Cohort differences in exercise adherence among primary care patients referred for mental health versus physical health conditions

Abstract

Aim: To compare the characteristics of mental health and physical health participants attending an exercise referral scheme (ERS) and investigate associations with their adherence to exercise. Background: While people referred to an ERS with a mental health diagnosis have similar initial rates of uptake as physical health participants, they are more likely to drop out. Comparisons of the groups to understand their differences and how these might impact on their adherence have been limited by the typically low numbers of mental health referrals in many schemes. Methods: Retrospective analysis of a participant cohort. Data were extracted on all participants enrolled over a 12-month period (n = 701) and included measurements at baseline, mid-point (13 weeks) and end of programme (20-26 weeks). Differences were explored between the mental health (n=141) and physical health (n=560) sub-cohorts, and between adherers and non-adherers in each group. Binomial logistic regression estimated the effect of group-level factors associated with adherence. Findings: Mental health referrals were more likely to be younger, White and unemployed, and had a lower mean body mass index and lower proportion of participants with high blood pressure. They were also more likely to drop out. While occupation was associated with exercise adherence among the physical health group, no predictive factors were identified in the mental health group. Conclusion: Participants referred for mental health disorders are more likely to drop out of exercise referral schemes than those with physical health problems. While no factors were found to be predictive of their exercise adherence, an understanding of their distinguishing characteristics and attendance behaviour can guide in making better referral decisions concerning them and planning more appropriately tailored support.

Aerobic exercise for adult patients with major depressive disorder in mental health services: A systematic review and meta-analysis

“…Depressed patients instead, may have a more challenging clinical profile given that they have suffered tenacious symptoms, including psychosocial impairment that led to a mental health service, and they may often experience failure or disappointment because the service use uncovers the disease severity/complexity and the need for systematic care (Bursztajn & Barsky, ; Maguire, Cullen, O'Sullivan, & O'Grady‐Walshe, ; Morgan, ). To this extent, depressed patients referred to exercise on referral schemes are, unsurprisingly, showing high dropout rates, often the highest among all health referrals (Crone et al., ; James et al., ; Tobi et al., ). Therefore, our findings that stem from trials with patients with a referral or clinical diagnosis of depression are representative to routine practice and, thus, of additional value.…”

“…Media respondents may have strong outcome expectations or motivation to lifestyle changes; Blumenthal and Ong () reported that community volunteers of exercise trials for depression are typically motivated to exercise. Instead, depressed patients recruited through health services do not seem to be comparably motivated, as they show high dropout rates from exercise on referral schemes (Crone, Johnston, Gidlow, Henley, & James, ; James et al., ; Tobi, Kemp, & Schmidt, ). In addition, a number of trials reviewed by these three meta‐analyses included samples with other mood disorders (e.g., dysthymia), or samples with older adult (+65 years) or both adult (18–65 years) and older adult depressed patients.…”

Physical activity and mental health; it is more than just a prescription

“…Acceptability. People with mental health issues may be at a particular risk for dropping out in physical activity programs (e.g., Cooney et al, 2013;Tobi, Kemp, & Schmidt, 2017). This issue must be addressed within the field.…”

Inequalities and Inclusion in Exercise Referral Schemes: A Mixed-Method Multi-Scheme Analysis

“…Across these studies, there are some consistent predictors of outcomes. For example, increased uptake is associated with being female or older [7][8][9][10], and adherence with being male or older [6,7], or on a physical rather than a mental health referral pathway [11]. Limited work has suggested that there may be differences in uptake and adherence based on the health condition and/or disability status [9,12,13], with higher rates for musculoskeletal and cardiovascular than other forms of referrals.…”