A co-produced research project studying how to improve physical activity for people with severe and enduring mental health problems.
People with severe mental health problems have a shorter life expectancy and a higher risk of developing some medical conditions. An empowering programme that increases levels of physical activity may play a role in reducing this mortality gap.
This report presents the findings from an exploratory study of a physical activity intervention based in Northern Ireland for people with severe and enduring mental health problems. The funding for the project came from DRILL, a £5 million research programme funded by the National Lottery Community Fund and employed a co-production approach between people with lived experience of mental health problems, Mental Health Foundation, Queen’s University Belfast, Praxis Care, Platinum Training Institute, Northern Ireland Chest Heart & Stroke and the Northern, South Eastern and Western Recovery Colleges.
Aims
- To increase our knowledge about what works to engage people with severe and enduring mental health problems in sustained physical activity to a level that is improving and protecting their physical health
- To identify the facilitators and opportunities that help engage and empower people with severe mental health problems in physical activity
- To explore the current barriers to physical activity
Methods
The physical activity programme was designed using co-production methods and delivered by personal trainers from Platinum Training Institute who had expertise in working with people with mental health problems.
Trained co-researchers (with lived experience of mental health problems) worked on the project at all stages, from informing programme design to interviewing participants and conducting the data analysis to disseminating the findings.
Quantitative data was collected on the health and lifestyles of participants and qualitative interviews and focus groups were used to explore the barriers and facilitators to physical activity and the impact of the programme that we developed.
Key findings
Fifty-seven participants from different mental health service use settings signed up for the programme and 31 participated regularly over the 12-weeks. Participation rates were affected by difficulties getting permission from GPs.
Effects
- Overall the participants reported physical and mental health benefits. These include improved sleep, improved energy and a reduction in the negative side effects of medication.
- The mental health and psychological benefits of engaging in physical activity were articulated by participants. These benefits included better decision-making, feeling mentally clearer and more alert. Improvements in mood and lower levels of stress were also reported.
- These achievements often resulted in behaviour change, with some participants able to establish new routines, incorporating more structure into their daily lives and making adjustments to diet and other lifestyle behaviours.
- The effects were noted to be particularly important for people with caring responsibilities involved in the study. The weekly activity created an outlet to engage socially, be active and promote self-care which in turn had a positive impact on their coping skills.
Facilitators
The social aspect of the programme was key for many participants. It made them more motivated to continue their involvement, created a sense of belonging and connectedness and for participants that were socially isolated, it provided new opportunities to meet new people and increase their social network.
The trainers’ qualifications, experience and knowledge of working with this population group, their creativity and flexibility in tailoring the programme content and environment and their patient and empathetic approach was identified as important in engaging participants and helped to mitigate other barriers such as low self-esteem, the negative side effects of medication and other diagnoses-related symptoms.
Barriers
One of the key barriers to the programme was gaining GP approval. This process was not always straightforward and led to delays in some sites. Whilst some participants had difficulty in booking a timely GP appointment, delays also resulted from the GPs themselves, with some willing to sign off for a small fee. This was not only an important health consideration but also a requirement of the trainers’ insurance.
Co-production
The co-production approach was an appropriate methodology for the project. The team benefitted from the range of skills and experiences relating to mental health and it was a rewarding experience for all the partners involved.
Recommendations
Though people with severe and enduring mental health problems have increased physical health risks and many could benefit from physical activity, they are disproportionately excluded from accessing it. Physical activity should be recognised as a core responsibility of health and social care and community-based provision of health and leisure facilities such as local council and school-based settings.
Physical activity interventions can be accessible and appealing to people with severe and enduring mental health problems, including carers who are often described as a forgotten workforce within service delivery. In addition, these programmes do not have to be costly. Successful programmes centred on walking and incorporated chair-based exercises and affordable equipment such as resistance bands, helping to meet the government recommended activity levels.
Given the importance placed on the social aspect of participation, which in some cases was more important than the physical or mental health gains, this should be at the forefront when planning and delivering programmes.
Even low-level physical activity like walking or chair-based exercises is beneficial to people with mental health problems. For schemes considering a more formal level of support, it is best that personal trainers delivering programmes to people with severe and enduring mental health problems should have an understanding of the benefits, challenges and opportunities of working with people with mental health conditions and experience of working with this population group.
Our findings support the use of physical activity in appropriate and supportive settings offering varying levels of intensity to meet the needs of patients with lower confidence and ability. Thought could be given to the establishment of a register of mental health qualified fitness professionals, for instance, personal trainers that have the Level 4 Award in Physical Activity for Adults with Mental Health Conditions qualification, to build confidence for health and social care services signposting to these resources.
Conclusion
Physical activity can have benefits for people’s physical and mental health and plays an important role in the social aspect of people’s lives. People with mental health problems care about their physical health and by providing the right kind of help, can be supported and encouraged to incorporate physical activity into their daily lives.
A co-produced intervention to improve the physical health of people with severe and enduring mental health problems evaluated by a co-research methodology resulted in an acceptable, feasible to deliver and valued intervention. The co-research approach gave additional benefits for the co-researchers in terms of training, confidence and a broader insight into the issue of physical and mental health.
Study limitations
As an exploratory study, the results reflect the views and experiences of a small population of mental health service users and their carers. The focus group methodology may also potentially be a source of bias. However, the results presented here are in line with the broader literature on this topic, which increases our confidence in the overall findings and conclusions.