Promoting exercise behaviour in a secure mental health setting: health care assistant perspectives

Individuals with severe mental illness engage in significantly less amounts of physical activity than the general population. A secure mental health setting can exacerbate barriers to exercise, and facilitate physical inactivity and sedentary behaviour. Health Care Assistants are intimately involved in the daily lives of patients and therefore, should be considered integral to exercise promotion in secure mental health settings. Our aim was to explore Health Care Assistants perceptions of exercise and their attitudes to exercise promotion for adult patients in a secure mental health hospital. Qualitative semi-structured interviews were conducted with 11 Health Care Assistants from a large UK based secure mental health hospital. Topics included Health Care Assistants personal experiences of exercise within a secure facility, their perceptions of exercise as an effective treatment tool for mental health, and their perceived roles and responsibilities for exercise promotion. Thematic analysis was used to analyse the data. Three main themes were identified; 1) exercise as multiply beneficial for patients, 2) perceived barriers to effective exercise promotion, and 3) strategies for effectives exercise promotion. Health Care Assistants considered exercise to hold patient benefits. However, core organisational and individual barriers limited Health Care Assistants exercise promotion efforts. An informal approach to exercise promotion was deemed most effective to some, whereas others committed to more formal strategies including compulsory sessions. With education and organisational support, we propose Health Care Assistants are well placed to identify individual needs for exercise promotion. Their consultation could lead to more efficacious, person-sensitive interventions

Physical activity in secure settings: A scoping review of methods, theory and practise

Evidence suggests that individuals with severe mental illness (SMI) engage in considerably less exercise and significantly more sedentary behaviour than the general population. It has been suggested that inactivity is likely to be exacerbated in secure services. The purpose of this scoping review was to explore and synthesise the existing literature with a view to facilitate discussion on methods, theory and practise used in current studies investigating exercise in secure settings. Additionally, this review aimed to identify gaps in the existing literature and highlight recommendations for future studies. Sixteen studies met the review inclusion criteria. Pre and post measurement was the most common study design. Only three studies utilised psychological or behaviour change theory to underpin their design. Self-report physical activity (e.g. attendance) and clinical measures (e.g. positive and negative symptomology) were the most commonly reported outcome. Length, type and intensity of sessions varied. Recruitment, attrition and limited staff involvement were noted as major challenges in data collection. Despite several uncertainties with methodology (design, validated scale and use of self-report data) and noted challenges with data collection (recruitment and attrition), the emerging data warrants future research into physical activity in secure settings

Family experiences of living with an eating disorder: a narrative analysis

Families are considered important in the management and treatment of eating disorders. Yet, rarely has research focused on family experiences of living with an eating disorder. Addressing this gap, this study explores the experiences of an elite 21-year-old triathlete with an eating disorder in conjunction with the experiences of her parents. Family members attended interviews individually on three separate occasions over the course of a year. In line with the narrative approach adopted, whereby stories are considered the primary means to construct experience, interviews encouraged storytelling through an open-ended, participant-led structure. Narrative analysis involved repeated readings of the transcripts, sensitising towards issues of narrative content (key themes) and structure (overarching plot). Family difficulties arose when personal experiences strayed from culturally dominant narrative forms and when family members held contrasting narrative preferences. Suggestions are forwarded as to how an appreciation of eating disorder illness narratives might inform treatment and support

Changes in body image perceptions upon leaving elite sport: The retired female athlete paradox

Little is known about the evolution of female athlete body image into retirement. In this study, 218 retired athletes from aesthetic sports answered a series of closed and open ended questions regarding bodily changes since retirement. Years since retirement was unrelated to current weight status (e.g., underweight, normal weight), what they were doing about current weight (e.g., lose weight), and satisfaction with current weight (all p’s > .69). Overall, 74.3% thought they were normal weight, yet 55% were dissatisfied with their weight and 59.6% were trying to lose weight. A rigorous thematic analysis of the qualitative data yielded 4 core themes that characterized participants’ experiences: 1) A move towards the feminine ideal; 2) Feeling fat, flabby and ashamed; 3) A continued commitment to a former self; and 4) Conflicting ideals: The retired female athlete paradox. Perceived muscle loss was considered indicative of either increased fat (dissatisfaction) or increased femininity (satisfaction). For some retired athletes, the satisfaction brought on by newfound femininity was complicated by a coinciding and conflicting commitment to a muscular athletic physique. Practical applications include strategies for sport psychologists to better support athletes in coping with the body changes that occur on retirement from elite sport

Learning to eat again: intuitive eating practices among retired female collegiate athletes

The present study used an open-ended survey to collect information about current eating practices and coping strategies among 218 retired female athletes. An inductive and deductive thematic analysis revealed three themes relevant to the intuitive eating framework -- Permission to eat, Recognising internal hunger and satiety cues, and Eating to meet physical and nutritional needs. Athletes described feeling liberated with regards to their eating following retirement from sport, and for some this included an alleviation of disordered eating practices. These changes, however, required an effortful process of recalibration, during which athletes had to re-learn and reinterpret their body’s physiological signals of hunger and satiety. Additional research is needed to understand just how this process unfolds and how retired athletes can be supported in developing a healthier and more adaptive approach to eating

Crossing boundaries: the perceived impact of disabled fitness instructors in the gym

Objectives For disabled individuals, the gym is perceived to be an inaccessible space to exercise due to the deeply embedded ableism within this environment. This study uniquely explored how disabled gym instructors perceived they impacted the gym environment and the possibilities of making the gym a more inclusive space for disabled people to exercise. Design We used an inductive, qualitative design whereby ten disabled gym instructors were purposefully sampled. Methods Data were rigorously collected through semi-structured interviews totalling 35 h, transcribed verbatim, and subject to thematic analysis. Results Participants perceived they made three key impacts in the gym. First, they believed they promoted the gym as a more inclusive environment through helping construct a more accessible physical space, embodying an alternate way of being and providing a relatable narrative. Second, instructors believed their own unique understanding of disability improved their capacity to relate to disabled gym clients by instilling a sense of camaraderie and acting as an aspirational future self. Third, participants felt they enhanced applied practice for training disabled clients through creativity in training and supporting non-disabled instructors. Conclusion This article makes a significant contribution to knowledge by highlighting that disabled gym instructors can play a vital role in promoting a more inclusive space to exercise. It also highlights that to increase gym use amongst disabled populations, efforts should consider the potential beneficial impacts of disabled gym instructors in relation to promoting health and well-being

Exercise attitudes and behaviours among retired female collegiate athletes

Objectives: The present study explored exercise attitudes and behaviours among retired female collegiate athletes. Design: A survey design incorporating both closed and open-ended questions was adopted. Method: A total of 218 former NCAA Division I female athletes (n = 144 gymnastics; n = 74 swimming/diving) provided details on their current exercise behaviours and their thoughts regarding exercise since retiring from collegiate sport. Results: No relations were found between years since retirement and athletes’ current exercise frequency, types of exercise activities, and reasons for exercising. Despite reporting activity levels consistent with recommendations (5 days/week, 1 hour per session), retired athletes remained dissatisfied with their activity levels and struggled to integrate exercise alongside occupational, academic and social demands. Conclusions: Athletes may require support in adapting to an independent and less intense exercise regime on retirement. Future research may look to explore exercise attitudes and behaviours among retired athletes from a longitudinal perspective

Disability and the gym: experiences, barriers and facilitators of gym use for individuals with physical disabilities

Purpose: Individuals with physical disabilities are among the most inactive population in society, arguably due to the lack of suitable environments to exercise. The gym is a space dedicated to improving physical fitness in a controlled environment with specialized equipment and qualified instructors. The feasibility of using this space to promote health to this population, however, is yet to be established. Method: Over an 18-month period, 21 people with physical disabilities were interviewed regarding their experiences in the gym. Data were collected using semi-structured interviews, transcribed verbatim, and subject to thematic analysis. Results: Four broad themes were identified: (1) experiencing enhanced well-ness, (2) perceived conflict between gym values and disability, (3) influence of a previous gym identity, and (4) experiences of psycho-emotional disablism. Conclusions: Participants were perceived to experience a variety of health benefits; however, they also experienced many barriers such as not aligning to the cultural norms of the gym, limited interpretations of health, oppressive messages from the built environment, and negative relational interactions. While there is potential for the gym to be used as a place to promote health, more must be done to foster an inclusive atmosphere in this space

Understanding physical activity participation in spinal cord injured populations: three narrative types for consideration

The aim of this study was to identity the types of physical activity narratives drawn upon by active spinal injured people. More than 50 h of semi-structured life-story interview data, collected as part of larger interdisciplinary program of disability lifestyle research, was analysed for 30 physically active male and female spinal cord injury (SCI) participants. A structural narrative analysis of data identified three narrative types which people with SCI draw on: (1) exercise is restitution, (2) exercise is medicine, and (3) exercise is progressive redemption. These insights contribute new knowledge by adding a unique narrative perspective to existing cognitive understanding of physical activity behaviour in the spinal cord injured population. The implications of this narrative typology for developing effective positive behavioural change interventions are critically discussed. It is concluded that the identified narratives types may be constitutive, as well as reflective, of physical activity experiences and therefore may be a useful tool on which to base physical activity promotion initiatives

Exercise is medicine? Most of the time for most; but not always for all

Based on extensive research on the relationship between exercise and health, exercise as a form of medicine is a powerful concept of growing popularity within healthcare, academia and policy. Proponents of this exercise is medicine (EiM) movement frame exercise as a panacea for a variety of health issues and uncritically promote exercise as good for all. Two clinical populations particularly influenced by the EiM agenda are spinal cord injury (SCI) and arthritis. The purpose of this research was to explore how individuals with SCI and arthritis personally make sense of their exercise experiences. Data were collected through semi-structured interviews with participants with SCI and 20 participants with arthritis. Following a thematic narrative analysis, three patterns were identified across the whole data set. These were: 1) exercise and restitution; 2) exercise and pain; and 3) exercise and pleasure. Taken together, these results provide new knowledge regarding the impact of exercise that both align with, and contrast, the dominant EiM discourse. When exercise is perceived as ‘medicine’, stories of exercise participation spoke of cure, and restitution, rather than health and well-being. Pain was an unwelcomed side effect of exercise participation for some, and had a detrimental impact upon motivation and engagement. Lastly, a focus upon the medicinal benefits of exercise did not reflect the multiple pleasures experienced through exercise participation. Thus, health professionals, academics and policy makers need to prescribe to more ethical forms of exercise promotion that may lead to more efficacious, person-sensitive interventions