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Physical Activity Preferences and Perceived Barriers to Activity Among Persons With Severe Mental Illness in the United Kingdom



This study assessed physical activity interests among psychiatric patients. A cross-sectional survey of 120 psychiatric patients in the United Kingdom assessed preferences for physical activity, perceived barriers to activity, and other psychosocial factors related to exercise levels. Compared with the general population, respondents were less active. Respondents reported very little confidence in their ability to exercise when feeling sad or stressed, and they reported low levels of social support toward exercising. Approximately half the respondents or more expressed a belief in the health benefits of exercise, enjoyment of exercise, and a desire to be more active. Walking was the most popular activity, and fatigue and illness were the most common barriers to activity. Equal numbers preferred individual and group activities. A majority agreed that they would exercise more if they talked with an exercise instructor or were advised by their doctor. Physical activity interventions for the psychiatric population need to bridge the gap between high interest and low uptake through, for example, professional support and enhancing self-efficacy by combating barriers and tailoring to preferences.
PSYCHIATRIC SERVICES March 2007 Vol. 58 No. 3 440055
Objective: This study assessed
physical activity interests among
psychiatric patients. Methods: A
cross-sectional survey of 120 psy-
chiatric patients in the United
Kingdom assessed preferences
for physical activity, perceived
barriers to activity, and other psy-
chosocial factors related to exer-
cise levels. Results: Compared
with the general population, re-
spondents were less active. Re-
spondents reported very little
confidence in their ability to ex-
ercise when feeling sad or
stressed, and they reported low
levels of social support toward ex-
ercising. Approximately half the
respondents or more expressed a
belief in the health benefits of ex-
ercise, enjoyment of exercise,
and a desire to be more active.
Walking was the most popular ac-
tivity, and fatigue and illness
were the most common barriers
to activity. Equal numbers pre-
ferred individual and group ac-
tivities. A majority agreed that
they would exercise more if they
talked with an exercise instructor
or were advised by their doctor.
Conclusions: Physical activity in-
terventions for the psychiatric
population need to bridge the gap
between high interest and low up-
take through, for example, pro-
fessional support and enhancing
self-efficacy by combating barri-
ers and tailoring to preferences.
(Psychiatric Services 58:405–408,
Physical activity has the potential
to enhance the quality of life for
people with serious mental illness. It
has been shown to improve physical
health and to alleviate psychiatric and
social disabilities (1). It has been rec-
ommended that physical activity pro-
grams be routinely integrated into
psychiatric services (1), and individu-
als with severe mental illness are in-
terested in physical activity as a com-
ponent of weight management (2).
For physical activity to be promot-
ed, the interests of particular groups
need to be considered (3), including
preferences for types of activity as
well as support and perceived barri-
ers to the activity. This information is
available for the general population
(4); however, we could not identify
any cross-sectional studies that have
elicited this information from persons
with severe mental illness. This infor-
mation would assist psychiatric serv-
ices in planning interventions, com-
munication campaigns, and recre-
ation facilities.
The study presented here assessed
physical activity preferences, pre-
ferred sources of assistance to pro-
mote physical activity, and perceived
barriers to physical activity among
persons with serious mental illness.
In addition, we assessed other psy-
chosocial variables (self-efficacy, be-
liefs, perceived social support, moti-
vation, and enjoyment) that have
been shown to be important influ-
ences on physical activity uptake in
the general population (5).
The study involved a cross-sectional
survey. Adults receiving treatment for
psychiatric illness in the United King-
dom National Health Service and re-
ceiving inpatient treatment or outpa-
tient treatment from community
mental health centers in southwest
London were eligible for the study.
Between January and April 2003, pre-
sentations describing the study were
made to patients at these centers and
hospital wards. After the presentation
all patients present were invited to
joined the study (N=151), irrespec-
tive of their psychiatric disorder. For
all individuals agreeing to be inter-
viewed the site manager confirmed
that the person had the capacity to
give written consent. None of those
volunteering were refused entry to
the study. All volunteers were inter-
viewed in a private room for approxi-
mately 20 minutes on a single occa-
sion by a researcher using a struc-
tured questionnaire. Questions were
read out loud to participants, and the
researcher wrote down the responses.
Participants were not compensated
for their involvement. Participants
Physical Activity Preferences and Perceived
Barriers to Activity Among Persons With
Severe Mental Illness in the United Kingdom
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Dr. Ussher, Dr. Stanbury, and Dr. Cheese-
man are affiliated with the Division of
Community Health Sciences, St. George’s,
University of London, Cranmer Terrace,
London, United Kingdom SW17 ORE (e-
mail: Dr. Faulkner
is with the Faculty of Physical Education
and Health, University of Toronto, Toron-
to, Ontario, Canada.
uss.qxd 2/14/2007 9:28 AM Page 405
gave written consent to participate
and to provide access to their medical
records. Approval of the local ethics
committee was obtained. Statistical
analyses were carried out by using
SPSS version 13.
Demographic characteristics and
primary psychiatric diagnosis were
extracted from patients’ medical
records. Physical activity during the
previous seven days was reported (6).
This measure has shown adequate va-
lidity and reliability in this population
(7). It was explained to participants
that the term “exercise” was used to
refer both to structured exercise and
to lifestyle activities—for example,
Preferences for physical activity
were assessed by asking, “Which of
the following types of exercise do you
most like to do?” (8). Table 1 shows a
complete list. Preferences were also
assessed by asking, “Given the choice,
would you prefer to exercise on your
own, with other people, or don’t you
have a preference?”
Preferences for assistance were as-
sessed by asking, “How much do you
agree with the following statements
(strongly disagree=1, disagree=2,
neither agree or disagree=3, agree=
4, strongly agree=5): (i) I would exer-
cise more if an [exercise] instructor
talked through with me what I should
be doing, (ii) I would exercise more if
my doctor suggested that I should,
(iii) I would exercise more at home
than at a gym.”
The psychological measures were
adapted from existing questions (9).
Perceived barriers to physical activity
were assessed by asking, “Which of the
following would you say is the most
important reason why you don’t do as
much exercise as you would like?”—
for example, takes too much time or
afraid of getting injured; Table 1 shows
a complete list of options. Self-efficacy
for exercise was assessed with the
question “How confident do you feel
about exercising [being able to exer-
cise] when you are feeling sad or
stressed?” Possible responses included
1, not at all; 2, mildly; 3, somewhat;
and 4, very. Beliefs regarding exercise
were determined by assessing level of
agreement with the statements “Exer-
cise is very important for my physical
health” and “Exercise is very impor-
tant for my mental health.” Possible
responses range from 1, strongly dis-
agree, to 5, strongly agree. Social sup-
port for physical activity was gauged by
asking, “How much help would you
get from family and friends if you were
to start taking more regular exercise?”
Possible responses ranged from 1, no
help at all; 2, very little; 3, a little; 4,
quite a lot; and 5, a lot. Motivation was
assessed by asking, “How much do you
want to start taking more regular exer-
cise?” Possible scores range from 1,
not at all, to 5, extremely so. Enjoy-
ment was assessed by asking, “How
much do you enjoy exercise?” Possible
scores are 1, not at all; 2, a little; 3,
somewhat; and 4, very much so.
Of the 151 patients invited, 120 pa-
tients agreed to be interviewed. Of
these a majority were male (70 pa-
tients, or 58%), smokers (70 patients,
or 58%), single (92 patients, or 77%),
unemployed (98 patients, or 82%),
and receiving inpatient treatment (80
patients, or 67%). A total of 82 pa-
PSYCHIATRIC SERVICES March 2007 Vol. 58 No. 3
TTaabbllee 11
Variables influencing physical activity uptake for 120 adults receiving treatment
for psychiatric illness in the United Kingdom National Health Service
Measure N %
Physical activity preferences (N=109)a
Exercise at a facility 11 10
Exercise at home 98 90
Walking 76 70
Housework 3 3
Do-it-yourself activities, such as yard work and home maintenance 1 1
Cycling 2 2
Gardening 1 1
Dancing 3 3
Individual sport 2 2
Team sport 3 3
Other 5 5
Preferred style of physical activity (N=120)
On own 37 31
With others 36 30
No preference 47 43
Preferred sources of assistance (N=120)
Agreed or strongly agreed that instructor’s help would increase
levels of exercise 70 58
Agreed or strongly agreed that he or she would exercise more
with doctor’s advice 76 63
Agreed or strongly agreed that he or she would exercise more
at home versus at the gym 57 48
Perceived barriers to activity (N=116)b
Too tired 23 20
Illness 17 15
Bad weather 15 13
Takes too much time 14 12
Other reason 13 11
Feel unsafe going outdoors 10 9
Afraid of getting injured 9 8
Self-consciousness 8 7
Not sure what to do 7 6
Other psychological assessments (N=120)
Agreed or strongly agreed that exercise is important for
physical health 108 90
Agreed or strongly agreed that exercise is important for
mental health 86 72
Wants to exercise more regularly very much so or extremely so 57 48
Enjoys exercise very much so or extremely so 68 57
Not at all confident or mildly confident about being able to
exercise when sad or stressed 70 58
Would receive no help, very little help, or a little help with exercise 82 68
aEleven respondents did not identify any physical activity preferences.
bFour respondents did not identify any barriers to exercise.
uss.qxd 2/14/2007 9:28 AM Page 406
tients (68%) were Caucasian, 27
(23%) were black, six (5%) were
Asian, and five (4%) were in another
racial or ethnic group. The mean±SD
age was 42.6±16.1 years. Sixteen pa-
tients (13%) had recently entered the
treatment service and a diagnosis had
not yet been made. Of 104 partici-
pants with a diagnosis, the largest
percentage had a primary diagnosis of
schizophrenia (36 patients, or 35%),
followed by depression (20 patients,
or 19%), bipolar disorder (18 pa-
tients, or 17%), schizoaffective disor-
der (nine patients, or 9%), personali-
ty disorder (eight patients, or 8%),
and psychosis (five patients, or 5%).
The remaining eight patients were di-
agnosed as having either mania (two
patients, or 2%), alcoholism (one pa-
tient, or 1%), anorexia (one patient,
or 1%), generalized anxiety disorder
(two patients, or 2%), monosympto-
matic delusional disorder (one pa-
tient, or 1%), or acute confusional
state (one patient, or 1%). Recom-
mended physical activity levels—at
least 30 minutes of at least moderate
intensity at least five days a week
(10)—were achieved by 24 partici-
pants (20%). Details of other assess-
ments are given in Table 1.
The most popular activity was walk-
ing, followed by structured exercise at
a facility. The sample was evenly split
between preferring individual exer-
cise or group exercise, and more than
a third expressed no preference. Al-
most half agreed or strongly agreed
that they would exercise more at
home rather than at a gym. A majori-
ty agreed or strongly agreed that they
would exercise more if they talked
with an instructor or were advised to
do so by their doctor. The most fre-
quently reported reasons for not exer-
cising were fatigue, illness, and bad
A vast majority of respondents re-
ported that they believed in the ben-
efits of exercise for both physical and
mental health and that they enjoyed
exercise, but they had little confi-
dence in being able to exercise when
feeling sad or stressed and received
little, if any, support for exercise from
family and friends. Around half re-
ported a high level of motivation to
exercise more regularly.
The findings for exercise levels
(number of days with 30 minutes of
activity) and for the key psychological
variables of motivation to exercise,
self-efficacy, and social support were
assessed for differences according to
gender, age, smoking status, treat-
ment setting, diagnosis, employment
status, and marital status. When re-
gression analysis was performed, we
found no significant differences in
reports of exercise levels, motivation,
or social support according to these
characteristics. However, self-effica-
cy for exercise was significantly lower
among women compared with men,
among patients with depression com-
pared with those with other disor-
ders, and among outpatients com-
pared with inpatients. When a
forced-entry regression analysis was
performed, several factors remained
associated with self-efficacy: gender
(β=.43, p=.042), outpatient versus in-
patient (β=.57, p=.011), and diagno-
sis (β=.76, p=.011).
Consistent with previous findings
(1,11), participants tended to be more
sedentary than the general popula-
tion and walking was the most com-
mon activity. There was a high level of
interest in being more active, and a
vast majority reported that they be-
lieved in the benefits of exercise and
enjoyed exercise. This should be
grounds for optimism in developing
physical activity opportunities for this
population. However, participants
tended to report very little confi-
dence in their ability to exercise when
feeling sad or stressed and little, if
any, social support for exercise. Lack
of regular social contact appears to be
a common correlate of inactivity in
this population (11,12), and low self-
efficacy is one of the strongest deter-
minants of inactivity in general (5).
Evidently, physical activity inter-
ventions for the psychiatric popula-
tion need to find ways to bridge the
gap between high levels of interest
and low levels of exercise. This might
involve increasing social support. Our
findings suggest that, consistent with
findings in the general population (8),
this population values the support of
health professionals. Self-efficacy for
exercise may need to be enhanced by,
for example, using cognitive-behav-
ioral strategies (4). In addition, our
findings suggest that such interven-
tions may be especially needed
among women, outpatients, and
those with depression. Moreover, in-
terventions may be more beneficial
by being integrated with recovery and
peer-support approaches to psychi-
atric rehabilitation (13,14) that em-
brace health promotion (15).
Interventions will need to address
barriers to the uptake of exercise,
such as fatigue and illness, which
have been reported more frequently
among persons with severe mental
illness than in the general population
(4), and interventions may need to
consider other barriers (12) not as-
sessed in the study presented here.
Physical activity interventions for
persons with severe mental illness
need to be tailored to individual pref-
erences—for example, toward the
mode of exercise and for exercising
alone versus with others. Education
may be beneficial concerning oppor-
tunities for leisure-based and
lifestyle activity on the basis of per-
sonal preferences, as opposed to pre-
scribed and structured exercise regi-
mens (16). The results presented
here provide support for interven-
tions focusing on walking, and en-
couraging an existing activity may be
a simpler task than trying to initiate a
novel behavior (16). This study was
limited in that it was a cross-section-
al study with a relatively small sample
and it used several measures that
have not been validated. Prospective
studies of preferences and barriers
are required with larger samples of
patients and with subgroups of pa-
tients—for example, with persons
with severe depression.
The persons with severe mental ill-
ness interviewed in this study tended
to be less active than the general pop-
ulation. They reported little confi-
dence in being able to exercise when
sad or stressed and reported that they
had had little social support for exer-
cising. More optimistically, the partic-
ipants reported high levels of interest
in exercise. Leisure and psychiatric
services need to respond to this inter-
est through providing programs of
physical activity that enhance self-
PSYCHIATRIC SERVICES March 2007 Vol. 58 No. 3 440077
uss.qxd 2/14/2007 9:28 AM Page 407
efficacy, provide adequate social sup-
port, and take into account the pref-
erences for physical activity reported
by those with severe mental illness.
Acknowledgments and disclosures
The authors report no competing interests.
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... Patients with mental illness seem to have a positive attitude towards being physically more active. Many complain about a lack of social support though [22]. Thus, regular support and feedback should be provided to engage patients in PA. ...
... MDD patients are typically characterized by low levels of physical activity (PA) and a reduced fitness compared to healthy controls [22,25]. Perceived barriers such as "no time", or "physically unable" to be active [26] and disease-specific obstacles may prevent patients from participating in PA. ...
... Perceived barriers such as "no time", or "physically unable" to be active [26] and disease-specific obstacles may prevent patients from participating in PA. Lower self-efficacy can lead to a lack of confidence to engage in PA, exacerbated by a lack of social support [22]. This illustrates the challenge to design webbased exercise concepts. ...
Full-text available
This commentary addresses web-based exercise, defined as exercise interventions delivered via email, mobile app or website as a promising therapeutic approach for the treatment of depressive symptoms. I summarize the current research in this area and offer an innovative perspective from the field of sports science on howexercise can be managed in this patient collective. The manuscript concludes with key features for future web-based approaches to further improve the evidence for this approach.
... In patients suffering from mental disorders, lack of motivation, lack of self-determination, fatigue, illness etc. are associated with significantly lower levels of PA [29,36,37]. In order to help patients with severe mental illnesses to engage in PA, the sessions should match the patients' abilities and (psychosocial) needs [38]. ...
... In order to help patients with severe mental illnesses to engage in PA, the sessions should match the patients' abilities and (psychosocial) needs [38]. Measures that may help are structured training in a facility [37], social support [37,[39][40][41][42], the support of an exercise instructor [37,39], the promotion of intrinsic and extrinsic motivation (empowering patients to control their training independently) [36,43,44], motivational interviewing, and goal setting [45]. In addition to pursuing physiological goals, it is also recommended to make use of exercise programs that provide psychological support to patients [40] and promote interaction with others [46]. ...
... In order to help patients with severe mental illnesses to engage in PA, the sessions should match the patients' abilities and (psychosocial) needs [38]. Measures that may help are structured training in a facility [37], social support [37,[39][40][41][42], the support of an exercise instructor [37,39], the promotion of intrinsic and extrinsic motivation (empowering patients to control their training independently) [36,43,44], motivational interviewing, and goal setting [45]. In addition to pursuing physiological goals, it is also recommended to make use of exercise programs that provide psychological support to patients [40] and promote interaction with others [46]. ...
Full-text available
Physical activity has gained importance in psychiatric and psychosomatic treatment schemes, but there is little knowledge on the use of physical activity for forensic rehabilitation, including psychosocial outcomes. A systematic review of the literature on PubMed and Livivo found only one study that specifically addressed the effects of physical activity in forensic patients. Twenty-three studies reported on physical activity in the context of non-forensic patients suffering from mental illnesses similar to those commonly diagnosed in forensic patients. We summarize the effects of physical activity with respect to therapeutic objectives suggested by German sport therapists working with forensic patients. In forensic patients or patients suffering from mental illness typical of forensic patients, physical activity promotes social skills (4 studies), self-image, body experience, and personality growth (9 studies). Physical activity also helps to activate patients (12 studies), while reducing their tension and anger (1 study). Yet, there is a significant lack of specific scientific evidence as to whether sport therapy for forensic patients is effective in terms of the therapeutic objectives of this patient group. Future research must focus on longitudinal dose-effect outcome studies on forensic patients and should also concentrate on studies in the area of psychosis, personality disorders and addiction in relation to forensic sport therapeutic objectives. Published in SPORTS PSYCHIATRY 2022, 1 - 9.
... We could also see, that participants improved their symptom severity, with this being observed in the control group in one study [58] and in the exercise group in two studies [56,57]. As there are associations between psychotic disorders and adverse health behaviours and risk factors for cardiovascular disease such as insufficient physical activity, poorer diet, and obesity [4,5,[64][65][66], exercise interventions could not only help to reduce smoking, but also to improve cardiovascular health and quality of life [67]. ...
... More attention should be paid to the individual needs of people with MI, in terms of programme content and outcome [15,19]. With regard to the content of exercise and smoking cessation programmes, individual preferences regarding modality, duration, and intensity should be considered [66]. An example of this is the study of Smits et al. [57], which showed a higher abstinence rate in the high-intensity exercise group in people with MI compared to the lowintensity exercise control group. ...
Full-text available
Background Smoking is the most common substance use disorder among people with mental illness. In contrast to people without mental illness, among whom the proportion of smokers has declined in recent decades, the proportion of smokers among people with mental illness remains high. There is a growing body of literature suggesting the use of exercise interventions in combination with smoking cessation in people without mental illness, but to our knowledge the available studies on this treatment option in people with mental illness have not been systematically reviewed. Therefore, this systematic review and meta-analysis aims to assess the effectiveness of exercise interventions as an adjunctive treatment for smoking cessation in people with mental illness. Methods Electronic databases (PubMed, Web of Science, PsycInfo, Sport Discus and Base) were searched for randomised controlled trials and prospective single-group studies that investigated exercise interventions in combination with smoking cessation programmes alone or in comparison with a control group in people with mental illness. A meta-analysis using the Mantel–Haenszel fixed-effect model was conducted to estimate the overall effect of treatment on smoking cessation (abstinence rate at the end of the intervention and at 6-month follow-up). Results Six studies, five randomised controlled trials and one study with a prospective single-group design, were included in the systematic review and four randomised controlled trials were included in the meta-analysis. The meta-analysis found a significantly higher abstinence rate after additional exercise at the end of the intervention [risk ratio (RR) 1.48, 95% confidence interval (CI) 1.13–1.94], but not at the 6-month follow-up (RR 1.34, 95% CI 0.89–2.04). Conclusions Exercise appears to be an effective adjunctive therapy to temporarily increase abstinence rates in individuals with mental illness at the end of the intervention. However, due to the small number of included studies and some risk of bias in the included studies, the results should be treated with caution. Therefore, future studies with larger samples are needed to provide a more accurate estimate of the effect in people with mental illness. Registration The systematic review and meta-analysis were registered in the International Prospective Register of Systematic Reviews (PROSPERO) (registration number: CRD42020178630).
... With respect to physical activity, there were significant improvements for walking and moderate physical activity sessions, but not for vigorous physical activity. The findings may reflect a preference for walking as a form of physical activity among people with a mental health condition (Chapman et al., 2016;Fraser et al., 2015;Ussher et al., 2007), and a focus within the coaching program on achievable and sustainable goals, possibly more aligned with walking and moderate activity domains. The present study was not able to capture any changes in sedentary behaviour as a result of program engagement, a health risk factor acknowledged to be lacking in behavioural interventions delivered to people with mental health conditions (Ashdown-Franks et al., 2018). ...
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Population-level telephone coaching services provide accessible behaviour change support for modifiable health risk behaviours. The NSW Get Healthy Information and Coaching Service® (GHS) is a free telephone-based coaching service in Australia, supporting improvements in healthy eating, physical activity and achieving or maintaining a healthy weight. This study compared measures of participation (such as program completion) and outcomes achieved immediate post-program (including changes in fruit and vegetable consumption, physical activity and weight) for GHS participants with and without a self-identified mental health condition (MHC). Secondary data analysis was conducted on service data collected at program intake and completion for individuals who enrolled in a coaching program between January 2018 and October 2019 (n=5,629); 33% identified as having had an MHC. While those with and without an MHC had similar rates of completion, those with an MHC were less likely to complete a coaching program (31% vs 36%, p = .003). Participants with an MHC made significant positive changes to their fruit and vegetable consumption, physical activity (walking and moderate), weight and BMI, but not to waist circumference or vigorous physical activity. When comparing the magnitude of change for those with and without an MHC, individuals without made greater improvements to their weight (adjusted mean difference -.623 kg, p = .034) and daily vegetable intake (adjusted mean difference -0.199 serves; p = .01). There were no differences for other variables. The GHS is an effective means of supporting behaviour change for people with an MHC who complete a coaching program. Further research should consider means of improving retention rates.
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There is strong evidence that physical activities (PAs) are an important factor in increasing and maintaining mental health as well as in preventing relapse after mental health disorders. Physical activity is an important part of the treatment program in psychiatric hospitals. However , when individuals with mental health disorders (IMHD) leave the hospitals in Switzer-land (CH), there are few possibilities to do physical activity in a given setting. One of them are voluntary sports groups for individuals with mental health disorders (SGPSY), which have been growing continuously in CH since 2016. Yet, little is known about these groups and their training settings. Therefore, the present study explores challenges, barriers, and enablers for participation in SGPSY from the point of view of the trainers of these groups. Additionally, as the sustainable implementation of SGPSY relies on the trainer, the study aims to identify reasons/motivations as well as the personality characteristics of the SGPSY trainers. Semi-structured interviews were conducted with 15 trainers of SGPSY in CH during spring 2022. Interviews were audiotaped, transcribed, and analyzed using thematic analysis in nVivo. Participants identified several intrapersonal (lack of motivation and fitness, mood problems, etc.), interpersonal (conflicts between participants), and structural barriers (time/ location) that hinder IMHD from participating in SGPSY. The participating trainer reported that trainer might be helpful in overcoming the barriers by supporting IMHD as enablers. They rate social skills to be essential for the successful management and organization of SGPSY, as well as the ability to set boundaries to protect one's private life and sports skills expertise. The reasons for their engagement as trainers of SGPSY were the satisfaction of doing sports with IMHD and to improve the physical activities habits of IMHD. The findings of the study highlight the need to upskill the trainers of SGPSY in order to improve recruitment of the future trainers of SGPSY by focusing on the assessment of appropriate personality characteristics of trainers and their motives. Additionally, these findings should be integrated in the educational materials of Swiss disabled sports systems. Further research should validate the results from SGPSY participants' point of view. PLOS ONE PLOS ONE |
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Background: Depression is the most prevalent mental disorder, with detrimental effects on the patient's well-being, high disability, and a huge associated societal and economic cost. There are evidence-based treatments, but it is difficult to reach all people in need. Internet-based interventions, and more recently smartphone-based interventions, were explored to overcome barriers to access. Evidence shows them to be effective alternatives to traditional treatments. This paper presents the protocol of a pilot study whose primary aim is to investigate the efficacy of a smartphone-based serious game intervention for patients with mild to moderate depressive symptoms. Methods: This randomized controlled pilot trial protocol foresees two arms design: 1/ smartphone- based serious game intervention (based on Cognitive Behavior Therapy with particular emphasis on Behavioral Activation and Physical Activity), 2/ waiting list control group. The study is expected to recruit 40 participants (18+), which will be randomly assigned to one of the experimental conditions. The duration of the intervention is two months. The primary outcome measure will be depressive symptomatology. Secondary outcomes will include other variables such as physical activity, resilience, anxiety, depression impairment, and positive and negative affect. Treatment expectation, satisfaction, usability, and game playability will also be measured. The data will be analyzed based on the intention-to-treat and per protocol analyses. Discussion: The study aims to establish initial evidence for the efficacy of a smartphone-based serious game intervention, to serve as input for a larger-scale randomized control trial. The intervention exploits advanced smartphone capabilities, such as the use of a serious game as delivery mode, with the potential benefit of engagement and treatment adherence, and motion sensors to monitor and stimulate physical activity. As a secondary objective, the study aims to gather initial evidence on the user's expectations, satisfaction, usability and playability of the serious game as a treatment.
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Objectives: To determine the prevalence of risk factors for cardiovascular disease (CVD) among people with mental illness attending the Mental Health Care Centre, Windhoek, Namibia. Design: Observational, cross-sectional study. Setting: Mental health Care Centre, Windhoek Central Hospital. Namibia. Participants: Adult patients with a mental illness attending the Mental Health Care Centre, Windhoek. Data collection: Within a systematic random sampling method, 385 adult patients with mental illness were recruited between May and December 2017. Statistical analysis: Validated assessment tools were used. Descriptive summary statistics and Chi-squared tests of association were conducted. Results: One-third (31.7%) of participants used alcohol, 21% used nicotine, 21.3% had hypertension, 55% were over-weight or obese, 59.2% of females and 11.5% of males had abdominal obesity. About twenty per cent (19.9%) of participants did meet the World Health Organisation recommended level of activity, while more than two-thirds of participants did not participate in moderate or vigorous physical activities. The patient's psychiatric condition was significantly associated with alcohol use (Chi-square=20.450, p=0.002) and physical activity (Chi-square=20.989, p=0.002). The psychiatric condition was not associated with the waist circumference and gender of the participant. Conclusions: The increased prevalence of CVD risk factors in people with mental illness calls for mental health practitioners to screen, monitor and manage these risk factors regularly. Systematically screening and monitoring for cardiovascular risk factors is likely to contribute to National targets and significantly impact cardiovascular morbidity and mortality in people with mental illness. Funding: This work was financed by internal resources of the Mental Health Care Centre, Windhoek Central Hospital.
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Objective To understand the acceptability of (a) reducing sedentary-behaviour in people with psychosis using ‘if-then’ plans and (b) the proposed app content. Design Qualitative acceptability study. Method Three structured focus-groups and an interview were conducted with eight participants who had experience of a psychotic episode. They discussed sedentary-behaviour, being more active, critical situations in which they may be tempted to be sedentary and solutions to these (the if-then plans), and a mock-up of the mobile application. The Theoretical Framework of Acceptability (TFA) was used to analyse qualitatively the transcripts. Results All TFA constructs were coded in each of the transcripts. The idea of reducing sedentary-behaviour was acceptable to people with psychosis, participants knew the importance of being more active, however it is not always their main priority. Likewise, the proposed content of the app was found to be acceptable, with participants already using some of the proposed solutions. Conclusion This was the first study to use the TFA framework to assess the acceptability of an app that uses critical situations and solutions (‘if-then plans’) to help reduce sedentary behaviour for people with psychosis. In this sample (male, English speaking mainly white people), participants understood the benefits of being more active. However, reducing sedentary-behaviour is not the main priority of this population and being sedentary has benefits when their mental-health is bad.
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Previous research has demonstrated the efficacy, effectiveness, and safety of exercise training in persons living with schizophrenia. However, the optimal exercise training program remains unclear. The aim of this paper was to conduct a systematic review and meta-analysis of the effects of aerobic, resistance, and combined aerobic and resistance training on health-related physical fitness and positive and negative symptoms in persons living with schizophrenia. Six electronic databases were searched systematically from their inception to December 2020 [MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, SPORTDiscus, and Cumulative Index to Nursing and Allied Health Literature (CINAHL)] to identify literature examining the effects of exercise training on psychiatric symptoms and health-related physical fitness indicators in persons living with schizophrenia. A total of 22 studies ( n = 913) were included in this review, and 12 studies ( n = 554) included within the meta-analysis reported the effects of exercise training (aerobic, resistance, and combined aerobic and resistance) in persons living with schizophrenia. Aerobic training had a significant decrease on Positive and Negative Syndrome Scale (PANSS) negative scores (ES −2.28, 95% CI −3.57 to −1.00; p = 0.0005) and PANSS general scores (ES −2.51, 95% CI −3.47 to −1.55; p < 0.00001). Resistance training did not lead to significant effects on PANSS total scores. Combined aerobic and resistance training did not lead to significant changes in body mass index, PANSS positive scores, or PANSS total scores. However, grouping together the results from all exercise training modalities (including aerobic training, resistance training, and combined aerobic and resistance training) revealed significant effects on body mass index (ES 1.86, 95% CI 0.84 to 2.88; p = 0.0003), maximal/peak oxygen consumption (ES 2.54, 95% CI 1.47 to 3.62; p = < 0.00001), body weight (ES 6.58, 95% CI 2.94 to 10.22; p = 0.0004), PANSS negative scores (ES −1.90, 95% CI −2.70 to −1.10; p < 0.00001), and Scale for the Assessment of Negative Symptoms (SANS) total (ES −14.90, 95% CI −22.07 to −7.74; p < 0.0001). Collectively, these findings support the importance of exercise participation (aerobic and resistance training) in persons living with schizophrenia.
Conference Paper
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Resumo: A esquizofrenia é uma das doenças mentais mais debilitantes, afetando 1% da população mundial. As elevadas taxas de doença cardiovascular, síndrome metabólica e mortalidade prematura associadas a esta doença, constituem uma preocupação epidemiológica. A investigação demonstra o impacto de programas de atividade física (PAF) na saúde física e mental de indivíduos com esquizofrenia. Deste modo, o objetivo deste trabalho foi elaborar um relato de experiência sobre um PAF para indivíduos com esquizofrenia promovido pela Faculdade de Desporto da Universidade do Porto (FADEUP). Com a caracterização deste programa de investigação-ação, pretendemos partilhar estratégias de intervenção, dirigidas para as necessidades específicas desta população, permitindo que o modelo implementado na FADEUP possa ser replicado noutros contextos ao nível nacional. O referido PAF teve início em 2010 e nele participam 45 pacientes adultos, com diagnóstico de esquizofrenia, de ambos os géneros, residentes na comunidade, provenientes de 3 serviços de saúde da área do grande Porto que se dedicam à reabilitação psiquiátrica. O PAF contempla sessões bissemanais de atividade física e desportiva, têm a duração de 50-60 minutos e decorrem nas instalações da FADEUP. Os participantes encontram-se envolvidos em estudos de natureza científica que visam avaliar o impacto da AF nos parâmetros físicos, biológicos, psicológicos e sociais dos indivíduos com esquizofrenia. Neste sentido, é regularmente aplicada uma bateria de testes que visa analisar variáveis como a qualidade de vida, o nível de AF, a capacidade funcional para o exercício, a qualidade do sono, a motivação para o exercício e a autoestima dos participantes. As evidências científicas permitem constatar que o referido PAF constitui uma importante ferramenta para a promoção de estilos de vida saudáveis em indivíduos com esquizofrenia, sendo também uma oportunidade para o desenvolvimento de interações sociais positivas, contribuindo para atenuar os estigmas e preconceitos da sociedade relativamente à doença mental. Palavras-chave: esquizofrenia, programa de atividade física, promoção da saúde
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As modern lifestyles offer ever more opportunities for a sedentary existence, physical activity has become, for many, a marginal aspect of life. Too little physical activity is linked to common, often serious, health problems, and although this link is now widely acknowledged, levels of sedentary behaviour continue to increase throughout western society. Psychology of Physical Activity, 2nd Edition addresses this concern, bringing together a wealth of up to date information about exercise behaviour including: motivation and psychological factors associated with activity or inactivity the psychological outcomes of exercising including the 'feel-good' factor understanding specific clinical populations interventions and applied practice in the psychology of physical activity current trends and future directions in research and practice. Updated to reflect new findings and research directions, this new edition includes full textbook features, and is accompanied by a dedicated website providing lecturers and students with extensive support materials, including powerpoint slides and student MCQ's. © 2001, 2008 Stuart J. H. Biddle and Nanette Mutrie. All rights reserved.
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Assessment of habitual physical activity in epidemiologic and health education studies has been difficult. A seven-day physical activity recall interview was developed and administered in a community health survey, a randomized clinical trial, and two worksite health promotion programs during 1979-1982. These studies were conducted in several populations in California, Texas, Pennsylvania, and New Jersey. Energy expenditure estimates from the physical activity recall conformed to expected age- and sex-specific values in the cross-sectional community survey. Estimates of energy expenditure were also congruent with other questions on physical activity and job classification. In a randomized, one-year exercise trial, the physical activity recall detected increases in energy expenditure in the treated group and was positively associated with miles run during training (p less than 0.05). Changes in energy expenditure were associated with changes in maximal oxygen uptake (VO2max (r = 0.33, p less than 0.05) and body fatness (r = -0.50, p less than 0.01) at six months, and in high density lipoprotein-cholesterol (r = 0.31, p less than 0.05) and triglyceride (r = -0.41, p less than 0.01) at one year. The physical activity recall detected significant (p less than 0.01) increases in energy expenditure in treatment groups in two worksite health promotion projects. These data suggest that the physical activity recall provides useful estimates of habitual physical activity for research in epidemiologic and health education studies.
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Low-income, racial and ethnic minority, and populations with disabilities are more likely to be sedentary than the general population. Increasing physical activity in these groups is an important public health challenge. This report summarizes interventions that have targeted populations at risk for inactivity. Computer and manual searches were performed to identify manuscripts published from 1983 to 1997. Interventions conducted in these populations in which physical activity was part of the intervention, and activity or cardiorespiratory fitness were outcome measures, were included in the review. Fourteen studies were identified. Most studies used pre-post or quasi-experimental designs. Common intervention features for the ten studies that included ethnic minority groups were community advisory panels, community needs assessments, and community members delivering the intervention. Eight studies reported a theoretical framework that guided the intervention. Increased physical activity was documented in two studies. Post-intervention follow-up was conducted in two studies; both reported no significant findings. Only four studies for people with disabilities were found; all four reported post-intervention physical activity change. Much work remains to develop effective interventions for these populations. Research that involves the community at all steps in the design and implementation of the intervention shows greatest promise for promoting behavior change. Future intervention studies should include: (1) rigorous experimental designs; (2) theoretically based interventions; and (3) validated assessment instruments to detect physical activity change.
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To review and update the evidence relating to the personal, social, and environmental factors associated with physical activity (PA) in adults. Systematic review of the peer-reviewed literature to identify papers published between 1998 and 2000 with PA (and including exercise and exercise adherence). Qualitative reports or case studies were not included. Thirty-eight new studies were located. Most confirmed the existence of factors already known to be correlates of PA. Changes in status were noted in relation to the influence of marital status, obesity, smoking, lack of time, past exercise behavior, and eight environmental variables. New studies were located which focused on previously understudied population groups such as minorities, middle and older aged adults, and the disabled. The newly reported studies tend to take a broader "ecological" approach to understanding the correlates of PA and are more focused on environmental factors. There remains a need to better understand environmental influences and the factors that influence different types of PA. As most of the work in this field still relies on cross-sectional studies, longitudinal and intervention studies will be required if causal relationships are to be inferred.
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This article reviews evidence supporting the need for interventions to promote physical activity among persons with serious mental illness. Principles of designing effective physical activity interventions are discussed along with ways to adapt such interventions for this population. Individuals with serious mental illness are at high risk of chronic diseases associated with sedentary behavior, including diabetes and cardiovascular disease. The effects of lifestyle modification on chronic disease outcomes are large and consistent across multiple studies. Evidence for the psychological benefits for clinical populations comes from two meta-analyses of outcomes of depressed patients that showed that effects of exercise were similar to those of psychotherapeutic interventions. Exercise can also alleviate secondary symptoms such as low self-esteem and social withdrawal. Although structured group programs can be effective for persons with serious mental illness, especially walking programs, lifestyle changes that focus on accumulation of moderate-intensity activity throughout the day may be most appropriate. Research suggests that exercise is well accepted by people with serious mental illness and is often considered one of the most valued components of treatment. Adherence to physical activity interventions appears comparable to that in the general population. Mental health service providers can provide effective, evidence-based physical activity interventions for individuals with serious mental illness.
Participation in regular moderate or vigorous physical activity substantially reduces risk for all-cause and cardiovascular-disease mortality and confers other health benefits. Efforts to decrease the population prevalence of inactivity will have a greater impact if they are tailored to the needs and preferences of the community. In the Pilot Survey of the Fitness of Australians, a questionnaire was administered to a randomly selected sample of 2,298 adults and included questions on the preferred sources of assistance or support to become physically active, preferred activities, and barriers to regular participation. The responses of those who were identified as insufficiently physically active (n = 1,232; 53.6%) were examined for men and women separately and for those aged 18 to 39, 40 to 59, and 60 to 78 years. The most-preferred activity was walking (38 and 68% of the youngest and oldest age groups, respectively). The most frequently cited barriers to more-regular participation in the youngest age group were insufficient time, lack of motivation and child care responsibilities. Among those aged 60 to 78 years, injury or poor health were the most frequently cited barriers to activity. The most-preferred source of advice or assistance changed with age: more than 50% of the oldest age group wanted advice from a health professional (compared with 22% of the youngest group) and the opportunity to exercise with a group was the most preferred source of support for the youngest age group. The physical activity-related attributes of men and women and of younger and older age groups described in this study may be used to provide more relevant and appealing options for those who might otherwise be missed by "one-size-fits-all" physical activity promotion strategies.
Increasing regular physical activity in adults at elevated risk of cardiovascular disease is an important target for preventive medicine. This study evaluated demographic, social and cognitive predictors of self-reported changes in physical activity after 4 and 12 months in a randomized trial of behavioral counseling in primary care. Data were analyzed from 234 male and 271 female sedentary patients with a body mass index of 25-35 (age 49.1 years, SD 11.2 years), who had been counseled by nurses in general practice using stage-matched behavioral methods or standard health promotion and who were reassessed after 4 months. A total of 187 men and 231 women were reassessed after 12 months. Physical activity at baseline was associated with educational status, having a partner who exercised, perceived barriers, and self-efficacy. Changes over 4 months were greater with behavioral counseling, in non-smokers and in patients with higher ratings of motivation to change and self-efficacy at baseline. Changes over 12 months were greater with behavioral counseling and were predicted in the behavioral group by social support variables, perceived benefits, and barriers. Stage of readiness to change predicted increased activity at 4 but not 12 months. Social support and cognitive variables predict increased physical activity following counseling in primary care of sedentary overweight adults. Different factors are relevant to short- and long-term modifications in behavior.
This paper describes a conceptual model of recovery from mental illness developed to aid the state of Wisconsin in moving toward its goal of developing a "recovery-oriented" mental health system. In the model, recovery refers to both internal conditions experienced by persons who describe themselves as being in recovery--hope, healing, empowerment, and connection--and external conditions that facilitate recovery--implementation of the principle of human rights, a positive culture of healing, and recovery-oriented services. The aim of the model is to link the abstract concepts that define recovery with specific strategies that systems, agencies, and individuals can use to facilitate it.
Although physical inactivity is a leading cause of death and the Surgeon General recommends regular moderate physical activity, many Americans are inactive. Because of their increased burden of obesity and diabetes, people with severe mental illness (SMI) especially may benefit from physical activity, yet little is known about the prevalence and types of physical activity in people with SMI. We surveyed outpatients with schizophrenia and affective disorders at two psychiatric centers in Maryland and compared physical activity patterns to an age-gender-race-matched national sample (National Health and Nutrition Examination Survey III) of the general population. We found that people with SMI are overall less physically active than the general population, although the proportion with recommended physical activity levels was equal. The participants with SMI were more likely to walk as their sole form of physical activity. Within the SMI group, those without regular social contact and women had higher odds of being inactive.