An International Consensus on Strategies for Implementing Physical Activity in Inpatient Mental Health Services: A Nominal Group Technique

Physical activity (PA) offers numerous physical and psychological health benefits for individuals with severe mental illness. PA is not routinely integrated into inpatient mental health services, despite its benefits. This study recruited participants with experience across different international contexts and inpatient psychiatric settings, from multidisciplinary professional backgrounds, with the aim of achieving consensus on effective, impactful, and feasible strategies to advance PA implementation and inform service design globally. Insights were gathered from thirteen stakeholders using the Nominal Groups Technique (NGT). The online NGT process followed five steps: an opening statement, silent idea generation, round-robin recording of ideas, group discussion, and voting to rank strategies based on their perceived effectiveness, impact and feasibility. Thirty-three consolidated strategies were generated and organised into three categories: leadership and policy, staffing, and PA delivery. The strategies ranked most effective and impactful were leadership and organisational top-down commitment, providing PA infrastructure, facilitating consistent access to opportunities, building workforce capacity, and creating a positive day-to-day PA culture. The most feasible strategies included protecting PA time within service user (SU) timetables, collecting and utilising SU feedback, ongoing services evaluations, the characteristics of the PA provider, co-design of PA programmes with SUs, and PA language. The findings emphasise the need for a multi-level implementation approach. Strategies that rely on organisational resources and leadership were considered more effective and impactful, whereas those operating independently of wider systemic and organisational barriers were considered more feasible. There is a need for increased collaboration across research and practice to test, refine and discover effective implementation strategies.