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

April 2007
Psychiatric services (Washington, D.C.) 58(3):405-8

DOI:10.1176/appi.ps.58.3.405

Source
PubMed

Authors:

Michael Ussher

St George's, University of London

Guy Faulkner

University of British Columbia

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.

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PSYCHIATRIC SERVICES ♦ps.psychiatryonline.org ♦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,

2007)

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).

Methods

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: mussher@sgul.ac.uk). 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,

walking.

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.

Results

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 ♦ps.psychiatryonline.org ♦March 2007 Vol. 58 No. 3

440066

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

weather.

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).

Discussion

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.

Conclusions

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 ♦ps.psychiatryonline.org ♦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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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.

Acceptability of reducing sedentariness using a mobile-phone application based on ‘if then’ plans for people with psychosis: A focus-group study conducted in North West England, UK

Article

Full-text available

Jun 2022
INT J SOC PSYCHIATR

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.

Effects of Aerobic, Resistance, and Combined Exercise Training on Psychiatric Symptom Severity and Related Health Measures in Adults Living With Schizophrenia: A Systematic Review and Meta-Analysis

Article

Full-text available

Feb 2022

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.

ATIVIDADE FÍSICA PARA INDIVÍDUOS COM ESQUIZOFRENIA NA FADEUP: RELATO DE EXPERIÊNCIA DE UM PERCURSO DE CINCO ANOS

Conference Paper

Full-text available

Jul 2015

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

Psychology of Physical Activity: Determinants, Well-Being and Interventions

Article

Full-text available

Jan 2001

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.

Assessment of habitual physical activity by a seven-day recall in a community survey and controlled experiments

Article

Full-text available

Dec 1985
AM J EPIDEMIOL

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.

Physical activity interventions in low-income, ethnic minority, and populations with disability

Article

Full-text available

Dec 1998
AM J PREV MED

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.

Correlates of adults' participation in physical activity: Review and update

Article

Full-text available

Jan 2003

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.

Integrating Physical Activity Into Mental Health Services for Persons With Serious Mental Illness

Article

Full-text available

Apr 2005

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.

Physical Activity Preferences, Preferred Sources of Assistance, and Perceived Barriers to Increased Activity among Physically Inactive Australians

Article

Jan 1997

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.

Psychosocial Predictors of Changes in Physical Activity in Overweight Sedentary Adults Following Counseling in Primary Care

Article

Sep 2000

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.

Linking Discharged Patients With Peers in the Community

Article

Nov 2000

Robert W. Bjorklund

What Is Recovery? A Conceptual Model and Explication

Article

May 2001

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.

Physical Activity Patterns in Adults With Severe Mental Illness

Article

Nov 2005

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.

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

Abstract

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