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.