Physical activity patterns, attitudes and counselling among adults with mental illness

Abstract

The life expectancy of adults with mental illness is significantly less than that of the general population. This is largely due to poor physical health. Physical activity is consistently recommended for the prevention and management of non-communicable diseases and also has mental health benefits. The aim of this thesis was to understand and promote physical activity in adults with mental illness, to improve physical health. Study One was a cross-sectional study of inpatients in a private hospital. It assessed the (i) feasibility of self-report and objective measurement of physical activity and sedentary behaviour, (ii) levels of physical activity and sedentary behaviour, and (iii) physical activity attitudes and preferences for contexts and sources of support. 101 participants completed questionnaires on physical activity and sitting time, activity preferences and attitudes, psychological distress and sociodemographic and health variables. 38 also wore an accelerometer for 7 consecutive days. Feasibility of measurement was assessed in terms of participant engagement; self-reported ease/difficulty; extreme self-report data values; and adherence to accelerometer wear time criteria. Findings demonstrated that inpatient adults with mental illness can engage with both questionnaire and accelerometry measurement, that it was more feasible but less acceptable to wear an accelerometer than to complete questionnaires, and that this was not influenced by level of psychological distress. Questionnaire data were used to determine time spent in (i) walking and moderate- and vigorous-intensity activity (MVPA), and (ii) domain specific sitting time. Accelerometry was used to determine mean daily time spent in MVPA and sedentary behaviour. Bivariate associations between self-reported MVPA, sedentary behaviour and explanatory variables of gender, age, education, body mass and distress were analysed using regression analyses. Self-report data indicated a median of 32 minutes/day in MVPA and a median of 761 minutes/day in sedentary behaviour. Accelerometry data indicated an average of 37 minutes/day in MVPA and 664 minutes/day in sedentary behaviour. Analyses indicated no significant associations between explanatory variables and MVPA or sedentary behaviour. Questionnaire data were used to determine (i) physical activity interest; (ii) reasons to do activity; (iii) general knowledge regarding activity benefits; (iv) preferences for activity type, context and sources of support; and (v) activity barriers. More than three quarters (77%) of participants expressed high interest to do physical activity while in hospital, with the most common reasons being to maintain physical health and improve emotional wellbeing (≥95%). More than 90% of participants agreed physical activity was beneficial for managing psychological wellbeing, heart disease, stress, diabetes and quality of life; but fewer than half agreed that activity had benefits for serious mental illness. Participants preferred walking; activity that can be done alone, at a fixed time and with a set routine and format; and a personal trainer, physiotherapist or an exercise physiologist to recommend, design or lead physical activity programs. Major barriers were fatigue and lack of motivation. There were no significant preference differences by level of psychological distress. Study Two was a nurse-led, two stage single group intervention trial that evaluated the effectiveness of a behavioural counselling program on improving metabolic health indicators, physical activity levels and psychosocial wellbeing of outpatient adults with mental illness. Participants received counselling every three weeks during stage one (19 weeks) and every six weeks during stage two (additional 12 weeks), and attended progress review sessions with a medical practitioner every six weeks. Assessment included self-report questionnaires of physical activity, sedentary behaviour and psychosocial wellbeing; objective measurement of physical activity and sedentary behaviour; blood pressure and anthropometric measurement. Of the 21 participants who consented, 16 completed stage one and 10 completed stage two of the intervention. During stage one, there were statistically significant improvements in waist circumference (-2.7cm, 95%CI -5.15, -0.22, p<0.035), and psychological quality of life (9.14, 95%CI 0.10, 18.18, p=0.048). During stage two, there were statistically significant reductions in waist circumference (-7.1cm, 95%CI 1.17, 12.93, p=0.024) and weight (-5.51kg, 95%CI 1.07, 9.95, p=0.033). Conclusions: Inpatient adults with mental illness are interested in activity programs and can achieve good levels of physical activity. Inpatients can engage with activity questionnaires and monitors, but may be reluctant to wear activity monitors and find sedentary behaviour questionnaires difficult. It is recommended that inpatient activity programs highlight the benefits for serious mental illness, focus on walking, be led by staff with exercise expertise, and include strategies to allow for fatigue and support motivation. There is a need for inpatient interventions to reduce sedentary behaviour. Physical activity counselling may be an effective strategy for improving the physical health of adults with mental illness, and can reduce waist circumference and weight, and improve quality of life. It is recommended that behavioural counselling programs involve face-to-face sessions at a frequency of least every three weeks, be sustained over time, and have an ‘open door’ policy to allow for attendance interruptions that may be caused by deteriorations in mental or physical health.