Improving the health of mental health staff through exercise interventions: a systematic review

Relationship between Psychosocial Factors and Physical Activity among Undergraduate Students from a South African University

Psychosocial factors such as mental health, motivation, and social support are key determinants of behavior that play a significant role in physical activity participation. Limited studies have investigated the relationship between psychosocial factors and physical activity among university students in Africa. The aim of this study was to determine the relationship between psychosocial factors and physical activity participation among undergraduate university students at a historically disadvantaged university (HDU) in South Africa. This was a cross-sectional study that used convenience sampling (n = 534, majority female, 53.6% with a mean age of 20.69). The study was conducted through an online, self-administered, and hard-copy, valid questionnaire in September 2022. Data on sociodemographic information were collected. Psychosocial factors were assessed using the Depression, Anxiety, and Stress-21 Scale for mental health, the Physical Activity and Leisure Motivation Scale for motivation, and the Perceived Social Support Scale for social support. Physical activity (calculated as MET-min/week) was assessed using the international physical activity questionnaire in short form. Results revealed that almost a third (29%) of undergraduate students were physically inactive, 31.1% were minimally active, and 39.9% were in the health-enhancing category. Physical activity was positively related to stress (r = 0.11, p < 0.05) and anxiety (r = 0.10, p < 0.05). Motivational factors were positively related to psychological condition and others' expectations (r = 0.10, p < 0.05), and depression and others' expectations (r = 0.11, p < 0.05). Results from this study highlighted that psychosocial factors were related to physical activity participation among undergraduate university students. Psychosocial factors should be considered a coping mechanism when implementing health-promoting strategies.

Individual and organizational interventions to promote staff health and well-being in residential long-term care: a systematic review of randomized controlled trials over the past 20 years

BACKGROUND

Staff in residential long-term care (RLTC) experience significant physical and mental work demands. However, research on specific interventions to promote staff health and well-being in RLTC facilities is limited. This systematic review aimed to synthesize the current evidence on health promotion interventions among RLTC staff.

METHODS

A comprehensive systematic literature review was conducted on studies published between January 2000 and April 2023. Four electronic databases were searched, including PubMed, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), and PsychArticles via EBSCO. The review followed the guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol. The methodological quality of the included studies was assessed using the Risk of Bias Assessment tool (RoB 2).

RESULTS

A total of 26 publications, referring to 23 different interventions with a randomized controlled design were included. Among these interventions, ten used training/educational approaches, six used behavioral approaches, and seven employed a multimodal approach. Significant improvements in health and well-being outcomes were found in four interventions using a training/educational approach, three interventions using a behavioral approach, and four interventions using a multimodal approach. Within the interventions studied, twelve specifically targeted the reduction of job demands, while only one intervention exclusively addressed job resources among RLTC staff. Furthermore, ten interventions addressed primary outcomes that encompassed both job demands and job resources.

CONCLUSION

Current evidence for health promotion interventions among RLTC staff is still limited, but research suggests that there is potential to improve certain outcomes related to RLTC staff health and well-being. Future research is recommended to contemplate a tailored intervention design that encompasses both individual-level and organizational-level approaches, and gender-specific physiological and sociological characteristics of RLTC staff. Moreover, detailed reporting of the development process, and research on the interaction between job demands and resources of RLTC staff are also recommended.

Perspectives on implementing exercise bikes for use by inpatient mental health staff in the workplace: A qualitative study investigating staff attitudes

WHAT IS KNOWN ON THE SUBJECT?: Mental health nursing staff may experience psychological stress and burnout. Exercise provision for mental health staff may improve staff physical and mental wellbeing and mitigate against psychological burnout. Existing research suggests the provision of exercise equipment for mental health nursing staff may improve staff attitudes towards physical activity and staff confidence in motivating physical activity amongst patient groups they care for, although more research is needed, and research investigating the attitudes of mental health staff towards such initiatives is warranted. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Access to fitness facilities in the workplace for mental health staff was endorsed. Logistical and practical concerns (i.e. shower access, time) were noted as barriers to implementation of fitness facilities in the workplace for staff use. Mental health staff expressed desire to have access to varied gym equipment at work WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The introduction of fitness facilities in the workplace environment for staff use was actively endorsed by mental health professionals, suggesting such initiatives may be warranted in mental health settings. However, barriers to successful implementation were noted and are worth considering in preparation for trialling provision of exercise equipment for staff use.

ABSTRACT

INTRODUCTION: Exercise equipment for mental health staff may improve staff wellbeing, mitigate against stress and improve staff attitudes towards physical activity. This said, there is a lack of researching investigating the attitudes of mental health staff towards the provision of fitness facilities in the workplace.

AIM

The study investigated staff attitudes towards being offered exercise bikes in the workplace.

METHOD

Three focus groups and one individual interview were conducted with 12 healthcare professionals. Data were subject to a thematic analysis.

RESULTS

Three themes were identified. (1) 'This sounds like a good idea', which reflected positive views in the provision of exercise in the workplace for staff use. (2) 'I'm not sure it would work because …', which reflected implementation concerns including not having access to shower facilities and time constraints. (3) 'Balancing choice', which reflected participant's desire to have access to varied gym equipment.

DISCUSSION

The introduction of fitness facilities in the workplace for staff use was endorsed. However, implementation barriers were noted.

IMPLICATIONS FOR PRACTICE

This research provides justification for the exploration of the feasibility and benefits of providing exercise equipment for mental health staff in the workplace but presents implementation barriers that are worth considering before trialling provision of exercise equipment.

Tackling change in mental health service delivery: A qualitative evaluation of a lifestyle program targeting mental health staff - Keeping our Staff in Mind (KoSiM)

ISSUES ADDRESSED

People with severe mental illness have adverse health outcomes compared to the general population. Lifestyle interventions are effective in improving health outcomes in this population. Current cultural processes in mental health services do not generally incorporate physical health care practices. Innovative education is required to improve knowledge and confidence of staff in the delivery of preventative health measures.

METHODS

The Keeping our Staff in Mind (KoSiM) program delivered a brief lifestyle intervention to mental health staff. A qualitative analysis following the Standards for Reporting Qualitative Research was undertaken. Semi-structured interviews designed to elicit information about the acceptability of the program and the impact of the intervention on participants' personal and professional lives. The interviews were analysed using thematic analysis, with coding independently developed and reviewed by three authors.

RESULTS

Of the 103 eligible participants, 75 were interviewed. Responses revealed four main themes: (i) positive changes in clinician's approach to physical health care, (ii) improvements in attitudes to self-care and family wellbeing, (iii) positive changes in workplace culture associated with physical health care delivery and (iv) high levels of acceptability of the program.

CONCLUSION

The KoSiM model may be useful in other settings as a means of changing the culture of mental health services to better integrate physical health care as a core part of mental health service provision. SO WHAT?: A novel approach using staff focussed lifestyle interventions model may cut through the resistance that is encountered when implementing proven methods of clinical intervention where cultural barriers exist.

Cardiorespiratory fitness and self-reported physical activity levels of referring mental healthcare professionals, and their attitudes and referral practices related to exercise and physical health

BACKGROUND

Physical activity (PA) interventions can improve mental and physical health of people with mental illness, especially when delivered by qualified exercise professionals. Also, the behaviour, engagement and support of referring mental healthcare professionals (HCP) seem essential, but research is scarce. We aimed to study HCP physical fitness and PA, and associations with their attitudes and referral practices related to physical health and PA interventions.

METHODS

HCP at the Dutch Association for Psychiatry congress (2019) were invited to an online questionnaire (demographic/work characteristics, stress, PA levels, knowledge/attitudes regarding PA, referral practices) and cycle ergometer test. Strongest associations were analysed using linear and logistic regression.

RESULTS

Of the 115 HCP who completed the questionnaire (40 also completed the ergometer test), 43% (n = 50) met PA guidelines (i.e., ≥150min moderate-to-vigorous PA and ≥2x bone/muscle-strengthening exercises/week). Women, HCP interns/residents and HCP experiencing more stress were less active and less likely to meet PA guidelines. Conversely, there were positive associations with personal experience with an exercise professional. Knowledge/attitudes on physical health and PA were positive. HCP were more likely to refer patients to PA interventions if they met PA guidelines (OR = 2.56, 95%BI = 0.85-7.13) or had higher beliefs that exercise professionals can increase adherence to PA interventions (OR = 3.72, 95%BI = 1.52-9.14).

LIMITATIONS

Mainly psychiatrists, affecting generalizability.

CONCLUSIONS

HCP report the importance and relevance of PA in mental healthcare. Despite strong evidence and guidance for PA interventions in prevention and treatment, referral to such interventions partly depends on the PA behaviour and attitude of patient's physician/clinician.

Exploring Perceived Stress among Students in Turkey during the COVID-19 Pandemic

Students have been highly vulnerable to mental health issues during the COVID-19 pandemic, and researchers have shown that perceived stress and mental health problems have increased during the pandemic. The aim of this study was to reveal the prevalence of perceived stress and mental health among students during the pandemic and to explore predictors of stress levels. A cross-sectional study was conducted on a sample of 358 undergraduates from 14 universities in Turkey, including 200 female students (56%). The measurements used in the study were the Generalized Anxiety Disorder 7-item (GAD-7) scale, Patient Health Questionnaire (PHQ-8), Satisfaction with Life Scale (SWLS), Perception of COVID Impact on Student Well-Being (CI), Perceived Stress Scale (PSS-10), Physical Activity Scale (PA), and a sociodemographic survey. Students reported high perceived stress, mild generalized anxiety, and low satisfaction with life. More than half of the students met the diagnostic criteria of GAD (52%) and depression (63%). Female and physically inactive students had higher PSS-10 levels. A hierarchical linear regression model showed that after controlling for gender and negative CI, anxiety and physical inactivity significantly predicted high perceived stress. The study shows that students’ mental health during the pandemic is at high risk.

Does Physical Activity Matter for the Mental Health of University Students during the COVID-19 Pandemic?

Research indicates that university and college students are at higher risk of experiencing mental health problems than other populations. This study aims to examine the relationship between Physical Activity (PA) and the mental health of Ukrainian university students during the Corona Virus Disease 2019 (COVID-19) pandemic lockdown. The conventional sample consisted of 1512 students from 11 Ukrainian universities, with a mean age of 20 years (M = 20.06, SD = 3.05) and 69% of whom were female. The cross-sectional online survey was disseminated through the most popular social media channels in Ukraine (i.e., Facebook, Viber, Telegram) and included the Generalized Anxiety Disorder (GAD-7) scale to measure anxiety and the Patient Health Questionnaire (PHQ-9) to assess depression. Data were collected from 14 May to 4 June 2020 during the COVID-19 pandemic outbreak in Ukraine. Among university students, 43% were engaged in PA ≥ 150 min weekly, 24% met the criteria of GAD, and 32% met the criteria of depression. More students were involved in PA before the COVID-19 outbreak than during the national lockdown. Students with anxiety and depression were almost two times less likely to engage in PA than their counterparts without mental health disorders. The inactive group had higher scores of anxiety and depression than the physically active group. The relationship of PA with anxiety and depression was statistically significant but weak during the COVID-19 pandemic.

COVID-19 lockdown in people with severe mental disorders in Spain: Do they have a specific psychological reaction compared with other mental disorders and healthy controls?

The COVID-19 pandemic and the lockdown restrictions could have adverse consequences for patients with severe mental disorders (SMD). Here, we aim to compare the early psychological impact (depression, anxiety, and stress responses, intrusive and avoidant thoughts, and coping strategies) on people with SMD (n = 125) compared with two control groups: common mental disorders (CMD, n = 250) and healthy controls (HC, n = 250). An anonymous online questionnaire using a snowball sampling method was conducted from March 19-26, 2020 and included sociodemographic and clinical data along with the DASS-21 and IES scales. We performed descriptive and bivariate analyses and multinomial and linear regression models. People with SMD had higher anxiety, stress, and depression responses than HC, but lower scores than CMD in all domains. Most people with SMD (87.2%) were able to enjoy free time, although control groups had higher percentages. After controlling for confounding factors, anxiety was the only significant psychological domain with lower scores in HC than people with SMD (OR = 0.721; 95% CI: 0.579-0.898). In the SMD group, higher anxiety was associated with being single (beta = 0.144), having COVID-19 symptoms (beta = 0.146), and a higher score on the stress subscale of DASS-21 (beta = 0.538); whereas being able to enjoy free time was a protective factor (beta = -0.244). Our results showed that patients with SMD reacted to the pandemic and the lockdown restrictions with higher anxiety levels than the general public, and suggesting this domain could be a criterion for early intervention strategies and closer follow-up.

Effectiveness of a brief lifestyle intervention targeting mental health staff: analysis of physical fitness and activity in the Keeping Our Staff in Mind study

BACKGROUND

People with mental illness die on average 15 years less than the general population, primarily to cardiometabolic disease. Lifestyle interventions are effective in reducing cardiometabolic risk but are not routinely provided to mental health consumers. Lifestyle interventions targeting mental health staff may be beneficial in changing culture surrounding physical health and subsequently improving consumer outcomes. This study examines exercise and fitness outcomes of a targeted lifestyle intervention directed at Australian mental health staff.

METHODS

A pragmatic single-arm intervention study was conducted within an Australian public mental health service. Mental health staff were provided a five-session individualised lifestyle intervention (incorporating exercise and nutritional counselling) over 5 weeks. Two waves of the programme were delivered between 2015 and 2016. This paper examines the exercise and fitness outcomes of the second wave of the study. Participants were assessed at baseline and at a 16-week follow-up. The primary exercise outcome was a measurement of cardiorespiratory fitness. Secondary outcomes included self-reported physical activity and a measurement of handgrip strength.

RESULTS

A total of 106 staff participated in this component of the study. Cardiorespiratory fitness increased significantly from baseline to follow-up (p<0.001). Significant improvements to physical activity occurred with decreases in sedentary time (p<0.0005) and increases in moderate-to-vigorous physical activity (p<0.005).

CONCLUSION

Lifestyle interventions incorporating exercise counselling may improve the physical health of mental health staff. Such strategies may be effective in improving culture surrounding physical health and/or increasing the effectiveness of lifestyle interventions targeting mental health consumers.

Interventions to reduce burnout of physicians and nurses: An overview of systematic reviews and meta-analyses

OBJECTIVE

Numerous systematic reviews and meta-analyses on the interventions to reduce burnout of physicians and nurses have been published nowadays. This study aimed to summarize the evidence and clarify a bundled strategy to reduce burnout of physicians and nurses.

METHODS

Researches have been conducted within Cochrane Library, PubMed, Ovid, Scopus, EBSCO, and CINAHL published from inception to 2019. In addition, a manual search for relevant articles was also conducted using Google Scholar and ancestral searches through the reference lists from articles included in the final review. Two reviewers independently selected and assessed, and any disagreements were resolved through a larger team discussion. A data extraction spreadsheet was developed and initially piloted in 3 randomly selected studies. Data from each study were extracted independently using a pre-standardized data abstraction form. The the Risk of Bias in Systematic reviews and assessment of multiple systematic reviews (AMSTAR) 2 tool were used to evaluate risk of bias and quality of included articles.

RESULTS

A total of 22 studies published from 2014 to 2019 were eligible for analysis. Previous studies have examined burnout among physicians (n = 9), nurses (n = 6) and healthcare providers (n = 7). The MBI was used by majority of studies to assess burnout. The included studies evaluated a wide range of interventions, individual-focused (emotion regulation, self-care workshop, yoga, massage, mindfulness, meditation, stress management skills and communication skills training), structural or organizational (workload or schedule-rotation, stress management training program, group face-to-face delivery, teamwork/transitions, Balint training, debriefing sessions and a focus group) and combine interventions (snoezelen, stress management and resiliency training, stress management workshop and improving interaction with colleagues through personal training). Based on the Risk of Bias in Systematic reviews and AMSTAR 2 criteria, the risk of bias and methodological quality included studies was from moderate to high.

CONCLUSIONS

Burnout is a complicated problem and should be dealt with by using bundled strategy. The existing overview clarified evidence to reduce burnout of physicians and nurses, which provided a basis for health policy makers or clinical managers to design simple and feasible strategies to reduce the burnout of physicians and nurses, and to ensure clinical safety.

Exercise prescription for people with mental illness: an evaluation of mental health professionals' knowledge, beliefs, barriers, and behaviors

OBJECTIVE

The aim of this study was to understand the knowledge, beliefs, barriers, and behaviors of mental health professionals about physical activity and exercise for people with mental illness.

METHODS

The Portuguese version of The Exercise in Mental Illness Questionnaire was used to assess knowledge, beliefs, barriers, and behaviors about exercise prescription for people with mental illness in a sample of 73 mental health professionals (68.5% women, mean age = 37.0 years) from 10 Psychosocial Care Units (Centros de Atenção Psicossocial) in Porto Alegre and Canoas, state of Rio Grande do Sul, Brazil.

RESULTS

Most of respondents had received no formal training in exercise prescription. Exercise ranked fifth as the most important treatment, and most of the sample never or occasionally prescribed exercise. The most frequently reported barriers were lack of training in physical activity and exercise prescription and social stigma related to mental illness. Professionals who themselves met recommended physical activity levels found fewer barriers to prescribing physical activity and did so with greater frequency.

CONCLUSION

Exercise is underrated and underused as a treatment. It is necessary to include physical activity and exercise training in mental health curricula. Physically active professionals are more likely to prescribe exercise and are less likely to encounter barriers to doing so. Interventions to increase physical activity levels among mental health professionals are necessary to decrease barriers to and increase the prescription of physical activity and exercise for mental health patients.

Test-retest reliability of the Italian version of the M-BACK questionnaire to assess the barriers, attitudes, confidence, and knowledge of mental health staff regarding metabolic health of psychiatric patients

OBJECTIVES

The Metabolic-Barriers, Attitudes, Confidence, and Knowledge Questionnaire (M-BACK) was developed to determine the barriers, attitudes, confidence, and knowledge of mental health practitioners regarding the metabolic health of patients in order to determine the efficacy of targeted training interventions. This study aimed to validate the Italian version of M-BACK questionnaire (M-BACK-IT) and to determine the test-retest reliability.

METHODS

The M-BACK questionnaire was translated into Italian and back-translated using an established protocol. In order to determine the test-retest reliability of the instrument, mental health professionals were recruited from a private psychiatric hospital located in northeast Italy and completed the questionnaire on two separate occasions, seven days apart. Intraclass correlation coefficients (ICC) were calculated for the total score, as well as each of the four M-BACK domains.

RESULTS

Thirty mental health professionals (4 psychiatrists, 9 psychologists, 12 nurses, and 5 exercise specialists) completed the M-BACK-IT. ICCs ranged from 0.58 to 0.94.

CONCLUSIONS

The test-retest reliability of the M-BACK-IT demonstrated comparable results to the English version. The M-BACK-IT is a reliable measure to assess key elements of practitioners' perceptions of the barriers, their knowledge, attitudes, and confidence regarding metabolic monitoring and intervention in people with mental illness.

Changing health workforce attitudes to promote improved physical health in mental health service users: Keeping our Staff in Mind (KoSiM)

ISSUE ADDRESSED

People living with mental illness die on average 15 years earlier than the general population, primarily due to preventable and premature cardiovascular disease. Lifestyle interventions can be effective in reducing cardiovascular risk, yet mental health services do not routinely provide targeted lifestyle interventions. Exposing mental health staff to lifestyle interventions prior to targeting patients may be critical to changing culture and improving patient outcomes. This study aimed to improve the physical health of mental health staff through a targeted lifestyle intervention.

METHODS

A pragmatic single-arm intervention study was conducted in a public mental health service, including inpatient and community settings, in Sydney, Australia. Participants in this study were n = 212 clinical and non-clinical staff. A five-session individualised lifestyle intervention (delivered over 5 weeks) incorporating physical activity and nutritional counselling was delivered by multidisciplinary teams. Participants were assessed at baseline, following the intervention, and at follow-up (mean = 16.7 weeks). The primary outcome was the barriers, attitudes, knowledge and confidence regarding screening, promoting and intervening to improve physical health outcomes of patients (M-BACK questionnaire). Secondary outcomes included anthropometric measures, cardiorespiratory fitness, sedentary time and nutritional intake. Repeated measures ANCOVAs were performed.

RESULTS

A total of 212 staff (79% female) participated in this study. M-BACK total score significantly increased from baseline to follow-up (P < .001). Waist circumference, sedentary time and total energy intake all significantly decreased (all P's < .001) and cardiorespiratory fitness significantly increased (P < .001).

CONCLUSION

A brief lifestyle intervention for staff of a public mental health service may increase the capability of the participants to improve their own physical health. SO WHAT?: Improving staff health may be an important strategy in improving the uptake and/or the effectiveness of lifestyle interventions targeting mental health service users.

Implementation barriers and facilitators of an integrated multidisciplinary lifestyle enhancing treatment for inpatients with severe mental illness: the MULTI study IV

BACKGROUND

Despite an increase in studies showing the efficacy of lifestyle interventions in improving the poor health outcomes for people with severe mental illness (SMI), routine implementation remains ad hoc. Recently, a multidisciplinary lifestyle enhancing treatment for inpatients with SMI (MULTI) was implemented as part of routine care at a long-term inpatient facility in the Netherlands, resulting in significant health improvements after 18 months. The current study aimed to identify barriers and facilitators of its implementation.

METHODS

Determinants associated with the implementation of MULTI, related to the innovation, the users (patients, the healthcare professionals (HCPs)), and the organisational context, were assessed at the three wards that delivered MULTI. The evidence-based Measurement Instrument for Determinants of Innovations was used to assess determinants (29 items), each measured through a 5-point Likert scale and additional open-ended questions. We considered determinants to which ≥20% of the HCPs or patients responded negatively ("totally disagree/disagree", score < 3) as barriers and to which ≥80% of HCPs or patients responded positively ("agree/totally agree", score > 3) as facilitators. We included responses to open-ended questions if the topic was mentioned by ≥2 HCPs or patients. In total 50 HCPs (online questionnaire) and 46 patients (semi-structured interview) were invited to participate in the study.

RESULTS

Participating HCPs (n = 42) mentioned organisational factors as the strongest barriers (e.g. organisational changes and financial resources). Patients (n = 33) mentioned the complexity of participating in MULTI as the main barrier, which could partly be due to organisational factors (e.g. lack of time for nurses to improve tailoring). The implementation was facilitated by positive attitudes of HCPs and patients towards MULTI, including their own role in it. Open responses of HCPs and patients showed strong commitment, collaboration and ownership towards MULTI.

CONCLUSIONS

This is the first study analysing the implementation of a pragmatic lifestyle intervention targeting SMI inpatients in routine clinical care. Positive attitudes of both HCPs and patients towards such an approach facilitated the implementation of MULTI. We suggest that strategies addressing organisational implementation barriers are needed to further improve and maintain MULTI, to succeed in achieving positive health-related outcomes in inpatients with SMI.

Developing an Evidence-Based Specialist Nursing Role to Improve the Physical Health Care of People with Mental Illness

The substantial physical health disadvantage experienced by people diagnosed with mental illness is now identified in a growing body of research evidence. The recent promulgation of improved physical health care as a goal of contemporary Australian Mental Health Policy should provide impetus for initiatives and strategies to address this inequity. To date increased knowledge of the problem has not resulted in obvious and sustained changes. The aim of this article is to introduce the role of the Physical Health Nurse Consultant as a potential strategy. The potential contribution and value of this role is considered by reviewing the evidence from the perspective of multiple stakeholders and considering the suitability of nursing to meet the complex needs involved in improving physical health. The requirement for a multi-faceted and comprehensive evaluation is also articulated. A robust, prospective and long-term evaluation plan includes physical health measures, changes in health behaviours, cost-benefit analysis and consumer acceptability to ensure the intervention is effective in the long term. This thorough approach is essential to provide the level of evidence required to facilitate changes at the practice and policy levels. The specialist nursing role presented in this article, subject to the comprehensive evaluation proposed, could become an integral component of a comprehensive approach to addressing physical health inequities in people with mental illness.

Incorporating Exercise Professionals in Mental Health Settings: An Australian Perspective

Low rates of physical activity, in addition to other poor physical health behaviors, contribute to lower quality of life and increased rates of premature mortality for people living with mental illness. Physical activity reduces this mortality gap while simultaneously improving mood, cognitive function, and symptomology for a variety of psychiatric disorders. While physical activity programs are feasible and acceptable in this population, significant barriers exist that limit long-term adherence. Accredited exercise physiologists (AEPs) are best-placed in Australia to lead physical activity interventions for people living with mental illness. Additionally, AEPs provide an important role in improving culture change within mental health settings by influencing clinicians' attitudes to physical activity interventions. Leading international mental health organizations should collaborate and promote the role of physical activity to increase the provision of such services to people living with mental illness.

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)

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.