Evaluating the feasibility of an exercise program for people with severe mental illness living within a rehabilitation unit.

Prospective single arm cohort study involving the delivery of an exercise intervention to people with severe mental illness by 4th year (senior) exercise physiology (EP) students of a University undergraduate degree program. EP students planned and delivered the exercise circuit, under supervision by their University Exercise physiology supervisor. A risk to exercise screen was undertaken by EP students (Adult pre-exercise screening system, APSS), before informed consent obtained from participants. A wrist worn accelerometer was worn by participants for 7 days prior to a range of baseline physical and mental health measures being obtained from participants. Collaboration between EP students and mental health staff of the residential rehabilitation unit occurred in order for the program to be delivered. EP students assessed metabolic outcomes, vascular, autonomic nervous system and functional exercise capacity, physical activity self report and a physical activity acceptability questionnaire. The consultant psychiatrist assessed mental health outcomes. The exercise intervention involved a group based circuit, that was supervised face to face by EP students, and delivered in the courtyard, on site, at a mental health rehabilitation facility Exercise frequency was three mornings per week, for 10 weeks. Participants who wished to complete a second 10 week block of exercise after the first 10 week block were encouraged to do so. Physical and mental health outcomes were assessed following any further 10 weeks blocks of exercise engaged in by participants. Exercise equipment utilised included a recumbent exercise bike, a step, boxing pads and gloves for boxing with the EP students, resistance bands, dumbbells, treadmill and skipping rope. . Each circuit was 45 minutes long, with a 5 minute warm up and 10 minute cool down. The active exercise lasted 30 minutes, and consisted of participants rotating through 10-15 stations that involved a mixture of aerobic and resistance exercises. The Borg Category Ratio 10 scale was used to assess rate of perceived exertion (RPE) and to guide intensity of exercise prescription, by the EP students. The circuit began at intervals of 30 seconds of exercise interspersed with 30 seconds of complete rest and progressed to 60 second interval as the participants’ functional exercise capacity increased. EP students aimed to maintain an RPE at 2-3 for the first 2 weeks, then increased to a minimum RPE of 4/10 by week 3 and further increased as per individual participant’s capacity. Stations were designed such that they can be modified (regressed/progressed) to suit individual participant capacity and preference. If certain elements of the circuit were preferred by participants, EP students documented this in logbooks and increased these elements for participants in the next circuit so as to individualise the circuit, even though it was still in a group format. This was to better engage the participants in the exercise intervention (and reduce non adherence). Adherence to the program was monitored by logbooks completed by participants and EP students together. Adherence was facilitated by encouragement from EP students and mental health staff of the facility at attend, and by addressing barriers to attendance for participants as they arose. EP students and mental health staff discussed adherence and identification of barriers (and solutions to these barriers), which occurred at team meetings and via email communication. Participation at each exercise session, preferred elements of the circuit and intensity level achieved was documented in logbooks collaboratively between EP students and participants. Motivational strategies such as motivational interviewing and goal setting was offered by EP students and the consultant psychiatrist of the unit, to participants, to encourage participation. EP students were provided with weekly mental health supervision with the consultant psychiatrist to up-skill in mental illness and better engage participants in exercise intervention.