Objective: To explore the potential impact of exercise and sport training on symptoms of post-traumatic stress disorder (PTSD), depression, anxiety, quality of life, pain, and fitness in male refugees living in a Greek refugee camp. Methods: This investigation was designed as a one group pre-test/post-test study. A total of 45 refugees (Mage = 25.6) participated in the data assessment. All participants were invited to engage in an 8-week exercise and sport intervention. Data were analysed with hierarchical regression analyses. Results: Baseline scores significantly predicted post-intervention scores across all study variables. Regression analyses showed that a higher participation rate predicted fewer anxiety symptoms, better health-related quality of life, higher self-perceived fitness, higher handgrip strength, and better cardiovascular fitness at post-intervention. A non-significant trend was also found for PTSD and depressive symptoms, showing that a higher participation rate was associated with fewer complaints at post-intervention. Conclusions: Among male refugees living in precarious conditions in a Greek refugee camp, frequency of participation in an 8-week exercise and sport training program seemed to have the potential to positively impact refugees’ health. Due to the pre-experimental study design, our results must be interpreted with caution.

Background Due to ongoing political and social conflicts, the number of international refugees has been increasing. Refugees are exposed to severe mental and physical strain, as well as traumatic experiences during their flight. Therefore, the risk of psychiatric disorders is markedly increased among international refugees. International organizations have criticized the lack of early interventions as a key problem, because untreated mental disorders are often difficult to cure at a later stage. Today, exercise and sport have been successfully employed to treat a wide range of psychiatric disorders. With patients with post-traumatic stress disorders (PTSD), very limited empirical evidence exists, and studies carried out with international refugees are nearly non-existent. Methods We intend to implement a pragmatic randomized controlled trial (RCT) with an exercise and sport intervention group (n = 68, 50% women) and a wait-list control group (n = 68, 50% women) in the Koutsochero refugee camp, located close to the city of Larissa (Greece). During the RCT, exercise and sport will be offered five times per week (60 min/session) for 10 weeks. Participants will be asked to participate in at least two sessions per week. The programme is developed according to the participants’ needs and preferences and they will be able to choose between a range of activities. PTSD symptoms will serve as primary outcome, and several secondary outcomes will be assessed. Qualitative data collection methods will be used to gain a more in-depth appraisal of the participants’ perception of the intervention programme. In the second year of study, the programme will be opened to all camp residents. A strategy will be developed how the programme can be continued after the end of the funding period, and how the programme can be scaled up beyond the borders of the Koutsochero camp. Discussion By moving towards the primary prevention of chronic physical conditions and psychiatric disorders, a relevant contribution can be done to enhance the quality and quantity of life of refugee camp residents in Greece. Our findings may also strengthen the evidence for exercise as medicine as a holistic care option in refugee camps, by helping camp residents to adopt and maintain a physically active lifestyle. Trial registration The study was registered prospectively on the 8 February 2021 with ISRCTN https://www.isrctn.com/ISRCTN16291983

BackgroundForcibly displaced people face various challenges and are therefore at higher risk of being affected by mental and physiological distress. The present study aimed to determine levels of psychological well-being, PTSD symptom severity, metabolic syndrome, and associated factors among forcibly displaced people in Greece in response to WHO’s call for evidence-based public health policies and programs for forcibly displaced people.MethodsWe conducted a cross-sectional study among n = 150 (50% women) forcibly displaced people originating from Sub-Sahara Africa and Southwest Asia living in a Greek refugee camp. Self-report questionnaires were used to assess psychological well-being, symptoms of PTSD, depression, generalized anxiety disorder and insomnia, perceived stress, headache, and perceived fitness. Cardiovascular risk markers were assessed to determine metabolic syndrome, and cardiorespiratory fitness was measured with the Åstrand-Rhyming Test of Maximal Oxygen Uptake.ResultsThe prevalence of mental distress and physiological disorders was overall elevated. Only 53.0% of participants rated their psychological well-being as high. Altogether, 35.3% scored above the clinical cut-off for PTSD, 33.3% for depression, 27.9% for generalized anxiety disorder, and 33.8% for insomnia. One in four (28.8%) participants met criteria for metabolic syndrome. While the prevalence of moderate or severe insomnia symptoms and metabolic syndrome differed little from the global population, the risk of being affected by mental distress was markedly increased. In multivariable analysis, higher perceived fitness was associated with higher psychological well-being (OR = 1.35, p = 0.003) and a decreased likelihood for metabolic syndrome (OR = 0.80, p = 0.031). Participants with elevated psychiatric symptoms were less likely to report high psychological well-being (OR = 0.22, p = 0.003) and had increased odds for higher PTSD severity (OR = 3.27, p = 0.034). Increased stress perception was associated with higher PTSD symptoms (OR = 1.13, p = 0.002).ConclusionThere is an elevated risk for mental distress compared to the global population and an overall high mental and physiological burden among people living in a Greek refugee camp. The findings underpin the call for urgent action. Policies should aim to reduce post-migration stressors and address mental health and non-communicable diseases by various programs. Sport and exercise interventions may be a favorable add-on, given that perceived fitness is associated with both mental and physiological health benefits.

Objective Refugees have a particularly high prevalence of psychopathological disorders. Despite this, little attention has been paid to the treatment of traumatized refugees, and research on the effects of exercise and sport among refugees is still in its infancy. Thus far, no randomized controlled trials have been carried out in a refugee camp setting, most likely because such trials are complicated by multiple organizational and methodological issues. We highlight some major challenges when carrying out experimental research in a refugee camp. Method This report of professional practice is based on systematic observations, individual and focus group interviews, and experiences made in a pre-experimental study, implemented in a refugee camp on the Greek mainland. Results The report provides background information about how refugees generally come to Greece, how transit camps are typically managed, which institutions are involved in the camp management, which rules need to be followed by people working in a camp, which countries refugees generally come from, and the conditions in which they live in the camp. We also identify general factors that complicate experimental research in such a setting, and highlight specific issues pertaining to sport and exercise-based intervention trials. Conclusions Currently, more people are fleeing their home regions than after the end of the Second World War. This situation calls for a change in the understanding of humanitarian aid. Pure material and technical support must be complemented by public health measures, including exercise and sport programs. Researchers who want to enter this field of research can learn important lessons from our observations.

Human made conflicts and natural disasters led to a doubling of forced displacement in the past 10 years (United Nations High Commissioner for Refugees, 2022). Forcibly displaced people are generally challenged with severe mental and physical strains before, during and after their flight. Whereas forcibly displaced people show high levels of resilience (Dangmann et al., 2021), their risk of mental health struggles is markedly increased (Mesa-Vieira et al., 2022). The objective of this study was to explore the perception of regular participation in a co-designed and tailored sport and exercise intervention among adults living in a Greek refugee camp. The methodological approach relied on ethnography including informal discussions and participative observations. Data was collected and documented daily in a research diary over a period of eight months. Additionally, debrief meetings with the coaches (4 women and 4 men) were held regularly. These insights built the basis for a critical understanding and interpretation of 13 focus group discussions (n = 49, 19 women) and 38 self-recorded testimonies (17 women). Focus group discussions were conducted after a 10-week physical activity intervention period. The same participants were asked, after a 10-week follow-up, to provide a self-recorded testimony. Overall, 58 (55.8%) of the participants took part in the physical activities on a regular basis. Regular participation benefitted domains of psychological well-being, social cohesion, personal competencies, change in behavior and physiological health. However, some of the same domains were likewise negatively affected for certain participants, namely social cohesion and physiological health. The results indicate that organized sport and exercise activities have the potential to positively impact the living conditions of adults living in a Greek refugee camp. However, participation is not imperatively beneficial and only a specific target population can be addressed. References Dangmann, C., Solberg, Ø., Myhrene Steffenak, A. K., Høye, S., & Andersen, P. N. (2021). Syrian refugee youth resettled in Norway: Mechanisms of resilience influencing health-related quality of life and mental distress. Frontiers in Public Health, 9, Article 711451. https://doi.org/10.3389/fpubh.2021.711451 Mesa-Vieira, C., Haas, A. D., Buitrago-Garcia, D., Roa-Diaz, Z. M., Minder, B., Gamba, M., Salvador, D., Gomez, D., Lewis, M., Gonzalez-Jaramillo, W. C., Pahud de Mortanges, A., Buttia, C., Muka, T., Trujillo, N., & Franco, O. H. (2022). Mental health of migrants with pre-migration exposure to armed conflict: A systematic review and meta-analysis. The Lancet Public Health, 7(5), e469-e481. https://doi:10.1016/S2468-2667(22)00061-5 United Nations High Commissioner for Refugees. (2022). Global Trends. Forced Displacement in 2021. Retrieved from https://www.unhcr.org/publications/brochures/62a9d1494/global-trends-report-2021.html