Exercise for Kelly Barton used to consist of walking circuits around the school playground, touching the wall and the fence for guidance. Born blind, she attended a special school for children with sensory impairments in Liverpool. Running was not under consideration. As an adult, she had tried the gym, and had a go at CrossFit, but felt isolated. ‘When you can’t see, you’re reliant on people coming over to you to say hello and maybe remind you that you were in the last class with them,’ she says. ‘You only know what’s immediately around you. Everything else has to come to you a little.’ At one gym class, the group would go outside for a warm-up jog beforehand and leave Kelly to wait on her own for them to come back.
In 2016 she went to see her GP, Simon Tobin, about her asthma, and mentioned her frustrations with trying to get a bit fitter as she approached 40. Dr Tobin not only told her about parkrun, he arranged to collect her at home, drive her to the Southport event and act as her guide during the 5k run. ‘I had just completed a course in learning how to be a guide runner and was desperate for someone to practise on,’ he says. Kelly had never run outdoors before – only used a treadmill, holding on to the sides.
That first time, she walked more than she ran, but Simon did his best to give her as full an experience as possible. He gave her the information she needed – ‘left’, ‘right’, ‘hill’, ‘tree roots underfoot’, what percentage of the route she had completed – but also described the scene as a whole. Who’s going past? What are they wearing? What’s that over there? He made her laugh. ‘We kept having to stop and walk because her breath would go.’ he says, ‘In hindsight, that was less about her fitness and more about all these sensations hitting her really quickly: the wind, the noise, the dogs, the kids. Once she was able to calm her breathing a bit, she finished it in about 45 minutes.’
After that, the same thing happened to Kelly that happens to most parkrunners: she wanted to do it again, and faster. Simon introduced her to his friend Mike Leatherbarrow. Mike had been a volunteer at the Paralympics in London 2012, which inspired him to keep trying to do something beneficial in that area. He trained to be a guide runner after that. With Mike’s help, Kelly came to the next 12 Southport parkruns in a row, setting a new PB every time. They started going out for runs away from parkrun too, eventually building the stamina to take on multiple Great North Runs and two London Marathons. More importantly though, last year Kelly and Mike got married.
‘I think it was about two and a half years before we actually got together,’ Kelly reflects. ‘He was a bit slow on the uptake!’
When you think about the potential outcome of a visit to your GP, you’re probably picturing a prescription for pills of one kind or another, not a marriage certificate. Simon’s eventual effect on Kelly’s life was of course far bigger than he could have imagined, but she’s far from the only patient he has sent parkrun’s way. He estimates that by now he’s recommended the free activity to around 200 others. This is one aspect of what’s known as social prescribing – a relatively new branch of our health service that recognises that medicine is only one way of helping people to feel better.
Kelly explains the change in her mental health that resulted from becoming a runner: ‘I used to be quite an anxious person. Exercise has made me feel a lot more confident,’ she says. ‘Nowadays I don’t really worry about too much. I’ll give anything a go. I just think: “I’ve run a marathon, so how hard can this be?”’
Simon also tells me about another of his patients, Eileen, who had moved to Southport with a young child after fleeing a bad marriage, and had been seeing him for years about
a combination of depression, anxiety, low self esteem and a tendency to drink when things got bad. Again, he got her to the parkrun startline. ‘She said she felt like a superstar when the volunteers cheered her in to the finish,’ he says. Eileen, too, eventually gained the confidence to move up to 10k races and the Great North Run, and also to join a charity trip to Malawi that she had previously turned down because she thought she would get in the way.
Parkrun’s official mission statement is: ‘To transform health & happiness by empowering people to come together, to be active, social and outdoors.’It’s not just about the exercise. People could run on their own if they could muster the motivation. It’s the combination of physical activity and social activity that, sometimes more than medication, has a significant impact on people’s mental and physical health.
Simon expresses enthusiasm for the fact that his local parkrun has an average finish time that is relatively slow, and getting slower, because it means that they’re reaching the people who probably wouldn’t go running without it – the older members of the community, the walkers, the less fit. Also among parkrun’s core principles is: ‘Targeting and supporting the people and communities who find it hardest to participate and have most to benefit.’ Walking is increasingly encouraged.
A report for Citizen’s Advice in 2015 found that GPs were spending about a fifth of their time dealing with issues that are not primarily about health, such as relationships, housing, unemployment, isolation and loneliness. The core idea of social prescribing is to ask ‘What matters to you?’ instead of ‘What’s the matter with you?’ Wendy Robinson, the Director of Services at CALM – the suicide prevention charity Campaign Against Living Miserably – says that this kind of holistic thinking is great for overall health. ‘We can’t think about mental health as a personal failing. Things that happen in your wider environment are going to affect it, and It is a shared social responsibility that we’re all well,’ she says. ‘The good thing about social prescribing is it’s actually empowering of people. It’s saying, “People need people.” It takes a team. It takes a tribe.’
It works by connecting you with a ‘link worker’, who isn’t a medical professional but who can talk to you about your needs and your interests and even accompany you to suitable activities. As well as sports, they’re likely to be connected to groups that do art, gardening, volunteering or cookery, and they can usually work with somebody for a number of weeks or months to help to build confidence.
Among the pioneers of this work are the Bromley by Bow Centre in east London, a community centre that set up its own GP practice and has been trying to help with the social issues that can affect people’s health since the late Nineties. They plug their service with the slogan: ‘Your doctor isn’t the only person who can help you feel better.’ There’s also the James Wigg Group Practice in Kentish Town, north London, which has its own garden for growing fruit and vegetables, weekly dance classes and cycle maintenance workshops. In 2018, when Theresa May was Prime Minister, she and her Health Secretary Matt Hancock picked the Practice as the venue to announce billions in new NHS funding for community healthcare. ‘Many of us might assume that hospital is the safest place to be – but in reality many patients would be much better off being cared for in the community,’ she said.
The organisation Ways to Wellness brought social prescribing to 17 GP practices in Newcastle in 2015, and in 2016 the British Society of Lifestyle Medicine was launched as a charity, with the aim of advising its 2,500 members in improving health and wellbeing by supporting people in behaviour change skills and techniques. In 2019 the National Academy for Social Prescribing arrived, with a goal for every community to have link workers, community hubs and trained local connectors by 2026. Dr Michael Dixon, the current Head of the Royal Medical Household (that means he keeps King Charles fighting fit) is also a long-term advocate for social prescribing. He has said: ‘Social prescribing is changing the landscape of health care, where our attention is moving beyond the brick and mortar of hospitals and into peoples’ communities.’
It’s encouraging a much broader look at the ways health can be improved. A 2024 study on ‘green social prescribing’, which followed more than 8,000 people who were directed towards outdoor activities such as nature walks, wild swimming and tree planting, found significant increases in general feelings of happiness and decreases in anxiety. In 2016, Sunderland even had a pilot scheme allowing GPs to prescribe new boilers to patients with respiratory problems. In 2018, parkrun started the ‘parkrun practice initiative’, providing a toolkit of posters, slideshows, videos and certificates to make it as easy as possible for doctors to extol the benefits of a Saturday morning 5k. Around 1,900 have signed up – that’s about a third of practices in the UK. This active parkrun connection with GPs also spread to Ireland in 2020 and Australia in 2022. One of their promotional videos concludes: ‘Prescribe parkrun, not drugs!’
Dr Simon Tobin’s Southport surgery was the first to become a parkrun practice. ‘It’s not about getting runners to do more running. Where it gets exciting is when you can get someone who doesn’t exercise at all to come down and walk, or a walker who walks to mix in some jogging,’ he explains. ‘That’s where you get the real bang for your buck in terms of outcomes with physical and mental health.’
Dr Chris Lutterodt is a GP in Cambridgeshire who joined the British Society of Lifestyle Medicine, where he is part of a Special Interest Group centred on physical activity. In a previous role as a surgeon, he remembers meeting a man who was having some toes amputated due to diabetes, who didn’t understand the role that his diet was having on his vascular problems. ‘That’s when I thought I would like to take a step back from just understanding his toes. How can we empower people in terms of lifestyle education, and focus on trying to fix the root causes?’ he says.
‘There are a lot of issues within General Practice that you can’t fix with a pill,’ he continues. ‘The impact of exercise on mental health is huge, so if I can prescribe a gym membership to someone, it’s really beneficial.’
In 2018, Mark Bellis, a 52-year-old process operator at the Kellogg’s factory in Manchester, experienced what he calls ‘a mini nervous breakdown’. He had lost both of his parents in quick succession, his father through cancer and his mother to Alzheimer’s. He was snapping all the time at his wife and daughters. Formerly a keen cyclist, he lost interest and sold all four of his bikes. He stopped taking sufficient care of his type one diabetes as well, and put on a few stone in weight.
Mark’s wife, who is a nurse, took him to the GP. ‘She actually came into the room with me, to make sure I said something,’ he says. It was suggested that he go along to a Stretford running club called Hard Yards and begin the Couch to 5k programme as part of a group. ‘That first week, I hadn’t done any exercise at all for a good four years,’ he says. ‘I thought I was dying. But I came home with a smile on my face. I’d got that buzz.’
Hard Yards began in 2017 when two mental health nurses were given funding through the NHS to trial running for mental health programmes in the community. The funding eventually stopped but the club carried on. Once Mark had conquered the Couch to 5k he moved on to another running and walking group in Manchester, a registered charity called MileShyClub. He’s now one of their run leaders, did the Manchester Marathon last year and has just completed his first ultramarathon.
Mark’s is a success story, but on the other hand, if you’re struggling mentally, it is undoubtedly much easier to go home and take a pill than to step outside, talk to strangers, do something physically tiring, and commit to all that on a regular basis. ‘We always tell people – and I’ve found this myself – that the hardest part of doing anything, especially if you have low self confidence, is leaving the front door,’ Mark says. ‘The running itself is not the biggest barrier. It’s getting out of the house. But once you’ve done that, the world’s your oyster.’
The NHS is all in on social prescribing. It was a key part of the ‘NHS Long Term Plan’, a 130-page document published in 2019 that set out a path for the health service for the next decade. The Plan stated an aim for around 2.5 million people to benefit from social prescribing by this year. According to the NHS: ‘This is the biggest investment in social prescribing by any national health system and legitimises non-medical community-based activities and holistic support alongside medical treatment as part of a personalised care approach.’
It stems from an official recognition that loneliness is a health issue. In 2023 the World Health Organization declared loneliness to be a ‘pressing global health threat’. The US Surgeon General, Dr Vivek H Murthy, said: ‘The mortality impact of being socially disconnected is similar to that caused by smoking up to 15 cigarettes a day.’ In the UK, the Labour MP Jo Cox was working on launching a commission into loneliness before her murder in 2016. Theresa May paid tribute to Cox when publishing her Government’s official ‘strategy for tackling loneliness’ in 2018: ‘Jo Cox was absolutely right to highlight the critical importance of this growing social injustice which sits alongside childhood obesity and mental wellbeing as one of the greatest public health challenges of our time,’ she said.
In 2021 another Government body, Sport England, published its own 10 year plan, which it called ‘Uniting the Movement’. It set out five ‘big issues’ and said that two of them, ‘connecting communities’ and ‘connecting with health and wellbeing’, can be brought together through social prescribing.
Some influential recent books have also identified social isolation as a health problem. The British journalist Johann Hari included a chapter praising social prescribing in Lost Connections: Uncovering the Real Causes of Depression – and the Unexpected Solutions, and in 2024 the American social scientist Kasley Killam published The Art and Science of Connection: Why Social Health is the Missing Key to Living Longer, Healthier and Happier. She explained: ‘Whereas physical health is about your body and mental health is about your mind, social health is about your relationships.’
By now, all GP practices in England have access to a social prescribing link worker such as Tracey Lilley, a community link officer in Trafford who also leads a walking group with the MileShyClub. She typically begins with a conversation with somebody about their interests. There’s no one-size-fits-all approach. She’s as likely to direct a person towards chair yoga or a knitting group as walking, and she recognises that running can be an intimidating idea for many who need this kind of help. The most important and beneficial thing, as her job title says, is linking them with a wider community of people.
To that end, a significant part of her role involves helping them to overcome any barriers that may be preventing them from getting out there. ‘I’ll go along with them to start with, because the first time is the hardest,’ she says. ‘I might help them to get registered for a travel pass or the Ring & Ride minibus service. I’ll also set them up on a WhatsApp group before they come. We have some people who haven’t actually come to the walking group yet, because of confidence, but they’re connecting through WhatsApp and eventually will turn up.’
At Manchester’s MileShyClub, a walker might gain the confidence to join the runners because the two tribes join together for other social events. When I talk to Tracey, they’ve just been out for an evening of stargazing.
Mark Landsborough, from south Manchester, is someone who’s currently benefitting from some prescribed groups, though due to spinal stenosis, walking is the extent of his physical exertions for now. After a traumatic childhood he struggled with addictions from the age of about 15. When he was 54, he was made redundant from a job in supply chain admin at Kellogg’s, where he had worked since his late teens. ‘It was a body blow,’ he says. ‘My self esteem went because I wasn’t doing anything constructive. I was just sat at home with the curtains closed, basically waiting to die.’
Now 63, things are finally looking up. ‘In the past I’ve tried to do something about it, but off my own back, which is very, very difficult,’ he says. ‘Also it’s very difficult to ask other people for help. In some ways that can feel like a bit of a stigma.’ As well as walking groups, he’s now going to a social group for recovering addicts, and has joined a nature conservation charity where he’s been helping to make fences out of willow. ‘I can still be lonely, but I’m looking at my diary now and I’ve got something to look forward to every single day. I’ve joined Slimming World. I just gave up smoking. I feel so much better.’
In 2023, a Dutch research paper published in the Journal of Affective Disorders asked whether running was as effective as antidepressants in combatting depression and anxiety. The study gave either medication or at least two weekly 45-minute sessions of group-based running therapy to a group of 141 adults who already had a diagnosed depressive disorder or anxiety disorder. After 16 weeks, a similar percentage of the medication group and the running group (45 and 43% respectively) were no longer diagnosable with depression or anxiety.
Good news for runners, but there were some caveats: even though the eventual outcome was similar, the antidepressants took effect more quickly. Also it was easier for those on the pills to see out the course. Just 52% of the runners got through the full 16 weeks. Sarah Croft, the social prescribing lead at Portsmouth’s Island City Practice, says that there are a range of additional barriers that can prevent the people she works with from taking up the offer of a fitness group. ‘About 60 per cent of our referrals are for low mental health, and the stem of that could be a wide range of factors,’ she says. ‘It could be to do with domestic violence, it could be poverty-driven, housing-driven, not being able to find work. We get a lot of social deprivation here. I spoke to a young lady this morning whose partner has just been sent to prison. There is a running group but it’s quite far from the city centre, so there will be barriers to affording the travel and also affording the time, because even if they could get a bus there, it might be 45 minutes there and 45 minutes back for a half hour run. It is difficult to get people motivated to do that.’
For Dr Chris Lutterodt, exercise might not be his first suggestion, but it can come up further along in the process. ‘It’s all about the right timing,’ he explains. ‘If someone is severely depressed and struggling to leave the house, they’re not likely to be excited about getting outside and moving. But if I see them again at a later stage and see a change in mood and motivation, that’s when I can broach the topic of exercise.’ Sarah Croft says something similar: ‘There are patients who don’t want medication, who say: “I don’t want to be on antidepressants.” These are the people who are slightly easier to motivate to do something.’
The stories I hear from all the people I speak to for this article are invariably inspiring, but because mental health can have so many competing contributing factors compared to a physical ailment, it can be harder to say definitively that social prescribing works. A study by the University of Westminster in 2019 asked ‘What does successful social prescribing look like?’ and concluded that because it ‘operates in a complex interconnected way’, its holistic approach makes it tough to measure specific outcomes. In 2022, in an Irish systematic review of eight studies of social prescribing programmes – five from the UK and three from the US – the authors concluded: ‘Social prescribing is designed to be different depending on the needs of the person and the resources in the local area, so determining if it works or doesn’t work on a larger scale is difficult.’ In the journal Frontiers in Medicine in 2023, a large review of social prescribing outcomes across 13 countries found that the most commonly reported improvement was to ‘overall wellbeing’ – as vague as it gets. And a report in the British Medical Journal in the same year argued that it is still ‘too early to judge if social prescribing link workers have produced sufficient benefits and warrant further NHS investment.’
The National Academy for Social Prescribing insists that SP is great value for money, delivering ‘between £2.14 and £8.56 in social and economic value’ for every £1 invested, but also admits that ‘More research is needed to access better data and demonstrate benefits more clearly.’ From the front line, Sarah Croft says that although social prescribers are currently funded centrally by the NHS, ‘I don’t think there’s any question that practices would continue funding us if they needed to pay for us in-house, because social prescribing takes so much pressure off the doctors.’
What’s next? In April 2024 a new GP contract continued to prioritise social prescribing, as it had over the previous 5 year block. Meanwhile Sport England has been funding research into the effects of combining NHS talking therapies with physical activity. There have been calls for this kind of work to be more focused on the needs of younger people, with the children’s charity Barnado’s publishing a report in 2023 pointing out that it can take so long to get help through CAMHS (Child and Adolescent Mental Heath Services), and that social prescribing could help in the meantime. University College London’s Social Biobehavioural Research Group is researching what it calls ‘Wellbeing While Waiting’ for young people with mental health issues in 10 NHS sites across England.
The academic studies will continue, but for Dr Simon Tobin, it’s very obvious that prescribing physical exercise combined with social interactions will help almost anyone who crosses his threshold. ‘I’ll flog parkrun to anybody that will listen!’ he says. ‘There are almost no conditions that aren’t improved by physical activity. Many of the people I see with anxiety, stress and depression, the problem isn’t a chemical imbalance in their brain. It’s often adverse life stuff: difficult childhood experiences, current stressful events, money worries, job stress, stress at home, relationships breaking down. As a GP, I feel we need to be to think more about whether just prescribing more and more pills is the answer to a problem. You know, pills don’t change those kinds of issues. What changes them is time, and support, and relationships with other people.’
As Wendy Robinson from CALM said earlier: ‘People need people.’ We’re social animals. Running, and other exercise, has clear mental as well as physical benefits. And when you can do it with others – that’s when it really is good medicine.
