Abstract. Physical activity has gained importance in psychiatric and psychosomatic treatment schemes, but there is little knowledge on the use of physical activity for forensic rehabilitation, including psychosocial outcomes. A systematic review of the literature on PubMed and Livivo found only one study that specifically addressed the effects of physical activity in forensic patients. Twenty-three studies reported on physical activity in the context of non-forensic patients suffering from mental illnesses similar to those commonly diagnosed in forensic patients. We summarize the effects of physical activity with respect to therapeutic objectives suggested by German sport therapists working with forensic patients. In forensic patients or patients suffering from mental illness typical of forensic patients, physical activity promotes social skills (4 studies), self-image, body experience, and personality growth (9 studies). Physical activity also helps to activate patients (12 studies), while reducing their tension and anger (1 study). Yet, there is a significant lack of specific scientific evidence as to whether sport therapy for forensic patients is effective in terms of the therapeutic objectives of this patient group. Future research must focus on longitudinal dose-effect outcome studies on forensic patients and should also concentrate on studies in the area of psychosis, personality disorders and addiction in relation to forensic sport therapeutic objectives.

Physical exercise interventions improve quality of life in people with mental disorders and improve abstinence and cravings in substance use disorders patients in both the short term and long term. In people with mental illness, physical exercise interventions significantly reduce psychiatric symptoms of schizophrenia and symptoms of anxiety. For forensic psychiatry, there is little empirical evidence supporting mental health-enhancing effects of physical exercise interventions. Interventional studies in forensic psychiatry deal mainly with three problems: heterogeneity of the individuals, a small sample size, and a low compliance rate. Intensive longitudinal case studies could be a suitable approach to address these methodological challenges in forensic psychiatry. This study uses an intensive longitudinal design to determine whether forensic psychiatric patients are content to complete several data assessments per day over the course of several weeks. The feasibility of this approach is operationalized by the compliance rate. Additionally, single-case studies examine the effects of sports therapy (ST) on momentary affective states (energetic arousal, valence, and calmness). The results of these case studies reveal one aspect of feasibility and offer insights into the effects of forensic psychiatric ST on the affective states among patients with different conditions. The patients’ momentary affective states were recorded before (PRE), after (POST) and 1 h after (FoUp1h) ST by questionnaires. Ten individuals (Mage = 31.7, SD = 11.94; 60% male) participated in the study. A total of 130 questionnaires were completed. To perform the single-case studies, data of three patients were considered. Repeated-measures ANOVA was performed for the individual affective states to test for main effects of ST. Due to the results, ST has no significant effect on none of the three affect dimensions. However, effect sizes varied between small to medium (energetic arousal: η2 = 0.01, η2 = 0.07, η2 = 0.06; valence: η2 = 0.07; calmness: η2 = 0.02) in the three patients. Intensive longitudinal case studies are a possible approach to address heterogeneity and the low sample size. The low compliance rate in this study reveals that the study design needs to be optimized for future studies.

Introduction: Some evidence showed positive effects of sports therapy in forensic settings. Most of these evaluation studies analyzed between-subject relations and used RCTs (randomized controlled trials) to investigate intervention effects. RCTs normally randomize participants to an intervention and a control group with the intention to compare averaged group-findings. However, such averaged results, which are based on group effects may not apply to every single forensic patient as they do not adequately address that these patients are unique due to their complex psychopathology. Thus, RCTs do not adequately address the following circumstances especially relevant in forensic settings: heterogeneity and low sample size of therapy groups and low compliance rate of forensic patients. To address these challenges, it could be worthwhile to focus on within-subject relations by using N-of-1 studies. Methods: This viewpoint summarizes the possibilities and limitations of N-of-1 study designs regarding the challenges heterogeneity, low sample size and a low compliance rate when evaluating forensic sports therapy. Results: N-of-1 studies offer a useful addition in the evaluation of sports therapy in forensic psychiatry. They are able to evaluate individual effects and they increase the power of the study by increasing the number of measurements. Nevertheless, they are associated with limitations, for example increased effort due to frequent measurements and long study duration or the difficulty to generalize the results. Conclusion: Future studies should implement N-of-1 study designs in forensic psychiatric sports therapy to gain evidence and should find solutions to deal with the limitations (e.g., digital technology).

No abstract

No abstract