Exercise and mental health : problems and possibilities.

Despite a sound evidence base, the consideration of exercise as a therapeutic adjunct remains rare in mental health settings. This research project reports a series of studies examining the consideration of exercise as a strategy for promoting mental health in clinical settings. A broad, multi-level and multi-method analysis of exercise and mental health was adopted by focusing on trainers (key stakeholders responsible for treatment dissemination), providers (individuals at the forefront of treatment) and service users (individuals with clinical depression). First, the perceptions of exercise as an adjunctive therapy is qualitatively explored through interviews with Course Directors of UK training programmes in clinical psychology and mental health nurses working in acute, inpatient settings. A range of conceptual barriers are revealed such as the perceived `simplicity' of exercise interventions and the incompatibility of exercise with traditional models of understanding and treating clinical conditions. Second, the nature and extent of exercise promotion are identified within one NHS Mental Health Trust. A lack of training and protocols are the most significant barriers. The Theory of Planned Behaviour variables of attitude, subjective norms, perceived behavioral control, and intention predict stage of change of physical activity promotion in a health care setting. However, the past promotion of physical activity overrides much of these effects. Third, the role of exercise in the lives of individuals with depression is explored in a case study analysis of four participants of an exercise referral scheme. The context of each person's life is instrumental in understanding adherence and the experiences associated with participation in exercise and/or physical activity. These studies offer insight to some of the conceptual and structural barriers inhibiting the promotion of exercise as well as factors that may contribute to the success of such promotion within mental health settings. Recommendations are offered to enhance the development of comprehensive physical activity provision for people with mental health problems.