This article reports on a qualitative research study that explored the experience of predominately LGBT—lesbian, gay, bisexual and trans—people who have exercised with a peer group; in this case, running. For the purpose of the study the authors used the Stonewall Scotland definition, which states that ‘trans’ is an umbrella term for individuals whose gender is not the same as the sex they were assigned at birth (https://tinyurl.com/trans-stonewall).
It is recognised that there are lower levels of participation in physical activity within the LGBT community (Gorczynski and Brittain, 2016). As such, nurses and health professionals need to understand the experiences of this patient group in order to encourage LGBT patients to become active and enjoy the health benefits associated with physical activity (Gorczynski and Brittain, 2016). This study aimed to understand the impact of being part of an LGBT running group had on those who attended. To achieve this, the authors conducted face-to-face interviews with participants with questions that explored:
Background
NHS Health Scotland (2019) recommends that most people should aim to do at least 150 minutes of moderate physical activity per week. It highlights that physical inactivity is a leading cause of premature death in Scotland and that work by the Scottish Government is ongoing to tackle the health inequalities that have an impact on the uptake of physical activity (NHS Health Scotland, 2019). The Scottish Government (2018) aims to create a multi-approach to ensuring that opportunities exist to participate in physical activity and to empower communities to play a key role in providing these opportunities. Nurses and other healthcare providers play a role by encouraging individuals to take ownership of their physical activity participation through brief interventions and referring people on to local activity groups.
Barriers to sports participation have been identified in the general population and include lack of time, motivational issues and lack of facilities (McIntosh et al, 2016). The Equality Network's (2015)Scottish LGBT Sports Charter highlights that LGBT people encounter perceived and real barriers that result in them feeling that participation in sports is not for them. This is in addition to the barriers that deter people who identify as heterosexual.
A systematic review by Meads et al (2012) found that LGBT people tend to have poorer health, particularly mental health, compared with those who identify as heterosexual. This finding was supported by the Stonewall (2018)LGBT in Britain Health Report, which also highlighted areas of discrimination in healthcare provision and issues around smoking, alcohol and drug use. An additional point emphasised by Meads et al (2012) was the overall lack of empirical research into the health of LGBT people in the UK. This appears to still be an issue because a literature search of electronic databases found little published research specific to the UK. Indeed, this could be a worldwide phenomenon. Gorczynski and Brittain (2016) highlighted the fact that in a US report on LGBT health, which made a call for research into areas of health inequalities, the impact of physical activity to address such inequalities was absent. Gorczynski and Brittain (2016) also suggest that historically, and currently, LGBT individuals are excluded from health research, resulting in a deficit of knowledge with regards physical activity interventions for this group of people.
As part of an exploratory-descriptive qualitative (EDQ) study, the aim of the literature review is to demonstrate that little or no previous research has been undertaken on the group, process or activity under investigation and to highlight that there are clear areas of the phenomenon that remain unexplored (Stebbins, 2001; Hunter et al, 2019). The review of the literature undertaken highlighted a clear need for this study reported here.
Aim
The study aimed to address the clear gap in the literature by understanding the experiences of LGBT individuals in Scotland who have become active members of a sports club, in this case running, which is made up predominately of peers.
Method
The methodology used in this study was an EDQ approach to research, as described by Hunter et al (2019). This methodology is appropriate when there is little or nothing known about the topic under investigation (Reid-Searl and Happell, 2012), as was the case here. Purposeful sampling was used to recruit participants. The authors aimed to recruit 15 participants in total but, in the end, 12 individuals offered to take part. Table 1 outlines the participant demographics. One participant identified as ‘straight’ and the researchers decided to incorporate this individual's responses to be as inclusive as possible.
| Sexual orientation* | Gay | Lesbian | Bi | Straight | No response provided | Number of participants |
| n | 7 | 3 | 1 | 1 | – | 12 |
| Gender Identity* | Male | Female | Non-binary | Straight | No response provided | Number of participants |
| n | 7 | 3 | 1 | - | 1 | 12 |
| Age (years) | 18–24 | 25–34 | 35–44 | 45–54 | 55+ | Number of participants |
| n | - | 5 | 5 | 2 | - | 12 |
Data were collected via individual face-to-face interviews, following completion of a written consent form. These took place between February and April 2019 and were arranged at a time and place to suit the participants. Interviews were audiorecorded and transcribed verbatim. The data collected were confidential, but because the researchers were conducting the interviews it was not anonymous to them.
The transcribed interviews were analysed thematically by the researchers, following the guidelines provided by Braun and Clarke (2006). Pseudonyms are used below when direct quotes from participants are provided. The participants chose their own pseudonyms at the beginning of the interview, so that they could recognise any quotes they had provided when the research was published (Duers, 2017).
The research was granted approval by the ethics committee at the University of the West of Scotland in June 2018.
Findings
The overall finding was the idea that being part of an LGBT running club represented ‘a healthier way to meet people’. Beyond that, we identified three main themes: ‘influence on physical health’, ‘influence on mental health’ and ‘influence on social health’. The authors recognised an interconnectedness between mental and social health and identified two subthemes relating to these (Figure 1). To ensure that the voices of all participants are heard, quotations from all 12 are used to illustrate the themes and subthemes.
It became apparent that the overall finding from the research was the idea that the running club was a mechanism that allowed people within, and allies of, the LGBT community to meet away from the gay scene, which is commonly associated with alcohol, and to participate in an activity that was about improving all aspects of their wellbeing. This overarching finding also captures the fact that, for the majority of participants, the social interaction that the club provides was just as important as the benefits for their health.
Influence on physical health
The first theme we identified was the ‘influence on physical health’. Our findings highlighted the positive influence that being part of the running club had on physical health. Participants talked about noticing an overall improvement in their physical health, as well as improved running performance/fitness, and how the club had helped them achieve their running goals:
‘And I'm a better runner, full stop, and probably in better health … as well’
For one participant, this improvement in physical wellbeing related to a pre-existing medical condition. For this individual, bone density was affected by treatment for renal disease. Since becoming a regular runner, this issue had resolved:
‘… now my bone density is back into the normal range, just from running, so there is a real, huge benefit to it …’
Influence on mental health
The second theme that the researchers identified was the ‘influence on mental health’. Ten of the 12 participants were explicit in discussing this during their interviews. They described how being part of the running club had made a positive contribution to their mental health. For example, one participant stated:
‘… you mentioned [the] physical health side first, but I think for mental health it's been a bigger benefit for me.’
They also discussed how their overall mental health had improved, how they felt supported in the club and how any initial anxieties had been quickly overcome. Similar to Michael, another participant linked his participation with the running club to significant improvements in his mental health:
‘… previously, I struggled with mental health issues—depression, anxiety and things like that—and now I don't take … I'm not medicated at all now for it … I think running has something to do with it.’
Clearly linked to the improvement in mental health that the participants highlighted was the concept of the different types of support gained by being a member of the club. This became apparent as they talked about feeling supported during the physical process of running, but also around some wider ideas of support such as feeling welcomed, existing members offering support for new people attending for the first time, being involved in a wider mission to support and encourage LGBT people to participate in sport/exercise, and support for slower runners:
‘I've never been the fastest runner, I've always been one of the ones towards the back that's needed maybe more support to keep going … it's sort of good [that] you've got that’
In addition, participants highlighted that their emotional wellbeing was also improved by being a member of the running club. This included peer support when relationships had ended and help following bereavement:
‘… it was certainly good when I look back at a time … it's good to have something there … my dad died during that year and it was just something that was, kind of, constant.’
Influence on social health
The third theme identified was that of the ‘influence on social health’. It also became clear to the researchers that this theme was interconnected with that of ‘influence on mental health’, with participants often discussing both aspects in response to the one question/prompt. The desire to make new social connections was highlighted as a driving force for many of the participants. Many participants talked about wanting to improve their health while simultaneously meeting new people. We found that most participants had made positive new connections, including some of a romantic nature:
‘Meeting people. Em, I've … met really good friends … I've had a few dates come through [the club] as well.’
‘So, I'd recently, em, split up with a long-term partner, em, and had to move out into a place on my own and it was partly as a way of trying to make new friends, meet new people. Em, that, that was a big part of the reason for joining [the running club], as well as the actual running.’
Six of the 12 highlighted the fact that they had made positive, new social connections through the club explicitly in their interviews. In addition, members liked the fact that being part of the club introduced them to new places around Glasgow, other parts of Scotland and, on club trips, to other countries.
Seeing and accepting yourself through representation
The impact on participants' social health is further divided into two subthemes. The first is ‘seeing and accepting yourself through representation’. This subtheme, which is also linked to ‘influence on mental health’, was identified as some participants discussed how joining the running club was a component in their personal journey of self-acceptance. Some participants highlighted that they had recently ‘come out’ and being around other LGBT people in the running club had helped them to accept their own sexuality through shared discussions and friendship formation:
‘I was really very new to coming out… I think [a benefit of running with the club is] just becoming far more comfortable about being gay.’
‘… another reason I joined the running group was so that I could be more, eh, comfortable with my own sexuality. I'm not out to my family. So, going out to gay bars and, eh, nightclubs … I didn't feel very comfortable in these settings. However, the running group, although being an LGBT organisation, was still, ah, kind of, a nice way for me to be myself. It was during daytime hours. It was with people who were not drinking. So I felt very comfortable and, on top of that, I was staying fit.’
Additionally, the authors found that participants were keen that the club continued to strive for diversity and representativeness, specifically by increasing the number of women, trans or black minority ethnic (BME) individuals who attend:
‘I was probably wondering, would there be any women at all in my group [faster paced] or would it just be entirely male … It's something I feel I want to support because its [running] got this big gender imbalance …’
Fostering a sense of belonging
The final sub-theme, and key finding of the study, was ‘fostering a sense of belonging’. This subtheme was clearly evidenced, with 10 participants explicitly discussing it during their interviews. Participants talked about feeling welcomed into the club and how important that was to them:
‘It was the first time I've ever felt like, properly, part of a wee community or I felt like fully 100% myself … It just made me feel like I belonged somewhere …’
‘It was good to have people … and I felt relaxed around people who were… of similar experience, similar lifestyle to myself. I could connect in some way.’
Participants also discussed being new to the LGBT community and keen to make new connections, away from the gay scene. As mentioned above, participants talked about being supported within the running club and how that added to their sense of belonging.
Discussion
As the findings identified, participants recognised that running with a peer group had a positive influence on their physical health. McIntosh et al (2016) highlighted the impact physical activity can have on a person's physical health, including improved cardiovascular health, reduced blood pressure, improved blood lipid profile and enhanced insulin action. The participants from a UK ethnographic study by Shipway and Holloway (2016) also identified that improved physical health was an important motivation for runners. However, many of Shipway and Holloway's (2016) participants discussed weight issues and body image whereas, in this study, only three participants directly mentioned this. In addition, participants in this study highlighted that being part of a running club had helped them achieve their running goals. Although the mechanisms behind this finding may be linked to the idea of peer support, discussed below, it also became apparent that it was as a result of improvements in the physical fitness levels of the participants. This finding is in line with Nowak (2017), who suggested that motivation of runners includes the idea of them competing with themselves, overcoming their own limits and improving their overall physical fitness.
The majority of the participants in the authors' study discussed how their mental health had improved as a result of joining a running club. Commonly, participants discussed issues around depression and anxiety disorders and how these had improved since becoming regular club runners. Stonewall (2018) highlights mental health issues in the LGBT community by stating that 52% of the those surveyed by the charity had experienced depression in the preceding year, with 61% experiencing an anxiety condition.
With regards to running, the findings of this study mirror those of Mikkelsen et al (2017) who, in a review of the literature, identified that the physiological effects of exercising alleviated the symptoms of anxiety, depression and stressed states. A large, cross-sectional study by Chekroud et al (2018) also identified that individuals who exercised had 43.2% fewer days of poor mental health in the preceding month than those who did not. Interestingly, Chekroud et al (2018) matched the participants in their two groups using a range of demographics, including age, gender, race, marital status, income, education level, body mass index calculation, previously diagnosed depression and self-reported physical health. Sexual orientation was absent, reinforcing the point made by Gorczynski and Brittain (2016) regarding the lack of LGBT representation in this type of research.
The impact of peer support is highlighted in the findings of the authors' research. This included aspects such as being welcomed to the group and how peer support encouraged participation. However, it also extended beyond the running aspects of the club to support following relationship breakdowns or bereavement. A qualitative study by Ceatha (2016) also identified the importance of peer support to LGBT wellbeing by providing encouragement during times of challenge. Additionally, Laukkanen (2018) highlighted that a group exercise scenario, which offers emotional support, may facilitate increased commitment for regular physical activity by the participants, regardless of factors such as age, sex or initial fitness level. These findings are important for nurses and other health professionals because they support the recommendations that they may make to patients regarding exploring group exercise to improve both physical and mental health.
The final theme that identified in this study was the ‘influence on social health’, with participants highlighting the importance of new social connections. This finding supports research by Stevinson et al (2015), who found that an inclusive atmosphere and inherent social support encouraged participation in group running. Other positive influences on club members' social health were around issues of participants accepting their own sexuality and having a sense of belonging by being part of the running group. By being with like-minded peers, who have similar background histories, participation in an activity can be enhanced and self-esteem fostered (Ceatha, 2016).
Participants in this study talked about their experience of running with a peer group as being a healthier way to meet people, away from the gay scene. The gay scene encompasses gay bars, pubs, clubs, events such as Gay Pride, social meet-up groups, and sports and hobby clubs, and should provide a social space for people to be openly gay without fear of homophobia (BGIOK, 2020).
Emslie et al (2015) highlighted that alcohol use and misuse is higher in the LGBT community compared with the heterosexual population and that alcohol is a central tenant of the commercial gay scene. It is therefore important to have alternative ways for LGBT individuals to meet and interact in a healthier environment. The sense of belonging that participants in this study discussed is also present in the literature. Ceatha et al (2016) highlighted that, in their study, some participants identified their sexual orientation or gender identity as an incentive for joining a group established for, and maintained by, LGBT communities. Like our study, Ceatha et al (2016) also found that LGBT community groups offered members social connections and a sense of belonging away from the gay scene, and support for those coming to terms with their own identities.
The positive socialising effects of exercising with a peer group, as highlighted above, can be used by nurses and other health professionals as incentives and benefits to encourage patients from the LGBT community towards regular exercise (Laukkanen, 2018).
Limitations
The findings of the study came from one LGBT running club in the West of Scotland. It is conceivable that participants from other clubs, either within the UK or internationally, would have had a different experience. Some participants from either end of the age spectrum may have made our sample more representative of the whole population. Consideration of the effects on health that other, non-running, LGBT sports clubs have had could have provided some additional perspectives.
Conclusion
The authors' study has shown the transformational power that engaging with a peer group for physical activity can have on members of the LGBT community. Although some of our findings around improvement in physical fitness were perhaps unsurprising, the richness of the responses and the heartfelt impact that some of our participants described in relation to other aspects of their lives were unexpected. This was particularly true in relation to their social health, finding their place in the community and accepting themselves and their sexuality. The research reported in this article also supports the findings of previous work in relation to how physical activity can improve mental wellbeing—and this is especially important in the LGBT community.
Recommendations
Nurses and health professionals should encourage any LGBT patients they encounter to consider a peer group as an entry to physical activity. Regardless of why the health professional is interacting with the LGBT person, the benefits of peer-assisted exercise to their physical, mental and social health can be discussed. Although this study took place within a running club, there are other LGBT groups offering a variety of different physical activities to suit a range of patient preferences. Organisations such as LEAP Sports Scotland, Pride Sports UK and Out for Sport can be accessed online to direct patients towards local clubs.