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

The experiences of peer-facilitators delivering a physical activity intervention for emergency service workers and their families

Introduction: Emergency service workers (e.g. police, fire, ambulance officers) are regularly exposed to occupational stressors and potentially traumatic events, resulting in an increased risk of poor mental and physical health. For example, emergency service workers are twice as likely to experience suicidal thoughts compared to the general population and one in ten will develop posttraumatic stress disorder. Despite this, emergency service workers face barriers to accessing traditional mental healthcare. Physical activity is non-stigmatising and may help improve the mental and physical health of this population; however, novel ways to help people engage are needed. Peers with lived experience may be well-placed to co-deliver physical activity programs alongside health professionals. The aim of this study was to understand the experiences of peer-facilitators co-delivering an online physical activity intervention for emergency service workers and their families. Methods: Qualitative interviews were conducted with 6 peer-facilitators. Interviews were audio recorded, transcribed, and analysed using exploratory thematic analysis. Results: Two main themes were explored. The first theme related to the value of lived experience that reflected two subthemes, i) credibility and relatedness by virtue of experience; and ii) knowledge and confidence by virtue of experience. The second theme related to the impact of the peer-facilitator role on the peers themselves, whereby peer-facilitators reported an increased sense of purpose and social connection. Discussion: This qualitative study provides insights into how peer-facilitators can complement health professionals in the delivery of physical activity interventions for emergency service workers. Further research is needed to elucidate training requirements and safety protocols

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

Redefining mental healthcare: Going multidisciplinary to manage multimorbidity

People with mental illness are twice as likely to develop cardiovascular, respiratory, infectious and metabolic diseases compared with the general population.1This disparity in health occurs from the earliest presentation of mental ill health and affects people across the life span,1 reducing life expectancy by 15–30 years compared with the general population.2 This poor physical health, as well as the associated widening mortality gap,3 has been described as a ‘human rights scandal’.2 This problem led to a Lancet Psychiatry Commission1 on protecting the physical health of people living with mental illness, with a focus on prevention and early intervention across all levels of treatment. The Lancet Psychiatry Commission outlines advances in our understanding of the link between physical and mental health, summarising findings from over 100 systematic reviews and meta-analyses, providing a practical blueprint towards protecting the physical health of this vulnerable population.1 Importantly, the blueprint recommends that all people living with mental illness have access to exercise and dietary interventions as part of routine mental healthcare