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

Reported growth following mountaineering expeditions: The role of personality and perceived stress

Results from previous studies suggest that stressful environmental conditions such as those faced on expedition may result in psychological growth. Building on previous research, the present cross-sectional study examined the role of personality and perceived stress in relation to post-expedition growth. Eighty-three participants who had completed a mountaineering expedition responded to measures of stress, personality, growth, well-being, and resilience. Findings implicate perceived stress, and personality dimensions of agreeableness and openness, in post-expedition growth. Growth was associated with well-being but distinct from psychological resilience, highlighting the need to consider growth and resilience independently. Present findings support the proposition that stressful expedition environments may promote positive psychological adjustment and identify factors that may influence this change. Research is needed to delineate the impact of other variables, such as coping, on changes that occurs during the post-expedition phase. Such research holds relevance for maintaining health following immersion in extreme and unusual environments

Changes in work affect in response to lunchtime walking in previously physically inactive employees: a randomized trial

Physical activity may regulate affective experiences at work, but controlled studies are needed and there has been a reliance on retrospective accounts of experience. The purpose of the present study was to examine the effect of lunchtime walks on momentary work affect at the individual and group levels. Physically inactive employees (N=56; M age=47.68; 92.86% female) from a large university in the UK were randomized to immediate treatment or delayed treatment (DT). The DT participants completed both a control and intervention period. During the intervention period, participants partook in three weekly 30-min lunchtime group-led walks for 10 weeks. They completed twice daily affective reports at work (morning and afternoon) using mobile phones on two randomly chosen days per week. Multilevel modeling was used to analyze the data. Lunchtime walks improved enthusiasm, relaxation, and nervousness at work, although the pattern of results differed depending on whether between-group or within-person analyses were conducted. The intervention was effective in changing some affective states and may have broader implications for public health and workplace performance

EPA guidance on physical activity as a treatment for severe mental illness: a meta-review of the evidence and Position Statement from the European Psychiatric Association (EPA), supported by the International Organization of Physical Therapists in Mental Health (IOPTMH)

Physical activity (PA) may be therapeutic for people with severe mental illness (SMI) who generally have low PA and experience numerous life style-related medical complications. We conducted a meta-review of interventions and their impact on health outcomes for people with SMI, including schizophrenia-spectrum disorders, major depressive disorder (MDD) and bipolar disorder. We searched major electronic databases until January 2018 for systematic reviews with/without meta-analysis that investigated PA for any SMI. We rated the quality of studies with the AMSTAR tool, grading the quality of evidence, and identifying gaps, future research needs and clinical practice recommendations. For MDD, consistent evidence indicated that PA can improve depressive symptoms versus control conditions, with effects comparable to those of antidepressants and psychotherapy. PA can also improve cardiorespiratory fitness and quality of life in people with MDD, although the impact on physical health outcomes was limited. There were no differences in adverse events versus control conditions. For MDD, larger effect sizes were seen when PA was delivered at moderate-vigorous intensity and supervised by an exercise specialist. For schizophrenia-spectrum disorders, evidence indicates that aerobic PA can reduce psychiatric symptoms, improves cognition and various subdomains, cardiorespiratory fitness, whilst evidence for the impact on anthropometric measures was inconsistent. There was a paucity of studies investigating PA in bipolar disorder, precluding any definitive recommendations. No cost effectiveness analyses in any SMI condition were identified. We make multiple recommendations to fill existing research gaps and increase the use of PA in routine clinical care aimed at improving psychiatric and medical outcomes

Preparing for a physical activity intervention in a secure psychiatric hospital: reflexive insights on entering the field

The medical model for treating severe mental illness has been critiqued for its insensitivity to the subjective and contextual facets of patients’ illness and recovery experiences. For many, mental health service efforts are a function of the social and institutional contexts in which they occur. Understanding this therapeutic context is therefore critical to planning effective care strategies. In this confessional tale, the first author reflects on one-year (>300 hours) within a medium secure psychiatric hospital - a process carried out to inform the future design of a physical activity intervention. Drawing upon reflexive journal entries, conversations across the research team, and personal introspection, three broad methodological insights are offered; 1) becoming a reflexive researcher, 2) negotiating ‘the self’ in a mental health context, and 3) cultural means to logistical ends. Researcher reflexivity is a challenging and effortful process that can lead to unforeseen insights about the research setting. Practicing reflexivity supported the first author towards an awareness of her own stigmatised attitudes to mental illness and how they might affect the research process. Immersive fieldwork is time consuming and presents a raft of methodological difficulties, but it supports deep and nuanced insights unavailable through other methods. When seeking to effectively tailor intervention strategies to the unique needs of a given healthcare setting, this added depth and nuance is valuable. Health intervention work that draws on immersive qualitative methods, rather than tokenistic forms of “patient public involvement”, is better equipped to deliver strategies that are not only efficacious but also effective. <br

A sports-based intervention for pupils excluded from mainstream education: A systems approach to intervention acceptability and feasibility

Pupil referral units educate young people excluded from mainstream education within England, UK. Exclusion is related to reduced continuation with education and training, unemployment, and an increased likelihood of entrance into the criminal justice system. Sport has been consistently used to improve reintegration into education. However, evidence surrounding sports interventions in this setting is sparse and/or lacks detail surrounding acceptability and feasibility. Systems-based approaches highlight the complexity of multi-component interventions. The current study aimed to independently evaluate the acceptability and feasibility of a co-produced sport-based intervention. The intervention used sport, mentorship, education, reflection, and role models to promote health, pro-social, behavioural, and educational outcomes. Conducted in one local authority pupil referral unit within the midlands, England, a sample of 38 pupils (n = 3 females), five support staff, eight teachers, eight mentors and three stakeholders participated in the evaluation. The intervention was evaluated through a multi-method approach which incorporated observation, interviews, visual methods, a pre-experimental study, and examination of school-level data. Data were analysed through an iterative process framed through inductive reasoning, and descriptive statistics. Layers of data were triangulated to produce a systems-map. Within a complex system of social networks and individual differences, the intervention components interacted to influence pupil health and behaviour. Findings suggested that sport is an acceptable and feasible conduit to support mentorship. Participation in sport can mitigate some challenges to engaging in reflection, education, and identifying role models. Challenges relating to acceptability and feasibility could be improved through adopting a robust co-production process beyond simple design centred ‘co-creation’, consideration of emotional and health literacy of pupil cohorts, and deliberation of the factors which shape long-term implementation and sustainability. Research should understand the extent to which our systems-map is replicable in a range of settings

Inpatient perspectives on physical activity in a secure mental health setting

This study offers the first insight into the perspectives of secure inpatients regarding exercise. Individuals living with severe mental illness (SMI) engage in less exercise and more sedentary behaviour than their counterparts in the general population. Secure psychiatric hospitals are often considered obesogenic environments that inadvertently promote inactivity. Access to exercise is often restricted due to issues of risk and patient safety. Existing literature exploring exercise perspectives is dominated by SMI populations living in the community. This study involved semi-structured interviews with 15 medium secure inpatients (aged 19-40, mean age 27.8). Primary diagnoses included; schizophrenia and affective disorders, mood disorders and personality disorders. Data were analysed using reflexive thematic analysis. Findings denoted three overarching themes; (i) Barriers to exercise; mental or environmental? (ii) Is exercise always holistically beneficial?; (iii) Staff; a barrier and facilitator to exercise. Acute mental health symptoms and unwanted medication side effects, such as lethargy and weight gain limited exercise motivation. The restrictions of a secure environment limited opportunities to regularly exercise. Exercise provided a relief from both psychiatric symptoms and associated low mood, however in some cases engaging in exercise exaggerated manic symptoms and led to acts of aggression. Inpatients considered staff crucial to facilitate exercise, however access, education and inconsistent attitudes limit provision. Strategies to change the sedentary ‘culture’ within secure wards should involve both staff and patients

Literature on peer-based community physical activity programmes for mental health service users: A scoping review

Physical activity is a key determinant of mental health; community programmes aim to increase health and well-being on a community wide scale with emphasis on social interaction. Regular physical activity participation in community settings yields additional social benefits, such as peer support. This scoping review aimed to explore existing literature that has included peer support as a component of community-based physical activity programmes for MHSU. Published literature was examined using electronic databases (SportDiscus, Web of Science, MEDLINE, and PsycINFO), reference lists, and hand searching of journals. Thirteen eligible articles included; adults aged 18 and over, a peer support component, physical activity and/or sport, participants with mental health diagnoses and were community-based. Research published between 2007 and 2019, peer-reviewed and written in English was included. Nine studies found a significant increase in perceived social support, seven studies reported increased mental wellbeing and five studies reported increased physical activity levels. Effectiveness of reviewed programmes were categorised as; overall improvements in physical activity levels, improvements to mental health, exercise related psychosocial benefits, knowledge relating to self-care, and improved social connections. Community-based physical activity programmes produced psychosocial benefits and positive behaviour change for MHSU, warranting greater focus towards implementing effective peer support into community programmes.</div

Is walking netball an effective, acceptable and feasible method to increase physical activity and improve health in middle- to older age women?: A RE-AIM evaluation

Background: Physical activity is a modifiable risk factor for health and wellbeing, all-cause mortality and healthy aging. However, for middle- to older-age females less is known about the benefits of sports participation on these outcomes. Further, the acceptability and feasibility of setting-up, implementing and maintaining sports-based programmes for an aging population is an understudied area of inquiry. The current study used the RE-AIM framework to investigate a nationwide Walking Netball (WN) programme. Methods: The evaluation used a mixed-methods approach incorporating a multiple-baseline study, quasi-experimental study, programme monitoring data and qualitative studies to evaluate the programme in Women’s Institutes (WI) in England. Data were analysed using multilevel growth modelling, mixed-design ANOVAs, multilevel regression, t-testing, and thematic analysis. Data were triangulated to address each dimension of the RE-AIM framework. Findings: The programme reached 1.4% (n=3148) of the WI population across 82.0% of WI regions in England and attracted inactive members at risk of ill-health. WN contributed to adaptations in physical function, mental health and wellbeing, social isolation, quality of life and increased physical activity. The adoption of the programme was successful with 87.7% WN groups’ maintaining participation beyond the 20-session initial delivery phase. Adoption was effective because of its setup, peer-mentorship and long-term delivery; these factors likewise shaped implementation. Adapting and tailoring WN to the varying characteristics of participants within the WI and the facilities available, along with training delivery staff and providing resources are key programme components. The Walking Netball programme can be maintained through promotion within the local community, sustainable funding, inter-WI competitions, festivals and networks, multiple-hosts and continued host development. Conclusions: WN was found to be an acceptable, feasible and effective intervention to increase physical activity and improve health in middle- to older- aged women. Future programmes may consider adapted styles of set-up and delivery. These include adapting to people, places and spaces through personalised support and providing a range of resources. Future designs may seek to understand how participation can contribute to healthy aging through longitudinal research beyond 12-months. Study registration: The evaluation protocol was published in Open Science Framework in December 2018 prior to follow-up data collection being collected (https://osf.io/dcekz). Date of registration: 17 December 2018