Physical activity interventions for inpatients in secure mental health settings: what works, for whom, in what circumstances and why? A protocol for a realist synthesis.

Introduction - The physical health of individuals with severe mental ill health (SMI) is a cause for concern. Whilst the purpose of inpatient mental health settings is rehabilitation and treatment, the physical health of hospitalised patients commonly deteriorates. Physical activity (PA) has been identified as an appropriate intervention to help improve the psychological and physical health of inpatients. To address the gaps in the current literature by exploring how, why, for whom, and in what contexts physical activity (PA) interventions help patients with Severe Mental Illness (SMI), who receive inpatient treatment, to increase their PA engagement. Methods and Analysis – Realist Synthesis. Six steps will be followed: 1) identification of the review question and scope of the review; 2) searching for evidence; 3) screening and appraisal; 4) extraction of data; 5) synthesis of the data; and 6) dissemination. Five databases will be searched: Web of Science, PubMed, PsychInfo, PsychArticles and EmBase. 10 to 15 stakeholders made up of academics and people living with SMI, sport and exercise therapists, psychiatrists, physiotherapists of low, medium and highly secure inpatient settings, will form an expert advisory group. They will provide their insight and knowledge of the secure setting contexts and perceived principles of how PA initiatives being undertaken in their hospitals for patients with SMI work, or not. The results will be published in accordance with the Realist And Meta-narrative Evidence Syntheses – Evolving Standards (RAMESES) publication standards. Ethics and Dissemination - Ethical approval has been granted. The review will produce context-specific guidance for Clinical Commissioning Groups and practitioners on how to optimise the provision of PA interventions for people with SMI in inpatient settings. Strengths and Limitation • The realist approach will facilitate a novel understanding of the conditions and caveats required for the successful outcomes of PA interventions for inpatients in secure mental health settings. • The advantage of using realist synthesis is that it allows for the use of a wider variety of evidence sources, both formal and informal, which might not have been included in a typical systematic review. • Since the synthesis is executed at the programme theory level (the mechanisms by which interventions work), rather than focusing on the interventions themselves, this study will facilitate an understanding of the conditions and caveats for successful outcomes in other areas with similar programme theories, such as PA interventions for people with SMI in community settings. • A significant strength of the realist approach is the inclusion of key stakeholders, comprising recipients of interventions, providers, subject experts and policymakers. • However, studies published in languages other than English will be excluded due to resource constraints.