It is common knowledge that leisure activities can support our health and wellbeing. Leisure activities such as exercising, music, and outdoor activities are typically defined as non-work activities that we enjoy (Hills et al., 1998). An extensive literature documents the benefits of engaging in leisure activities for our physical and mental health both in the short-term and long-term (Adams et al., 2011; Fancourt et al., 2018; Muro et al., 2017). For example, leisure activities have been shown to prevent and mitigate symptoms of depression and anxiety (Fancourt et al., 2020; Fancourt et al.., 2019; Kim et al., 2010), and protect against health conditions like heart disease (Ellaway et al., 2007; Sundquist et al., 2004). Therefore, leisure activities that are of value to each individual are often incorporated into interventions to support health and wellbeing. 

Although extensive research illustrates the positive relationship between leisure activities and wellbeing, there is no clear theory that maps the underlying mechanisms relating to leisure and wellbeing. Moreover, there is a lack of a unifying, cross-disciplinary approach that highlights the multitude of factors and benefits at the individual, group, and societal levels. With research that is connected across disciplines, understanding the different underlying factors at play may maximise the benefits of tailored interventions to specific populations. 

Fancourt and colleagues (2021) investigated this issue in their research. The aims of their review were to “catalogue each specific potential mechanism, and to present these mechanisms in a new theoretical framework: the Multilevel Leisure Mechanism Framework.”

Methods

The authors conducted a review to meet their research aims.

The search strategy involved using three textbooks, in addition to papers, that were searched using a list of key terms on seven databases. The search criteria included articles published in English between 1950-2020. All potential mechanisms were catalogued in a master database, and four of the researchers grouped similar mechanisms into themes by consensus discussions. The fifth author subsequently conducted a full review and thematically grouped the mechanisms, and all the researchers approved the final versions. 

For the purpose of the review, ‘leisure’ was defined as “voluntary activities not related to employment responsibilities that are engaged in during free time, predominantly for enjoyment.”

‘Mechanisms of action’ were defined as “how leisure activities lead to mental and physical health outcomes”. Mechanisms that were included had previously been empirically tested or theoretically discussed.

Results

This review identified over 600 potential mechanisms of action. These were categorised into five processes, all of which included mechanisms at an individual, group and societal level:

1. Psychological

• This included processes such as resilience, sense of self, and psychological capabilities on the individual level,
• and for group level outcomes this included changing group attitudes. 

2. Biological

• Processes like impacting the immune system, the CNS, and physical performance were found at the individual level,
• and processes included at the group level were susceptibility of groups to disease.

3. Social

• Individual processes included learning and building relationships,
• whilst building group strength was an example found at the group level.

4. Behavioural

• Decision-making, habits and behavioural development were examples for individual level processes,
• and enhancing the ability to cooperate was an example found for groups.

5. Health behaviours

• The review found that leisure activities led to engaging in healthy behaviours and a reduction of unhealthy behaviours on an individual level.
• On the group level, this can positively impact health care delivery and performance.

New theoretical framework

• The new theoretical framework (the Multilevel Leisure Mechanism Framework) proposes that the mechanisms of action interact across levels and categories, where some fall under multiple categories. 
• The framework says this is not a deterministic system, and the interactions between different levels and categories are dynamic.
• Lastly, this framework sets out to be fluid, moving and developing over time.
  

Conclusions

The authors concluded that the Multi-level Leisure Mechanisms Framework highlights the mechanisms of action that link leisure engagement to health outcomes. The mechanisms by which leisure activities affect health are seen through psychological, biological, social, and behavioural processes at individual, group and societal levels. The authors also conclude that the Multi-level Leisure Mechanisms Framework will evolve as new research is done.

Strengths and limitations

The review was rigorous, using a large number of databases and sources across multiple disciplines for the framework to be developed from. This novel framework has laid the foundation for research to build on, and as the framework is set out to be particularly fluid.

However, we can acknowledge that there are some limitations. One limitation may be publication bias, as the search strategy only included studies published in English. English-language journals typically publish more positive findings than studies with inconclusive findings (Bigby, 2014), which may limit the generalisability of the framework. This is important within the context of this research, as different cultures influence what people do with their non-working time, like which types of activities people should engage with, and how much of their time and money is spent on these. If this framework is to shape future research developments, it will be important to expand the research strategy to be more inclusive of cultural variations. 

Another limitation is that the review focuses on the positive effects of leisure on wellbeing. It is important to consider that there are moderating factors within this relationship, as some activities may have adverse effects if they become excessive (Stenseng et al., 2011). For example, excessive engagement with exercising may lead to physical health difficulties like damaged joints and muscles, whilst also impacting mental health by generating difficulties regarding body image. It is important for future research to build on the framework by understanding moderating factors, as the authors acknowledge.

Implications for practice

The development of this framework has important research implications. The cross-disciplinary method of the review can support future research designs aiming to adopt a more pluralistic approach. This is particularly beneficial for research because instead of keeping a narrow lens, this would unveil the multiple factors and relationships simultaneously, paving the way for further research avenues.

The review and framework also have additional policy implications. The findings could help support the development of social prescribing services that are part of the NHS Long Term Plan. Having a better understanding of the underlying mechanisms between leisure activity engagement and wellbeing means that this can support social prescribing link workers and other healthcare professionals develop more effective treatment plans with more effective lasting benefits. Not only would this have benefits for individual service-users, but having the most effective social prescribing services may help reduce GP workload (RCGP, 2018), and provide a general reduction of demand on NHS services (Polley et al., 2017), demonstrating individual, group, and societal benefits.

Consequently, the findings also have important clinical implications. This theory can support clinicians by helping to guide bespoke treatment plans that are of value and benefit to service users. For example, this may provide guidance when using CBT techniques like Behavioural Activation, as it would identify which activities more likely to provide benefits to individual service users. Furthermore, this new theoretical framework provides support for the value of arts-based interventions within the community, that can be used clinically, to prevent and treat difficulties.

Statement of interest

None.

Links

Primary paper

Fancourt, D., Aughterson, H., Finn, S., Walker, E., & Steptoe, A. (2021). How leisure activities affect health: A narrative review and multi-level theoretical framework of mechanisms of action (PDF). Lancet Psychiatry, 8, 329-339.

Other references

Adams, K., Leibbrandt, S., & Mood, H. (2011). A critical review of the literature on social and leisure activity and wellbeing in later life. Aging & Society, 31, 683-712. https://www.cambridge.org/core/journals/ageing-and-society/article/critical-review-of-the-literature-on-social-and-leisure-activity-and-wellbeing-in-later-life/2F2A22FDE0F28D435F56D6E69B25FF9E

Bigby, M. (2014). Understanding and evaluating systematic reviews and meta-analyses. Indian Journal of Dermatology, 59, 134-139. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3969671/

Ellaway, A., & Macintyre, S. (2007). Is social participation associated with cardiovascular disease risk factors? Social Science & Medicine, 64, 1384-1391. 

Fancourt, D., Opher, S., de Oliveira, C. (2020). Fixed-effects analyses of time-varying associations between hobbies and depression in a longitudinal cohort study: Support for social prescribing? Psychotherapy & Psychosomatics, 89, 111-113. https://www.karger.com/Article/FullText/503571

Fancourt, D., & Steptoe, A. (2019). Effects of creativity on social and behavioural adjustments in 7 to 11 year old children. Annals of the New York Academy of Sciences, 1438, 30-39. https://pubmed.ncbi.nlm.nih.gov/30079606/

Fancourt, D., & Steptoe, A. (2018). Community group membership and multidimensional subjective wellbeing in older age. Journal of Epidemiology & Community Health, 72, 376-382. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5909739/

Hills, P., & Argyle, M. (1998). Positive moods derived from leisure and their relationship to happiness and personality. Personality & Individual Differences, 25, 523-535. https://www.sciencedirect.com/science/article/abs/pii/S0191886998000828

Kim, J., & Pai, M. (2010). Volunteering and trajectories of depression. Journal of Aging & Health, 22, 84-105. https://psycnet.apa.org/record/2010-00502-005

Muro, A., & Artero, N. (2017). Dance practice and wellbeing correlates in young women. Women Health, 57, 1193-1203. https://pubmed.ncbi.nlm.nih.gov/27700698/

Polley, M., & Pilkington, K. (2017). A review of the evidence assessing impact of social prescribing on healthcare demand and cost implications. University of Westminster. https://westminsterresearch.westminster.ac.uk/item/q1455/a-review-of-the-evidence-assessing-impact-of-social-prescribing-on-healthcare-demand-and-cost-implications

Royal College of General Practitioners. (2018). RCGP calls on government to facilitate ‘social prescribing’ for all practices. 

Subdquist, K., Lindstrom, M., Malmstrom, M., Johansson, S., & Sundquist, J. (2004). Social participation and coronary heart disease: A follow-up study of 6900 women and men in Sweden. Social Science & Medicine, 58, 615-622. https://pubmed.ncbi.nlm.nih.gov/14652057/

Stenseng, F., Rise, J., & Kraft, P. (2011). The dark side of leisure: Obsessive passion and its covariates and outcomes. Leisure Studies, 30, 49-62. https://www.tandfonline.com/doi/abs/10.1080/02614361003716982

Photo credits

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