A whole systems approach to integrating physical activity to aid mental health recovery – translating theory into practice

MACHACZEK, Katarzyna, QUIRK, Helen, FIRTH, Joseph, CARNEY, Rebekah, COPELAND, Robert, POLLARD, Nicholas, PECKHAM, Emily, HAMPSHAW, Susan, DE-LA HAYE, Stephanie, BURTON, Hannah and GOYDER, Elizabeth (2022). A whole systems approach to integrating physical activity to aid mental health recovery – translating theory into practice. Mental Health and Physical Activity, 23: 100480. [Article]

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Abstract
Improving health outcomes for people with severe mental illness (SMI) through increased physical activity (PA) on a large scale remains an elusive goal. There is promising evidence that increasing levels of PA in people with SMI can improve psychological and physical health outcomes. However, SMI is associated with reduced levels of physical activity and more sedentary behaviour than is usual in people without SMI. Increasing PA and reducing sedentary behaviour among people with SMI is a complex process, as there are drivers of these behaviours at the individual, household, community and policy levels. Examples of these include the symptoms associated with SMI, poverty, unemployment, social isolation and stigma. Such drivers affect opportunities to take part in PA and individuals’ abilities to do so, creating negative reinforcing loops of behaviours and health outcomes. Most previous approaches to PA for this population have focused largely on individual behaviour change, with limited success. To increase levels of PA effectively for people with SMI at scale also requires consideration of the wider determinants and complex dynamic drivers of PA behaviour in this population. This position paper sets out a rationale and recommendations for the utilisation of whole systems approaches to PA in people with SMI and the improvement of physical and psychological outcomes. Such approaches should be delivered in conjunction with bespoke, individual-level interventions which address the unique needs of those with SMI.
Plain Language Summary

Whole Systems Approach for Physical Activity in Mental Health Recovery

This paper discusses the need for a whole systems approach to improve physical and mental health outcomes for people with severe mental illness (SMI). Current approaches have primarily focused on individual behavior change, but the drivers of physical inactivity are complex and include social isolation, stigma, poverty, and unemployment. A whole systems approach involves identifying collective action to address complex problems and requires shared purpose, emergence, and consideration of multiple factors that influence behavior. The paper argues that integrating physical activity into the routine treatment of SMI requires a systems-thinking approach, and provides examples of how this can be applied.

This research is important because it highlights the need for a whole systems approach to increasing physical activity for people with severe mental illness (SMI). SMI is associated with reduced levels of physical activity and more sedentary behavior, which can exacerbate mental and physical health problems. Previous approaches have mostly focused on individual behavior change, with limited success. A whole systems approach considers the broader determinants and complex dynamic drivers of physical activity behavior in this population, which is essential for effective and sustainable improvements on a large scale.

Key Takeaways:

1. A whole systems approach is needed to address the complex drivers of physical inactivity in people with SMI.

2. Individual-level interventions should be combined with systems-level approaches to improve outcomes.

3. Shared purpose and commitment to long-term change are crucial for successful implementation.

4. Emphasize the importance of considering both initiation and maintenance of physical activity for sustainable improvements.

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