Inpatient perspectives on physical activity in a secure mental health setting

This study offers the first insight into the perspectives of secure inpatients regarding exercise. Individuals living with severe mental illness (SMI) engage in less exercise and more sedentary behaviour than their counterparts in the general population. Secure psychiatric hospitals are often considered obesogenic environments that inadvertently promote inactivity. Access to exercise is often restricted due to issues of risk and patient safety. Existing literature exploring exercise perspectives is dominated by SMI populations living in the community. This study involved semi-structured interviews with 15 medium secure inpatients (aged 19–40, mean age 27.8). Primary diagnoses included; schizophrenia and affective disorders, mood disorders and personality disorders. Data were analysed using reflexive thematic analysis. Findings denoted three overarching themes; (i) Barriers to exercise; mental or environmental? (ii) Is exercise always holistically beneficial? (iii) Staff; a barrier and facilitator to exercise. Acute mental health symptoms and unwanted medication side effects, such as lethargy and weight gain limited exercise motivation. The restrictions of a secure environment limited opportunities to regularly exercise. Exercise provided a relief from both psychiatric symptoms and associated low mood, however in some cases engaging in exercise exaggerated manic symptoms and led to acts of aggression. Inpatients considered staff crucial to facilitate exercise, however access, education and inconsistent attitudes limit provision. Strategies to change the sedentary ‘culture’ within secure wards should involve both staff and patients.     

Behavior modification in education: Contributions and limitations

Behavior modification has been applied widely in educational settings encompassing a wide range of student populations, ages, and areas of focus. Major contributions of behavior modification include development and evaluation of a large number of techniques with extensive classroom research. As a direct consequence of technique development, behavior modification has provided teachers with a selection of classroom practices and information regarding their use. Despite the widespread application of behavioral principles in education, several limitations can be identified including the responses that are altered, the emphasis on response consequences, the focus on child performance rather than behaviors of teachers and others, and the lack of maintenance of improvements evident in many programs. Although limitations can be identified within the field, remarkable advances have been made in identifying educational practices that can improve student and teacher behavior. A major limitation in applying behavior modification to education pertains to dissemination and extension of existing techniques to a large number of settings likely to profit their use. The present paper considers various contributions and limitations of contemporary behavior modification and suggests areas for expansion to augment the progress that has been made.