PHYSICAL ACTIVITY AND

QUALITY OF LIFE IN PEOPLE

WITH PSYCHOSIS

Jackie Hepples

Supervisors: Professor Mike Lucock, Malcolm Cliff, Dr Alison Rodriguez

OUTLINE Background to physical activity (PA) and

quality of life (QoL) Focus group questions in two’s or threes Results Questions

WHY FOCUS ON QOL? QoL is poor in people with psychosis White Paper: Choosing Health (Department of Health, 2004) From Values to Action: The Chief Nursing Officers Review of Mental Health Nursing

(Department of Health, 2006) Recovery model

Physical activity: ‘any bodily movement produced by muscles that results

in energy expenditure’

Barry on swimming:

“ Well, it got me out, for a start. Something new, something I hadn’t done in a long time. And I felt better for it, felt I benefited from it a bit, you know. I felt a bit more mobile, getting around in general seemed to be a bit easier….I felt a bit self-stimulated, a bit proud of myself. I was actually doing something that was worthwhile and slightly constructive”

(Faulkner & Sparkes, 1999).

PHYSICAL ACTIVITY, PSYCHOSIS AND QOL Physical health Mental health Social health

Limited research Difficulties with population Limited cross-sectional research Limited exploratory research

OVERALL AIMSTo investigate if and how physical activity is

beneficial to quality of life in people with psychosis.

1) To investigate the relationship between physical activity and quality of life in people with psychosis.

2) To explore the experiences of physical activity in people with psychosis

3) To explore the perceptions and experiences of mental health staff with regard to physical activity and quality of life in people with psychosis.

Are the results of

the studies similar or do they differ?

Physical activity and

quality of life in people with

psychosisStudy 3What are the experiences and perceptions of staff with regards to physical activity and quality of life.Qualitative

Study 2Explore the lifeworld of people with psychosis and their experiences with physical activityQualitative

Study 1Is there a relationship between physical activity and quality of life?How does this relate to Self-Determination Theory?Quantitative

If there is a relationship between PA and QOL what are the reasons for this? What are the benefits and barriers? Why do people do physical activity?

Do staff and service users have the same or different perspectives of physical activity?

What reasons do staff give to any potential relationship? What are the perceived benefits and barriers of PA and interventions? How can PA be implemented?What is the rationale for providing PA interventions?

METHODS Study 1:

Self-report measures of PA, QoL, SDT & depression Convenience sample through CMHTs, Assertive

Outreach, Early Intervention, Outpatient clinics Multiple Regressions

Study 2: Interviews with active people with psychosis Template Analysis Interpretive phenomenology

Study 3: Focus groups Template Analysis Interpretive phenomenology

IN PAIRS/THREESRight hand side of the room

Centre of the room

Left hand side of the room

What PA services do you know of?

How do you think PA would affect somebody with psychosis?

Problems of implementing PA in people with psychosis?

Why do you think these services are provided?

Any benefits of introducing PA services?

Would PA benefit/worsen the service you provide?

What are your experiences of PA in people with psychosis?

How? What do you thin prevents people from being active?

QUANTITATIVE RESULTS SO FAR......

Physical QoL

Mental QoL

Autonomy

Competence

Relatedness

Physical Activity

r = 0.389 p = 0.001*

r = 0.161p = 0.100

r = 0.237p = 0.028*

r = 0.225p = 0.035*

r = 0.260p = 0.018*

Physical QoL

r = -0.098p = 0.209

r = 0.197p = 0.52

r = 0.166p = 0.087

r = 0.27p = 0.412

72 participants

QUALITATIVE STUDY Participants

Semi-structured interviews 45 – 70 minutes Confidential room

Male Female Bipolar Disorder 2 2Schizophrenia 3 1

THEMESPhysical activity (PA) and Quality of Life1. Empowerment and strive for normality

1.1. Cope with symptoms1.2. Cope with medications1.3. Day-to-day life

2. Confidence 2.1. Body image2.2. Achievement2.3. Platform for future aspirations

Mike and Tina

MIKE

21 years oldSchizophreniaNever engaged in structured physical

activity before diagnosis. Illness drove physical activityEmpowerment and strive for normality

MIKE & EMPOWERMENT PA and coping with symptoms

‘me favourite one for doing me good is boxing. I hear voices all the time and when I do I go boxing for an hour and a half, I don’t hear one voice I think it’s really weird cos they say relaxing can help, when I relax they get louder, the voices and when I do boxing on a punch bag they go completely so that’s my favourite one, I seem to come out with a really clear head, like I haven’t even got a mental illness’

MIKE & EMPOWERMENT PA and coping with medication

‘it’s better than feeling lethargic I find, it’s just better than feeling lethargic, that’s all I can think really, you feel just about like everyone else feels when you’ve done exercise you know what I mean, I don’t know how you feel, a bit of adrenaline maybe, clear head it seems to clear your head a bit doesn’t it’

MIKE & EMPOWERMENT“I were doing some press-ups actually in

hospital and they said you can stop them you’re here to rest, so I stopped doing that and erm rested up and it just made me worse you know what I mean, just sinking back into chair it just felt like I was sinking back into chair, I was getting depressed, I went really lethargic and I didn’t like it one bit”

However...........

MIKE CONCLUSION Chose to undertake physical activity Meaningful activity in control of illness ‘like I haven’t even got a mental illness’.

TINATina

34 years oldBipolar DisorderConsistently struggled with weight and

participated in physical activity on and offWeight loss was motivation for physical

activityConfidence

TINA AND CONFIDENCE PA and body image

‘I feel as though I’m working towards looking good in my clothes. Looking good when I go out, people don’t look at me and think ‘god isn’t she fat’ you know what I mean which is what they used to do before which has added to my bipolar syndromes because it made me feel like down here because people were looking at me and judging me and they didn’t even know me do you see what I mean, but now when I look in the mirror and I like what I see and it’s been hard but I’ve done it’

TINA AND CONFIDENCE PA and platform for the future

“because I feel good about myself I want to more, does that make sense? like I’m looking at things like I’ve always wanted to do, like car body parts...I think I’m going to do it and my boyfriend’s like ‘are you sure?, you know it’s at night during the week in September and you’d have to go and mix with others’ cos I’m not good with groups and stuff and I’m like ‘I really want to do it’, I look good, I want to do it I feel better, I’m exercising I feel as though I’m at a stage of me life where everything’s coming together I want to do it and I’m getting to that stage now where I’m getting a little bit more adventurous, that’s because I feel good though, does that make sense?”

TINA CONCLUSIONImproved self-perception

More confidence

Recovery & enhanced quality of life

FITT OR EXPERIENCE OF PA? Frequency Intensity Type Time

Experience providing meaning and purposeMike: purpose was to control illnessTina: purpose was to improve selfFor others part of a former self was

recovererd

PHYSICAL ACTIVITY RECOMMENDATIONS Autonomous Stage of illness Balance of medications Meaningful

EnvironmentType

FOCUS GROUPS 9 participants 2 focus groups

Early Intervention teamMix of service leads, psychiatrist & support

worker Results......... Key points:

PA is seen as beneficialDifficult to promote because of time

constraintsPA is implemented bottom-upWould worry if it became top-down

CONCLUSION Physical activity is related to physical

quality of life Could be explained through change in

body image/fitness Quant study found no relationship

between PA and mental quality of life Qual study found that PA is beneficial to

mental quality of life Difficult to separate the mind and body;

Treat one you treat the other.