Physical activity for patients with severe mental illness: Preferences, barriers and perceptions of counselling

Mental health clients' receptiveness to and recommendations for integrating physical activity discussions into therapy: a mixed methods study

OBJECTIVE

The mental health benefits of physical activity are well-established. Integrating physical activity counseling into therapy would expand the reach of this evidence-based treatment for mental illness. This mixed methods study examined mental health clients' receptiveness and recommendations for effectively discussing physical activity in therapy.

METHODS

A diverse sample of U.S. adults in therapy (N = 478) completed a survey that included the open-ended question: What specific recommendations would you have for your therapist to effectively discuss physical activity with you? We conducted a qualitative content analysis to identify their most common recommendations.

RESULTS

Most participants indicated they would be comfortable discussing physical activity with their therapist. The content analysis resulted in 26 unique categories; most common recommendations included: provide information about what to do (n = 81), discuss physical activity benefits (n = 63), be understanding and nonjudgmental (n = 49), provide accountability (n = 41), and consider physical/mental health conditions (n = 35). Overarching themes emphasized making mental health central to discussions, tailoring discussions to each client, and reframing physical activity as a feasible, enjoyable activity.

CONCLUSIONS

Mental health clients are open to discussing physical activity during therapy if it is approached in a supportive, understanding, and personalized way. Clients' recommendations can inform future professional development for therapists.

Evaluation of an implementation support package to increase community mental health clinicians' routine delivery of preventive care for multiple health behaviours: a non-randomised controlled trial

BACKGROUND

People with a mental health condition are more likely to engage in risk behaviours compared to people without. Delivery of preventive care to improve such behaviours is recommended for community mental health services, but inadequately implemented. This study assessed the effectiveness of an implementation support package on clinicians' delivery of preventive care (assessment, advice, referral) for four risk behaviours (tobacco smoking, harmful alcohol consumption, physical inactivity, inadequate fruit and vegetable intake) compared to no implementation support. The participatory approach to developing the support package, and fidelity of the implementation strategies, are also described.

METHODS

A non-randomised controlled trial was undertaken in 2019-2020 with two community mental health services (control and target) in one health district in New South Wales, Australia. A 4-month support package consisting of multiple implementation strategies was delivered to one site following a two-phase participatory design process. Five implementation strategies were proposed to service managers by researchers. After consultation with managers and clinicians, the final implementation support package included four strategies: training and education materials, enabling resources and prompts, client activation material, and audit and feedback. Client-reported receipt of the three elements of preventive care for the four risk behaviours was collected from a cross-sectional sample of clients who had recently attended the service at baseline (6 months) and follow-up (5 months). Logistic regression models examined change in receipt of preventive care to assess effectiveness.

RESULTS

A total of 860 client surveys were completed (control baseline n = 168; target baseline n = 261; control follow-up n = 164; and target follow-up n = 267). Analyses revealed no significant differential changes in preventive care receipt between the target and control sites from baseline to follow-up, including across the four primary outcomes: assessed for all behaviours (OR = 1.19; 95% CI 0.55, 2.57; p = 0.65); advised for all relevant risk behaviours (OR = 1.18; 95% CI 0.39, 3.61; p = 0.77); referred for any relevant risk behaviour (OR = 0.80; 95% CI 0.40, 1.63; p = 0.55); and complete care (OR = 3.11; 95% CI 0.62, 15.63; p = 0.17). Fidelity of the implementation strategies was limited as one of the four strategies (audit and feedback) was not delivered, components of two strategies (enabling resources and prompts, and client activation material) were not delivered as intended, and one strategy (education and training) was delivered as intended although some components were offered late in the implementation period.

CONCLUSIONS

The implementation support package was ineffective at increasing preventive care delivery. Further investigation is required to determine optimal participatory design methods to develop effective implementation strategies, including those that support delivery of care in community mental health settings within the ongoing context of uncertain environmental challenges.

TRIAL REGISTRATION

Australian and New Zealand Clinical Trials Registry ACTRN12619001379101.

Association Between the Use of Wearable Devices and Physical Activity Among US Adults With Depression and Anxiety: Evidence From the 2019 and 2020 Health Information National Trends Survey

Objective The objective of this study was to examine the relationship between wearable device (WD) use and physical activity (PA) levels among US adults with self-reported depression and anxiety. Methods Data were pooled from 2026 adults who self-reported depression and anxiety from the 2019 and 2020 Health Information National Trends Survey. The explanatory variable was WD use, and the outcomes were weekly PA levels and resistance strength training. Logistic regression was conducted to investigate the association between WD and PA parameters. Results About 33% of adults with self-reported depression/anxiety reported WD use. Only 32.5% and 34.2% of the population reported meeting the weekly recommended levels of physical activity (≥150 minutes/week) and strength and resistance exercise (≥2 times weekly), respectively. In adjusted analyses, the use of WD was not associated with meeting the national weekly recommendation for physical activity (OR 1.38, 95% CI (0.94, 2.04); p=0.10) or resistance strength training (OR 1.31, 95% CI (0.82, 2.08); p=0.26). Further exploratory analysis also showed that physical activity levels did not differ with the frequency of WD use. Conclusion Despite the popularity of WD use among people with mental disorders, we found that use of WD was not associated with increased physical activity measures, suggesting that although there is a promise for these tools to augment mental health, their real-world effectiveness in promoting physical activity in people with mental disorders remains to be proven.

Benefits, Facilitators and Barrier Reductions in Physical Activity Programmes for People with Severe Mental Disorder: A Systematic Review

The current high prevalence of people with Severe Mental Disorder and the high impact the latter has on their quality of life is one of the main problems in terms of health, as it affects both physical and mental health. One of the lines of action to intervene in these factors is the practice of physical activity, as this usually has a low level of participation due to different barriers. However, there are several facilitators that improve adherence to these practices. The main objectives of this work were (1) to conduct a systematic review of the scientific literature on the possible benefits obtained by people with SMD from their participation in physical activity programmes; (2) to identify the characteristics of physical activity programmes and determine the barriers to their implementation that have been considered and (3) the facilitators incorporated. To meet these objectives, the SCOPUS, Web of Science, PubMed, Dialnet and Elsevier online databases were consulted and, following the PRISMA statement, 17 articles were finally selected. Their analysis has revealed various physical, psychological and social benefits, as well as the barriers that appear in the intervention programmes, mostly related to personal factors and the programme itself, and those factors that facilitate their adherence or development, the most common being the carrying out of the activities outdoors, the inclusion of social components and the possibility of adapting the activities. In this way, the results obtained have made it possible to highlight the characteristics that should be taken into account when planning this type of intervention.

Physical Activity in Adults with Schizophrenia and Bipolar Disorder: A Large Cross-Sectional Survey Exploring Patterns, Preferences, Barriers, and Motivating Factors

Adults with severe mental ill health may have specific attitudes toward physical activity. To inform intervention development, we conducted a survey to assess the physical activity patterns, preferences, barriers, and motivations of adults with severe mental ill health living in the community. Data were summarised using descriptive statistics, and logistic regressions were used to explore relationships between physical activity status and participant characteristics. Five-hundred and twenty-nine participants (58% male, mean age 49.3 years) completed the survey. Large numbers were insufficiently active and excessively sedentary. Self-reported levels of physical activity below that recommended in national guidelines were associated with professional inactivity, consumption of fewer than five portions of fruit and vegetables per day, older age, and poor mental health. Participants indicated a preference for low-intensity activities and physical activity that they can do on their own, at their own time and pace, and close to home. The most commonly endorsed source of support was social support from family and friends. Common motivations included improving mental health, physical fitness, and energy levels. However, poor mental and physical health and being too tired were also common barriers. These findings can inform the development of physical activity interventions for this group of people.

Using sport-based interventions for people with severe mental disorders: results from the European EASMH study

People with severe mental disorders report significantly poorer physical health and a higher mortality rate compared with the general population. Several interventions have been proposed in order to challenge this mortality gap, the promotion of physical activities represents one of the most important strategies. In fact, in people with severe mental disorders, physical activity can improve body composition, quality of life, personal functioning, self-esteem, cognition, and cardiorespiratory fitness, as well as reducing affective, psychotic and anxiety symptoms, cardiometabolic burden and increase the global recovery. While sport-based programs are consistently being proposed as an integral part of effective personalized treatment approaches for people with severe mental disorders, their routine implementation is hampered by poor working task integration among different professionals and the lack of training programmes for sport professionals focused on people with severe mental disorders. In this paper, we will: (a) review the efficacy of exercise/sport-based interventions for people with severe mental disorders; (b) describe the main difficulties in engaging patients with severe mental disorders in these interventions; and (c) report the results of the first study on the best practices available in Europe in the field of sport and mental health carried out in the context of the European Alliance for Sport and Mental Health (EASMH) project. According to the EASMH survey, sport-based psychosocial interventions are not frequently available in mental health services, with significant differences at the European level. In the near future, it would be advisable to promote the integration and collaboration between mental health professionals and sport professionals, in order to improve the dissemination and availability of sport-based interventions in routine clinical practice. The EASMH project aims to fill this gap by creating a network of collaborators, researchers and stakeholders with different backgrounds in order to improve the dissemination of sport-based rehabilitation interventions and by developing an innovative training programme for sport coaches in order to improve their skills in interacting and building an effective relationship with people with severe mental disorders.

Implementing experience-based co-design to develop a physical activity programme in recovery-focused outpatient mental health services

Background/Aims

As mental health services focus on recovery orientated service delivery, there is a need to adopt recovery orientated approaches in interventions that promote physical activity. This article presents a process of using and modifying an experience-based co-design approach to develop an intervention that can be used to promote physical activity in mental health services: the ‘Move with Recovery’ programme.

Methods

A facilitated experience-based co-design approach was undertaken over four sessions. This approach included the use of a trigger film of touchpoints and sample physical activity experiences of service users, in addition to the use of a storyboard for emotional mapping and prioritising exercises. The final two co-design sessions involved programme prototyping and development using the TIDieR framework.

Results

The outcome of this process, the Move with Recovery programme, was a peer-developed and peer-led, community-focused programme structured around nine action points. It is made up of a combination of motivation, education and support sessions, together with light intensity aerobic activity sessions that is structured using the TIDieR framework, and intended for implementation in the recovery college. In this regard, the developed programme is inherently recovery orientated in its design and its aim.

Conclusions

The developed programme can be embedded into existing mental health services that lack integrated exercise resources. This articles details the experience-based co-design process undertaken here and offers future learning for using experience-based co-design to promote physical activity in mental health.

Effect of a nurse-led intervention program on the physical health and quality of life of individuals with severe mental illness

PURPOSE

The aim of this study was to investigate the effect of nurse-led intervention programs on patients' physical health, physical activities, healthy lifestyle behaviors, and quality of life.

DESIGN AND METHODS

The research was conducted with a quasi-experimental design. The sample consisted of 33 individuals with severe mental illness. Data were collected with the Healthy Lifestyle Behavior Scale II, the Short Form-36 Quality-of-Life Instrument, and pedometers.

FINDINGS

The individuals in the intervention group showed a statistically significant decrease in waist circumference and increases in the physical activity and nutrition dimensions of healthy lifestyle behaviors and the physical function of quality of life. No statistically significant changes were detected in anthropometric measurements, healthy lifestyle behaviors, or quality-of-life subscales in the control group.

PRACTICE IMPLICATIONS

Mental health nursing and psychiatric nurses should plan and implement interventions to encourage healthy eating and physical activity for patients.