Table 2.

Summary of data extraction to understand the role of physical activity in individuals who have been bereaved

Author (year) and country [Ref Number]	Title of article	Study type (Methods)	Sample size	Participant details Age range (Mean) Sex	Type of bereavement [length of bereavement (mean)]	Grief outcome (measure used)	Type of physical activity	Main findings
Brewer and Sparkes (2011) UK [53]	Young people living with parental bereavement: Insights from an ethnographic study of a UK childhood bereavement service	Qualitative (ethnography—interviews and observations)	13	9–25 years (25.15) Male (n = 6) Female (n = 7)	Parental death [2–15 years (9.75)]	Aggression, anxiety, depression.	Martial arts, football, walking, running	Seven key themes related to a bereavement camp experience identified: (1) expressing emotion, (2) physical activity, (3) positive adult relationships, (4) area of competence, (5) friendships/social support, (6) having fun/humour and (7) transcendence
Brewer and Sparkes (2011) UK [54]	The meanings of outdoor physical activity for parentally bereaved young people in the United Kingdom: insights from an ethnographic study	Qualitative (semi-structured interviews and observations)	13	9–25 years (25.15) Male (n = 6) Female (n = 7)	Parental death [2–15 years (9.75)]	Anxiety, aggression, panic attacks, stress	Martial arts, rugby, sports, exercise	Physical activity provided: (1) a sense of freedom, (2) a distraction/escapism, 3) enabled memories to be retained and 4) created family cohesion
Chen et al. (2005) USA [41]	Health behaviours associated with better quality of life for older bereaved persons	Quantitative (questionnaire)	200	50+ years (66.3) Male (N = 53) Female (N = 147)	Later Life bereavement [no range or mean]	Quality of life, depression, stress (RAND-36)	Exercise (Not Specified)	Exercising one or more days per week consistently predicted better quality of life outcomes.
Gorman and Cacciatore (2020) USA [46]	Care-farming as a catalyst for healthy and sustainable lifestyle choices in those affected by traumatic grief	Qualitative (questionnaire and semi-structured interviews)	120	18–55 years Male (n = 21) Female (n = 99)	Multiple bereavements [no range or mean]	Grief [non-defined]	Walking, Kayaks, non-defined physical activity	Bereaved parents, siblings and spouses described significant pivots toward healthier eating, sleeping and increased physical activity. Care-farming may have a potential influence in positive changes to health and health behaviours. Experiences at the care-farm prompted an uptake in physical activity in the outdoors.
Granek et al. (2017) Canada [56]	Experiences of Canadian oncologists with difficult patient deaths and coping strategies used	Quantitative (online questionnaire)	98	20–61+ (No mean) Male (N = 50) Female (N = 48)	Patient death [0–3+ deaths per month (no mean)]	Coping strategies	Exercise (not specified)	A broad variety of coping strategies were used in responding to patient death. Exercising and watching sports were among those used as a coping strategy.
Granek et al. (2016) Israel [58]	Barriers and facilitators in coping with patient death in clinical oncology	Qualitative (interviews—grounded theory)	22	32–70 years (47) Male (N = 14) Female (N = 8)	Patient death [1–25 deaths per month (5)]	Coping strategies	Watching soccer, sports (not defined)	Coping strategies for a patient death included cognitive, behavioural, relational, professional and spiritual methods. Participating or watching sports were included within behavioural coping strategies.
Granek et al. (2016) Canada [57]	Paediatric oncologists' coping strategies for dealing with patient death	Qualitative (interviews—grounded theory)	21	31-74 years (43) Male (N = 10) Female (N=11)	Patient death [1–13 deaths per month (1.5)]	Coping strategies	Walking, yoga, running, cycling, hiking, dancing	After a patient’s death, physical activity was an important coping strategy; it allowed oncologists to ‘let off steam’. Oncologists participated in a variety of regular physical activities, often outdoors and in nature.
Grimby et al. (2008) Sweden [60]	Walking habits in elderly widows	Mixed methods (questionnaire and interviews)	701	51–89 years (76)	Spousal death [3 months–4 years (no mean)]	Stress	Walking	Initially following the death of a spouse, there was a reduction in physical activity, with women having a reduced perception of being healthy. This physical activity, and perception increased with time after bereavement.
Gyasi and Phillips (2019) Africa [61]	Risk of psychological distress among community-dwelling older adults experiencing spousal loss in Ghana	Mixed methods (interviews and questionnaires)	1200	50+ Male (N = 759) Female (N = 441)	Spousal death [no range of mean]	Psychological distress	Non-defined sports	Psychological distress, increased with spousal loss, in women but not in men. The association between spousal loss and psychological distress was reduced as social support resources and physical activity was increased.
Huberty et al. (2014) USA [47]	A qualitative study exploring women's beliefs about physical activity after stillbirth	Qualitative (interviews)	24	19–44 years (33) Female (N = 24)	Foetal/pre-natal death [< 12 months (6.33)]	Depression, quality of life	Physical activity	The major barriers to physical activity were emotional responses, lack of motivation, feeling tired, guilt, letting go of the pregnancy body, seeing other babies and lack of time. Physical activity allowed them to feel better emotionally, helping them to cope; gave time for themselves to work through grief and was motivated by body shape/weight.
Huberty et al. (2014) USA [48]	Physical activity and depressive symptoms after stillbirth: Informing future interventions	Quantitative (descriptive exploratory)	175	19–45 years (31.26) Female (N = 175)	Foetal/pre-natal death [0–12 months (no mean)]	Depression (EPDS)	Yoga, walking, jogging	38% of women used physical activity to cope with depression following a stillbirth. Women participated in the recommended guidelines for physical activity: 60% before stillbirth, 47% during pregnancy and 61% after still birth. Of those that reported using physical activity to cope after stillbirth, they did so to help with depression (58%), weight loss (55%), and better overall physical health (52%). To cope with stillbirth, women used walking (67%), jogging (35%), and yoga (23%).
Huberty, et al., (2020) USA [40]	Online yoga to reduce post-traumatic stress in women who have experienced stillbirth: a randomised controlled feasibility trial	Quantitative (RCT)	90	18+ Female (N = 90)	Foetal/pre-natal death [6 weeks–24 months (40.92 weeks)]	PTSD, depression, anxiety, emotional regulation	Yoga, stretch and tone	There were significant decreases in PTSD and depression; and improvements in self-rated health, post intervention for those within the intervention (yoga) conditions.
Kang and Yoo (2007) Korea [42]	Effects of a bereavement intervention program in middle-aged widows in Korea	Qualitative (quasi-experimental)	27	36–64 (intervention 55.8, control 54.4) Female (N = 27)	Spousal death [2–6 months (no mean)]	Grief, stress, immune response	Dan-Jeon breathing and stretching	An experimental group, participating in Dan-Jeon breathing sessions, a self-help group activity, and a health check showed significantly greater decrease in grief levels and symptoms of stress compared to a control group who received only a health check.
Li et al., (2015) Hong Kong [43]	From body to mind and spirit: qigong exercise for bereaved persons with chronic fatigue syndrome-like illness	Quantitative (intervention)	46	23–52 years (intervention 46 [median], control 45 [median]) Male (N = 6) Female (N = 40)	Spousal death, sibling death, parental death, other death [< 2 years (no mean)]	Fatigue, depression, anxiety, well-being	Qigong	Bereaved participants with an illness likened to chronic fatigue syndrome had significantly higher mental fatigue scores and lower physical functioning than non-bereaved participants. Participants within the Qigoing intervention group had a significant decrease in mental and physical fatigue after 3 months compared to the control group.
McClatchey et al. (2009) USA [44]	Efficacy of a camp-based intervention for childhood traumatic grief	Quantitative (intervention)	100	6–16 years (no mean) Male (N = 48) Female (N = 52)	Parental death [0–48 months (Camp A 12.57 months), Camp B 15.11 months)	PTSD [DSM-IV] Childhood traumatic grief (Extended Grief Inventory)	Canoeing, hiking, treasure hunts, and other play activities.	A short term, trauma-focused grief camp reduced traumatic grief and post traumatic grief disorder in children who had been parentally bereaved. Children participated in a range of traditional camp activities (canoeing) and counselling. Symptoms of both traumatic grief and PTSD continued to decline at a 2-week follow-up.
McClatchey al. (2012) USA [49]	Healing components of a bereavement camp: Children and adolescents give voice to their experiences	Qualitative (semi-structured interviews)	32	8–17 years (11.47) Male (N = 5) Female (N = 27)	Parental death [not mentioned (no mean)]	Grief	Traditional camp activities: canoeing	Traditional camp activities such as canoeing were viewed as the most enjoyable and a healing element where children were able to connect with each other. Counselling was viewed as the most beneficial element of the grief camp.
Moores et al. (2007) UK [52]	Memorable patient deaths: Reactions of hospital doctors and their need for support	Quantitative (cross-Sectional)	188	N/A (no mean) Male (N = 100) Female (N = 85) Missing (N = 3)	Patient death [not mentioned (no mean)]	Coping strategies, appetite changes, fatigue, sleep, crying, numbness, emptiness, sadness	Exercise (not specified)	The most frequent coping strategy after experiencing patient death was talking with others (83.5%). Other coping mechanisms were: having time alone (64.4%), socialising (36.2%), exercise (26.2%) and religious guidance (21.8%).
Phoenix and Orr (2017) UK [55]	Analysing exceptions within qualitative data: promoting analytical diversity to advance knowledge of ageing and physical activity	Qualitative (narrative constructionism—interviews)	51	N/A (no mean) Male (N = 23) Female (N = 28)	General bereavement [not mentioned (no mean)]	Anxiety, depression	Physical activity (not specified)	Following the death of a loved one, physical activity was found to strengthen or generate new social networks. Results show that pre-arranged physical activity provided motivation, and a reason to get out of bed and interact with other individuals in a social environment.
Richardson (2010) USA [50]	Length of caregiving and well-being among older widowers: Implications for the dual process model of bereavement	Quantitative (survey)	200	58–91 years (75) Male (N = 200)	Spousal death [13–24 months (520 days)]	Affect	Social clubs, playing sports	Negative affect was influenced by time since death, ethnicity, and participation in clubs. Following the death of a spouse (wife), participants joined clubs and participated in sports often. Factors which influenced positive affect included length of caregiving, number of friends, and having a confidante.
Simpson et al. (2014) USA [51]	The impact of mid- and late-life loss on insomnia: Findings from the Health and Retirement Study, 2010 cohort	Quantitative (database—Health and Retirement Study: HRS)	12,759	50–70 years (no mean) Male (N = 6084) Female (N = 6675)	Spousal death, parental death, child loss, sibling [not mentioned (no mean)	Insomnia, depression	Active (not specified)	Those experiencing one or more bereavements in mid-later life were found to have significantly higher proportions of subclinical and clinical symptoms of insomnia than those with no loss even when age, sex, and lifestyle behaviours (smoking, alcohol use, BMI, and physical activity) were taken into consideration.
Stahl et al., (2020) USA [39]	Digital monitoring of sleep, meals, and physical activity for reducing depression in older spousally-bereaved adults: a pilot randomised controlled trial	Quantitative (RCT)	57	60+ (75) Males and females (no breakdown given)	Spousal death [< 8 months no mean)]	Depressive symptoms, anxiety, PTSD, suicidality	Physical activity (non-defined)	Behavioural interventions, that incorporate digital monitoring behaviours (sleep, diet, physical activity) and a motivational health coach, are feasible and acceptable to older bereaved adults at high risk of depression. Depression symptoms decreased pre to post intervention.
Wicker and Orlowski (2020) Germany [62]	Coping with adversity: physical activity as a moderator in adaption to bereavement	Quantitative (dataset—German socio-economic)	139,097	20–105 (51.21) Males (N = 66,352) Females (N = 72,745)	Multiple deaths [< 12 months (no mean)]	Life satisfaction, Subjective well-being	Physical activity (non-defined)	The results found that those individuals who were physically active in the past were found to adapt quicker to adverse life events, thus supporting the moderating effect of physical activity following bereavement.
Yoo and Kang (2006) South Korea [45]	Effects of a bereavement intervention program on depression and life satisfaction in middle aged widows in Korea	Quantitative (quasi-experimental design)	27	35–64 years (intervention 55.8, control 54.4) Female (N = 27)	Spousal death [0–6 months (no mean)]	Depression, life satisfaction	Dan-Jeon breathing and stretching	Participants within the experimental group, engaging in physical activity significantly decreased levels of depression when compared to the control group who had no physical activity engagement. In addition, participating in physical activity significantly increased life satisfaction.
Zhang et al. (2008) Country not given [63]	Depressive symptom trajectories and associated risks among bereaved Alzheimer disease caregivers	Quantitative (questionnaires)	182	(62.8) Male (N = 30) Female (N = 152)	Caregiver death [post loss assessment, 13.9,37.9, 63.6-week medians]	Depression	Exercise (not specified) caregiver scale—exercise for > 15–30 minutes at least 3 times per week)	Three depressive symptom trajectories reported: syndromal, syndromal-beginning-threshold and persistently absent depression. Risks of syndromal-beginning-threshold level depression were: lack of family support, caregiver burden and adverse health behaviours (e.g. physical inactivity). Having access to early intervention for these factors may decrease the risk of depression after loss.
Zhao et al. (2014) China [59]	Extracurricular interest as a resilience building block for children affected by parental HIV/AIDS	Quantitative (cross-sectional)	1625	6–18 years (12.25) Male (N = 826) Female (N = 799)	Parental death [not mentioned (no mean)]	Depression, loneliness, self-esteem	Sport (not specified)	Participating in extra-curricular activities including sports decreased the negative effects of parental death from HIV/AIDS in children. After controlling for age, gender, family and socioeconomic status, children’s self-esteem increased, and loneliness decreased by participating in extracurricular activities such as sport.