Developing an intervention to increase physical activity in schizophrenia

Abstract

BACKGROUND: People with schizophrenia die approximately 15-20 years earlier than those in the general population, largely due to poor physical health and related cardiovascular disease (CVD). Many of the risk factors for CVD are positively modifiable with regular physical activity (PA), but few people with schizophrenia engage in the recommended levels of PA and we do not yet know the best way to encourage the uptake and maintenance of regular PA in this patient group.

METHOD: Drawing on the MRC guidelines for the development of interventions to improve health, a behavioural change intervention was developed to increase PA in people with schizophrenia. A narrative review was conducted to summarise potential barriers and facilitators to PA in people with schizophrenia in the relevant literature, which were categorised according to an ecological model encompassing the multiple levels of influence on PA. Then ten people with schizophrenia were interviewed in a qualitative study to further explore this topic, using the TDF as a framework for analysis. A12-week intervention to increase PA was then developed, based on previous work in stroke, current relevant research and informed by the findings of the narrative review and qualitative study. This intervention was then trialled to assess feasibility and acceptability. Results: The intervention proved to be feasible and acceptable to participants with schizophrenia who live in the community. Of the 20 people enrolled, 18 (90%) completed the full 12 weeks. Reasons for dropout were work commitments and illness. Of the 18 who completed the intervention, 16 (89%) increased their weekly step count, 10 (56%) experienced weight loss, 12 (67%) took up an additional health promotion opportunity, and 13 (72%) initiated another form of PA in addition to walking. Informal feedback from staff confirmed the need for such a service and indicated that, if it was to be implemented into mental health services, it would be a popular and useful resource.

CONCLUSIONS: In the future, the intervention will be further developed based on participant feedback gathered at the end of the study. Then an RCT will be conducted with data collected at long-term follow-up to formerly assess the intervention’s efficacy to improving PA behaviour and other physical and mental health outcomes in community-dwelling people with schizophrenia.