Effects of an exercise and sport intervention among refugees living in a Greek refugee camp on mental health, physical fitness, and cardiovascular risk markers: A randomized controlled trial
University of Thessaly:
A. Hatzigeorgiadis, Y. Theodorakis, I. D. Morres, K. Filippou
University of Basel, Switzerland - Coordinating Institute
University of Thessaly, Greece - Partner
University Hospital Zurich, Switzerland - Partner
Funding -Swiss Network for International Studies, Switzerland
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Summary:
Due to ongoing political and social conflicts, the number of international refugees has been increasing. Refugees are exposed to severe mental and physical strain, as well as traumatic experiences during their flight. As a consequence, the risk of psychiatric disorders is markedly increased among international refugees, with particularities based on gender. International organizations have criticized the lack of early interventions as a key problem because untreated mental disorders are often difficult to cure at a later stage. Today, exercise and sport have been successfully employed to treat a wide range of psychiatric disorders. With PTSD patients, however, very limited empirical evidence exists, and studies carried out with international refugees are nearly non-existent. In 2017, we implemented a first pilot one-group pre-test/post-test study in a Greek refugee camp, corroborating the potential benefits of exercise and sport on refugees’ mental health and fitness. The proposed study will take place in the Koutsochero refugee camp, located close to the city of Larissa (Greece).
The randomized controlled trial will include an exercise and sport intervention group (n=68) and a wait-list control group (n=68). Participants (50% men/women, 16-59 years) will be assessed three times at baseline, immediately post-intervention (after 3 months), and follow-up (after 6 months). In the second year of the study, the program will be opened to all camp residents. Exercise and sport will be offered five times per week (60 min/session) for three months. Participants will participate in at least two sessions per week. The program is developed according to the participants’ needs and preferences, and they will be able to choose between a range of activities. PTSD symptoms will serve as the primary outcome. Several secondary outcomes will be assessed, and the project will identify potential gender issues. A strategy will be developed on how the exercise and sport program can be continued after the SNIS funding comes to an end, and how the program can be scaled up beyond the borders of the Koutsochero camp.
Outcomes/Papers from the Project:
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Filippou, K., Knappe, F., Hatzigeorgiadis, A., Morres, I. D., Tzormpatzakis, E., Proskinitopoulos, T., Meier, M., Seelig, H., Ludyga, S., Pühse, U., Von Känel, R., Theodorakis, Y., & Gerber, M. (2025). Effects of an exercise and sport intervention on symptoms of post-traumatic stress disorder and other mental health indices among asylum seekers in a camp. A pragmatic randomized controlled trial. Mental Health and Physical Activity, 28, 100676. https://doi.org/10.1016/j.mhpa.2025.100676 |
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Filippou, K., Knappe, F., Morres, I. D., Tzormpatzakis, E., Proskinitopoulos, T., Theodorakis, Y., Gerber, M., & Hatzigeorgiadis, A. (2024). Objectively measured physical activity and mental health among asylum seekers residing in a camp. Psychology of Sport and Exercise, 102794. https://doi.org/10.1016/j.psychsport.2024.102794 |
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Knappe, F., Filippou, K., Hatzigeorgiadis, A., Seelig, H., Meier, M., Pieters, L. A., Zollino, C., Pühse, U., & Gerber, M. (2025). ‘A spark to start’: Experiences of forcibly displaced individuals participating in a co-designed exercise and sport intervention. Mental Health and Physical Activity, 28, 100681. https://doi.org/10.1016/j.mhpa.2025.100681 |
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Filippou, K., Knappe, F., Hatzigeorgiadis, A., Morres, I. D., Tzormpatzakis, E., Havas, E., Pühse, U., Theodorakis, Y., & Gerber, M. (2024). Self-reported physical activity and mental health among asylum seekers in a refugee camp. Journal of Physical Activity and Health, 21(7), 657-667. https://doi.org/10.1123/jpah.2023-0325. [Shortlisted for the 2025 Journal of Physical Activity and Health Article of the Year Award for Best Article from an Emerging Researcher]. |
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Gerber, M., Filippou, K., Knappe, F., Morres, I. D., Tzormpatzakis, E., Havas, E., Seelig, H., Colledge, F., Ludyga, S., Meier, M., Theodorakis, Y., von Känel, R., Pühse, U., & Hatzegeorgiadis, A. (2024). Does cardiorespiratory fitness moderate the relationship between overweight, cardiovascular risk markers and mental health among forcibly displaced individuals living in a Greek refugee camp. Frontiers in Sports and Active Living 6, 1334230. https://doi.org/10.3389/fspor.2024.1334230 |
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Knappe, F., Filippou, K., Hatzigeorgiadis, A., Morres, I. D., Ludyga, S., Seelig, H., Tzormpatzakis, E., Havas, E., Theodorakis, Y., von Känel, R., Pühse, U., & Gerber, M. (2024). The impact of an exercise and sport intervention on cognitive function and pain among forcibly displaced individuals at risk for PTSD: A secondary analysis of the SALEEM randomized controlled trial. BMC Medicine 22, 387. https://doi.org/10.1186/s12916-024-03601-x |
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Knappe, F., Filippou, K., Hatzigeorgiadis, A., Morres, I. D., Tzormpatzakis, E., Havas, E., Seelig, H., Ludyga, S., Colledge, F., Meier, M., Theodorakis, Y., von Känel, R., Pühse, U., & Gerber, M. (2024). Effects of a co-designed exercise and sport intervention on cardiorespiratory fitness and metabolic syndrome components among individuals living in a refugee camp in Greece: A randomized controlled trial. Journal of Migration and Health 9, 100227. https://doi.org/10.1016/j.jmh.2024.100227 2023 |
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Gerber, M., Filippou, K., Knappe, F., Morres, I. D., Tzormpatzakis, E., Havas, E., Seelig, H., Colledge, F., Ludyga, S., Meier, M., Theodorakis, Y., von Känel, R., Pühse, U., & Hatzegeorgiadis, A. (2023). Associations between grip strength, cardiorespiratory fitness, cardiovascular risk and mental health in forcibly displaced people from a Greek refugee camp. Scientific Reports 13, 20970. https://doi.org/10.1038/s41598-023-48032- |
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Knappe, F., Filippou, K., Hatzigeorgiadis, A., Morres, I. D., Tzormpatzakis, E., Havas, E., Seelig, H., Colledge, F., Ludyga, S., Meier, M., De Quervain, D., Theodorakis, Y., von Känel, R., Pühse, U., & Gerber, M. (2023). Psychological well-being, mental distress, metabolic syndrome, and associated factors among adults living in a refugee camp in Greece: A cross-sectional study. Front. Public Health, 11. https://doi.org/10.3389/fpubh.2023.1179756 |
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Gerber, M., Colledge, F., de Quervain, D., Filippou, K., Havas, E., Knappe, F., Ludyga, S., Meier, M., Morres, I.D., Panagos, A., Pühse, U., Ramadan, K., Seelig, H., Theodorakis, Y., Kanel, R., Hatzigeorgiadis, A. Effects of an exercise and sport intervention among refugees living in a Greek refugee camp on mental health, physical fitness and cardiovascular risk markers: study protocol for the SALEEM pragmatic randomized controlled trial. Trials 22, 827 (2021). https://doi.org/10.1186/s13063-021-05808-2 |
