Purpose – The purpose of this paper is to evaluate the effectiveness of measures designed to increase physical activity in women in secure psychiatric care. Design/methodology/approach – A range of interventions (environmental and motivational) designed to increase participation in physical activities were introduced on two secure wards for women. A pre-post design assessed frequency, duration and intensity of physical activity, attendance at physical activity sessions, exercise motivation, exercise-related mood, attitudes to exercise and health and biological indices. Measures collected over a three-month baseline period were repeated six months post-intervention. Findings – Significant changes occurred in both attitudes to exercise and health, exercise motivation and exercise behaviour following change initiatives. With the exception of resting pulse rate and perceived exertion, the increased level of activity was not reflected in changes in body mass index, body fat or body muscle. Practical implications – Management led, multi-disciplinary interventions to increase physical activity can have a positive impact on both lifestyle behaviours and physical health. Originality/value – This study adds to a small literature on increasing physical activity in women in secure psychiatric settings where obstacles to change are formidable.

Purpose – The purpose of this paper is to describe healthy lifestyle initiatives in a secure psychiatric facility and the evidence base for these interventions. Design/methodology/approach – Following a detailed review of the literature on the physical health of psychiatric inpatients, a trans-diagnostic approach to behaviour change is advocated in selected areas. Findings – Lifestyle strategy proposals were produced that incorporate the principle of “libertarian paternalism” in making changes to eating and exercise behaviour; a programme of motivational and reinforcement strategies; and facility-specific environmental restructuring to include maximising the therapeutic use of green space. Practical implications – Instituting described changes needs to be accompanied by a programme of evaluation to assess intervention-specific physical health changes. Originality/value – This paper provides a synthesis of findings in key areas of behaviour change relevant to improving the physical health of psychiatric patients in secure settings. It is a co-ordinated and interlinked lifestyle strategy that has applicability to similar services.

Incontinence is associated with mental illness and neuroleptic medications but diagnosis and treatment is often poor or non-existent. Problems of incontinence are compounded in secure psychiatric services for women by poor health, obesity, and a sedentary lifestyle. Addressing the physical health of this group necessitates a more accurate picture of the nature, incidence, and management of incontinence. A point-in-time survey of 108 women who agreed to be interviewed (93%) covered presence, frequency, and nature of incontinence, and information on management case note data was used to gather demographic and previous medical history, comparisons were made between patients with and without problems of incontinence. Findings indicate a problem of incontinence in 48% of women with a dominance of problems of stress and urge enuresis. Of modifiable factors that contribute to enuresis, the current study highlighted the contribution of obesity, smoking and clozapine medication. A further finding was the preference for managing rather than treating problems of incontinence. Actions to improve the detection and treatment of this problem are described.