A study of a structured exercise program with members of an ICCD Certified Clubhouse: program design, benefits, and implications for feasibility

Informing the development of the coaching online and community health (COACH) program: a qualitative study of clubhouse members living with serious mental illness

Health and wellness interventions addressing risk factors for early mortality among individuals with serious mental illness have demonstrated success and can be further augmented with digital technology. These programs may be suitable for delivery in psychosocial rehabilitation clubhouses, especially given many services have transitioned to digital platforms during the pandemic. This qualitative study aimed to: (a) explore clubhouse members' experiences engaging with the virtual clubhouse platform, and their preferences for accessing digital wellness and health promotion content; and, (b) gauge members' interest in an online peer-driven lifestyle intervention and their suggestions for program design. This study was guided by a community-based participatory action research framework. Ten focus groups were conducted with clubhouse members. Focus groups were coded and analyzed thematically by trained clubhouse members and the research team. Thirty-three members participated in the focus groups. Participants expressed the importance of having technical support from staff; that one-on-one support and consistent communication are important to keep them engaged in health and wellness programming; and described mixed views about use of the virtual platform, but generally were open to engaging in lifestyle intervention programming virtually. Participants who joined the clubhouse during the pandemic expressed feeling overwhelmed by in-person gatherings, and were especially interested in opportunities for remote participation. This study can inform health and wellness programming for delivery on the virtual clubhouse platform for members. The taxonomy of codes, created to generate a framework with recommendations, will inform the design of a virtual health and wellness intervention.

Losing to Gain: The Effects of a Healthy Lifestyle Intervention on the Physical and Psychosocial Well-being of Clients in a Community-based Mental Health Setting

Individuals with severe and persistent mental illness (SPMI) encounter both poorer physical health and psychosocial well-being in comparison to the general population. Obesity, hypertension, heart disease, and diabetes can result from the symptoms of mental illness, the side effects from psychotropic medications, as well as disparities associated with being mentally ill. Mental health nurses are in a prime position to implement healthy lifestyle interventions (HLIs). This study tested a HLI (physical exercise and nutrition) and examined the effects on physical and psychosocial outcomes in clients obtaining mental health services at a community-based facility. Key findings included a decrease in anxiety and depressive symptoms at 3 months and consistent improvement in self-efficacy for exercise in the intervention group. Bridges and barriers to achieving optimal results in physical and psychosocial well-being were identified. Findings from this study offer insight into designing and executing more effective HLIs with individuals who have SPMI.

Feasibility and effects of an exercise-based intervention in prison inmates with psychiatric disorders: the PsychiActive project randomized controlled trial

OBJECTIVE

To evaluate the feasibility and effects of a 12-week intervention combining aerobic and strength exercises in prison inmates with psychiatric disorders.

DESIGN

Two parallel-group, randomized controlled trials.

SETTING

A psychiatric prison hospital.

SUBJECTS

Forty-one men prison inmates (mean age ± SD = 38.2 ± 9.2 years, mean prison duration ± SD = 2.6 ± 2.5 years) with psychiatric disorders (primarily personality disorder, n = 27; mean illness duration ± SD = 12.0 ± 10.5 years).

INTERVENTIONS

Participants were randomly allocated to intervention group consisted of exercise plus usual care (n = 21) or control group which received usual care (n = 20) for 12 weeks. The exercise programme included three weekly sessions of group-based moderate-to-high intensity combined exercises designed and supervised by exercise professionals.

MAIN MEASURES

Fitness and anthropometric measures were assessed using field-based tests (6-minute walk, Incremental Shuttle Walk, Arm-Curl, and Chair-Stand), handgrip dynamometry, bioelectrical impedance, and waist and hip circumferences.

RESULTS

There were no adverse events, and 10 intervention participants withdrew. The remaining 11 participants attended a mean of 28 sessions, of which nine met the compliance criteria. Between-group change differences substantially favoured the compliance intervention group for the 6-minute walk (+21.2%), Incremental Shuttle Walk (+33.9%), Arm-Curl (+13.8%), waist (-3.5%), waist/height^0.5 (-1.7%) (-2.7%), waist/hip (-3.4%), and Body Shape Index (-3.3%) (-3.5%). Additional analysis showed beneficial effects of exercise participation on handgrip strength.

CONCLUSION

The intervention was safe, had a high dropout rate, and seemed to be effective for improving fitness and anthropometric measures in men prison inmates with psychiatric disorders who attended and participated in the exercise sessions.

A Systematic Review of Evidence for the Clubhouse Model of Psychosocial Rehabilitation

The Clubhouse Model has been in existence for over sixty-five years; however, a review that synthesizes the literature on the model is needed. The current study makes use of the existing research to conduct a systematic review of articles providing a comprehensive understanding of what is known about the Clubhouse Model, to identify the best evidence available, as well as areas that would benefit from further study. Findings are summarized and evidence is classified by outcome domains. Fifty-two articles met the selection criteria of Randomized Clinical Trials (RCT's), quasi-experimental studies, or observational studies for domains of employment (N = 29); quality of life/satisfaction (N = 10); reductions in psychiatric hospitalization(s) (N = 10); social relationships (N = 10); education (N = 3); and health promotion activities (N = 2). RCT results support the efficacy of the Clubhouse Model in promoting employment, reducing hospitalization(s), and improving quality of life. Quasi-experimental and observational studies offer support in education and social domains. The findings from this review indicate that Clubhouses are a promising practice but additional studies using rigorous methods that report the strength of the outcomes are needed to evaluate Clubhouse programs with fidelity to the Clubhouse Model.

Using Smartphone Apps to Promote Psychiatric and Physical Well-Being

This pilot study tested the acceptability and usability of a prototype app designed to promote the physical well-being of adults with psychiatric disorders. The application under evaluation, WellWave, promoted walking as a physical exercise, and offered a variety of supportive non-physical activities, including confidential text-messaging with peer staff, and a digital library of readings and videos on recovery from psychiatric illness. Study participants engaged strongly in the app throughout the 4-week study, showing a 94 % mean daily usage rate, and a 73 % mean response rate across all electronic messages and prompts, which approximates the gold standard of 75 % for momentary ecological assessment studies. Seven of the ten study participants averaged two or more walks per week, beginning with 5-min walks and ending with walks lasting 20 min or longer. This responsiveness to the walking prompts, and the overall high rate of engagement in other app features, suggest that adults with psychiatric conditions would welcome and benefit from similar smartphone interventions that promote healthy behaviours in life domains other than exercise. Pilot study results also suggest that smartphone applications can be useful as research tools in the development and testing of theories and practical strategies for encouraging healthy lifestyles. Participants were prompted periodically to rate their own health quality, perceived control over their health, and stage-of-change in adopting a walking routine, and these electronic self-ratings showed acceptable concurrent and discriminant validity, with all participants reporting moderate to high motivation to exercise by the end of the study.

Lifestyle and Behavioral Interventions to Reduce the Risk of Metabolic Syndrome in Community-Dwelling Adults With Serious Mental Illness: Implications for Nursing Practice

Adults with mental illness are at increased risk of being diagnosed with metabolic syndrome and consequently cardiovascular disease, diabetes, and stroke. The current article explores community-based interventions to decrease the risk of metabolic syndrome by changing health behaviors among adults with serious mental illness (SMI). Ovid Medline, PsycINFO, and CINAHL were searched for nonpharmacological studies of behavioral or lifestyle interventions addressing risk of metabolic syndrome among adults with SMI. Thirteen studies, seven with statistically significant results, were included in the review. Despite the well-known risks of metabolic syndrome, the majority of available studies had small samples with insufficient power. There was little consistency in methods or outcome measures. Studies that were client-directed and involved peer and staff support appeared most useful in changing health behaviors and improving quality of life. Further research is needed to guide nursing practice in implementing effective methods to reduce the risk of metabolic syndrome in community-dwelling adults with SMI.

Enhanced physical health screening for people with severe mental illness in Hong Kong: results from a one-year prospective case series study

BACKGROUND

People with severe mental illness have significantly poorer physical health compared to the general population; previous health screening studies conducted outside Asian countries have demonstrated the potential in addressing this issue. This case series aimed to explore the effects and utility of integrating an enhanced physical health screening programme for community dwelling patients with severe mental illness into routine clinical practice in Hong Kong.

METHOD

This study utilises a consecutive prospective case series design. The serious mental illness Health Improvement Profile (HIP) was used as a screening tool at baseline and repeated at 12 months follow-up.

RESULTS

A total of 148 community-based patients with severe mental illness completed the study. At one year follow-up analysis showed a significant improvement in self-reported levels of exercise and a reduction in the numbers of patients prescribed medications for diabetes However, mean waist circumference increased at follow-up. In addition to the statistically significant results some general trends were observed, including: a lack of deterioration in most areas of cardiovascular risk; a reduction in medicines prescribed for physical health problems; and general improvements in health behaviours over the 12 month period.

CONCLUSIONS

The findings demonstrate that using the HIP is feasible and acceptable in Hong Kong. The results of the enhanced physical health-screening programme are promising, but require further testing using a randomised controlled trial design in order to more confidently attribute the improvements in well-being and health behaviours to the HIP.

TRIAL REGISTRATION

CLINICAL TRIAL REGISTRATION NUMBER

ISRCTN12582470.

The effects of cognitive remediation on functional outcomes among people with schizophrenia: a randomised controlled study

OBJECTIVE

Cognitive remediation is an intervention to overcome cognitive deficits through drills and use of strategies. Previous studies have reported positive effects for cognitive remediation on neurocognition, but researchers' allegiance effects are not always adequately controlled. Furthermore, its efficacy amongst the Asian population has not been established. Hence, this study aimed to determine if cognitive remediation would have positive effects on neurocognition and functioning within an English-speaking Asian population, when compared against the effects of a credible and balanced control provided by therapists blinded to the study hypothesis.

METHOD

A total of 70 participants with schizophrenia who attended vocational training or day rehabilitation programmes were randomised to receive a 60-hour programme of either cognitive remediation or physical exercise. Neurocognition and functional outcomes were measured at baseline, upon completion of treatment, 6 months after treatment and 1 year after treatment.

RESULTS

Participants who received cognitive remediation had significantly greater improvement in all neurocognitive domains. Furthermore, the cognitive remediation group achieved greater attainment of vocational or independent living skills and better functional outcomes at post-intervention and at the end of the 1-year follow-up.

CONCLUSIONS

When compared against a credible intervention such as physical exercise, cognitive remediation was able to show significant positive effects on both neurocognition and functional outcomes among the Asian population of schizophrenia patients.

Age and physical health as predictors of family contact among adults with severe psychiatric illness

We assessed the association of frequency of family contact with age and physical health for a sample of adults with severe psychiatric illness (N = 171). This cross-sectional, observational study measured frequency of face-to-face and telephone contact with family members; satisfaction with family relations; and severity of participants' chronic or permanent physical health conditions. In this sample of adults with severe psychiatric illness, having a physical health condition and advancing age correlated negatively with frequency of face-to-face contact with family members. However, a hierarchical regression analysis controlling for residence in a family member's home, and participants' ratings of satisfaction with family relations, showed that the combination of being older and having more severe health conditions was associated with a more frequent rate of family contact than would be expected based on age or physical health considered alone. Because almost all older participants in this heterogeneous sample had serious physical health conditions, as well as frequent telephone and face-to-face contact with their family members, we recommend the recruitment of family members as collaborators in illness management interventions for aging and mid-life adults with psychiatric illness.

An adjunct exercise program for serious mental illness: who chooses to participate and is it feasible?

Despite evidence that exercise is beneficial for serious mental illness, it continues to be an under utilized adjunct treatment strategy. Thus, the aims of this study were to examine if self-selected or volunteer exercise programs are feasible in a structured outpatient program and who might choose to participate in such a program. Individuals with serious mental illness admitted to a partial hospital program were offered an adjunct exercise group or a control, psychoeducation group. The exercise group (N = 38) met three times a week for 50 min. Individuals who chose not to exercise (N = 28), attended a psychoeducational control group. Those who self-selected the exercise group tended to have a higher level of education, employment rate and to be Caucasian. The control group had more medical problems, a higher body mass index and alcohol intake. The groups did not differ on age, sex, or use of cigarettes and caffeine. The exercise group was regularly attended. Both groups improved equally on all outcomes symptom and psychological well-being outcomes. These data highlight that certain individuals with serious mental illness may be more likely to exercise based on demographic opposed to clinical features, or illness characteristics. Thus, adjunct exercise programs for individuals with serious mental illness seem to be feasible, but certain groups of individuals (i.e., ethnic minorities, unemployed) should be targeted for recruitment as they are less likely to volunteer for such adjunct exercise programs.

Health behaviour interventions to improve physical health in individuals diagnosed with a mental illness: a systematic review

Individuals diagnosed with mental illness experience high rates of morbidity and mortality as a result of poor physical health and unhealthy lifestyle behaviours. The aim of this paper is to systematically review the literature on health behaviour interventions to improve the physical health of individuals diagnosed with a mental illness. A systematic search strategy was undertaken using four of the major electronic databases. Identified articles were screened for inclusion, included articles were coded, and data were extracted and critically reviewed. A total of 42 articles were identified for inclusion. The most commonly targeted physical health behaviour was weight management. The majority of studies reported improvements in health behaviours following interventions. The findings provide evidence for the positive effect of health behaviour interventions in improving the physical health of individuals diagnosed with a serious mental illness. A focus on health behaviour interventions within the mental health nursing profession might lead to improvements in health behaviours and general health in consumers of mental health services.

Physical Activity in Individuals With Severe Mental Illness

The Physical Activity Scale for Individuals With Physical Disabilities was examined as a physical activity measure for people with severe mental illness. Case manager ratings were more closely related to body mass index than clients’ ratings, challenging the accuracy of self-report physical activity measures for individuals with severe mental illness.

The Impact of Exercise on the Mental Health and Quality of Life of People with Severe Mental Illness: A Critical Review

Introduction:

Physical exercise has been proven to benefit the general population in terms of mental health and wellbeing. However, there is little research investigating the impact of exercise on mental health and quality of life for people who experience a severe and enduring mental illness.

Method:

This review aims to describe the effect of physical exercise intervention on the mental health and quality of life of people with severe mental illness. Quantitative and qualitative articles published between 1998–2009 were sourced using electronic databases. Articles were included if the study intervention involved exercise and the outcome measure included mental health or quality of life. Sixteen articles were analysed for common themes and appraised critically.

Findings:

The findings show that exercise can contribute to improvements in symptoms, including mood, alertness, concentration, sleep patterns and psychotic symptoms. Exercise can also contribute to improved quality of life through social interaction, meaningful use of time, purposeful activity and empowerment.

Implications:

Future research is warranted to describe the way exercise can meet the unique needs of this population. Studies with a focus on psychological outcome measures would provide greater evidence for its use in therapy.

A pilot study of health and wellness program development in an International Center for Clubhouse Development (ICCD) Clubhouse: procedures, implementation, and implications

OBJECTIVE

This article describes the development, implementation and results of a health and wellness initiative at an ICCD Clubhouse in North Carolina.

METHODS

This pilot study used a collaborative and consultative focus group process to identify sustainable health and wellness programming components, and then used networking to develop community resources in order to implement and sustain these components at the Clubhouse. The series of focus group questions was based on Glasser's (1998) choice theory; focus groups included members and staff, and had the support of Clubhouse administration. Once focus groups identified specific health and wellness categories of interest to members, program developers located and initiated links with potential presenters, volunteers, and/or local resources. Approximately one year after the final focus group, followup health and wellness surveys were administered to members and staff at a Clubhouse community meeting to assess perceptions of health and wellness at the Clubhouse after all planned components had been implemented.

RESULTS

Using a choice theory approach to health and wellness programming development in this ICCD Clubhouse venue involved members and staff collaboratively in identifying health and wellness components for the Clubhouse that have been implemented and sustained for over thirteen months.

CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

Choice theory-based focus group outcomes are currently being assessed for another three Clubhouse health and wellness initiatives. This approach to health and wellness program development may also be effective in other programs that provide services with and/or for this population.

Educating for wellness: a wellness education group intervention for adults with chronic severe mental illness living in the community

Chronic severe mental illness (CSMI) is a common disorder in the United States associated with numerous adverse health effects. Health promotion educational interventions can be beneficial. The purpose of this project was to implement and evaluate a community-based educational program for adults with CSMI. Analyses of quantitative and qualitative data showed overall satisfaction with the program and achievement of some specific consumer health modifications. Three primary areas of interest and benefit included socialization and support, education and information, and motivation to change. The Wellness Education Group Intervention (WEGI) can serve as a model for wellness education with adults in similar communities.

A pilot evaluation of the In SHAPE individualized health promotion intervention for adults with mental illness

This pilot study examined whether participation in the individualized, community-integrated In SHAPE health promotion program would result in improved physical activity and dietary behaviors, health indicators, and psychological functioning or symptoms in 76 adults with schizophrenia, bipolar disorder, major depression, or other mental disorders. Over a 9-month period, participation was associated with increased exercise, vigorous activity, and leisurely walking (P < .01), and a trend toward improved readiness to reduce caloric intake (P = .053). Participants demonstrated a reduction in waist circumference (P < .05), but no change in BMI. Satisfaction with fitness (P < .001) and mental health functioning (P < .05) improved, and severity of negative symptoms decreased (P < .01). This study demonstrated the feasibility and potential effectiveness of the In SHAPE program, which consisted of exercise and dietary modification. Based on these promising results, randomized controlled trials of the In SHAPE program are necessary to establish its effectiveness compared with usual care and alternative approaches to enhancing fitness.

A small group aerobic exercise programme that reduces body weight is feasible in adults with severe chronic schizophrenia: a pilot study

PURPOSE

To evaluate the feasibility and effects of an exercise programme on people with severe, chronic schizophrenia.

METHOD

A single-group, pre-post pilot study incorporating a baseline familiarisation phase was followed by a 24-week, small-group aerobic exercise programme for up to 30-min each session, twice a week and a 30-min weekly walking session. Adherence was assessed by attendance, and by analysing the exercise supervisor's comments in a programme diary and in each participant's exercise logbook. Body weight, cardio-respiratory fitness (VO₂ max), walking endurance (6-min walk test) and psychiatric symptoms (the Positive and Negative Syndrome Scale) were measured at each time point.

RESULTS

Eight participants (6 men, 2 women; mean age 45 years, 9 months (SD 10 years, 1 month); mean body mass index 27.0 (SD 4.2)) attended a mean of 73% of the scheduled exercise sessions, and 83% of the walking sessions, with no adverse events and no dropouts. All participants displayed positive and negative behaviours during training sessions. There were significant reductions in weight (2.4%) and body mass index (2.2%), but no changes in other measures.

CONCLUSIONS

It was feasible and safe to conduct a small-group aerobic exercise programme for adults with severe chronic schizophrenia that reduced body weight.

Integrating wellness, recovery, and self-management for mental health consumers

Three distinct, yet interrelated, terms-wellness, recovery, and self-management-have received increasing attention in the research, consumer, and provider communities. This article traces the origins of these terms, seeking to understand how they apply, individually and in conjunction with one another to mental health consumers. Each shares a common perspective that is health-centered rather than disease-centered and that emphasizes the role of consumers as opposed to professional providers as the central determinants of health and well-being. Developing approaches combining elements of each construct may hold promise for improving the overall health and well-being of persons with serious mental disorders.

Health promotion in clubhouse programs: needs, barriers, and current and planned activities

A survey was designed to obtain information concerning ways clubhouses affiliated with the International Center for Clubhouse Development (ICCD) promote practices that improve the physical health of members. This study examined perceptions of the need for health promotion interventions, current and planned health promotion practices, and barriers to change and program development. The mean number of health promotion activities ICCD clubhouses (N = 219) report providing was 5.24, SD = 2.42, range = 1 to 10. Despite barriers (e.g., cost), results indicate that every clubhouse responding to this survey offers at least one health promotion activity.