Integration of the exercise professional within the mental health multidisciplinary team

Exercise and physical activity are now well-established and well-accepted as a stand-alone or adjunct therapy for a range of mental illnesses. However, the question of how to best delivery this potentially powerful therapeutic toll in real-world settings remains. Studies show that programs that are tailored to the individual's needs, supervised by qualified exercise professionals, and delivered in settings which are supportive and welcoming are likely to result in better outcomes for consumers and service providers alike. This chapter provides a brief background on exercise and mental illness, describes the role and attributes of the exercise professional, then provides examples of how such a role can be successfully integrated into mental health care setting, answering questions relevant to service providers, clinicians, and consumers

Accredited exercise physiologists and the treatment of people with mental illnesses

Accredited Exercise Physiologists are allied health professionals trained in the delivery of exercise and lifestyle interventions for people with chronic illness including mental illness. This study aimed to investigate how Accredited Exercise Physiologists engage in the treatment of people with a mental illness. Accredited Exercise Physiologists were invited to complete an online survey via communication from Exercise and Sports Science Australia. Sixty-one Accredited Exercise Physiologists completed the online survey. The majority of AEPs agree that exercise is valuable in the treatment of people with a mental illness. General Practitioners are the most common referral source. Exercise Physiologists believe more people with a mental illness should be referred for services, however more than half agree that people with a mental illness are likely to be less adherent to an exercise intervention compared to people without a mental illness. More than half of respondents report no formal training in training in the prescription of exercise for people with a mental illness however 89% believe additional professional development would be beneficial. Given the support for the efficacy of exercise in the treatment of people with mental illness, this group of health professionals appears to be an underutilised resource

A systematic review of the aerobic exercise program variables for people with schizophrenia

A number of studies demonstrate the positive benefits of exercise for people with schizophrenia and schizoaffective disorders; however the exercise program variables resulting in these positive effects have not been evaluated. Therefore the aim of this systematic review was to describe the aerobic exercise program variables used in randomized controlled trials reporting the positive effect of exercise in the treatment of schizophrenia or schizoaffective disorder. Studies were analyzed for exercise frequency, intensity, session duration, exercise type, intervention duration, delivery of exercise, and level and quality of supervision and adherence. Study quality was assessed using the Physiotherapy Evidence Database scale. Three studies met the inclusion criteria. In general, exercise intervention variables are reported poorly. We find that aerobic exercise including treadmill walking and cycle exercise undertaken as a supervised group intervention lasting 30 to 40 min per session and undertaken 3 times weekly at moderate intensity appears to be valuable for people with schizophrenia or schizoaffective disorder. Interventions ranged from 10 to 16wk. No adverse events were reported in the included studies. Evidence suggests that aerobic exercise is safe and beneficial for people with schizophrenia or schizoaffective disorder

An exercise prescription primer for people with depression

A substantial body of evidence supports the value of exercise inthe treatment of people with depression. The guidelines for exerciseprescription, however, are limited, and based on those developed forhealthy populations. This article explores the evidence for exercisein the treatment of depression and the role mental health nursesmay play in the delivery of this information. A model of exerciseprescription is put forward based on the available evidence andtaking into account the challenges faced by mental health nursesand people with depression

Temporal trends in exercise physiology services in Australia—Implications for rural and remote service provision

Objective: To assess temporal trends in service provision by Accredited Exercise Physiologists based on remoteness classification using Australian Bureau of Statistics remoteness classifications of Major Cities, Inner Regional, Outer Regional, Remote and Very Remote. Design and participants: Cross-sectional analysis of publicly available Medicare Benefits Schedule datasets, for Medicare item number 10953 from 2012-2013 to 2016-2017. Main outcome measure(s): Number of claims, benefits paid, fees charges and number of providers for Medicare item number 10953. Results: Accredited Exercise Physiologist service delivery demonstrates growth across all areas of remoteness classification. Rebates and fees mirror service delivery trends. The rate of service growth was significantly greater in Major Cities compared with all other remoteness classifications. Provider numbers show a steady increase from 2012-2013 to 2016-2017 but number remains higher in Major Cities compared with all other remoteness locations. Conclusion: Given the high proportion of chronic and complex illness in rural and remote areas, and the limited access to allied health care services, we propose more needs to be done to position Accredited Exercise Physiologists in these regions of increasing need. These findings have implications for future development of the Accredited Exercise Physiologist profession. © 2019 National Rural Health Alliance Ltd

Exercise prescription for people with depression

Examines exercise prescription variables to enable exercise physiologists or allied health professionals to prescribe exercise to patients or clients with depression

Specialist nursing role to address poor physical health

It is now well known that people diagnosed with mental illness have poorer health behaviours, lower levels of physical activity, multiple comorbid chronic health conditions and poorer health compared to the general population (Scott et al 2012). This alarming health disparity has led the Institute for Health and Social Science Research and Centre for Mental Health Nursing Innovation at CQUniversity to trial a speciaiist "cardiometabolic healthcare nurse' as a link between community-based mental health consumers and primary health care

Exercise for mental illness : a systematic review of inpatient studies

A substantial body of evidence supports the role of exercise interventions for people with a mental illness. However, much of this literature is conducted using outpatient and community based populations. We undertook a systematic review examining the effect of exercise interventions on the health of people hospitalized with depression, schizophrenia, bipolar disorder, or anxiety disorders. Eight studies met our inclusion criteria. Several studies show positive health outcomes from short-term and long-term interventions for people hospitalized due to depression. Although positive, the evidence for inpatients with schizophrenia, bipolar disorder, or anxiety disorders is substantially less. There is an urgent need to address the paucity of literature in this area, in particular the optimal dose and delivery of exercise for people hospitalized as a result of mental illness. Standardization of reporting exercise programme variables, the assessment of mental illness, and the reporting of adverse events must accompany future studies

An exploratory study examining the core affect hypothesis of the anti-depressive and anxiolytic effects of physical activity

We propose the core affect hypothesis that physical activity enhances valence and activation for people with depression symptoms but only valence for people with anxiety symptoms. In an exploratory study, affective valence and activation were assessed before and after a bout of exercise at a self-selected intensity in a small sample of inpatients. For most people with depressive disorders, affective valence (57%) and activation (55%) increased; whereas for people with anxiety disorders, half (50%) experienced an increase in affective valence, but only some (35%) experienced increased activation. Although exploratory and underpowered to test for statistically significant differences, these findings provide tentative support for more robust exploration into the core affect hypothesis. It may be that practitioners can enhance the impact of physical activity on depression or anxiety symptoms by applying the core affect hypothesis

Barriers to exercise prescription and participation in people with mental illness: the perspectives of nurses working in mental health

Evidence is mounting for the efficacy of exercise in the treatment of people withmental illness. Nurses working in mental health settings are well placed to provideexercise advice for people with mental illness. However, quantitative examinations ofthe barriers to exercise prescription experienced by nurses, or their views regardingthe barriers to exercise participation experienced by people with mental illness, arelacking. In this study, 34 nurses completed the Exercise in Mental Illness Questionnaire– Health Professionals Version (EMIQ-HP). This survey examined the frequencyof exercise prescription and the level of agreement with statements regardingbarriers to exercise prescription for, and exercise participation by, people with mentalillness. The level of agreement scores for statements for each section was summed,with a higher score indicating a higher level of agreement. Nurses disagree with manyof the barriers to exercise prescription presented in the literature. The level ofagreement scores did not differ between nurses who prescribe exercise ‘Always’, ‘Mostof the time’, ‘Occasionally’ or ‘Never’. We found a non-significant negative relationshipbetween frequency of exercise prescription and summed level of agreement scoresfor barriers to exercise prescription. Consensus regarding barriers to exercise participationby mental health consumers is less clear. This study provides valuable newinsight into the role of nurses in the provision of exercise for people with mentalillness. Confirmation in larger samples is needed before translation of research topractice