It has become common practice to recommend engagement in physical activity for those who are ill-affected with severe mental illness. However, this population typically engages in low levels of physical activity with poor adherence to exercise interventions.
For practitioners and allied health professionals, understanding how exercise can positively impact mental health, as well as patient-focused motivators and barriers, can assist with patient engagement and ultimately them taking the first steps towards sustainable behavioural change.
Generic physical activity guidelines show that adults need at least 150 minutes of moderate (or 75 minutes of vigorous) aerobic activity and muscle training on two or more days a week to achieve significant health benefits. Extensive research has been completed investigating what modality, intensity, duration and/or frequency is most effective for those with mental illness.
While some evidence has suggested intensity can impact certain neurotransmitter and inflammatory processes, a recent systematic review has suggested inconclusive findings around exact specifics, with contradicting verdicts around parameters in both aerobic and resistance training.
Despite the specific parameters being debatable, most researchers within the field agree the first step in eliciting the benefits of exercise is establishing regular engagement in physical activity. If we appreciate that improvements in physiological and psychometric measures of mental health have been displayed through various exercise interventions – including yoga, walking, running, cycling, rock climbing, resistance training and more – messaging to those prescribing exercise should focus on satisfaction, empowerment and promoting self-efficacy of exercise.
Barriers, motivators, and goals
Research has shown that 91% of people with severe mental illness have outlined ‘improving health’ as a reason for exercising, with most common specific motivators being ‘losing weight’ (83%), ‘improving mood’ (81%) and ‘reducing stress’ (78%). Interestingly, low mood and increased stress were identified as the most prevalent barriers to engaging in regular exercise (61%), with ‘lack of support’ (50%) being the most prominent socio-ecological barrier.
Importantly, exercise interventions delivered and supported by qualified exercise professionals (with a university qualification in physiotherapy or exercise physiology) have significantly greater physical and psychological benefits and adherence compared with interventions delivered by non-specialised practitioners.
When accounting for the dropout rates among sedentary individuals who commence exercise/physical activity (47% by the second month and 96% by the 12th month), the importance of identifying the stages of behavioural change is evident. In addition to understanding motivators for exercise, an important component of developing adherence to regular physical activity – particularly for those currently inactive with mental illness – is goal setting.
Traditional principles have consisted of ‘SMART’ goals, which implement specific, time measurable parameters. However, leading researchers and exercise professionals have identified a gap with SMART goals, with the multitude of potential barriers that can impact the trajectory of achieving established goals, ultimately negatively affecting self-esteem and adherence.
A common example is the goal of achieving 10,000 steps a day, which on the surface is evidence-based, however, for sedentary individuals with severe mental illness, this is often unachievable in the initial stages of behavioural change. As a result, a transition towards open and stepped goals is gaining traction, with researchers terming this new approach as ‘do your best’ and ‘open’ goals.
Following the previous example of achieving 10,000 steps per day, this ‘do your best’ approach encourages a gradual increasing of steps with messages such as “a little is better than none” to reinforce positive changes and responses to increases in physical activity, despite not completing the desired 10,000 steps.
In summary, understanding that exercise has been identified as a complex learning task, additional support through exercise professionals, the implementation of open-goals and education around the benefits of exercise can assist in overcoming dropout rates.
Key messages
- Exercise is beneficial for those with mental health problems
- This cohort will need additional support
- Set realistic and open goals.
– References available on request
Author competing interests – nil