Mind in motion: patients' experiences with group-based physical activity in psychiatric treatment- a mixed-methods study

Background:
Individuals with severe mental illness face significant health challenges, such as cardiovascular diseases and social isolation. Physical activity is increasingly recognized as an integral part of psychiatric treatment, with evidence showing it can prevent and manage somatic diseases, enhance mental health, reduce premature mortality, and support social inclusion. In Oslo, Norway, group-based physical activity is offered as part of routine care at Diakonhjemmet Hospital. Participants attended one to four sessions per week, including endurance- and strength-based activities such as hiking, swimming, and strength training. In this study, we aimed to explore how adults with severe mental illness experienced this group-based physical activity program during psychiatric treatment.

Methods:
Participants were receiving psychiatric treatment for severe mental illness, including schizophrenia spectrum disorders and bipolar disorder. This qualitative-driven mixed-methods study combined eight in-depth, semi-structured interviews with questionnaire data from 33 adults, including the interview participants. Three main areas were explored: (1) holistic health benefits (2), addressing barriers, and (3) transition and continuity. Data analyses were organised around the three predefined study areas, using reflexive thematic analysis of the interview data and descriptive statistics from the questionnaire. Quantitative results were integrated at the thematic level to enrich interpretation and understanding.

Results:
Within each study area, two-three themes were constructed. Combined findings from both methods showed that participants experienced broad health improvements, including fostering well-being, social connectedness, and structured daily routines. Perceived barriers were related to medication side effects, fatigue, and fluctuating motivation. Support from knowledgeable and enthusiastic activity leaders was essential in helping participants overcome barriers and stay active. While most participants intended to remain active after treatment, limited follow-up support and access to similar community programs hindered the prospect of continued engagement.

Conclusions:
Participants perceived that tailored and well-led physical activity during treatment contributed to improvements in health and social connectedness. However, long-term maintenance was perceived to be hindered by limited access to follow-up programs, highlighting the need for better post-treatment support. These findings underscore the importance of expanding access to physical activity programs within real-world psychiatric care, to ensure that individuals with severe mental illness have genuine opportunities to establish physical activity as a routine part of daily life.