Academic journal article British Journal of Occupational Therapy

The Impact of Exercise on the Mental Health and Quality of Life of People with Severe Mental Illness: A Critical Review

Academic journal article British Journal of Occupational Therapy

The Impact of Exercise on the Mental Health and Quality of Life of People with Severe Mental Illness: A Critical Review

Article excerpt

Introduction

Exercise has long been proven to benefit the general population in terms of mental health and wellbeing (Stathopoulou et al 2006). Many studies have examined its effect on anxiety disorders, minor depression and substance abuse (Stathopoulou et al 2006). In comparison, very little research has investigated the use of exercise in people who experience more severe and enduring mental illnesses. This systematic review adopts this focus and examines the impact that exercise can have on mental health and quality of life (QOL) for people with a severe mental illness. For the purposes of this review, the term 'severe mental illness' (SMI) encompasses severe and enduring illnesses, such as severe depression, bipolar disorder, schizophrenia, schizoaffective disorder and psychosis.

Observational studies of people with SMI have highlighted a link between reported regular levels of exercise and physical activity and improved mood and QOL (McCormick et al 2008). Researchers, however, have emphasised the limited number of intervention studies regarding the effect of exercise on mental health and QOL in this population group (Fogarty et al 2004, Richardson et al 2005).

Two main factors support the need for more research on the use of exercise intervention in this population. First, people with SMI are typically prescribed with antipsychotic medications. The risks and side effects of these medications and polypharmacy warrant a need to explore safer treatment approaches, such as exercise (Trivedi et al 2006). Secondly, people with SMI experience greater rates of obesity and risky health behaviours, and poorer levels of fitness, compared with the general population (Smith et al 2007a). There is already an extensive body of research on the need for exercise interventions to address the physical health issues in people with SMI (Faulkner et al 2007). Confirmation of the benefits of exercise interventions for improving QOL could potentially add secondary benefits beyond the recognised improvements in physical health parameters.

The World Health Organization describes quality of life as a 'broad ranging concept affected in a complex way by the person's physical health, psychological state, level of independence, social relationships, personal beliefs and their relationship to salient features of the environment' (World Health Organization 1997, pi). Occupational therapy researchers theorise that QOL can be obtained through engagement and participation in personally meaningful occupations (Hammell 2004). Occupational therapists use meaningful activity as a medium through which people can engage in doing, being, becoming and belonging; these concepts have been described as core aspects in the meaning of occupation (Wilcock 1998, Hammell 2004). Exercise has been defined by the American College of Sports Medicine (2006) as '... planned, structured, and repetitive bodily movement done to improve or maintain one or more components of physical fitness' (p3). Exercise as a purposeful activity therefore may be able to provide people with the opportunity to 'do' exercise, to 'be' and 'become' exercisers, and to 'belong' to an exercise group or culture. The related term 'physical activity' extends not only to exercise, but also to '... activities which involve bodily movement and are done as part of playing, working, active transportation, house chores and recreational activities' (World Health Organization 2011).

Method

Aim of review

The aim of this review was to describe the effect of exercise intervention on the mental health and QOL of people with SMI. To gain a broad understanding of these issues, both quantitative and qualitative studies were included in the review.

Search strategy

A search was conducted using CINAHL, PsycInfo, the Cochrane Library, Scopus and Medline. The key words were 'physical exercise', 'exercise', 'exercise therapy', 'physical activity' and 'exercise movement therapies'. …

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