The relationship between exercise and hopelessness in prison

Healthy prison cultures: factors influencing male prisoners' engagement in exercise and subsequent healthy behaviours

PURPOSE

The purpose of this paper is to identify the factors which influence male prisoners' motivation for, and engagement in, exercise and subsequent healthy behaviours.

DESIGN/METHODOLOGY/APPROACH

The first authors conducted 20 semi-structured interviews with male prisoners inside an English medium-security male prison. Interviews were recorded and transcribed, themes were identified using thematic analysis and a critical realist perspective applied to understand objective processes behind prisoners' experiences and shared meanings of exercise and engaging in healthy behaviours in prison.

FINDINGS

Emerging themes indicate that in the context of healthy behaviours male prisoners aspired to a masculine ideal that was characterised by a culture of either adaptive behaviours, or maladaptive behaviours. The former fostered an adaptive exercise culture which promoted psychological well-being through an autonomy-supportive environment, consequently internalising motivation and minimising perceived barriers to engaging in healthy behaviours. Conversely, a culture of maladaptive behaviours fostered a maladaptive exercise culture which led to negative psychological well-being, underpinned by external forms of motivation which emphasised barriers to engaging in healthy behaviours.

PRACTICAL IMPLICATIONS

Findings emphasise the need for prisons to promote an internal perceived locus of control for male prisoners when engaging in healthy behaviours.

ORIGINALITY/VALUE

The authors adopt a rare interdisciplinary approach combining a psychological theory of motivation and criminological perspectives of prison culture to understand how best to minimise the impact of prisons as an institution on the psychological well-being of male prisoners.

Diet-Related Risk Factors for Chronic Noncommunicable Diseases in Italian Prisoners: B.A.C.I. (Benessere All'interno delle Carceri Italiane, Well-Being Inside the Italian Prisons) Project by the Italian Society of Penitentiary Medicine and Public Health (S.I.M.S.Pe. Società Italiana di Medicina e Sanità Penitenziaria)

PURPOSE OF REVIEW

The review aims to present an overview of inmate health, focusing on lifestyle-related diseases, physical activity levels, and nutritional status. It also presents the B.A.C.I. (Benessere All'interno delle Carceri Italiane, well-being inside the Italian prisons) project, which aims to offers an innovative path of prevention, diagnosis, and treatment of noncommunicable diseases (NCDs) related to unhealthy lifestyles in prisons in the Campania region, Italy.

RECENT FINDINGS

The global prison population has risen by 24% since the year 2000, with over 10.77 million people detained worldwide in 2021. In Italy alone, there are currently over 57,000 inmates. Inmates face a higher risk of NCDs such as cardiovascular disease due to unhealthy lifestyles characterized by poor diets and lack of physical activity. Additionally, sleep disorders, particularly insomnia, are prevalent among inmates, further contributing to health disparities. While physical activity has shown positive effects on inmate well-being, there is limited research on nutritional status and interventions in prison populations. Providing quality healthcare to inmates is an international policy norm, but the standards vary globally and are often inadequate. The economic burden of NCDs is rising, and this is exacerbated in prisons, making it challenging for individuals to reintegrate into society after release.

Predicting attrition of men with a history of violence from randomised clinical trials

Preventing dropout (attrition) from clinical trials is vital for improving study validity. Dropout is particularly important in justice-involved populations as they can be very challenging to engage and recruit in the first instance. This study identifies factors associated with dropout in a double-blind, placebo-controlled randomised control trial of a selective serotonin reuptake inhibitor (SSRI) aimed at reducing reoffending in highly impulsive men with histories of violent offending. Age, education, social support, psychiatric history, and length of previous incarceration were identified as factors that predict attrition. These findings are consistent with previous research examining variables associated with attrition in clinical trials for community and offender populations. We also explored referral source and treatment allocation as attrition predictors. Although neither significantly predicted attrition, we identified that there are discernible differences in the median time to attrition among the referral source subgroups. Understanding factors that predict treatment completion and attrition will allow researchers to identify participants for whom additional provisions may optimise retention and inform development of targeted interventions.

Impact of COVID-19 on Physical Activity in Families Managing ADHD and the Cyclical Effect on Worsening Mental Health

Physical activity supports symptom management in children with ADHD and reduces the mental health burden associated with caregiving for children with ADHD. Survey-based research shows that COVID-19 reduced physical activity among diverse populations. This study used a qualitative approach situated within a socioecological framework to (1) understand how COVID-19 impacted physical activity of children with ADHD and their caregivers, to (2) identify barriers to their physical activity, and to (3) identify potential areas of support. Thirty-three participants were interviewed between October 2020 and January 2021. Content analysis revealed that physical activity declined for children and caregivers; significant barriers were social isolation and rising intrapersonal difficulties such as diminishing self-efficacy and energy levels and increased mental health difficulties. Worsening mental health further alienated caregivers and children from physical activity, undermining its protective effects on ADHD symptom management and mental wellbeing. Participants identified needing community support programs that offer virtual, live physical activity classes as well as psycho-emotional support groups. There is vital need to support physical activity opportunities during high-stress situations in families managing ADHD to buffer against diminishing mental wellbeing. This will promote further physical activity engagement and allow families to reap the cognitive, psychological, and emotional benefits.

Relationship between Sports Practice, Physical and Mental Health and Anxiety-Depressive Symptomatology in the Spanish Prison Population

The objective of this study was to evaluate, in a group of Galician inmates, if there were variations in the levels of physical and mental health and anxiety-depressive symptomatology, depending on the sports' practice performed. The relationship between these constructs was also investigated. The sample was composed of 509 people deprived of liberty in prisons in the Autonomous Community of Galicia, Spain. A quantitative methodology was used, with the questionnaire as an information collection instrument, Student's t-tests, Pearson's correlation analysis and a stepwise regression analysis were carried out. The results indicated that those who performed physical activity during their stay in prison had higher levels of physical and mental health, as well as lower indicators of anxiety-depressive symptoms. People who did not practice sports showed a decrease in their perceived health levels when compared to those perceived in their pre-prison stage. A negative association was shown between perceived health levels and anxiety-depressive symptomatology. Perceived physical health, alone, explained 35% of the variance in perceived mental health. These results add to knowledge about the relationships between perceived health, anxiety-depressive symptoms and sports practice in the group of people deprived of liberty, highlighting the importance of promoting physical activity in penitentiary institutions.

Prison and the brain

Imprisonment is a common punishment in most countries. Goals of imprisonment are often not only retribution, but also prevention. Specific prevention aims to reduce the risk of reoffending of the imprisoned offender. The question is whether the goals of retribution and specific prevention contradict each other. Retribution is not only expressed in taking away ones freedom, but also in the prison environment itself. Prisoners live in a sober regime, with a minimal amount of autonomy. There are few cognitive challenges, meaningful social interaction is reduced significantly, and many prisoners are highly sedentary. In other words, prison can be viewed as an impoverished environment. In the last few decades, much knowledge has been gained on the influence of enriched versus impoverished environment on the brain. In this chapter, we discuss the influence of the impoverished prison environment on brain functions of prisoners, with an emphasis on self-regulation and executive functions, since these functions are (1) often impaired in offenders, (2) highly sensitive to environmental influences, and (3) crucial for successful resocialization. We conclude this chapter by discussing possibilities for and potential effects of enriching prison environments.

Barriers and facilitators to attending and being physically active during recreation time among women incarcerated

BACKGROUND

Most women incarcerated in jail are not physically active and do not attend recreation time (rec-time), a time dedicated to being physically active, outside. The purpose of this study was to determine barriers and facilitators to attending and being physically active during rec-time among women incarcerated in jail.

METHODS

We recruited and distributed a cross-sectional questionnaire to 100 women incarcerated at the Coconino County Detention Facility (CCDF) in Flagstaff, Arizona from March to July 2020. Women were asked about their experience with rec-time at CCDF, including if they had ever attended, how often they attended, if they exercised at rec-time, activities they participated in, and facilitators, barriers, and benefits to attend rec-time.

RESULTS

Among 99 women who completed the questionnaire, 89% had ever attended rec-time. Most women identified environmental- and health-related facilitators to attending rec-time including enjoying natural light (74%), getting fresh air (83%), a change in environment (62%), and to move around and exercise (72%). Many women indicated environmental-, equipment-, clothing, and motivation-related barriers to attending rec-time. Specifically, women believed there was a lack of equipment (56%) and limited access to proper footwear (49%).

CONCLUSIONS

As health and environment are important facilitators and barriers to being physically active among women incarcerated in jail, it is important to identify appropriate environmental and policy interventions to increase the use of rec-time and physical activity. If a correctional facility does not offer rec-time or a similar alternative, one should be established, accessible, and welcoming.

Patterns of Physical Activity Among Women Incarcerated in Jail

The physical and mental health benefits of physical activity in all populations are well established. In 2019, incarcerated women at a Southwest county jail were observed during "recreation time," a time when physical activity is encouraged, to identify the proportion of women who participated in recreation time and their physical activity levels. During observed recreation times, 28% of women attended; 56% were sedentary, 4% engaged in vigorous physical activity, and approximately 40% walked or performed similarly moderate physical activity. Future research should identify barriers to being physically active while incarcerated, leading to targeted interventions to promote physical activity.

Factors associated with depression among prisoners in Mizan prison institute, southwest Ethiopia

PURPOSE

In spite of the vulnerability of prisoners to depression and their increased number, the issue has not been thoroughly investigated in Ethiopia. In particular, the determining factors of depression have not been exhaustively identified. Thus, the purpose of this study is to assess the prevalence of depression and associated factors among prisoners in Mizan prison institute, southwest Ethiopia.

DESIGN/METHODOLOGY/APPROACH

An institution-based cross-sectional study was conducted from April 6-27, 2020. A total of 340 randomly selected prisoners were included. Depression was assessed using the Patient Health Questionnaire-nine and participants were considered to be in a state of depression if they scored five and above. Binary logistic regression was used to assess the association between the outcome variable (depression) and the independent variables (factors). The odds ratio with a 95% confidence interval (CI) was used to measure the strength of association. The final significance was decided using a p-value < 0.05.

FINDINGS

The prevalence of depression was 29.9% (95% CI: 25%, 34.8%). Prisoners whowere not participating in the duty work of the prison had 55% (adjusted odds ratio [AOR] = 0.45; 95% CI: 0.22, 0.93) less odds of depression compared to those who were participating in the duty work. Similarly, physically active respondents had 81% (AOR = 0.19; 95% CI: 0.10, 0.35) less odds of depression than physically inactive respondents. Moreover, undernourished participants had two times (AOR = 2.03; 95% CI: 1.08, 3.82) higher odds of depression than normal participants.

RESEARCH LIMITATIONS/IMPLICATIONS

Considering their risk of exposure compared to the general population and the limitations of cross-sectional study design, special care should be provided to the prisoners' mental health. Moreover, priority attention should be given to the undernourished, physically inactive and those who are participating in duty work in the prison.

ORIGINALITY/VALUE

This study demonstrated important and modifiable factors associated with prisoners' depression. It also evaluated the contribution of new variables (such as participation in the duty work, nutritional status and physical activity) that were not considered in previous local studies.

COVID-19 Pandemic and Physical Exercise: Lessons Learnt for Confined Communities

The novel pandemic called "Coronavirus Disease 2019" (COVID-19), as a global public health emergency and global threat, has affected many countries in unpredictable ways and impacted on physical activity (PA) behaviors to various extents. Specific populations including refugees, asylum seekers, and prisoners, are vulnerable groups with multiple complex health needs and worse health outcomes with respect to the general population worldwide and at high risk of death from the "Severe Acute Respiratory Syndrome-related Coronavirus type 2" (SARS-CoV-2). Governments around the world have been implementing preventive healthcare policies, including physical and social distancing, isolation, and confinement, to mitigate against the burden imposed by the COVID-19 outbreak. This pandemic period is characterized by reduced or lack of movement. During this period of lockdown, PA can represent an immunotherapy and a preventative approach to avoid the harmful effects of inactivity due to the pandemic. Moreover, PA could be prescribed to improve the immune system of specific populations (refugees, asylum seekers, and prisoners), which particularly experience the condition of being confined. The present narrative review discusses the potential impacts of COVID-19 pandemic on these specific populations' health status and the importance of performing PA/exercise to reduce the deleterious effects of COVID-19 pandemic. In addition, we aim to provide useful recommendations on PA/exercise for these specific populations to maintain their level of independence, physical, and mental health as well as their wellbeing.

Time out of cell and time in purposeful activity and adverse mental health outcomes amongst people in prison: a literature review

PURPOSE

The purpose of this study is to synthesise the available peer-reviewed literature on the impact of time out of cell (TOOC) and time in purposeful activity (TIPA) on adverse mental outcomes amongst people in prison.

DESIGN/METHODOLOGY/APPROACH

The outcomes of interest of this literature review were mental health, suicide, deliberate self-harm (DSH) and violence. Exposures of interest were TOOC, TIPA or a partial or indirect measure of either. In total, 14 studies were included. An abbreviated review methodology was used because of time constraints.

FINDINGS

There was consistent evidence of an association between lower TOOC and TIPA and worse mental health and higher suicide risk. Limited evidence suggests a link between TOOC and DSH. No evidence was identified regarding the relationship between TOOC/TIPA and violence.

RESEARCH LIMITATIONS/IMPLICATIONS

A lack of longitudinal studies prevents conclusions regarding causality. Significant heterogeneity of mental health outcomes limits the comparability of studies.

PRACTICAL IMPLICATIONS

These findings highlight the importance of considering the impact of TOOC and TIPA on adverse mental outcomes for prisoners when designing prison regimes, including during urgent adaptation of such regimes in response to Covid-19. They are likely to be of interest to practitioners and policymakers concerned with prison regime design.

ORIGINALITY/VALUE

This paper is the first to synthesise the existing literature on the impact of TOOC and TIPA on mental health outcomes.

Could Physical Activity Have any Role in Cardiovascular Disease Prevention in Prisoners? A Systematic Review

More than 10.74 million people are currently held in penal institutions worldwide. Moreover, there is also evidence that the percentage of elder and female prisoners has been consistently growing. Cardiovascular diseases are the leading cause of death worldwide. Exercise training and physical activity help to prevent both primary and secondary cardiovascular events. Data on the influence of physical activity on the well-being in prison population is scarce. Here, we discussed, in a systematic review, the general health conditions and the cardiovascular risk profile in the prisoners compared to the general population and evaluated whether or not exercise could be a valuable tool in preventing these diseases in inmates. We performed a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement: 769 were initially identified, and a total of 24 studies were finally included. Nine studies evaluated the health conditions in prisoners, five studies evaluated the incidence of cardiovascular disease (CVD) and coronary heart disease (CHD) in the prison population, and 10 studies evaluated the feasibility and the effectiveness of exercise programs in prisoners. Sports-educational programs can benefit prison inmates. It appears that supervised exercise training is an effective coping strategy to deal with incarceration. Moreover, it seems the sports programs might be a useful tool in improving physical and mental health of prisoners as well as in decreasing cardiovascular risk factors.

A rapid review of home-based activities that can promote mental wellness during the COVID-19 pandemic

Background

During the COVID-19 pandemic, public health measures such as isolation, quarantine, and social distancing are needed. Some of these measures can adversely affect mental health. Activities that can be performed at home may mitigate these consequences and improve overall mental well-being. In this study, home-based activities that have potential beneficial effects on mental health were examined.

Methods

A rapid review was conducted based on a search of the following databases: MEDLINE, EMBASE, CINAHL, PyscINFO, Global Health, epistemonikos.org, covid19reviews.org, and eppi.ioe.ac.uk/covid19_map_v13.html. Eligible studies include randomized controlled trials and non-randomized studies published between 1/1/2000 and 28/05/2020 and that examined the impact of various activities on mental health outcomes in low-resource settings and contexts that lead to social isolation. Studies of activities that require mental health professionals or that could not be done at home were excluded. Two review authors performed title/abstract screening. At the full-text review stage, 25% of the potentially eligible studies were reviewed in full by two review authors; the rest were reviewed by one review author. Risk of bias assessment and data extraction were performed by one review author and checked by a second review author. The main outcome assessed was change or differences in mental health as expressed in Cohen’s d; analysis was conducted following the synthesis without meta-analysis guidelines (SWiM). PROSPERO registration: CRD42020186082.

Results

Of 1,236 unique records identified, 160 were reviewed in full, resulting in 16 included studies. The included studies reported on the beneficial effects of exercise, yoga, progressive muscle relaxation, and listening to relaxing music. One study reported on the association between solitary religious activities and post traumatic stress disorder symptoms. While most of the included studies examined activities in group settings, particularly among individuals in prisons, the activities were described as something that can be performed at home and alone. All included studies were assessed to be at risk of bias in one or more of the bias domains examined.

Conclusions

There is some evidence that certain home-based activities can promote mental wellness during the COVID-19 pandemic. Guidelines are needed to help optimize benefits while minimizing potential risks when performing these activities.

Are People Experiencing the 'Pains of Imprisonment' During the COVID-19 Lockdown?

BACKGROUND

By the end of March 2020, more than a fifth of the world's population was in various degrees of "lockdown" in order to slow the spread of COVID-19. This enforced confinement led some to liken lockdown to imprisonment. We directly compared individual's experiences of lockdown with prisoners' experiences of imprisonment in order to determine whether psychological parallels can be drawn between these two forms of confinement.

METHODS

Online surveys of adults in lockdown in the UK (N = 300) and California (N = 450) were conducted 4 and 5 weeks into lockdown in each region, respectively. The UK data was then compared to Souza and Dhami's (2010) sample of 267 medium security prisoners in England, and the Californian data was compared to Dhami et al.'s (2007) sample of 307 medium security Federal prisoners in California. We measured the effects of Group (Lockdown v. Prison) on five categories of dependent variables (i.e., activity, social contact, thoughts, feelings, and rule-breaking), controlling for demographic differences between the groups.

RESULTS

In both regions, people in lockdown thought significantly less often about missing their freedom, as well as missing their family and friends living elsewhere than did first-time prisoners. However, people in lockdown in both regions were also significantly less engaged in a range of daily activities than were first-time prisoners. Additionally, in both regions, people in lockdown reported feeling more hopeless than first-time prisoners.

CONCLUSION

Although Governments introducing lockdown policies do not intend to punish their citizens as courts do when sending convicted offenders to prison, such policies can have unintended adverse consequences. Psychological parallels can be drawn between the two forms of confinement.

The Level of Aggressiveness During Karate Practice of Inmates in Correctional Settings

Karate is known to enhance cognitive functioning, emotional well-being, and self-regulation and to contribute to an overall behavior rehabilitation process. However, few data are available on the impact of practicing karate in adult prison inmates. The main objective of this research was to evaluate aggressive behavior, comparing prison inmates and club practitioners during karate practice. The level of aggressiveness was rated by observers during defined elements and training situations in karate classes held in France. Data were collected during 77 observations of 75 prison inmates (55 male and 20 female) in a prison setting, and 188 observations of 117 club practitioners (80 male and 37 female) in a club setting over a period of 26 months. Licit aggressiveness was graded by observers during launched actions, kiais, and bows, and the practice level (belts) was also considered. Interrater reliability of the observational measure was highly acceptable (Cohen κ = 1). Comparisons between female and male prison inmates and club practitioners were made using the non-parametric Mann–Whitney U-test for independent samples. The results revealed that a higher level of aggressiveness was observed in both male and female club practitioners during launched actions and kiais than in prison inmate practitioners (p < 0.001, small effect size). However, prison inmates (of both genders) showed a higher level of aggressiveness during bows (p < 0.001, medium effect size). While the analyses showed no significant differences between genders, the level of karate practice was associated with distinct changes. Significant differences in observed aggressiveness were present only in beginners and in those with a low level of karate practice, whereas no differences in aggressiveness between prison or club practitioners were observed during karate practice in those with a high level of karate practice (black belt). However, these results must be interpreted with caution as there was no way to control the multiple factors that might also affect inmate behaviors in a correctional setting. We suggest that karate practice in prison may positively contribute to interactional behaviors.

Adaptation of the System for Observing Play and Recreation in Communities (SOPARC) for the Measurement of Physical Activity in Jail Settings

Over 9 million people are incarcerated in jail each year, but physical activity has not been assessed among incarcerated populations. Measuring physical activity in the jail setting is complicated as current physical activity measurement tools are not designed for use inside jail facilities. Therefore, we adapted an evidence-based physical activity measurement tool, the System for Observing Play and Recreation in Communities (SOPARC), to assess physical activity within a jail facility. SOPARC was designed to obtain observational information on physical activity of individuals. The study team created a protocol for SOPARC for use in jail facilities. Unlike the original SOPARC, access to recreation time in jail required prior scheduling. Target areas were unnecessary as recreation spaces were enclosed. The adapted SOPARC protocol for jails included start and end times, the number of individuals that attended, and recreation time users’ physical activity levels, footwear, outerwear, uniform color, and use of mobility assistive devices. The use of SOPARC in the jail setting requires adaptation to adequately capture physical activity data among incarcerated individuals. Accurately measuring physical activity among incarcerated individuals and the environment in which they are active may allow for future development and testing of physical activity interventions in jail facilities.

Social Networks and Health in a Prison Unit

Although a growing body of research documents lasting health consequences of incarceration, little is known about how confinement affects inmates' health while incarcerated. In this study, we examine the role of peer social integration and prisoners' self-reported health behaviors (smoking, exercise, perception of health, and depression) in a prison unit. We also consider whether inmates with similar health characteristics cluster within the unit. Drawing on a sample of 132 inmates in a "good behavior" unit, we leverage social network data to ask: In prison, is it healthier to become friends with other prisoners or keep your head down and "do your own time"? Using exponential random graph models and community detection methods, findings indicate that social integration is associated with better health outcomes. However, race-ethnicity, religious identity, and exercise intensity emerge as key factors sorting inmates into social groups and likely shaping the distribution of health behaviors observed in the unit.

Reduced Self-Control after 3 Months of Imprisonment; A Pilot Study

Background: Prison can be characterized as an impoverished environment encouraging a sedentary lifestyle with limited autonomy and social interaction, which may negatively affect self-control and executive function. Here, we aim to study the effects of imprisonment on self-control and executive functions, and we report the change in neuropsychological outcome after 3 months of imprisonment.

Materials and Methods: Participants were 37 male inmates in a remand prison in Amsterdam, Netherlands, who completed six tests of a computerized neuropsychological test battery (the Cambridge Automated Neuropsychological Test Battery) in the first week of arrival. Participants were retested after 3 months of imprisonment. Change in performance was tested using the Wilcoxon Signed-Rank test.

Results: After 3 months of imprisonment, risk taking significantly increased (measured as an increase in the proportion of available points used for betting) and attention significantly deteriorated (measured as increased variability in reaction times on a sustained attention task), with large to medium effect sizes. In contrast, planning significantly improved (measured with a task analog to the Tower of London) with a medium effect size.

Discussion: Our study suggests that 3 months of imprisonment in an impoverished environment may lead to reduced self-control, measured as increased risk taking and reduced attentional performance. This is a significant and societally relevant finding, as released prisoners may be less capable of living a lawful life than they were prior to their imprisonment, and may be more prone to impulsive risk-taking behavior. In other words, the impoverished environment may contribute to an enhanced risk of reoffending.

Health related quality of life and physical activity in prison: a multicenter observational study in Italy

Background

Inmates have a poorer health status than the general population. The physical activity is well know that improve the wellness of the people. This multicentric cross-sectional study aimed to assess the relationship between Quality of Life (QoL) and physical activity levels among Italian prisoners.

Methods

Inmates from eight prisons compiled a questionnaire. The Metabolic Equivalent of Task (MET) was used to measure inmates' weekly physical activity levels (MATwk). Their QoL was measured using two components of Short Form with 12 items (SF12): MCS (mental score) and PCS (physical score).

Results

A total of 636 questionnaires were compiled. High level of MET was significantly (P <0.05) associated with both PCS (OR = 1.02) and MCS (OR = 1.03). The correlations between PCS, MCS vs. METwk scores were respectively significant: r = 0.17 and r = 0.10, P < 0.05. The number of years of detention was associated to higher MET (OR = 1.04 P < 0.05). The presence of Physical Exercise Areas (PEAs) within Jails did not improve the QoL level.

Conclusions

Jails may not seem like the ideal place to fight sedentary behavior, but, in any case, health promotion can occur within its walls. The heterogeneity of Italian jails, and particularly relative PEAs therein (areas had different characteristics between jails), suggests that such spaces should be regulated or well defined. Furthermore, the implement of training schedules could be done in a standardized way. Despite this heterogeneity both the physical and mental components of inmates' quality of life were associated to a high level of physical activity.

The role of sport in promoting prisoner health

PURPOSE

The existing evidence base and policy context of sports-based prisoner health promotion is evaluated, and an original analysis of current provision and best practice in delivering sport to address physical, mental and substance misuse needs among prisoners across the secure estate in England and Wales is presented, with a focus on the variability of provision across different prison establishments.

DESIGN/METHODOLOGY/APPROACH

Inspectorate reports published by Her Majesty's Inspectorate of Prisons (n=184) were analysed to assess the extent to which health promotion objectives are being implemented through physical education in prisons across England and Wales. Examples of innovative sport-based health promoting programmes are drawn upon in order to illustrate principles of best practice.

FINDINGS

Despite health promotion being engrained in existing policy, the degree to which physical, mental health and substance misuse needs are addressed through sport in prison remains highly variable and locally contingent across the secure estate, although examples of innovative practice are evident.

RESEARCH LIMITATIONS/IMPLICATIONS

For sport to promote prisoner health most effectively, tailored sports provision should be embedded within multi-modal interventions which draw on internal and external partnerships and promote opportunities for ongoing sporting participation. Further research is required to delineate principles of best practice applicable to discrete prisoner populations.

ORIGINALITY/VALUE

Sport can play a key role in addressing a multitude of prisoner health needs whilst contributing to achieving "healthy prison" objectives in practice. Sport and physical activity clearly offers a valuable way of motivating prisoners to engage in health promoting initiatives.

Study Protocol: The influence of Running Therapy on executive functions and sleep of prisoners

Background: Executive dysfunction appears to be related to increased recidivism. Of note is that sleep disturbances, which are highly prevalent in prisons, may attenuate executive functions. Thus, improving executive functions, either directly or indirectly through the improvement of sleep, may reduce recidivism. It is hypothesised that physical exercise, in the form of Running Therapy, has a direct positive effect on executive functions as well as an indirect effect through the improvement of sleep.

Methods/Design: Seventy two (N = 72) detainees in various penitentiary institutions in the Netherlands will be recruited in this study. A baseline measurement, including six neuropsychological tests of the Cambridge Neuropsychological Test Automated Battery (CANTAB), an assessment of sleep quality and duration using the Actiwatch (Actiwatch 2, Philips Respironics, Murrysville, PA, USA) and various other measurements will be administered before the start of the treatment. After 3 months of Running Therapy, participants will be assessed again with the same tests for neuropsychological and physical functioning. Primary outcomes are executive functioning and various sleep variables.

Discussion: This study will be the first to investigate the possible influence of Running Therapy on the cognitive functioning, sleep and aggression in prisoners.

Participation in a 9-month selected physical exercise programme enhances psychological well-being in a prison population

BACKGROUND

There is general population evidence that physical exercise is effective in reducing the risk of depression and has positive effects on mood. Some prisons encourage exercise, but there is no evidence specific to this group on its benefits or the relative merits of different programmes.

AIMS

To test the effect of physical exercise on the psychological well-being of prisoners and to determine which mental disorders are most affected by physical activity.

METHODS

Sixty-four participants were randomly assigned across three groups: cardiovascular plus resistance training (CRT), high-intensity strength training (HIST) and no exercise. Before and after the 9-month experimental period, all participants completed the Symptom Checklist-90-Revised.

RESULTS

Each form of exercise significantly reduced depression scale scores compared with those in the control group, in which average depression scale scores actually increased. The CRT group also showed a significant decrease in GSI scores on the Symptom Checklist-90 and on its interpersonal sensitivity scale, whereas the HIST group also significantly improved on the anxiety, phobic anxiety and hostility scale scores.

CONCLUSIONS

Our evidence, taken together with general population studies, supports introduction of supervised, moderately intense exercise for at least 1 h per week for men in prison. They form a high risk group for mental disorders, and such exercise reduces depression and anxiety. Minimal special equipment is needed for CRT. Further research should replicate the study in a larger, multi-centre trial, and examine impact on shorter-term and longer-term prisoners, female prisoners and effects on recidivism.

Incarcerated women develop a nutrition and fitness program: participatory research

PURPOSE

Women in prison throughout the world experience higher rates of mental and physical illness compared with the general population and compared with men in prison. The paper finds no published studies that report on men or women in prison engaging in participatory health research to address their concerns about nutrition and fitness. The purpose of this paper is to describe a pilot nutrition and fitness program, which resulted from a unique prison participatory health research project.

DESIGN/METHODOLOGY/APPROACH

Women in prison designed, led, and evaluated a six-week pilot fitness program in a minimum/medium security women's prison. Pre- and post-program assessments included a self-administered questionnaire and body measures. Open-ended questionnaire responses illuminated the quantitative findings.

FINDINGS

Sixteen women in prison completed the program evaluation. Weight, body mass index, waist-to-hip ratio, and chest measurements decreased, and energy, sleep, and stress levels improved by the end of the program.

RESEARCH LIMITATIONS/IMPLICATIONS

As a component of a participatory research project, incarcerated women designed and led a nutrition and fitness program, which resulted in improved body measures and self-reported health benefits. ORIGINALITY VALUE: Incarceration provides opportunities to engage women in designing their own health programs with consequent potential long-term "healing" benefits.

Aging Prisoners in Switzerland

Objective: This study assessed health care utilization of aging prisoners and compared it with that of younger prisoners. Method: Health care utilization comprised visits to general practitioners (GPs), nurses, and mental health professionals (MHPs) for a period of 6 months. Using retrospective study design, data were extracted from medical records of 190 older prisoners (50 years and older) and 190 younger inmates (18-49 years). Age group was a dichotomous predictor variable with type of sentencing and time spent in prison as covariates. Descriptive statistics and generalized linear mixed models (GLMMs) were performed. Results: For each of the three outcome variables, two GLMMs were constructed. The first model only included age group as the predictor variable (3 × Unadjusted models). The second included the two covariates in addition to the predictor variable (3 × Adjusted model). Results from the adjusted model indicate that visits to GPs significantly differed between the two age groups ( p = .022). Older prisoners visited GPs 1.43 times more often than younger prisoners over the 6-month period (adjusted risk ratio [RR] = 1.43, 95% confidence interval [CI] = [1.05, 1.94]). The finding for visits to nurses was not statistically significant ( p = .080). However, older prisoners visited nurses 1.36 times more frequently (adjusted RR = 1.36, 95% CI = [0.96, 1.91]). Finally, older prisoners visited MHPs 1.24 times more often than younger prisoners (adjusted RR = 1.24, 95% CI = [.95, 1.61]) and this finding was also not statistically significant ( p = .11). Discussion: Study findings underline that older prisoners utilized health care more often than younger prisoners although in most models the finding did not reach statistical significance. The prison system must develop solutions to address the needs of an aging population, particularly those with physical and mental health problems.

A systematic review of interventions for anxiety, depression, and PTSD in adult offenders

There is a high prevalence of anxiety and depression in offender populations but with no recent systematic review of interventions to identify what is effective. This systematic review was undertaken to identify randomised controlled trials of pharmacological and non-pharmacological interventions in adult offenders in prison or community settings. A search of five databases identified 14 studies meeting inclusion criteria, which considered the impact of psychological interventions, pharmacological agents, or exercise on levels of depression and anxiety. A narrative synthesis was undertaken and Hedges g effect sizes calculated to allow comparison between studies. Effect sizes for depression interventions ranged from 0.17 to 1.41, for anxiety 0.61 to 0.71 and for posttraumatic stress disorder 0 to 1.41. Cognitive behavioural therapy interventions for the reduction of depression and anxiety in adult offenders appear effective in the short term, though a large-scale trial of sufficient duration is needed to confirm this finding.

Prison brain? Executive dysfunction in prisoners

A better understanding of the functioning of the brain, particularly executive functions, of the prison population could aid in reducing crime rates through the reduction of recidivism rates. Indeed, reoffending appears to be related to executive dysfunction and it is known that executive functions are crucial for self-regulation. In the current paper, studies to executive functions in regular adult prisoners compared to non-offender controls were reviewed. Seven studies were found. Specific executive functions were found to be impaired in the general prison population, i.e., attention and set-shifting, as well as in separate subgroups of violent (i.e., set-shifting and working memory) and non-violent offenders (i.e., inhibition, working memory and problem solving). We conclude that the limited number of studies is remarkable, considering the high impact of this population on society and elaborate on the implications of these specific impairments that were found. Further empirical research is suggested, measuring executive functioning within subjects over time for a group of detainees as well as a control group.

Forensic nursing interventions with patients with personality disorder: a holistic approach

Research findings suggest that nursing assessment and care and psychotherapy of forensic patients with personality disorder should be based on a holistic approach that addresses a wide range of their needs. Such an approach should be in collaboration with patients, informal carers, and other professionals and informed by appropriate education, training, clinical supervision, and support. Holistic care includes areas (such as physical health, cultural, spiritual, and psychosexual needs) that are addressed to a limited extent in the literature on patients with personality disorder. Despite limitations in research evidence, findings suggest that some patients with personality disorder benefit from psychotherapies, sometimes facilitated by nurse-therapists, and therapeutic community principles. These interventions should take account of patients' cultural and spiritual needs and perspectives. Helping patients to manage anger has potentially positive consequences for their physical health, personal and work relationships, and other areas. Research is needed to consider how to deliver holistic care with limited resources and in organizations, such as prisons, with conflicting goals.

Cardiovascular risk factors among prisoners: an integrative review

BACKGROUND AND AIM

Incarceration is characterized by inequalities in disease burden and an increased risk for cardiovascular disease (CVD). The aim of this review was to critique published empirical research studies on cardiovascular risk factors among prisoners and to summarize and synthesize current knowledge and findings across these studies.

DESIGN AND REVIEW METHOD

An integrative review of the studies was conducted. Cooper's five stage method was used as a framework to guide data collection, analysis, and synthesis. Quality appraisal of retrieved studies was done using a combined evaluation tool for quantitative research studies and a checklist. The following databases were searched: CINAHL, MEDLINE, PubMed, Cochrane, Indigenous Studies Portal (iPortal), Native Health Database, Criminal Justice Abstracts, and PsychInfo using keywords. Inclusion criteria were used to select published papers.

RESULTS AND CONCLUSION

A total of 12 studies that met the inclusion criteria were identified and analyzed. Hypertension, among other CVD risk factors such as smoking, physical inactivity and obesity, was one of the three most common CVD risk factors found in prisoners. Women and young offenders had a higher prevalence of hypercholesterolemia. Identifying prevalent risks factors among prisoners might influence the development of CVD prevention strategies that are specifically directed to at risk prisoners.

Influenza control can be achieved in a custodial setting: pandemic (H1N1) 2009 and 2011 in an Australian prison

OBJECTIVES

Information on the effectiveness of interventions regarding control in closed institutional settings, including prisons, is limited. This study gathered evidence relating to influenza control in an Australian prison.

STUDY DESIGN

This study built on a 2009 H1N1 outbreak investigation at the Alexander Maconochie Centre (AMC) in the Australian Capital Territory (ACT).

METHODS

Influenza surveillance data, ACT 2010 Inmate Health Survey data, New South Wales 2001 and 2009 Inmate Health Survey data, ACT Department of Corrective Services administrative data, and ACT Health clinical data were analysed.

RESULTS

In 2011, the AMC was exposed to influenza virus, resulting in a single case. Public health activities included exclusion of symptomatic cases from the health facility, isolation of cases, and quarantine of contacts. Contact between prisoners and the ACT community was maintained; the AMC detainee visitor rate was one visitor per prisoner every 10 days.

CONCLUSIONS

The rehabilitative benefits of human contact for AMC detainees were not compromised during the surveillance period, despite the potential that a higher visitor rate may suggest. This highlights some features of the AMC which make its operational context different from many other correctional settings, but gives some indication of how good public health practice supports human rights.