Step-by-Step
A twelve-week program for people with severe depression and anxiety
We were given an intersection: Exercise as Medicine, group medical visits, mental health. The challenge was to weave them into a single program for one of the hardest populations to engage. People with severe depression and anxiety are, by the nature of the condition, the ones who don't show up - not because they don't want to, but because showing up is part of what the illness takes from them.
I conceived, designed, implemented, and evaluated end-to-end a novel care model pairing psychiatry and a fitness trainer to deliver psychiatric care and exercise-as-medicine in a community setting. I designed the behavioural-change approach from literature and best practices, and translated research into a workable program with measurable outcomes.
The setting was a gym, not a clinic. Activities were often chosen by the participants. The group was designed as community - because isolation is the disease and the group was the medicine, deliberately. The psychiatrist and the personal trainer worked in the same room, treating one whole person.
A second iteration, Jump Step, was funded by a major Canadian foundation and run with peer researchers from the original cohort as co-designers. Participants of the first program became guides for the next. The program was later adapted into a provincial YMCA strategy, where it continues to run.
It was not the exercise. It was not the psychiatry. It was not the peer support. It was the synthesis - designed from inside what severe depression actually feels like, outward into a world that made showing up feel like becoming.
Published outcomes - BMJ Open Sport & Exercise Medicine, 2015
93% completion. Anxiety -50%. Depression -38%. Sustained at three-month follow-up. Peer-reviewed and published. Provincially adopted.