Psychosocial and lifestyle predictors of distress and well-being in people with mental illness during the COVID-19 pandemic.

OBJECTIVES: People with mental illness may be vulnerable to psychological distress and reduced well-being during the COVID-19 pandemic. The aim of this study was to assess psychosocial and lifestyle predictors of distress and well-being in people with mental illness during the pandemic. METHOD: People with mental illness who participated in an exercise programme prior to the pandemic were invited to complete surveys about mental health and lifestyle corresponding to before and during the pandemic. RESULTS: Social support reduced, alcohol intake increased, and sleep quality and diet worsened during the pandemic, contributing to distress. Psychological distress was associated with the two or more mental illnesses, and negatively associated with having a physical disease. Better diet appeared to protect against increases in distress; loneliness hindered improvements in well-being. CONCLUSIONS: Healthy lifestyle programmes designed to improve social connection may improve health for people with mental illnesses during and after the COVID-19 pandemic.

Preferences of people with mental illness for engaging in exercise programs under COVID-19 restrictions.

OBJECTIVES: People with mental illness may be vulnerable to decline in mental health and reduced physical activity because of the COVID-19 pandemic and associated restrictions. The aim of this study was to inform the design of physical activity interventions for implementation under these conditions to improve/maintain well-being and physical activity in this population. METHODS: People with mental illness who had participated in a physical activity program prior to the pandemic were invited to complete a survey about the impact of COVID-19 on mental health and physical activity and their preferences for engaging in a physical activity program under pandemic-related restrictions. RESULTS: More than half the 59 respondents reported worse mental health and lower physical activity during the pandemic. The preferred format for a physical activity program was one-on-one exercise instruction in-person in a park. Program components endorsed as helpful included incentivization, provision of exercise equipment and fitness devices, and daily exercise programs. About a third of the participants reported limitations in using technology for a physical activity program. CONCLUSIONS: In-person exercise support is preferred by people with mental illnesses during pandemic-related restrictions. Enablement strategies such as providing equipment and self-monitoring devices should be utilized; assistance may be needed to incorporate the use of technology in exercise programs.

Protocol for a randomised controlled trial of interventions to promote adoption and maintenance of physical activity in adults with mental illness.

INTRODUCTION: Physical activity (PA) has diverse benefits for physical and mental health and can reduce symptoms of mental illness. Adults with mental illness face practical, psychosocial and socioeconomic barriers to adopting and maintaining PA, and it is unclear how to effectively promote PA in this group. Supervised exercise interventions provide high support but may not promote autonomous motivation, which is important for PA maintenance. The aim of this study is to compare the effectiveness of two interventions to promote PA in adults with mental illness. METHODS AND ANALYSIS: This is a randomised controlled trial of two interventions to promote PA: (1) supervised exercise and gym membership and (2) motivational discussions and self-monitoring of PA using fitness trackers. The intervention duration is 16 weeks, including 8 weeks of weekly supervised group sessions, and 8 weeks of access to the gym or fitness tracker unsupervised. Participants are community-dwelling adults recruited from outpatient clinics of public mental health services. The primary outcome is PA adoption assessed using GENEActiv accelerometers worn continuously over 8 weeks. Secondary outcomes measured at baseline, postintervention (8 weeks) and follow-up (16 weeks), include exercise motivation, psychological distress and self-reported PA assessed using self-administered questionnaires and indicators of physical health measured by a researcher blinded to allocation (blood pressure, weight, waist circumference, 6 min walk test). Participant experiences will be assessed using qualitative focus groups with analysis informed by a theoretical model of behaviour (COM-B). ETHICS AND DISSEMINATION: Ethics approval has been obtained from the Royal Brisbane and Women's Hospital (HREC/17/QRBW/302). We plan to submit a manuscript on protocol development from pilot work, and a manuscript of the results to a peer-reviewed journal. Results will be presented at conferences, community and consumer forums and hospital grand rounds. TRIAL REGISTRATION NUMBER: ACTRN12617001017314; Pre-results.

Quantification of free-living activity patterns using accelerometry in adults with mental illness.

Physical activity is disrupted in many psychiatric disorders. Advances in everyday technologies - such as accelerometers in smart phones - opens exciting possibilities for non-intrusive acquisition of activity data. Successful exploitation of this opportunity requires the validation of analytical methods that can capture the full movement spectrum. The study aim was to demonstrate an analytical approach to characterise accelerometer-derived activity patterns. Here, we use statistical methods to characterize accelerometer-derived activity patterns from a heterogeneous sample of 99 community-based adults with mental illnesses. Diagnoses were screened using the Mini International Neuropsychiatric Interview, and participants wore accelerometers for one week. We studied the relative ability of simple (exponential), complex (heavy-tailed), and composite models to explain patterns of activity and inactivity. Activity during wakefulness was a composite of brief random (exponential) movements and complex (heavy-tailed) processes, whereas movement during sleep lacked the heavy-tailed component. In contrast, inactivity followed a heavy-tailed process, lacking the random component. Activity patterns differed in nature between those with a diagnosis of bipolar disorder and a primary psychotic disorder. These results show the potential of complex models to quantify the rich nature of human movement captured by accelerometry during wake and sleep, and the interaction with diagnosis and health.

Physical activity preferences, motivators, barriers and attitudes of adults with mental illness.

BACKGROUND: Adults with mental illness may have specific attitudes toward physical activity (PA). AIMS: To assess the PA attitudes of non-institutionalised adults with mental illness, and associations with psychological distress. METHOD: Participants completed questionnaires on activity preferences (type, context and sources of support), motivators, barriers and attitudes toward personal training (PT). Relationships between responses and distress were assessed using logistic regressions. RESULTS: One-hundred forty-two participants completed the questionnaires. PA context preferences included activities done close to home, outdoors, with professional instruction, with people of the same ability, as part of a healthy lifestyle program and with a social component. The most commonly endorsed source of support was an exercise instructor. Most respondents had never received PT; however, PT had high acceptability. Common barriers included poor physical and mental health, and lack of money. Distress was positively associated with barriers of poor mental health, tiredness, disorganisation, exhaustion and being shy/embarrassed (p ≤ 0.001). CONCLUSIONS: Local outdoor walking groups that include social and healthy lifestyle components, and that are led by an exercise instructor who can provide support for overcoming barriers, may best meet PA interests of this group. PT could be an acceptable method for offering individualised support.

Physical activity and sedentary behaviour among inpatient adults with mental illness.

OBJECTIVES: The aim of this study was to assess levels and patterns of physical activity and sedentary behaviour among inpatient adults with mental illness. DESIGN: Cross-sectional. METHODS: 101 participants completed questionnaires on time spent in walking, moderate- and vigorous-intensity activity in the past week and domain specific sitting time on a usual weekday and weekend day. 36 participants also provided valid accelerometry data. Regression analyses were used to explore associations between MVPA and sedentary behaviour and explanatory variables of gender, age, education, body mass index and psychological distress. RESULTS: Self-report data indicated median of 32min/day (IQR: 14.46-85.71) in weighted MVPA and a median of 761min/day (12.7h) (IQR: 552.43-917.14) in sedentary behaviour. Accelerometry data indicated an average of 115min/day in light activity, 37min/day in MVPA and 664min/day (11.1h) in sedentary behaviour. Bivariate analyses indicated no significant associations between explanatory variables and MVPA and sedentary behaviour. CONCLUSIONS: Inpatient adults with mental illness can be physically active, with walking comprising the major component of MVPA time. Inpatient adults with mental illness spend a significant amount of time sitting; intervention strategies could focus on reducing the time spent sitting in general relaxation and doing nothing.

The Feasibility of Using Questionnaires and Accelerometers to Measure Physical Activity and Sedentary Behavior Among Inpatient Adults With Mental Illness.

BACKGROUND: The aim of this study was to assess the feasibility of using questionnaires and accelerometers to measure physical activity and sedentary behavior among inpatient adults with mental illness. METHODS: Participants completed a physical activity and sitting time questionnaire and wore an accelerometer for 7 consecutive days. Feasibility was assessed in terms of participant engagement, self-reported ease/ difficulty of completing study components, extreme self-report data values and adherence to accelerometer wear time criteria. Ease/difficulty ratings were examined by level of distress. RESULTS: 177 inpatients were invited to the study, 101 completed the questionnaires and 36 provided valid accelerometry data. Participants found it more difficult to complete sitting time and physical activity questionnaires than to wear the accelerometer during waking hours (z = 3.787, P < .001; z = 2.824, P = .005 respectively). No significant differences were found in ease/ difficulty ratings by level of distress for any of the study components. Extreme values for self-reported sitting time were identified in 27% of participants. CONCLUSION: Inpatient adults with mental illness can engage with self-report and objective methods of measuring physical activity and sedentary behavior. They were initially less willing to participate in objective measurement, which may however be more feasible than self-report measures.

Physical activity and sedentary behaviour of adults with mental illness.

OBJECTIVES: To assess physical activity (PA) and sedentary behaviour (SB) in non-institutionalised adults with mental illness, using a combination of self-report and objective measures. DESIGN: Cross-sectional METHODS: Participants completed PA questionnaires (time spent walking for transport, walking for recreation, gardening, vigorous-, and moderate-intensity activities), and SB questionnaires (time spent sitting for TV, travel, work, computer use, and reclining). Participants also wore an accelerometer for 7 days. Accelerometry estimates of time spent in SB, light activity, and moderate-to-vigorous activity (MVPA), bout durations, and, breaks in sedentary time, were calculated. RESULTS: 142 participants completed the questionnaires. The median time spent in self-reported MVPA and SB was 4.5h/week and 10.7h/day, respectively. Walking for transport, and sitting to watch TV, contributed most to self-report estimates; time spent reclining was an important contributor to SB. Ninety-nine participants completed the accelerometry. The median time spent in accelerometer-derived MVPA and SB was 26min/day and 9.2h/day respectively; 7% of MVPA time was in bouts of 10min or more, and 34% of SB time was in bouts of over 20min. CONCLUSIONS: A high proportion of participants reported activity levels consistent with physical activity guidelines; however, a small proportion of activity was accumulated in bouts of 10min or more. Participants also had high levels of SB, about one-third of which was accumulated in bouts over 20min. PA and SB interventions for this group could target increasing recreational walking, and reducing television time.

The feasibility and acceptability of questionnaires and accelerometry for measuring physical activity and sedentary behaviour in adults with mental illness.

BACKGROUND: Adults with mental illness may have difficulties with data collection methods such as questionnaires and accelerometry. AIMS: To assess the utility of questionnaires and accelerometry for assessing physical activity (PA) and sedentary behaviour (SB) in non-institutionalised adults with mental illness. METHODS: Participants were recruited from outpatient clinics and community organisations. Participants completed PA and SB questionnaires, wore accelerometers for 7 d, and rated the ease/difficulty of completing study components. Recruitment numbers, adherence, and ease/difficulty ratings were examined. Ease/difficulty ratings were compared between study components, and between participants by distress level. RESULTS: One hundred forty-two participants completed the questionnaires; they found it easier to report PA than reclining time (p = 0.017), and reclining time than sitting time (p < 0.001). Participants with high distress found it more difficult to report sitting time and PA than participants with low distress (p < 0.017). Ninety-nine participants (70%) completed the accelerometry; the majority (88%) met the minimum wear-time criteria. They found it easier to wear the monitor during the day than while sleeping (p < 0.001), and easier to complete accelerometry than questionnaires (p < 0.001). CONCLUSIONS: Accelerometry was more feasible for assessing SB than questionnaires. Questionnaires were feasible for assessing PA, but less acceptable for people experiencing high distress.

Physical activity attitudes and preferences among inpatient adults with mental illness.

The life expectancy of adults with mental illness is worse than that of the general population and is largely due to poor physical health status. Physical activity has been consistently recommended for the prevention and management of many chronic physical health conditions and can also have benefits for mental health. This cross sectional study assessed the attitudes towards and preferences for physical activity among inpatient adults with mental illness, and differences by distress and gender. Self-report questionnaires were completed by 101 patients. Findings indicated that inpatient adults with mental illness are interested in doing physical activity while in hospital, primarily to maintain good physical health and improve emotional wellbeing. Fewer than half of participants agreed that physical activity has benefits for serious mental illness. Participants indicated a preference for walking and physical activity that can be done alone, at a fixed time and with a set routine and format. Major barriers were fatigue and lack of motivation. Females were more likely than males to prefer activities done with others of the same gender (P = 0.001) and at the same level of ability (P < 0.001). There were no significant differences by level of distress. These findings can inform physical activity intervention programming in hospital settings, which may contribute to decreasing the chronic disease burden and improve the psychological wellbeing in adults with mental illness.