Survey of Australian mental health nurses on physical activity promotion

Exercise Promotion Practices among Mental Health Professionals: A Scoping Review

Mental health professionals (MHPs) have a unique opportunity to integrate PA and exercise promotion into clinical care. This scoping review employed the information-motivation-behavioral Skills (IMB) model to examine the exercise promotion practices of MHP. An electronic search of four major databases from 2007 to August 2020 was conducted and results were reported using PRISMA. Seventeen studies were included where the variables of interest were knowledge, attitudes, and beliefs regarding exercise promotion. MHP expressed a need for additional training and the integration of exercise specialists to care for the physical health of patients. Practitioners need additional education to understand the guidelines for exercise prescription for individuals with SMI and the role exercise could have in improving the quality of life for their patients. Findings were conceptualized utilizing the IMB model to inform future quantitative measures and health behavior interventions.

Improving Practices of Mental Health Professionals in Recommending More Physical Activity and Less Sedentary Behaviour to Their Clients: An Intervention Trial

We investigated the effects of increasing physical activity (PA) and reducing sedentary behaviour (SB) of mental health professionals on their attitudes towards and practices in recommending more PA and less SB to their clients. A 4-week pre-post intervention trial was conducted involving 17 mental health professionals. The participants who increased their own physical activity during the intervention increased the frequency of recommending more PA (p = 0.009) and less SB (p = 0.005) to their clients. A relatively simple, low-cost intervention, consisting of group behaviour change counselling, goal setting and positive feedback, may improve the practices of mental health professionals.Supplemental data for this article is available online at https://doi.org/10.1080/01612840.2021.1972189 .

Implementation barriers and facilitators of an integrated multidisciplinary lifestyle enhancing treatment for inpatients with severe mental illness: the MULTI study IV

BACKGROUND

Despite an increase in studies showing the efficacy of lifestyle interventions in improving the poor health outcomes for people with severe mental illness (SMI), routine implementation remains ad hoc. Recently, a multidisciplinary lifestyle enhancing treatment for inpatients with SMI (MULTI) was implemented as part of routine care at a long-term inpatient facility in the Netherlands, resulting in significant health improvements after 18 months. The current study aimed to identify barriers and facilitators of its implementation.

METHODS

Determinants associated with the implementation of MULTI, related to the innovation, the users (patients, the healthcare professionals (HCPs)), and the organisational context, were assessed at the three wards that delivered MULTI. The evidence-based Measurement Instrument for Determinants of Innovations was used to assess determinants (29 items), each measured through a 5-point Likert scale and additional open-ended questions. We considered determinants to which ≥20% of the HCPs or patients responded negatively ("totally disagree/disagree", score < 3) as barriers and to which ≥80% of HCPs or patients responded positively ("agree/totally agree", score > 3) as facilitators. We included responses to open-ended questions if the topic was mentioned by ≥2 HCPs or patients. In total 50 HCPs (online questionnaire) and 46 patients (semi-structured interview) were invited to participate in the study.

RESULTS

Participating HCPs (n = 42) mentioned organisational factors as the strongest barriers (e.g. organisational changes and financial resources). Patients (n = 33) mentioned the complexity of participating in MULTI as the main barrier, which could partly be due to organisational factors (e.g. lack of time for nurses to improve tailoring). The implementation was facilitated by positive attitudes of HCPs and patients towards MULTI, including their own role in it. Open responses of HCPs and patients showed strong commitment, collaboration and ownership towards MULTI.

CONCLUSIONS

This is the first study analysing the implementation of a pragmatic lifestyle intervention targeting SMI inpatients in routine clinical care. Positive attitudes of both HCPs and patients towards such an approach facilitated the implementation of MULTI. We suggest that strategies addressing organisational implementation barriers are needed to further improve and maintain MULTI, to succeed in achieving positive health-related outcomes in inpatients with SMI.

A Qualitative Examination of the Physical Activity Needs of People with Severe Mental Illness

It is recognised that physical activity has a positive impact on quality of life, social well-being and overall health of people with severe mental illness. However, there is a lack of theory informed programmes that support people with mental illness to adopt regular physical activity behaviour. The aim of this case study was to identify determinants of long-term physical activity among people with severe mental illness that may then inform the development of more suitable physical activity programmes. Semi-structured interviews were conducted with 15 people (13 men and 2 women) with a mean age of 36.7 [standard deviation (SD)=11.8] who had a diagnosed mental illness and were attending a physical activity programme run by a mental health non-governmental organisation. Interview data was analysed using the documentary method to emphasise the perspective of people with severe mental illness. Three participation types were generated in the context of individuals' physical activity orientation and social background-first 'rehabilitative orientated' (physical activity as a supportive measure to re-enter the labour market and develop a daily routine); second 'social-orientated' (social well-being within the group as the primary motive); finally, 'trust-orientated' (a sense of trust that encourages participation). Based on these type-specific categories, it is suggested that different settings (mental health care centres and sport clubs) might be needed to attract and maintain the physical activity engagement of people with severe mental illness. In the context of sport clubs, it is recommended that coaches undergo training in mental health literacy.

Associations between physical activity and motivation, competence, functioning, and apathy in inhabitants with mental illness from a rural municipality: a cross-sectional study

BACKGROUND

There is increasing evidence for physical activity (PA) having a positive impact on physical and mental health as well as illness symptoms in individuals with severe mental illness (SMI). However, individuals with SMI experience several barriers that makes it difficult to take advantage of the benefits associated with PA. One barrier consistently reported to impede PA is motivational issues. Thus, the main aim of the present study was to examine associations between PA and motivation for PA, perceived competence for PA, functioning, apathy, and demographic variables among individuals with SMI. This was conducted within a larger study aiming at including all inhabitants with SMI in one particular small, rural municipality.

METHOD

A total of 106 participants were recruited to the study. Questionnaire-based interviews conducted by two mental health nurses assessed self-reported PA, motivation and competence for PA, functioning, and apathy. Additionally, 71 participants accepted to wear an accelerometer-equipped wristwatch yielding an objective assessment of PA.

RESULTS

The participants engaged in little PA. However, they did not lack motivation, as over 90% stated that they would like to be more active, and participants across PA level displayed high scores of a motivation reflecting that they valued the benefits of PA. Results showed that higher self-reported PA level was associated with higher levels of integrated regulated motivation and perceived competence for PA while it was unrelated to functioning and apathy. In the subpopulation with objectively measured PA, integrated regulated motivation for PA remained significantly associated with PA level, whereas poor scores on functioning lowered the odds ratio for higher PA level.

CONCLUSION

The results show that PA specific motivation is associated with PA even when controlling for functioning and apathy. This highlight the importance of facilitating context specific motivation (i.e., motivation for PA) and that health care practitioners should emphasise helping people with SMI develop more intrinsic forms of motivation.

Clinician perspectives and practices regarding the use of exercise in the treatment of adolescent depression

Initial evidence suggests that exercise is an effective method in reducing symptoms of depression amongst adolescents. It is important to examine clinician attitudes and practices regarding the incorporation of exercise in mental health treatment, and to examine potential facilitators and barriers to exercise prescription. An online survey was conducted amongst mental health clinicians (N = 125) working in the treatment of adolescent depression. Clinicians held favourable attitudes towards exercise, most frequently ranking exercise as the second most important treatment for adolescent depression following cognitive behaviour therapy. The majority of clinicians were found to prescribe exercise "always" (24.3%) or "most of the time" (43.4%). Significant positive relationships were found between confidence to prescribe exercise and knowledge surrounding exercise prescription and clinician exercise prescription rates, however no significant relationship was identified between clinician levels of exercise and exercise prescription. The most frequently endorsed barriers to exercise prescription included the belief that exercise prescription should be implemented by an exercise professional, a lack of knowledge surrounding exercise prescription for adolescent depression, and the belief that depressed adolescents will not adhere to an exercise program. Overall, clinicians held positive attitudes towards exercise in the treatment of adolescent depression, and often recommended exercise as part of treatment.

Motivational factors associated with physical activity and quality of life in people with severe mental illness

BACKGROUND

There has been increasing interest for investigating the role of motivation in physical activity among people with severe mental illness (SMI). Autonomous motivation has been suggested to have a potentially important role in adoption and maintenance of physical activity. However, the knowledge about factors that facilitate autonomous motivation among people with SMI is scarce.

AIM

The aim of this study was to examine factors associated with motivation for physical activity as well as the relationships between motivation, physical activity and health-related quality of life in individuals with SMI that were currently physically active.

METHODS

A cross-sectional design was used, and 88 participants were recruited from a public health network promoting physical activity for people with SMI. They answered a questionnaire package consisting of scales measuring psychological need support - psychological need satisfaction - and motivation for physical activity, physical activity and health-related quality of life.

RESULTS

The majority of participants reported to be in regular physical activity. Associations between variables were tested according to the self-determination theory process model. Structural equation modelling yielded good fit of the process model to the data. Specifically, a need-supportive environment was positively associated with psychological need satisfaction, while psychological need satisfaction was positively associated with autonomous motivation and mental health-related quality of life, and negatively associated with controlled motivation and amotivation. Physical activity was positively associated with autonomous motivation and physical health-related quality of life, and negatively associated with amotivation.

CONCLUSION

This study indicates that individuals with SMI can be regularly physically active when provided with suitable opportunities. Furthermore, the present results suggest that it is vital for health-care practitioners to emphasise creating a need-supportive environment when organising physical activity because such an environment is associated with both increased autonomous motivation for physical activity and mental health-related quality of life.

Motivation for physical activity and exercise in severe mental illness: A systematic review of intervention studies

There has been increasing interest for research on motivation for physical activity (PA) and exercise among individuals with severe mental illness (SMI). The aim of this systematic review is to summarize findings from all intervention studies on PA or exercise that either include empirical data on motivational constructs or apply motivational techniques/theories in their intervention. Systematic searches of seven databases were conducted from database inception to February 2015. Studies were eligible if they: (i) included participants with SMI, (ii) had PA as part of the intervention, and (iii) reported empirical data on motivational constructs related to PA or incorporated motivational techniques/theory in their intervention. Of the 79 studies that met the inclusion criteria only one had motivation for PA as its main outcome. Nine additional interventions reported empirical data on motivational constructs. Altogether these studies yielded mixed results with respect to change in motivational constructs. Only one of those examined the association between motivation and PA, but found none. Sixty-four studies reported using motivational techniques/theory in their intervention. Motivational interviewing and goal-setting were the most popular techniques. Due to the exploratory nature of most of these studies, findings from intervention studies do not so far give very clear directions for motivational work with the patients. There is an urgent need for a more systematic theory based approach when developing strategies that target to increase engagement in PA among people with SMI.

Motivation for physical activity and exercise in severe mental illness: A systematic review of cross-sectional studies

Individuals with severe mental illness (SMI) are less physically active than the general population. One important barrier contributing to this inactivity is lack of motivation. The aim of this paper is to systematically review all cross-sectional literature on motivation for physical activity among people with SMI and to use the results as basis for guidance on how mental health nurses can facilitate motivation for physical activity. Systematic searches of seven databases were conducted from database inception to February 2015. Studies were eligible if they included participants with SMI and reported data on motivation for physical activity. In total, 21 articles were included and over half them were published in 2011 or later. The present results indicate preliminary evidence of how the motivational processes do not differ between individuals with SMI and the general population, and that they are independent of diagnosis, medication, age, gender, and body mass index. Results from the current systematic review can give some tentative guidance on how to facilitate motivation for physical activity within mental health-care. However, there is still a great need for developing and examining practical strategies that can enhance adoption and adherence of physical activity among people with SMI.

Scoping review of research in Australia on the co-occurrence of physical and serious mental illness and integrated care

The physical health of people with serious mental illness (SMI) has become a focal area of research. The aim of the present study was to ascertain the attention and distribution of research from within Australia on physical illness and SMI co-occurrence, and to identify gaps. A scoping review of peer-reviewed research literature from Australia, published between January 2000 and March 2014, was undertaken through an electronic literature search and coding of papers to chart trends. Four trends are highlighted: (i) an almost threefold increase in publications per year from 2000-2006 to 2007-2013; (ii) a steady release of literature reviews, especially from 2010; (iii) health-related behaviours, smoking, integrated-care programmes, and antipsychotic side-effects as the most common topics presented; and (iv) paucity of randomized, controlled trials on integrated-care models. Despite a marked increase in research attention to poorer physical health, there remains a large gap between research and the scale of the problem previously identified. More papers were descriptive or reviews, rather than evaluations of interventions. To foster more research, 12 research gaps are outlined. Addressing these gaps will facilitate the reduction of inequalities in physical health for people with SMI. Mental health nurses are well placed to lead multidisciplinary, consumer-informed research in this area.