Evaluating the Feasibility of a Pilot Exercise Intervention Implemented Within a Residential Rehabilitation Unit for People With Severe Mental Illness: GO HEART: (Group Occupational Health Exercise and Rehabilitation Treatment).

Nicole H Korman,Simon Rosenbaum,Dan Siskind,Shelukumar Shah,Ketevan Nadareishvili,Shuichi Suetani,Frances Dark,Karen Kendall

doi:10.3389/fpsyt.2018.00343

Abstract

Purpose: People with severe mental illness are sedentary, have high cardio-metabolic risks and significantly reduced life expectancy. Despite considerable data regarding positive physical and mental health outcomes following exercise interventions, implementation and evaluation of real-world programs is lacking. The primary aim of this study was to assess the feasibility of an exercise intervention implemented by exercise physiology (EP) students within a residential rehabilitation unit for residents with severe mental illness, together with assessment of a range of secondary physical and mental health outcomes pre- and post- the intervention.Design: Single arm, prospective pilot study evaluating outcomes pre- and post- a 10 week intervention.Method: Inactive people with severe mental illness participated in a mixed aerobic and resistance exercise intervention, three times per week for 10 weeks. Data was obtained from a sample of 16 residents with severe mental illness; primary diagnosis schizophrenia (n = 12). Primary outcomes were feasibility as assessed using recruitment, retention and participation rates, as well as reasons for withdrawal and amount of exercise achieved. Secondary outcomes included: functional exercise capacity was measured by the 6-min walk test; metabolic data obtained from anthropometric measurements; blood pressure; fasting cholesterol and blood sugar levels; and physical activity levels and mental health as assessed by self- administered questionnaires measured before and after the intervention.Results: Broad level acceptance of the program: high recruitment (81%), retention (77%), and participation (78%) rates were observed. Promising improvements in functional exercise capacity, volume of exercise, and negative symptoms was demonstrated in those who completed.Conclusions: Exercise interventions delivered by EP students in a residential rehabilitation setting for people with SMI are feasible; group setting, supervision and choice for engagement are important considerations. Evaluation of longitudinal, multi site studies, with the addition of dietary interventions within residential rehabilitation units are warranted. Addressing cost feasibility and cost effectiveness of such programs is recommended.The trial was registered with the Australian New Zealand Clinical Trials Registry (ANZCTR) number, Unique Identifier: ACTRN 12618000478213, http://www.anzctr.org.au Universal trial number (UTN) – U1111-1211-4009.

Highlights

People living with severe mental illness (SMI) die approximately 15 years earlier than the general population [1], due in part to their increased risk of preventable conditions such as cardiovascular disease (CVD) [2]
Future trials of exercise interventions that continue beyond 24 weeks, with follow up periods longer than one year are recommended for people with SMI
Unhelpful staff attitudes about physical health has been reported as an important barrier to exercise engagement for people with SMI [57]. We addressed this issue by inviting collaborative discussion between mental health staff, exercise physiologist (EP) students and the consultant psychiatrist, to address fears, concerns and myths about people with SMI engaging in exercise interventions, and ensuring comprehensive dissemination of the available evidence about the benefits of physical activity in team meetings and via group email

Summary

Introduction

People living with severe mental illness (SMI) die approximately 15 years earlier than the general population [1], due in part to their increased risk of preventable conditions such as cardiovascular disease (CVD) [2]. There is an urgent need to address modifiable risk factors that contribute to the mortality gap, such as physical inactivity and low cardio-respiratory fitness by developing effective strategies to improve the poor physical health of people with SMI [9, 10]. Individuals with SMI engage in lower amounts of exercise and have lower cardiorespiratory fitness (CRF) compared with the general population [11,12,13]. An increasing body of evidence demonstrates a wide range of mental health benefits of exercise for people with SMI, including improved mood, cognition, quality of life, and reduced positive and negative symptoms of schizophrenia. [15,16,17,18]

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