Developing an understanding of exercise in the inpatient mental health setting

Abstract

Research evidence increasingly highlights the effectiveness of exercise in the treatment of mental illness. The inpatient mental health setting represents an ideal opportunity to initiate exercise for mental health consumers, and nurses employed in inpatient setting are well placed to facilitate exercise programs. However, detailed examinations of the effectiveness of exercise in the inpatient mental health setting, the current exercise prescription practices of nurses, and their perceptions of the barriers to exercise interventions are lacking. The resultant inadequate evidence base to inform clinical practice hampers the implementation of exercise interventions in the inpatient mental health setting. Through a series of five related papers, four of which are already published, this thesis has four main aims: i) to critically examine evidence for the effectiveness of exercise interventions delivered in the inpatient mental health setting; ii) to develop and validate a novel questionnaire, the Exercise in Mental Illness Questionnaire – Health Professional Version (EMIQ – HP),which investigates the knowledge, attitudes, beliefs and behaviours of nurses regarding exercise in the treatment of mental illness; iii) to administer the questionnaire to examine the exercise prescription practices of nurses working in mental health, the relationship of these practices to personal exercise behaviour, and quantitatively examine nurses’ perceptions of barriers to exercise prescription for, and exercise participation by, people with mental illness; and iv) to bring together findings from the exercise and mental illness literature and findings from the implementation of the EMIQ – HP reported in Manuscript 3,to examine the affective and arousal responses to self-selected exercise in an inpatient mental health setting. In Manuscript 1,eight studies informed a systematic review of exercise interventions in the inpatient mental health setting. The findings showed positive outcomes from exercise for people hospitalised with depression, but less evidence for those hospitalised due to schizophrenia, bipolar disorders or anxiety disorders. Manuscript 2 describes the development and validation of a novel questionnaire the EMIQ – HP, which quantitatively examines the exercise knowledge, attitudes, beliefs and behaviours of nurses in mental health settings. Content validation was achieved by expert consensus. The excellent test-retest reliability suggests the EMIQ – HP is suitable for determining the effect of educational or other interventions that affect the development and delivery of exercise in healthcare settings, including inpatient mental health settings. Using the valid and reliable EMIQ – HP, Manuscript 3 examines the exercise prescription practices employed by nurses in a mental health setting and relationship between these practices and nurses’ personal exercise behaviours. The findings suggest that nurses’ exercise prescription parameters are consistent with those presented in the current literature. Importantly, there is support for affect-regulated exercise, where participants self-select an exercise intensity that makes them feel ‘Good’. However, unlike other healthcare disciplines, the findings suggest the personal exercise behaviours of nurses working in mental health settings are not associated with their exercise prescription practices. Manuscript 4 uses the EMIQ – HP to explore nurses’ perceptions of the barriers to exercise prescription for, and exercise participation by, people with mental illness, and how these perceptions are associated with the exercise prescription practices employed by nurses within inpatient mental health settings. The findings suggest nurses are optimistic about the potential for exercise in the treatment of mental illness. Moreover, the findings suggest nurses disagree with many of the barriers to exercise prescription cited in the previous literature investigating exercise prescription for people with mental illness, such as excessive workloads and the poor physical health of mental health consumers. However the results suggest nurses in mental health settings agree with many of the consumer-identified barriers to exercise participation including consumers not having knowledge of what to do, and lack of social support. Finally, Manuscript 5 builds on evidence in the exercise and mental illness literature and the findings described in Manuscript 3 supporting the use of self-selected exercise for people with mental illness. The paper examines the affective and arousal responses to acute exercise in the inpatient mental health setting. The data suggests that acute, self-selected aerobic and strengthening exercise significantly improves affect and arousal in people with bipolar and depressive disorders, and significantly improves affect in those with anxiety disorders. Taken together, the findings presented in the above five papers make a significant and original contribution to the field of exercise and mental illness. Translation of these findings to clinical practice may improve the implementation of exercise as part of usual care in the inpatient mental health setting.

Date of Award	2015
Original language	English
Supervisor	Brenda Happell (Supervisor) & Peter Reaburn (Supervisor)