Abstract

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. 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 (≥18years) 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. 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. 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).

Highlights

  • Individuals living with serious mental illness (SMI), inclusive of major depressive disorder, schizophrenia and bipolar disorder, experience premature mortality [1], increased morbidity, and higher rates of obesity [4,5] are compared with the general population

  • The current review aimed to explore how adults diagnosed with SMI experience the initiation of community-based group physical activity (PA) and key features of social support within these contexts

  • The outcomes and subsequent “journey” presented in this review provide an authentic narrative of the lived experience of the initiation of community-based group PA for people living with SMI

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Summary

Introduction

Individuals living with serious mental illness (SMI), inclusive of major depressive disorder, schizophrenia and bipolar disorder, experience premature mortality [1], increased morbidity (e.g., type 2 diabetes [2], metabolic syndrome, and cardiovascular disease [3]), and higher rates of obesity [4,5] are compared with the general population.Reducing the premature death rate by targeting the physical health conditions experienced by people living with SMI is complex and multifactorial. Individuals living with serious mental illness (SMI), inclusive of major depressive disorder, schizophrenia and bipolar disorder, experience premature mortality [1], increased morbidity (e.g., type 2 diabetes [2], metabolic syndrome, and cardiovascular disease [3]), and higher rates of obesity [4,5] are compared with the general population. The benefits of PA for people living with SMI include improvements in psychiatric symptoms, quality of life, physical fitness, cardiometabolic risk factors, body mass index, and weight [10]. 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. 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)

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