mainly exercised aerobically at 70% intensity, as well as doing various other types of exercises. She described exercise in terms of being healthy, strong and making proper use of one’s body. Well-being meant being able to cope with daily challenges – physical, mental and emotional. She improved in well-being from 70% to 83%, a 13 % increase. Mrs Z, a 30-year-old isiZulu-speaking woman, who had been exercising regularly for three months, visited the health club on average four times a week for about thirty to fourty five minutes and exercised, mainly aerobics and circuit training, at about 40% intensity. She described exercise as keeping her body moving and well-being as being physically fit. She improved in well-being from 42% to 58%, a 16% increase.

DISCUSSION

In this study, psychological well-being was conceptualised as a positive component of mental health. Previous research had established that health club members were more mentally healthy and psychologically well than non-members, and that regular exercise, in particular, was associated with psychological well-being (Edwards, 2002, 2003b). The present study extends this earlier study in its findings that continued regular exercise is associated with further improvements in well-being. The findings provide further support for the vital role that health clubs and regular exercise play in the promotion of mental health and well-being. The results support and extend those of other earlier studies on the effect of physical activity on mental health and psychological well-being (Anshel, 1996; Berger, 1994, 1996, 2001; Biddle & Faulkner, 2001; Biddle, Fox, & Boutcher, 2000; Fox, 2000; Hayes & Ross, 1986; Pate, Pratt, & Blair, 1995; Roth & Holmes, 1985; Scully et al., 1998; Sinyor et al., 1983; Stephens, 1988; Summers et al., 1999). Earlier research advocating the validity of the well-being components is also supported in this research (Antonovsky, 1987, 1993; Dean et al., 1990; Diener et al., 1985; Flannery & Flannery, 1990; Frenz et al., 1993; Holmes & Rahe, 1967; McNair et al., 1971; Noakes & Granger, 1995; Pretorius, 1998). Further research using standardised scales of psychological well-being (Ryff, 1989; Ryff & Keyes, 1995) and physical 366


self perception (Fox, 1990) in relation to various forms of sport and exercise is currently in progress. Randolfi (2002) has suggested the following reasons as to why an activity such as exercise, which is sometimes physiologically identical to the physiological response of psychological stress, is helpful as a coping technique: detoxification of stressrelated compounds, outlet for anger and hostility, a form of moving meditation, enhanced feelings of self-esteem and self-efficacy, periodic solitude and introspection, opportunities for social support, the power of human touch, reduction of muscular tension, increased endorphin, increased somatic awareness, training for competition, improvement in sleep and rest, enhanced fitness to fight stress and disease. Previous qualitative research on fitness, mental health promotion and the exercise experience (Edwards, 1999, 2001a, 2001b) also emphasised the above and various other related factors. Discussions with participants in the present study in health clubs particularly pointed to two primary factors, which may be described as ‘feel good’ and social support factors respectively. These factors are known to be related to mental health (Weinberg & Gould, 1999). Psychosocial support acts as a buffer for stressful life events (Sinyor et al., 1983). This research has been limited to a psychosocial perspective on stress, with special reference to the perceptions and experiences of life events, and coping with the stress of such events. Stress itself is an extraordinarily diverse phenomenon with biochemical, physiological, psychological, social and spiritual concomitants with different effects on different people at different times and in different contexts (Lazarus, 1993; Selye, 1976). In view of the many unanswered questions about the stress response, with its extensive physiological and psychological concomitants, Scully et al. (1998) have argued that the role of exercise is probably best described as preventative rather than corrective. The present research provides evidence towards the promotive mental health effects of physical exercise. The lived body is mediator and anchor in the world (Merleau-Ponty, 1962). In dialogue with the world, it is a source of pre-reflective intentionality, meaning and goal- directed behaviour (Stelter, 1998, 2000, 2001). Building on positive past experiences that have been bodily re-experienced as anchors is the phenomenological base for remedial breathing, progressive relaxation, systematic desensitisation, visualisation and imagery used in exercise psychology (Acharya, 2001; Weinberg & Gould, 1999), crisis intervention (Gilliland & James, 1997), solution-focused counselling, multicultural counselling and psychotherapy (Ivey, Ivey, & Simek-Morgan 1997). This implies that researchers and practitioners in the field need to take great care in exploring and explicating various meanings of mental health, physical activity and exercise before, during and after therapeutically focused investigations and interventions. The findings do not exclude sources of well-being, health and strength beyond the physical. They simply provide a further phenomenological perspective on taking care of the human, lived body for such sources of well-being, energy, health and 367

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strength (Edwards, 2001b; Stelter, 1998, 2000, 2001). Earlier research, participant observation and qualitative interviews with health club participants indicated various aspects of the exercise experience and many reasons why people exercise (Edwards, 2001a, 2001b, 2002). Despite the increasing popularity of health clubs by an exercise conscious public, it would be inaccurate to assume that health clubs are typically modern, urban phenomena, patronised by affluent people in developed countries. I have personally observed home-made gyms, with various ingeniously crafted apparatuses, such as weight-lifting equipment made from steel pipes and motor car tyre rims in poor areas of Senegal. The four health clubs in the present study ranged from a small privately owned gym, with broken equipment to an international version, complete with professional instruction, state-of-the-art equipment and modern facilities, such as a heated swimming pool. The results emphasise the importance and value of models of positive health and positive psychology such as those of Edwards (2001a); Seeman (1989); Seligman and Csikszentmihalyi (2000); and Tannahill (2000). Taken together the results also provide further support for the promotion of public health, through regular exercise in general and membership of a health club in particular, for those members of society who are able to afford such membership. Many large companies and institutions have instituted health clubs on their premises in both developed and developing countries. In view of findings as to decreased work absenteeism, and increased productivity and general wellness (Corbin & Lindsey, 1997; Fox, 2000), this trend is likely to continue. Health professionals in general and mental health workers in particular could routinely consider referrals of persons with mental health or stress-related problems to such health clubs as well as recommending regular exercise. The findings extend previous qualitative and quantitative investigations, revealing universal, essential, diverse and contextual aspects of the exercise experience and its community effects (Edwards, 2002, 2003a, 2003b). The findings reflect perennial values, such as the notion of a healthy mind in a healthy body in a healthy community and society, which have been reported in traditional African, Eastern and Western forms of health promotion for millennia (Giatsis, 2001; Madu, Baguma, & Pritz, 1998; Ngubane, 1977; Reid, 2001, 2002; Zervas, 2001). The concept of psychological well-being has much potential value in interventions for promoting health in general and mental health in particular through its positive emphasis on survival, health and strength, through managing stress, coping with crises, and developing resilience, competencies, skills, supplies and resources, such as health clubs and regular exercise.

CONCLUSION

Previous research established that health club members were more psychologically well than non-members and that regular exercise, in particular, was associated with 368


psychological well-being (Edwards, 2002, 2003b). The present study extended earlier research in its findings that continued regular exercise was associated with further improvements in psychological well-being. Discussion has emphasised the vital role that health clubs and regular exercise play as resources for the promotion of mental health and well-being. The specific findings of this research was the relationship between regular physical exercise of at least two months’ duration in health clubs and various components of psychological well-being. The significance of these findings increases when it is considered that as a group, the 26 health club members were mostly already seasoned exercisers. Furthermore, the significant well-being improvement within the group of 26 exercisers was not predicted by any other variables such as particular health club affiliation, length of membership, age, gender, home language, years of exercise experience, estimation of well-being improvement and the type, amount, duration or intensity of exercise. This research was contextualised within a public health model of mental health promotion. Physical exercise was conceptualised as a subset of physical activities that are planned to improve health and well-being, and psychological well-being conceptualised as a positive component of mental health. The research provided empirical evidence for a relationship that has received experiential and cultural recognition for millennia. Physical exercise, particularly of the regular, balanced, moderate, enjoyable type, promotes mental health and well-being. Given the limited percentage of the population engaged in such beneficial physical activity, the crucial challenge remains to find better and more effective ways to promote such knowledge and behaviour for the benefit of all.

ACKNOWLEDGEMENTS

This research was supported by a South African National Research Foundation Grant (Gun Number: 2050348) for the project entitled: ‘Methods of health promotion’.

REFERENCES

Acharya, J. (2001). Workshop: Remedial breathing exercise for relaxation, controlling of emotion and improving concentration for success in sport. In A. Papaioannou, M. Goudas, & Y. Theodorakis (Eds.), In the dawn of the new millennium, Vol. 5 (pp. 26–28). Proceedings of the 10th World Congress of Sport Psychology. May 28 to June 2, Skiathos Greece. Thessaloniki: Christodoulidi. Antonovsky, A. (1987). Unravelling the mystery of health: How people manage stress and stay well. San Francisco: Jossey-Bass. —. (1993). The structure and properties of the Sense of Coherence scale. Social Science and Medicine, 36(6), 725–733. Anshel, M.H. (1996). Effect of chronic aerobic exercise and progressive relaxation on motor performance and affect. Behavioral Medicine, 21(4), 186–197.

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