Lessons Learned From a Physical Activity Intervention in Psychiatric Treatment: Patient, Staff, and Leader Perspectives.

OBJECTIVE: To explore how the implementation of a motivational physical activity (PA) intervention for inpatients with severe mental illness was experienced by patients, staff, and leaders at a psychiatric institution. METHOD: After the intervention individual semi-structured interviews were conducted with patients (n = 6) and staff (n = 6), and a focus group interview was conducted with the leaders (n = 4). RESULTS: All had a positive view on PA as part of psychiatric treatment, thinking it would benefit the patients' health. There were some differences among the groups as to the importance of PA relative to traditional treatments. Positive outcomes were reported from all three groups, but with different foci. The patients and the staff underscored the importance of PA professionals in order to achieve high quality activities, whereas the leaders, due to restraints in resources, could not prioritize to hire PA professionals. CONCLUSION: PA was considered a positive part of treatment. Ideas about what it takes to obtain the potential physical, mental, and social benefits of PA differed between patients, the staff involved, and the leaders. Having staff with PA as a primary responsibility and with sufficient competence as PA instructors seems to be important.

Associations between physical activity and motivation, competence, functioning, and apathy in inhabitants with mental illness from a rural municipality: a cross-sectional study.

BACKGROUND: There is increasing evidence for physical activity (PA) having a positive impact on physical and mental health as well as illness symptoms in individuals with severe mental illness (SMI). However, individuals with SMI experience several barriers that makes it difficult to take advantage of the benefits associated with PA. One barrier consistently reported to impede PA is motivational issues. Thus, the main aim of the present study was to examine associations between PA and motivation for PA, perceived competence for PA, functioning, apathy, and demographic variables among individuals with SMI. This was conducted within a larger study aiming at including all inhabitants with SMI in one particular small, rural municipality. METHOD: A total of 106 participants were recruited to the study. Questionnaire-based interviews conducted by two mental health nurses assessed self-reported PA, motivation and competence for PA, functioning, and apathy. Additionally, 71 participants accepted to wear an accelerometer-equipped wristwatch yielding an objective assessment of PA. RESULTS: The participants engaged in little PA. However, they did not lack motivation, as over 90% stated that they would like to be more active, and participants across PA level displayed high scores of a motivation reflecting that they valued the benefits of PA. Results showed that higher self-reported PA level was associated with higher levels of integrated regulated motivation and perceived competence for PA while it was unrelated to functioning and apathy. In the subpopulation with objectively measured PA, integrated regulated motivation for PA remained significantly associated with PA level, whereas poor scores on functioning lowered the odds ratio for higher PA level. CONCLUSION: The results show that PA specific motivation is associated with PA even when controlling for functioning and apathy. This highlight the importance of facilitating context specific motivation (i.e., motivation for PA) and that health care practitioners should emphasise helping people with SMI develop more intrinsic forms of motivation.

Motivational factors associated with physical activity and quality of life in people with severe mental illness.

BACKGROUND: There has been increasing interest for investigating the role of motivation in physical activity among people with severe mental illness (SMI). Autonomous motivation has been suggested to have a potentially important role in adoption and maintenance of physical activity. However, the knowledge about factors that facilitate autonomous motivation among people with SMI is scarce. AIM: The aim of this study was to examine factors associated with motivation for physical activity as well as the relationships between motivation, physical activity and health-related quality of life in individuals with SMI that were currently physically active. METHODS: A cross-sectional design was used, and 88 participants were recruited from a public health network promoting physical activity for people with SMI. They answered a questionnaire package consisting of scales measuring psychological need support - psychological need satisfaction - and motivation for physical activity, physical activity and health-related quality of life. RESULTS: The majority of participants reported to be in regular physical activity. Associations between variables were tested according to the self-determination theory process model. Structural equation modelling yielded good fit of the process model to the data. Specifically, a need-supportive environment was positively associated with psychological need satisfaction, while psychological need satisfaction was positively associated with autonomous motivation and mental health-related quality of life, and negatively associated with controlled motivation and amotivation. Physical activity was positively associated with autonomous motivation and physical health-related quality of life, and negatively associated with amotivation. CONCLUSION: This study indicates that individuals with SMI can be regularly physically active when provided with suitable opportunities. Furthermore, the present results suggest that it is vital for health-care practitioners to emphasise creating a need-supportive environment when organising physical activity because such an environment is associated with both increased autonomous motivation for physical activity and mental health-related quality of life.

Changes in return to work among patients in vocational rehabilitation: a self-determination theory perspective.

PURPOSE: The aim of the current study was to examine whether patient perceptions of autonomy support from the treatment team in a vocational rehabilitation program will be associated with change (increase) in need satisfaction, autonomous motivation, perceived competence, well-being, physical activity, and return to work (RTW), and whether the self-determination theory (SDT) Model of Health Behavior will provide adequate fit to the data. METHOD: A total of 90 participants were enrolled in a longitudinal study and completed measures at four time points over 15 months. RESULTS: Participants reported increases in all variables, and in general these changes were maintained at six weeks post-rehabilitation and at 15 months post-baseline. As well, the SDT Model of Health Behavior provided adequate fit to the data. CONCLUSIONS: These results underscore the importance of health care practitioners' providing support for their patients' autonomy, competence, and relatedness to improve well-being, physical activity, and RTW in the context of vocational rehabilitation. Implications for Rehabilitation Vocational rehabilitation that emphasizes physical activity is associated with increases in patients' well-being, physical activity, and return to work (RTW). It is important for health care practitioners to provide support for their patients' autonomy, competence, and relatedness in the context of vocational rehabilitation, as doing so is associated with increases in patients' autonomous motivation, perceived competence, and psychosocial outcomes.

Motivation for physical activity and exercise in severe mental illness: A systematic review of intervention studies.

There has been increasing interest for research on motivation for physical activity (PA) and exercise among individuals with severe mental illness (SMI). The aim of this systematic review is to summarize findings from all intervention studies on PA or exercise that either include empirical data on motivational constructs or apply motivational techniques/theories in their intervention. Systematic searches of seven databases were conducted from database inception to February 2015. Studies were eligible if they: (i) included participants with SMI, (ii) had PA as part of the intervention, and (iii) reported empirical data on motivational constructs related to PA or incorporated motivational techniques/theory in their intervention. Of the 79 studies that met the inclusion criteria only one had motivation for PA as its main outcome. Nine additional interventions reported empirical data on motivational constructs. Altogether these studies yielded mixed results with respect to change in motivational constructs. Only one of those examined the association between motivation and PA, but found none. Sixty-four studies reported using motivational techniques/theory in their intervention. Motivational interviewing and goal-setting were the most popular techniques. Due to the exploratory nature of most of these studies, findings from intervention studies do not so far give very clear directions for motivational work with the patients. There is an urgent need for a more systematic theory based approach when developing strategies that target to increase engagement in PA among people with SMI.

Motivation for physical activity and exercise in severe mental illness: A systematic review of cross-sectional studies.

Individuals with severe mental illness (SMI) are less physically active than the general population. One important barrier contributing to this inactivity is lack of motivation. The aim of this paper is to systematically review all cross-sectional literature on motivation for physical activity among people with SMI and to use the results as basis for guidance on how mental health nurses can facilitate motivation for physical activity. Systematic searches of seven databases were conducted from database inception to February 2015. Studies were eligible if they included participants with SMI and reported data on motivation for physical activity. In total, 21 articles were included and over half them were published in 2011 or later. The present results indicate preliminary evidence of how the motivational processes do not differ between individuals with SMI and the general population, and that they are independent of diagnosis, medication, age, gender, and body mass index. Results from the current systematic review can give some tentative guidance on how to facilitate motivation for physical activity within mental health-care. However, there is still a great need for developing and examining practical strategies that can enhance adoption and adherence of physical activity among people with SMI.