The Use of the Wii Fit in Forensic Mental Health Exercise for People at Risk of Obesity
Bacon, Nicola, Farnworth, Louise, Boyd, Richard, British Journal of Occupational Therapy
Adverse side effects of the medications used to treat the symptoms of psychoses often include sedation and decreased metabolism, leading to rapid weight gain (Wilson 2008). This weight gain can lead to problems with an individual's health, wellbeing and quality of life (World Health Organization [WHO] 2010) and ability to perform necessary daily occupations (Wilson 2010). This is especially problematic for individuals with mental illness in the criminal justice system. It can be difficult to address their rapid weight gain when they are incarcerated, because physical, legal and institutional barriers prevent them from accessing exercising opportunities that are available in the general community. Additionally, negative symptoms of mental illness, such as avolition, further make it difficult for these forensic mental health patients to be motivated to participate in physical activity (Wilson 2008).
The challenge for occupational therapists is to find a better match between the person, environment and occupation (Townsend and Polatajko 2007) in this scenario, in order to assist forensic mental health patients to participate in exercise within a secure setting, to improve their health and wellbeing, and potentially to assist them to lose weight. Virtual reality technologies, and specifically the Nintendo Wii system, are being investigated for their potential use in rehabilitation to assist in meeting physical activity goals (Miyachi et al 2010). The motivating aspect of the competitive Wii games (Reid 2005) and the bodily movements that are required to play them (Graf et al 2009) suggest that it could be a more enjoyable and motivating way to encourage patients to exercise. As no such research has been conducted within forensic mental health, this exploratory study aimed to address the knowledge gap and to evaluate the feasibility of using the Nintendo Wii Fit game to change forensic mental health patients' engagement in physical activity.
It is well known that side effects of psychotropic medication often lead to rapid weight gain (Cormac et al 2004). Research indicates that even modest increases in weight over a short period of time can lead to secondary health problems, including diabetes, heart disease, stroke and death (Faulkner et al 2007, WHO 2010). An inability to lose gained weight has further been associated with body dissatisfaction, poorer self-esteem, eating disorders and worse overall mental health (Catapano and Castle 2004). Associated occupational performance problems, such as difficulties dressing, toileting, ambulating and socialising (Reed 2001), as well as medication non-compliance (Catapano and Castle 2004), make rehabilitation more problematic.
For long-term forensic mental health patients, identified as being in hospital for over one year (Cormac et al 2004), this propensity to gain weight is accentuated, and programmes to address it through exercise are compromised by the secure environment. For example, Cormac et al (2005) evaluated the physical health and health risk factors in long-stay psychiatric patients at the high security Rampton Hospital in the United Kingdom in 2001. They found that since admission there was a mean increase in weight of 10.62 kg in males, and of 12.74 kg in females, at a rate of 36% (male) and 75% (female) (Cormac et al 2005).
Physical activity guidelines recommend that adults engage in a minimum of 30 minutes of moderate intensity physical activity every day, and 20 or more minutes of vigorous intensity physical activity 3-4 times a week, for optimal physical and mental health (WHO 2010). Studies on institutionalised forensic mental health patients have consistently found that patients' time use is imbalanced, being dominated by personal care and passive leisure occupations (Farnworth et al 2004, Sturidsson et al 2007, O'Connell et al 2010). In Australia, Farnworth et al (2004) used time-use diaries to show that forensic mental heath patients spent 51% of their time in personal care occupations, such as sleeping and eating, and 40% in leisure occupations, such as smoking and listening to music, with only 2% of that time being spent in physical activities. …