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Sport and Exercise Sciences, Leisure and Tourism: Improving health of homeless through exercise

Prof Lee Smith

ARU research on the benefits of promoting physical activity among vulnerable groups led two charities to run an exercise intervention which improved health parameters among homeless clients. The intervention won a London Sports Award 2019.

Epidemiological and meta-research techniques showed that positive mental and physical health is associated with regular participation in physical activity, reduction in sedentary time, and improvement in physical functioning.

Individuals who were once homeless have poorer health and are more likely to be physically inactive; health disparities exist even after people transition out of homelessness.

Prof Smith’s research and intervention protocol has improved physical and mental health for over 1,000 homeless people and created jobs in two charities.

Prof Lee Smith

Professor Lee Smith

Lee is an epidemiologist and Professor of Public Health. He researches ways in which we can increase levels of physical activity and reduce sedentary behaviour across the lifespan and within special populations.

Find out more about Prof Lee Smith Explore ARU researchers' original work via our open access repository, ARRO

Research summary

Prof Smith’s meta-review of lifestyle psychiatry supports the use of physical activity in primary prevention and clinical treatment across a spectrum of mental disorders.

Epidemiological analyses demonstrated that a high handgrip strength (a measure of physical functioning) was partially protective against depressive symptoms.

A meta-research analysis concluded that handgrip strength serves as a useful indicator for general health status - it is an effective indicator of early all-cause and cardiovascular mortality.

Epidemiological work demonstrated that some aspects of sedentary behaviour are associated with cognitive decline.

Prof Smith's research focused on the health of older adults who transitioned out of homelessness found that individuals who were once homeless have poorer mental and physical health and are more likely to be physically inactive. This demonstrates that health disparities exist even after people transition out of homelessness.

Altogether, the research demonstrated that promoting physical activity, increasing physical functioning, and reducing sedentary time may improve mental and physical health for particularly vulnerable populations, such as the homeless community.

The Single Homeless Project (SHP) used Prof Smith’s research in a successful funding application to Sport England for over £399,000 to run an exercise/sedentary behaviour reduction intervention. Aimed at improving mental and physical health among the homeless and those at risk of becoming homeless in central London, the target beneficiaries were known to be suffering from mental illness and drug and/or alcohol dependency.

Smith worked on the development, delivery and evaluation of this intervention, which has been undertaken across 24 London boroughs. As a result The Purfleet Trust in King’s Lynn, Norfolk ran a similar intervention with Smith.

  • Participants attended one exercise class per week over 12 months.
  • All exercise sessions were designed to be run by qualified fitness instructors or sport coaches.
  • All sessions were designed to cater for the participants’ needs after conversations with participants and charity leaders at the start and throughout the intervention.
  • Each participant attended the same centre and there was only one type of exercise class at each centre each week. Examples of exercise classes run include yoga, tai chi, aerobics, dance and self-defence/boxing.
  • Each session lasted approximately 2 hours and consisted of:
    • A 30-minute introduction, which allows participants to enjoy refreshments and socialise.
    • A physical activity session lasting a minimum of 30 minutes.
    • Lunch.
A group of people doing Tai Chi outside on some grass

Summary of the impact

  • Homeless clients who participated in the exercise/sedentary behaviour interventions experienced significant positive impacts in their behaviour and physical and mental health
  • The vast majority of participants continued to be active 12 months later
  • These interventions were the springboard to funding for further health initiatives for homeless patrons


As a direct result of the successful Sport England funding bid, three full-time jobs were created at SHP to deliver the intervention.

  • 87% of participants were still active after 12 months, demonstrating sustainability
  • 75% of participants improved mental health outcomes (such as reduced depressive symptoms)
  • Of the clients who were underweight, 80% gained weight through the intervention, with approximately two thirds reaching a healthy body mass index (BMI)
  • Of the clients who were overweight, 27% lost over 10lbs or more
  • Average handgrip strength improved by 2kg in 12 months, demonstrating an improvement in physical functioning
  • The majority of participants’ blood pressure improved from hypertensive to a normal range. s and Emotional Competencies Foundation, Japan Positive Education Association, Schools of Positive Psychology in Japan and Singapore, and Partnership for Children.

As a consequence of this success SHP expanded the intervention to all its 7,000 clients. They secured an additional funding of £7,000 from Transport for London to provide bicycles for homeless patrons to improve their physical activity levels. Prof Smith assisted the charity in writing their application, which was based on his research in relation to active travel, physical activity and health.

The exercise intervention won the Physical Activity for Health Award at the London Sports Awards 2019, a showpiece event that recognises the best of grassroots physical activity and sport across London.

Read more about more about impact generated via single homeless project.

The vast majority of the homeless population in King’s Lynn signed up for the exercise programme. Evaluation results after three months showed:

  • those who were overweight experienced an average reduction in body fat of 3%, with an average increase of 3% in lean muscle mass
  • improvements in other measures of function, such as an average increase in flexibility, of 8cm, as measured by the sit and reach.

As a direct result of the successful intervention, one full-time job has been created at the Purfleet Trust to deliver the exercise intervention and ensure changes remain sustainable over longer terms.

In November 2020 a Horizon 2020 grant of €2.8 million was secured to develop and implement a new cancer prevention and care pathway for the homeless working with The Purfleet Trust as a key stakeholder.

United Nations Sustainable Development Goals

We have mapped our REF 2021 impact case studies against the United Nations' Sustainable Development Goals (SDGs).

The 17 SDGs, adopted by all UN Member States in 2015, are an urgent call for action. They recognise that ending poverty and other deprivations must go hand-in-hand with strategies that improve health and education, reduce inequality, and spur economic growth – all while tackling climate change and working to preserve our oceans and forests.

This case study is mapped to SDG 1: Poverty eradication, target 1.3.

See also

Read the full REF 2021 impact case study for UoA 24: Improving Health of Homeless Through Exercise

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