Incentives and barriers to lifestyle interventions for people with severe mental illness: A narrative synthesis of quantitative, qualitative and mixed methods studies

Research Fellow, Institute of Medical and Social Care Research (IMSCaR), Bangor University, Wrexham Technology Park, Wrexham, UK.
Journal of Advanced Nursing (Impact Factor: 1.74). 02/2011; 67(4):690-708. DOI: 10.1111/j.1365-2648.2010.05546.x
Source: PubMed


To examine the evidence for incentives and barriers to lifestyle interventions for people with severe mental illness.
People with severe mental illnesses, particularly those with schizophrenia, have poorer physical health than the general population with increased mortality and morbidity rates. Social and lifestyle factors are reported to contribute to this health inequality, though antipsychotic therapy poses additional risk to long-term physical health. Many behavioural lifestyle interventions including smoking cessation, exercise programmes and weight-management programmes have been delivered to this population with promising results. Surprisingly little attention has been given to factors that may facilitate or prevent engagement with these interventions in this population.
Eight electronic databases were searched [1985-March 2009] along with the Cochrane Library and Google Scholar. Electronic 'hand' searches of key journals and explosion of references were undertaken.
A narrative synthesis of qualitative, quantitative and mixed-methods studies was undertaken.
No studies were identified that specifically explored the incentives and barriers to participation in lifestyle intervention for this population. Existing literature report some possible incentives and barriers including: illness symptoms, treatment effects, lack of support and negative staff attitudes as possible barriers; and symptom reduction, peer and staff support, knowledge, personal attributes and participation of staff as possible incentives.
Healthcare professionals, in particular nurses, should consider issues that may hinder or encourage individuals in this clinical group to participate in lifestyle interventions if the full benefits are to be achieved. Further research is needed to explore possible incentives and barriers from the service users' own perspective.

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    • "Previous research has identified that one significant and contributing factor to inactivity is the problem of social isolation (Vancampfort et al., 2012a). Being or feeling isolated influences an individual's everyday physical activity (Roberts & Bailey, 2011). Further to this, social isolation and a lack of desired relationships are reported by around a half of individuals with schizophrenia (Perese & Wolf, 2005). "
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    ABSTRACT: Background Research is needed to understand how mental health physiotherapists use social support when promoting physical activity. Aims The aim of this study was to establish which dimensions of social support are used within physiotherapy sessions for individuals with schizophrenia. Method A cross sectional international survey design of specialist mental health physiotherapists was undertaken. Results. Forty mental health physiotherapists provided in depth accounts of the four functional dimensions of social support (informational, tangible, esteem and emotional) and the one structural dimension (importance of group exercise). The results illustrate how these different dimensions of social support are used by physiotherapists to engage patients and identify the value of group work as a specific form of support. Specifically the importance of all types of support was reported and this helped to provide a detailed consideration to the skills that mental health physiotherapist have. Conclusion Providing social support is a significant part of the rehabilitation professionalsā€™ role. The current results advance the current understanding of how social support is provided to individuals with schizophrenia in rehabilitation settings.
    Journal of Mental Health 10/2014; DOI:10.3109/09638237.2014.951481 · 1.40 Impact Factor
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    • "In order to overcome exercise barriers, other studies have found community-based exercise programmes [23], [25] and group activities [20] to be the most useful programmes with people with disabilities or chronic health conditions stating that these programmes were helpful as they could exercise with patients of similar abilities and share their experiences of their illnesses [21]. In contrast our T1DM patients preferred individually tailored exercise support, designed with consideration of their preferences, circumstances and fitness levels. "
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    ABSTRACT: Background Regular physical activity has recognised health benefits for people with T1DM. However a significant proportion of them do not undertake the recommended levels of activity. Whilst questionnaire-based studies have examined barriers to exercise in people with T1DM, a formal qualitative analysis of these barriers has not been undertaken. Our aims were to explore attitudes, barriers and facilitators to exercise in patients with T1DM. Methodology A purposeful sample of long standing T1DM patients were invited to participate in this qualitative study. Twenty-six adults were interviewed using a semi-structured interview schedule to determine their level of exercise and barriers to initiation and maintenance of an exercise programme. Principal findings Six main barriers to exercise were identified: lack of time and work related factors; access to facilities; lack of motivation; embarrassment and body image; weather; and diabetes specific barriers (low levels of knowledge about managing diabetes and its complications around exercise). Four motivators to exercise were identified: physical benefits from exercise; improvements in body image; enjoyment and the social interaction of exercising at gym or in groups. Three facilitators to exercise were identified: free or reduced admission to gyms and pools, help with time management, and advice and encouragement around managing diabetes for exercise. Significance Many of the barriers to exercise in people with T1DM are shared with the non-diabetic population. The primary difference is the requirement for education about the effect of exercise on diabetes control and its complications. There was a preference for support to be given on a one to one basis rather than in a group environment. This suggests that with the addition of the above educational requirements, one to one techniques that have been successful in increasing activity in patients with other chronic disease and the general public should be successful in increasing activity in patients with T1DM.
    PLoS ONE 09/2014; 9(9):e108019. DOI:10.1371/journal.pone.0108019 · 3.23 Impact Factor
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    • "Adherence rates of schizophrenia patients to physical exercise may not differ much from those in other groups, but have not been formally established in controlled trials of sufficient size and quality (Martinsen, 2003; Roberts and Bailey, 2011). Individuals with schizophrenia and 'normal' sedentary members of the population do not differ widely in their attitudes to exercise Faulkner and Biddle, 1999 In fact, a survey we completed in 143 patients with chronic schizophrenia showed a desire to exercise, but limited resources and know-how (Strassnig et al., 2005). "
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    ABSTRACT: Despite 50 years of pharmacological and psychosocial interventions, schizophrenia remains one of the leading causes of disability. Schizophrenia is also a life-shortening illness, caused mainly by poor physical health and its complications. The end result is a considerably reduced lifespan that is marred by reduced levels of independence, with few novel treatment options available. Disability is a multidimensional construct that results from different, and often interacting, factors associated with specific types and levels of impairment. In schizophrenia, the most poignant and well characterized determinants of disability are symptoms, cognitive and related skills deficits, but there is limited understanding of other relevant factors that contribute to disability. Here we conceptualize how reduced physical performance interacts with aging, neurobiological, treatment-emergent, and cognitive and skills deficits to exacerbate ADL disability and worsen physical health. We argue that clearly defined physical performance components represent underappreciated variables that, as in mentally healthy people, offer accessible targets for exercise interventions to improve ADLs in schizophrenia, alone or in combination with improvements in cognition and health. And, finally, due to the accelerated aging pattern inherent in this disease ā€“ lifespans are reduced by 25 years on average ā€“ we present a training model based on proven training interventions successfully used in older persons. This model is designed to target the physical and psychological declines associated with decreased independence, coupled with the cardiovascular risk factors and components of the metabolic syndrome seen in schizophrenia due to their excess prevalence of obesity and low fitness levels.
    Schizophrenia Research: Cognition 06/2014; 1(2). DOI:10.1016/j.scog.2014.06.002
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