You can change your life through sports: Physical activity interventions to improve the health and wellbeing of adults experiencing homelessness: a mixed methods systematic review

ObjectivesSystematically synthesise evidence of physical activity interventions for people experiencing homelessness (PEH). DesignMixed-methods systematic review. Data sourcesEMBASE, Web of Science, CINAHL, PubMed (MEDLINE), PsycINFO, SPORTDiscus, and Cochrane Library, searched from inception to October 2022. Eligibility CriteriaPICO framework: Population (quantitative and qualitative studies of PEH from high-income countries); Intervention (physical activity, any setting); Comparison (with/ without comparator); Outcome (any health/wellbeing-related outcome). Results3,614 records screened, generating 17 reports [16 studies, 11 qualitative and 5 quantitative (1 RCT, 3 quasi-experimental, 1 analytical cross-sectional)] from UK, USA, Denmark and Australia, including 539 participants (501 PEH, 38 staff). Interventions: soccer (n= 6), group exercise [indoor (n=3), outdoor (n=5)] and individual activities (n=2). Risk of bias assessed using JBI critical appraisal tools. Mixed methods synthesis identified physical and mental health benefits. Qualitative evidence highlighted benefits carried into wider life, challenges participating and positive impact on addiction. Qualitative and quantitative evidence was aligned for the mental health benefits of outdoor exercise and increase in physical activity from indoor group exercise. Quantitative evidence suggested improved bone health and blood lipid markers. ConclusionDiverse interventions were identified with soccer predominating. Qualitative evidence suggested physical activity can benefit health and wellbeing with positive translation to wider daily life. There was some positive quantitative evidence, although most was inconclusive. Evidence suggests a tentative recommendation for physical activity interventions for PEH, however a limitation is that results may not be transferable outside high-income countries. More high-quality research is required to determine effectiveness and optimal programme design. What is already known?People experiencing homelessness suffer a disproportionally higher burden of physical and mental health conditions than housed populations. Regular physical activity can address many health conditions prevalent amongst people experiencing homelessness. What are the new findings?There is evidence of a variety of physical activity interventions that have been designed and provided to engage people experiencing homelessness (for example: soccer, outdoor and indoor group activities, and individual activities). The synthesis of qualitative and quantitative evidence suggests that physical activity can benefit the mental and physical health of people experiencing homelessness with positive translation of benefits to wider life.