Outcome assessments used in studies examining the effect of prescribed exercise interventions for people living with severe mental illness, a scoping review

Background: Exercise interventions are increasingly incorporated in the management of severe mental illness; however, best practice screening and outcome monitoring for this unique population are yet to be established. This review aims to explore assessment measures reported in publications of exercise interventions in severe mental illness. Methods: A scoping review was implemented with a structured search of Embase, PubMed, Medline, PsychINFO, Scopus, and SportDiscus using terms related to severe mental illness, exercise, and health. Studies were included if they incorporated an exercise intervention for people with severe mental illness and measured physical and/or mental health outcomes. Studies were analysed for population, assessment measures, and methodological quality. Results: 1832 studies were identified and following screening and full text review 38 studies involving 2854 participants were included for analysis, primarily psychotic (n = 13), depressive disorder (n = 9) and mixed severe mental illness populations (n = 13). The most frequently reported health domains and assessment measures used included body composition (weight and body mass index), symptom severity, cardiorespiratory fitness (volume of oxygen consumption), cardiometabolic health (blood pressure and metabolic blood sampling), and quality of life. Methodological quality varied with 13 determined as good, 12 fair, and 13 poor. Conclusion: The review identified domains and assessment tools frequently reported in the exercise and severe mental illness literature. However, given the heterogeneity and scarcity of the research, along with lack of reporting of sufficient detail, best-practice clinical recommendations are still limited. There remains a need to establish best practice assessment and monitoring procedures within exercise interventions in severe mental illness

Exercise is medicine… when you enjoy it: Exercise enjoyment, relapse prevention efficacy, and health outcomes for youth within a drug and alcohol treatment service

Evidence for the effectiveness of exercise as therapy for youth substance use disorder (SUD) is scarce. In this study, we investigated associations between exercise enjoyment and recovery outcomes for youth undergoing residential SUD treatment. Method: Using ecological momentary assessment, each week participants reported perceptions of exercise enjoyment, relapse prevention efficacy, self-esteem, and physical health, and associations between these variables were assessed at both between- and within-person levels. There were 97 participants (age: M = 17.5, SD = 1.57, range = 14 to 21; 37 female, 60 male), with a final sample of 64 due to participants (n = 33) discontinuing treatment within 2 weeks of commencement. Of the remaining sample, 50% (n = 32) completed 3 or more assessments, 40% (n = 26) completed 5 or more, and 25% (n = 16) completed 7 or more. Results: Relapse prevention efficacy, self-esteem, and perceived physical health increased over time in the program. Youth who, on average, enjoyed exercise more had higher self-esteem, perceived physical health, and relapse prevention efficacy than those who enjoyed it less. Additionally, on occasions when youth enjoyed exercise more (relative to their own average), they reported higher self-esteem, perceived physical health, and relapse prevention efficacy than on occasions when they reported enjoying it less. Conclusion: Participation in—and importantly, enjoyment of—exercise was linked to key health indices and predictors of relapse for youth during SUD treatment. These findings demonstrate that participation in enjoyable structured exercise may provide an important component of successful SUD treatment

A qualitative exploration of the experience and attitudes of exercise professionals using telehealth for people with mental illness

Purpose: Physical activity is an important component of treatment for people living with mental illness, and exercise practitioners are well placed to deliver these interventions. In response to the COVID-19 pandemic and associated lock-down regulations, exercise professionals have rapidly adapted to the online delivery of services to continue care for their clients. To date, the research surrounding the delivery of exercise sessions via telehealth for this population has been scarce. Therefore, this study aims to explore how exercise professionals working in mental health have adapted to telehealth, the barriers and facilitators they have experienced and the implications for the future. Design/methodology/approach: A qualitative study using semi-structure interviews was conducted. Interviews were audio recorded, transcribed and analysed using reflexive thematic analysis. Findings: Nine exercise physiologists working in mental health settings in Australia participated in the interviews. Two main themes were explored. The first related to the implementation of telehealth and was divided into four sub-themes: service delivery, accessibility and suitability, technology barriers and facilitators, adaptations to exercise prescription. The second theme related to attitudes and was categorised into two sub-themes: attitudes towards telehealth and future recommendations. Practical implications: Telehealth appears to be a feasible and well accepted platform to deliver exercise sessions for people with mental illness, and this study provides guidance for clinicians including service and training recommendations. Originality/value: To the best of the authors’ knowledge, this is the first study to examine the experiences of exercise physiologists working in mental health and using telehealth

Exercise is medicine... when you enjoy it: exercise enjoyment, relapse prevention efficacy, and health outcomes for youth within a drug and alcohol treatment service

Objective: Evidence for the effectiveness of exercise as therapy for youth substance use disorder (SUD) is scarce. In this study, we investigated associations between exercise enjoyment and recovery outcomes for youth undergoing residential SUD treatment. Method: Using ecological momentary assessment, each week participants reported perceptions of exercise enjoyment, relapse prevention efficacy, self-esteem, and physical health, and associations between these variables were assessed at both between- and within-person levels. There were 97 participants (age: M = 17.5, SD = 1.57, range = 14 to 21; 37 female, 60 male), with a final sample of 64 due to participants (n = 33) discontinuing treatment within 2 weeks of commencement. Of the remaining sample, 50% (n = 32) completed 3 or more assessments, 40% (n = 26) completed 5 or more, and 25% (n = 16) completed 7 or more. Results: Relapse prevention efficacy, self-esteem, and perceived physical health increased over time in the program. Youth who, on average, enjoyed exercise more had higher self-esteem, perceived physical health, and relapse prevention efficacy than those who enjoyed it less. Additionally, on occasions when youth enjoyed exercise more (relative to their own average), they reported higher self-esteem, perceived physical health, and relapse prevention efficacy than on occasions when they reported enjoying it less. Conclusion: Participation in — and importantly, enjoyment of — exercise was linked to key health indices and predictors of relapse for youth during SUD treatment. These findings demonstrate that participation in enjoyable structured exercise may provide an important component of successful SUD treatment