Understanding the experience of initiating community-based group physical activity by people with serious mental illness: A systematic review using a meta-ethnographic approach

Abstract

Background: People living with serious mental illness (SMI) experience debilitating symptoms that worsen their physical health and quality of life. Regular physical activity (PA) may bring symptomatic improvements and enhance wellbeing. When undertaken in community-based group settings, PA may yield additional benefits such as reduced isolation. Initiating PA can be difficult for people with SMI, so PA engagement is commonly low. Designing acceptable and effective PA programs requires a better understanding of the lived experiences of PA initiation among people with SMI. Methods: This systematic review of qualitative studies used the meta-ethnography approach by Noblit and Hare (1988). Electronic databases were searched from inception to November 2017. Eligible studies used qualitative methodology; involved adults (≥18 years) with schizophrenia, bipolar affective disorder, major depressive disorder, or psychosis; reported community-based group PA; and captured the experience of PA initiation, including key features of social support. Study selection and quality assessment were performed by four reviewers. Results: Sixteen studies were included in the review. We identified a "journey" that depicted a long sequence of phases involved in initiating PA. The journey demonstrated the thought processes, expectations, barriers, and support needs of people with SMI. In particular, social support from a trusted source played an important role in getting people to the activity, both physically and emotionally. Discussion: The journey illustrated that initiation of PA for people with SMI is a long complex transition. This complex process needs to be understood before ongoing participation in PA can be addressed. Registration-The review was registered on the International Prospective Register of Systematic Reviews (PROSPERO) on 22/03/2017 (registration number CRD42017059948).

An implementation evaluation of the physical activity counseling in in-patients with major depressive disorder (PACINPAT) randomized controlled trial

“…It could be hypothesized that the Mo-Vo content is suitable for people with major depression, however there may need to be initial counseling sessions devoted to trust and relationship building before the behavior change content is addressed. This hypothesis is supported by qualitative ndings, iterating the importance of the source of physical activity support in people with severe mental illness (42).…”

Health-risk behaviours among people with severe mental ill health: understanding modifiable risk in the Closing the Gap Health Study

“…This is highly concerning and indicates a need for interventions to facilitate motivation to increase physical activity in this group, as it is highly unlikely that those who do not express a desire to increase physical activity are going to make a change from being inactive to becoming active. 18 Current knowledge regarding effective strategies to motivate those not currently motivated to change health-risk behaviours is limited and requires further investigation. However, it has been suggested that targeting self-efficacy, outcome expectancies, effort and value beliefs, and using motivational interviewing techniques may prove beneficial 19 when facilitating motivation to change.…”

Impacts of Physical Activity Interventions on Psychiatric Symptom Severity in Adults with Severe Mental illness: A Systematic Review

“…While there is an abundance of evidence on the bene ts of PA on mood and wellness in the general population, and the physical health bene ts of all people, there is a paucity of research on the e cacy of PA in reducing psychiatric symptom severity in individuals with severe mental illness. This is unique population that faces signi cant barriers to participation in regular PA yet could bene t immensely (9,27). The physical health bene ts of regular PA among this population are well established and were therefore not a focus of this review.…”

“…One reason for this difference in PA levels may be the considerable barriers that individuals with SMI face to participating in regular PA. A recent systematic review compiled 16 qualitative studies examining the experiences of individuals with SMI in PA initiation and the unique barriers faced and supports needed, which offers some insight into the lower level of PA in this population. This study identi ed support from a trusted source as a key piece to helping this population overcome some of the unique challenges they face when attempting to engage in regular PA (9).…”