Feasibility of an Intervention Targeting Health through Exergaming as an Alternative to Routine Treatment (FIT HEART)

The FIT HEART study will be conducted as a quasi-experimental, two-arm pilot study comparing a physical activity intervention (exergaming) with “routine treatment”. The study will employ a non-randomised, pre-test/post-test parallel group design. The study will be conducted in high secure wards at the Long Bay Hospital Mental Health Unit, an inpatient facility that provides specialty mental health services for patients in the NSW correctional system. Wards will be allocated to the intervention or control arm based on available facilities (i.e. space, audiovisual equipment) to implement the intervention. Potential participants will be screened for eligibility by members of the FIT HEART project team. The team is based at the Justice Health and Forensic Mental Health Network Research Unit and comprises experienced researchers with qualifications in nursing, psychology, forensic mental health, and exercise physiology. Screening will entail the following: i) assessment by the FIT HEART project team of capacity to provide informed consent; ii) assessment by the treating team of security risk and risk factors that could prevent participants being issued an accelerometer; iv) clinical assessment of physical contraindications to exercise by a medical officer. Eligible participants in both the intervention and comparison units will be administered a face-to-face baseline interview by a member of the project team assessing: demographics; incarceration history; smoking; physical and mental health history; current psychopathology (depression, anxiety, stress, psychosis); and, current activity levels. A baseline assessment of physical health and cardiometabolic risk (e.g. weight, body mass index, waist and hip circumference, blood pressure, HBA1c, fasting glucose, lipid profile, liver function) will also be conducted. VO2 max, a measure of cardiorespiratory fitness, will be determined via a 3-minute step-test protocol using a height-adjustable step, metronome and Polar heart rate monitor. Following the baseline interview, all participants in the intervention and comparison groups will be issued with an accelerometer (Fitbit® Charge 3) designed to record data on objective measures of daily physical activity (e.g. number of steps, calorie expenditure, heart rate). Participants will be asked to wear the Fitbit for the duration of the intervention period (12 weeks), and up until the post-intervention assessments (Weeks 13-14). All participants will be provided with a weekly summary progress which will include their average steps over the preceding week, average heart rate, activity intensity levels (i.e. low, average, high) and average calorie expenditure. Eligible participants at the intervention site will receive a physical activity program comprising 3 x 30-minute individual exergaming sessions per week for 12 weeks using activity-based games designed to simulate moderate intensity exercise. The exergaming program will be delivered via Xbox KinectTMvideo gaming consoles, with face-to-face supervision of all sessions provided by the FIT HEART Research Project Officer and Senior Research Nurse, unit-based Corrective Services NSW officers (Long Bay Hospital), and nursing staff. Each 30-minute session will be preceded by a 10-minute warm-up session using one of the exergaming activities and will be followed by a 5-minute cool-down period of stretching. Exergaming activities include soccer, baseball, track and field events (long jump, hurdles, sprinting), skiing, white water rafting, obstacle courses, dancing, and tennis. The subjective intensity of physical activity during each exergaming session will be measured using the OMNI Walk/Run Scale of Perceived Exertion. Participants from the comparison site will receive “routine care”, defined as the standard model of care provided by the Justice Health and Forensic Mental Health Network. The intervention will be delivered by members of the FIT HEART project team. All Justice Health and Forensic Mental Health Network staff participating in data collection and intervention delivery will undergo project-specific training and will be provided with a FIT HEART Operations Manual detailing all study procedures. The feasibility of the intervention will be assessed by examining: participation refusal rates; participant compliance and adherence (i.e. number, length and frequency of intervention sessions attended); rates of retention/attrition; occurrence of adverse events; fidelity of intervention delivery; accelerometer and Xbox durability; “lessons learned”. Acceptability will be assessed using post-intervention patient and staff evaluation surveys administered by the FIT HEART project team (intervention site only). Participant acceptability questions include questions on self-reported satisfaction with the intervention, ease of use of the exergaming system, and motivation to use exergaming as a form of physical activity in the future. Perceived utility of the intervention will be measured by asking participants about the impact of exergaming on their physical and mental health. Acceptability from the service perspective will be assessed by asking staff about their perceptions of the intervention content and delivery, benefit for patients, and barriers to implementation and uptake.