Transcript – Programme 93: Easy Being Green

Airing Pain al fresco: the benefits of gardening for our physical and mental health, and why, when it comes to green space, size isn’t everything…

To listen to this programme, please click here.

This programme was funded by a grant from The D’Oyly Carte Charitable Trust.

Getting some gentle exercise tops the NHS’ list of ten self-help tips for managing pain, with distraction and communication also playing important roles. In this episode of Airing Pain we see how gardening can help with all three, and the benefit for our minds as well as our bodies.

We talk to Craig Lister and Chris Speirs from The Conservation Volunteers about their community garden project Green Gym, which brings together volunteers in shared green spaces in cities across the UK. One such space is Waterlow Park in London, where Paul chats to volunteers Maddy and Rosie about how the weekly sessions have helped them overcome difficulties including depression, anxiety and chronic pain.

A few miles away from Waterlow Park is the Rheumatology department at Whipps Cross Hospital, where clinical nurse specialist Margaretta Rooney created a garden designed specifically with the needs of patients with arthritis in mind. Raised beds allow people to sit down as they weed, reducing stress on the joints, and a patio means there’s no need for mowing or other heavy equipment.

For fifteen years, volunteers Brian and Josephine have been meeting up each week to help tend to the garden. Brian explains how, thanks to Margaretta, even with arthritis in his hands he still has green fingers and enjoys the social aspect of being out in the fresh air with his friend. Josephine describes the vital role the garden played in managing her chronic pain and depression, and the feeling of giving back to the department and hospital community.

Issues covered in this programme include: Arthritis, arts and crafts, CBT: cognitive behavioural therapy, depression, exercise, gardening, Green Gym, mental health, mindfulness, pancreatitis, Parkinson’s Disease, social therapy, alternative therapies and volunteering.

Paul Evans: This is Airing Pain, a programme brought to you by Pain Concern, the UK charity providing information and support for those of us living with pain, and for health care professionals. I’m Paul Evans, and this edition has been funded by a grant from the D’Oyly Carte Charitable Trust.

Chris Speirs: Some of the greatest biodiversity in the country is actually in the city, about a third of London is covered in green space. A lot of those green spaces are filled with trees, they’re filled with hedgerows, they’re filled with ponds, they’re filled with lakes. Some of our national parks and some of the best natural spaces that we have you could say have a lot lower biodiversity value than some of spaces within a city. It’s really important to have both, and a wide range of different species, but there is so much value in urban ecology.

Paul Evans: In this edition of Airing Pain, I’m going to explore how that value can be extended to those of us living with chronic pain.

Green Gym is a nationwide programme that supports positive changes in the health of participants and the green spaces they create and maintain. It helps to transform people’s health and wellbeing through weekly participation in outdoor activities such as conservation, park management and growing food. Each Green Gym project mobilises community members to work together, and volunteers become physically active while improving their local environment.

Craig Lister is the managing director of Green Gym.

Craig Lister: The Green Gym is effectively the outdoor world, it’s specifically not the equipment you see in parks, we don’t do that. I’m an exercise physiologist by trade and I have a particular interest in evolution, how we evolved. We evolved in the outdoor world for the vast majority of our lifespan, so two or three hundred thousand years, depending on which research you look at, and we became perfectly attuned to living in the outdoors. So muscle is what we call an endocrine organ, it releases different hormones in response to physical activity, temperature changes. We typically function during the day, so the amount of light in our eyes changes brain chemistry and other chemistry. And actually we became so good at living in the outdoor world, amongst all of the species that there are, that we became the world’s dominant species, so clearly we were really, really good at that.

And Green Gym really seeks to take up back into that environment, which is the outdoor world, working in groups, we’re a pack animal and we like to work in groups. We do physical activity so it has a purpose, so we’ll plant trees, create paths, open areas for other people to enjoy. And those things in combination seem to have a very positive impact on health and wellbeing, particularly mental health, depression and anxiety, which in turn tends to have a positive impact on pain.

Maria Schlatter: My name is Maria, I’m the senior project officer for the Camden Green Gym, which is a volunteering programme run by the conservation volunteers. We organise twice weekly sessions, three hours at a time, for anyone who wants to join. It’s open to all ages, all walks of life, and volunteers work in the green spaces in Camden, in the local parks, in community gardens, urban woodlands, and we use the time to improve the biodiversity, to improve access for the public, to make sure that wildlife thrives, that green places are looked after, we pick litter. We try and help Camden Council to keep them in good condition, and in the process volunteers get active, they improve their physical and mental wellbeing and they have a nice sociable time.

Today it’s a special day, we don’t normally work on the tours, it’s a twice yearly event, but we’ve combined that with our summer barbeque, so it’s a social event today as well. Normally we tend to cut back vegetation, build insect hotels or work in the pond, build deadwood hedging, that kind of thing. Lots of different activities.

Paul Evans: Where exactly are we?

Maria Schlatter: We’re in Waterlow Park, which was donated in the 19^th century to become a garden for the gardenless, so it’s a fantastic resource for North London. It’s a really beautiful park, and we work in a couple of nature reserve areas and we also at times support the friends of Waterlow Park.

Paul Evans: It must be a barbeque day because the rain is forecast.

Maria Schlatter: It is, we’ve come prepared, we have two gazebos so hopefully we won’t have to use them, but it’s fine. Our volunteer are very hard because they come out in all weather, they come out in the winter, come rain, shine. I’m still surprised by how dedicated our volunteers are because even when it’s bucketing down a group of them turn up. But the whole idea is to be outdoors, to get exercise, to be connected to nature, to be connected to other people, keep active, which of course is incredibly good for chronic pain relief. It’s very good to keep fit and just being out in nature is incredibly good for your mental wellbeing.

Paul Evans: And the great thing about the outdoors and the garden, is that it’s never finished.

Maria Schlatter: Exactly.

Paul Evans: It’s not as if the course can end after six weeks.

Maria Schlatter: Yes, there are always surprises, there are always lovely things to see. It’s nice for the volunteers to see the work they’ve achieved, and also to see the wildlife, to see the birds, see the insects and see the flowers, and experience the seasons, which is really important I think, especially for people living in cities, often if they don’t have gardens themselves it just really enhances people’s wellbeing.

Craig Lister: My research degree was on community based interventions for chronic low back pain, and there are a number of measures for that, but what I found which as a physiologist was surprising to me in my early years as a physiologist, was that a questionnaire called the fear avoidance belief questionnaire was a better predictor of pain. And that is a psychological questionnaire, and that means I’m not going to do something because I’m fearful it will hurt me, I don’t do it I become less active, I’m less able to support my spine, I’m more likely to feel pain, it’s becomes this self fulfilling prophecy. Obviously there is more to it than that, but in simple terms that’s it.

Whereas my research, and in fact Green Gym is very similar, we get people to do things that are intrinsically interesting and in a group, and so for an amount of time they forget about the pain if you like, and sometimes that’s referred to as the distraction hypothesis. So I’m doing something else that is attracting most of my conscious attention, and then you can look back on what you’ve done, and other people say what a good job you’ve done. And in fact when we were working in London this Saturday other members of the public were coming to say what are you doing, thanks for doing that. And so people think, so you know what I have done something, I do feel better about myself because of that, but actually at the same time, because we operate in a free environment, digging, cutting whatever it may be, we’re building muscle strength and muscle control that protects people from pain in the future.

Rosie Broadley: My name is Rosie Broadley.

Paul Evans: And you have chronic pain?

Rosie Broadley: I have chronic pain on a daily basis. It’s pancreatitis and liver failure, liver failure really messed my body up and I went to less than six stone.

Paul Evans: How long have you been volunteering for Green Gym?

Rosie Broadley: Not this Green Gym, but I’ve been doing it for about six months now. So it’s helping me tone my muscles up, it’s helping me stop focussing on pain the whole time every single day. And people have said that my face has changed since I’ve started, my literal face has changed, I’ve started smiling a little bit more. Feeling chronic pain you know that it’s constant, it’s there with you. The only way that you can get your head away with it is to do something else, take you mind off of it and gardening really does help, I’ve sorted out so many problems whilst I’m cutting the hazel bushes, it’s absolutely, I feel like I’ve had a full blown conversation in my head, and that is helping. Otherwise I’d just be sitting at home watching TV with my dog, and I would be probably doubled over.

This should be given to the doctors, it should be prescribed by the doctors.

Paul Evans: Six months ago if a doctor had said to you, I think you should go gardening, what would you have said?

Rosie Broadley: I’d say I wouldn’t be able to do it, no I don’t know these people, what am I supposed to do, I’ll be all embarrassed. But now it’s like water off a ducks back it’s helped me so much alleviate my pain, even just the walk to going to the Green Gym, knowing that I’m getting up and doing something alleviates it in a certain way.

Paul Evans: Listeners to Airing Pain will know that psychological wellbeing is good, and they psychological therapies, cognitive behavioural therapy, they’re good. It can often be difficult explaining to somebody that you need your head mended, or your brain mended if you like. But recommending physical work when somebody is in pain, that’s another barrier isn’t it?

Craig Lister: It can be yeah, and again that’s perception, you know that, let’s focus on back pain, that medical evidence has changed. Medical evidence used to be go back and rest now, don’t do anything. Which we now know is the worst thing that you can do, so with everything medical evidence advances. But muscle is an endocrine system, it produces lots of different chemicals, a lot of those chemicals are anti inflammatory, or pain reducing, and for a lot of pain the actual pain is caused by inflammation of muscle or tissue pressing on the nerves and that causes the pain. So if you are physically active and you produce these natural products that reduce inflammation that can be one mechanism towards reducing pain.

And another one is increasing stability in all your muscles, so people talk about core stabilisation, sometimes I think that’s a bit faddy, it doesn’t really matter. You do need a strong core, so a simple example is stepping down a step you didn’t know was there, I’m sure we’ve all done that once or twice, and you get that jarring sensation. If your core is strong, and importantly if you are able to recruit your muscles very quickly without knowing that, just doing it very quickly because you’re regularly physically active, you’re much more likely to stabilise yourself very quickly and reduce your pain there. So it may seem counterintuitive, I don’t think it is, that physical activity is good for pain reduction, I just think we’ve been told it is and now we believe that’s true, but I don’t think it ever was true. The only caveat I would put to that is that is has to be appropriate physical activity, which is the right level, and interesting.

Paul Evans: That’s Craig Lister, managing director of Green Gym.

This seems a good time to remind you that whilst we in Pain Concern believe the information and opinions on Airing Pain are accurate and sound based on the best judgements available, you should always consult your health professional on any matter relating to your health and wellbeing. He or she is the only person who knows you and your circumstances and therefore the appropriate action to take on your behalf.

Maddy: My name is Maddie and I used to be a volunteer officer for Green Gym in Camden. I was a VO for two years, I had a period of illness and it helped me get back on my feet and gave me confidence, I then left a year ago and went on to work somewhere else, paid work. So it’s been incredibly helpful for me.

Paul Evans: In what way?

Maddy: I had depression and anxiety, so it really wrecks your confidence, and you get taught here to lead groups and to do the warm up and warm down and tools talk. And it helped me gain confidence really, because I was looking after 15 volunteers. And being outside is just incredible and it’s definitely true you feel more connected if you’re working with nature. And I do feel very passionately about environmental concerns.

Paul Evans: Just explain to me how it helps depression and anxiety.

Maddy: First of all you’re working with other people, and they may also be people who have depression and anxiety, so it’s not anything like, oh god you’re mentally ill. There’s none of that, it’s just like everyone mucks in together. And then there’s also having the connection with nature and using your hands, digging and planting wild meadows and looking after the habitats that we encounter. It made me feel very peaceful, and my anxiety levels went right down.

It’s a really lovely thing to do, and also if you want a change of career and you think you need to have some time and do this, I’ve seen a lot of people come through the Green Gym who have decided that they want to change their careers and they weren’t sure what to do. And then they do go into environmental charities or gardening even.

Craig Lister: In the NHS and public health there’s a phrase which is no health without mental health. So I could be apparently well, apparently without a disease, but really in quite a poor place, and in fact if you look at the World Health Organisation’s acceptance of health and wellbeing it’s a complete state of health and wellbeing. And certainly I know many people, including my father who has parkinsons is otherwise reasonably well but sometimes can be challenged. He has processes to overcome that, and in fact is a volunteer at Hampton Court Palace, he’ll tell you that distraction of being a valued member of staff at Hampton Court Palace, and taking tours, is much better at reducing his perception of pain than his med are.

So in Green Gym actually our evidence that we can reduce anxiety, reduce depression, improve self esteem, how I feel about myself globally. And actually one of the other things is feelings of usefulness, people say they feel useful. All of those things seem to have a very strong mental impact, so now I’m more likely to be physically active, and more confident that it’s safe for me to do that. I want to be part of the group as well, so Green Gym is a group activity, we’re group animals. In public health if we are going to inoculate people we actually refer to herd immunity, so your herd. And that recognises the impact, and we know that when people come together to achieve things there’s a change to brain chemistry, so you might see changes in dopamine, which can have a positive effect on how you interpret pain signals. And actually what we are seeing, and I’ve been doing this for a long time and so have many colleagues, really promoting the medical fraternity to actually go back to its roots, from Hippocrates and Socrates, people might remember, who spoke about the benefits of physical activity, letting food be your medicine. Not discovering that but rediscovering that, there’s quite a few people who are really engaged in this process, and I’m really glad that they are because you need people within the medical fraternity to drive that medical fraternity forwards.

Paul Evans: Well, just a few miles to the east of Waterlow Park in London is Whipps Cross Hospital where you’ll find another green space, albeit on a slightly smaller scale. Margaretta Rooney is clinical nurse specialist in rheumatology at Whipps Cross Hospital.

Josephine Kilkenny: I’m Josephine Kilkenny, I am a patient of Margaretta.

Brian Halls: I’m Brian Halls, I’ve been a patient here for years. Margeretta I’ve known for years, has been treating me. Margaretta talked me into being a volunteer to this garden, which I’m very glad she has cause she’s kept me mobile.

Paul Evans: Margaretta just explain to me where we are.

Margaretta Rooney: We’re in a garden at Whipps Cross in the outpatients department, which has been designed for people with arthritis so they can carry on with their favourite hobby after they’ve had their diagnosis, it’s a model garden.

Paul Evans: It looks like a model garden, it’s very well manicured, better than I could imagine a garden being to be honest.

Margaretta Rooney: Well that’s thanks to Brian and Josephine who come in here every week and give their time to maintain the plants and keep the place clean and tidy.

Paul Evans: So how did this garden start?

Margaretta Rooney: Back in the mid nineties a patient donated a small amount of money to the consultant David Doyle at that time, and myself, in gratitude for the care that they were receiving from us. We thought what can we do that would live on forever really. This part of the hospital had just been opened and we had a blank space. Many patients are concerned about their ability to carry on their usual activities of living, and their activities of pleasure, and one of them is gardening. So we thought we could develop a garden here for people with arthritis.

Paul Evans: Brian tell me how you got involved in the first place then.

Brian Halls:  I was walking down Snakes Lane West and a young lady named Margeretta stopped me and said would you come and put some bulbs into the garden, she said I have another young lady that’s volunteered called Josephine, would you meet up together which we did do, and for 15 years we’ve been doing the garden. And because the garden is made for arthritic people, because as you see yourself there are raised beds, which was thoughtful when they organised the garden. We make sure that Josephine and myself, we don’t have to climb anywhere. We work as a team, if you want something tall she’ll pull it down with a broom, I’ll cut what I can. It’s a social event, because sometimes you’re out in the garden people come and ask you, and they realise I’ve got arthritic hands and they go, oh you could do that so could I perhaps, you know what I mean. It gets you out of bed, because if you’ve got arthritis you can lay in bed and feel sorry for yourself, and you get up and you get yourself motivated, and it’s been going ever since.

Paul Evans: Josephine how did you get involved?

Josephine Kilkenny: I had chronic arthritis, I was about 49, 50 and I also suffered with a bit of depression. And Margaretta one day she said, right I want you to take a new interest, she didn’t want me, she encouraged me. And it was the best thing that ever happened to me. It took my mind off the pain, it was giving back to the hospital, it was therapeutic, it got me up and dressed in the morning, not sitting at home as Brian says worrying about pain. And Brian and I have been great partners, we’re like friends now, I’m like the second wife I suppose.

But Margaretta played a vital role in this for me. She went over the white line, and it’s a wonderful department here, rheumatology, it’s excellent.

Paul Evans: You have arthritis?

Josephine Kilkenny: Yes.

Paul Evans: And you suffered from depression as well?

Josephine Kilkenny: Yes I did.

Paul Evans: Did the two go together?

Josephine Kilkenny: Well I was working in a very happy job, catering, I suppose it did a little bit, but the arthritis was very bad, it happened quite suddenly at work. And I think it all got down in a black hole, and it really helped me. It was better than medication, I’ve got medication and I’ve got much better now with modern medication, but the gardening played a vital role. I was learning a new skill. Catering was quite stressful, I suppose in ways, I loved it. And friendship, and people came out here socially, come out and have a bit of banter with us, and all those things make you feel good. Money isn’t everything. I find it so important to be thankful to our National Health, and our rheumatology team played this vital role. Margaretta was there for me, and I cannot think the hospital and Margaretta [enough] for this, and Brian my gardening partner, he’s played a vital role.

Paul Evans: Margaretta how did you envisage this would help people?

Margaretta Rooney: Well it’s well known that people’s ability to cope with pain depends on what else they have to think about. The more active you are, the more you are able to cope with your pain. Getting a diagnosis of arthritis is the first thing, it can be devastating. Patients in the beginning have pain and discomfort and distress, and the aim is to get patients out of pain quickly, which we do, and now with the advent of all the new treatments for arthritis, we give these treatments very early on so they don’t have the terrible outcomes that they had 20, 30 years ago. However many patients expect us to be able to give them a pill or an injection to help and to take the pain away. But that isn’t always possible. Some people expect medicine to help with every pain and ache but it’s not like that. So if you accept that this is a condition that you’ve got, whatever rheumatological condition you may have, then you have to work within the limits of that.

The aim of my role as a clinical nurse specialist, the doctor makes the diagnosis and prescribes the treatments, my role as a nurse is to help the patient to understand the diagnosis to understand the treatment and to manage their activities of living as if they didn’t have arthritis. So they have to make some adjustments, but not all the time, and that’s my role, is to discuss with them how they live with their condition. If you’re in pain and you enjoy for example dancing, well we try and encourage people to keep dancing, but the patient will perceive it as not being able to do it anymore. If you’re a pianist and you know you develop arthritis it can be devastating for that patient. People who garden always think of the heavy digging, you know the mowing the grass, the pruning all that, but this is an example of a garden where you can maintain and manage easily and that was what we put into the design. If you want to you can sit as you do your weeding because of the way the raised beds are, there’s no grass but the patio looks very nice, the area is quite calm and comforting and relaxing. There are lots of papers that have been written about gardening and arthritis, Arthritis UK have a very nice leaflet, I’ve got one of them to take away with you, that talks about gardening and arthritis and tips on how to manage their gardening. You know it’s good therapy for any of us even if we haven’t got pain or arthritis or fibromyalgia or any of the rheumataolgical conditions if you can get out in the fresh air it’s always good.

Paul Evans: Indeed it is. That’s clinical nurse specialist in rheumatology at Whipps Cross Hospital, Margaretta Rooney. And Margeretta is keen to find the next generation of volunteers to carry on with the upkeep and development of the garden. Get in touch with her at Whipps Cross Hospital rheumatology department or us at Pain Concern, and we’ll put you in touch with Margaretta.

And that Gardening and Arthritis booklet leaflet she mentioned can be ordered or downloaded from the Arthritis Research UK website which is http://www.arthritisresearchuk.org

Now back to the Green Gym. Chris Spiers works with the Conservation Volunteers organisation developing Green Gyms across the UK. Check out their website https://www.tcv.org.uk/greengym to find out if there is one near you, and if not.

Chris Speirs: We’re here to support anyone, whether that’s an individual, an organisation, a small community group, to enjoy the benefits of Green Gym, so we would be very keen to help. Our email address is greengym@tcv.org.uk if you were to get in touch we would be happy to support you to set up a group locally, make those health referral links. We have a Green Gym leadership programme which we offer out to other organisations and community groups to support them to be able to take on and run Green Gym to the same standard that we run elsewhere across the UK, and we’re working with communities and organisations all the time to do that. In the UK over 40 of the Green Gym groups that are running presently are completely independent to TCV, so many of them were established by us, but they are run by volunteers or people from the community who come together, meet once a week and they very much have the ownership to take their Green Gym, to take that forward. They do everything from the fundraising, to managing the projects, to looking after the spaces, to buying the tools, managing the first aid and everything else that needs to be done on the day.

Paul Evans: You mentioned the word referral, what do you mean by referral, who are the referrers?

Chris Speirs: We talk sometimes about self referral and referral, self referral would be if someone heard about the programme and took a decision to come along, as I did, for the health benefits of coming and participating, rather than being signposted by a health practitioner. So in order to reach a wider audience, a more diverse audience, we have for about 20 years been working very closely to proactively engage health referral partners. We work with GPs, physiotherapists, a wide range of different health professionals, not only from services within the local authorities, other charities such as mind, such as rethink, with people who might be coming out of prison looking to be rehabilitated. So really a huge range, it’s a very mainstream programme and very much open to anyone to join and we look to run the programme to have a range of activities to make it accessible for everyone.

Paul Evans: Chris Speirs. Once again the Green Gym website ishttps://www.tcv.org.uk/greengym and don’t forget to contact Margeretta Rooney at Whipps Cross Hospital Rheumatology department if you can help support their garden, or contact us at Pain Concern – our website is www.painconcern.org.uk – contact us there and we’ll pass on your details to Margaretta.

Don’t forget that you can download all editions and transcripts of Airing Pain from Pain Concern’s website which is www.painconcern.org.uk. There you’ll find information and support for those of us living with chronic pain, our families and carers, and of course for healthcare professionals. There’s also information on how to order Pain Concern’s magazine, Pain Matters.

Now, we at Pain Concern need your help. Like all charities we rely on the generosity of individuals and funding bodies to keep us going. Don’t worry, I’m not asking you to make a donation, although we would never turn it down on our ‘Just Giving’ page, although you are very welcome to do so and we would never turn it down. But in order to carry on making these Airing Pain programmes into the future, we really need to know that what we are doing is of benefit to people living with chronic pain, your family members and supporters, and yes, for health care professionals, and this is really important for us, how do the programmes help you help your patients?

So for everybody listening we need your feedback: Has listening to Airing Pain improved your day-to-day living, and if so, in what way? Have the programmes helped you manage your pain, how? And In a broader sense, has living with chronic pain or with a family member who has chronic pain become more manageable? And I can’t emphasise too much how important it is that we also get feedback from healthcare professionals on how these programmes help your patients.

So do please go onto the Pain Concern website and click on the Feedback button to take part in our short survey. Have your say, without your views we won’t know what we’re doing well, and what needs improving.

Okay I look forward to your feedback. Now back to the Green Gym. Rosie Broadley will end this edition of Airing Pain.

Rosie Broadley: My life has changed completely, I know it sounds absolutely ridiculous, there is hope out there, there is. And I’ve got somewhere to go, even if I don’t get up and do it, I have got somewhere to go. And September I start college for a whole year, Regents Park, to get my landscape degree, and this has all happened in six months since meeting Green Gym. So life has changes completely, thank you very much.

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Contributors:

• Chris Speirs, Health Development Manager The Conservation Volunteers
• Craig Lister, Managing Director of the TCV Green Gym
• Maria Schlatter, Project Officer at TCV Green Gym
• Josephine, Whipps Cross Hospital garden volunteer
• Brian, Whipps Cross Hospital garden volunteer
• Margaretta Rooney, clinical nurse specialist in rheumatology at Whipps Cross University Hospital NHS Trust
• Rosie, Green Gym volunteer
• Maddy, Green Gym volunteer.

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More information:

• For advice on gardening with disability and specially adapted equipment, see Thrive: thrive.org.uk/thrives-carry-on-gardening-website.aspx
• The gardening and arthritis booklet leaflet mentioned by Margaretta can be ordered or downloaded from the Arthritis Research UK website, now Versus Arthritis: versusarthritis.org
• To get involved with a TCV green gym near you, visit The Conservation Volunteers: tcv.org.uk/greengym
• To contact Margaretta, email production@painconcern.org.uk and we’ll put you in touch!