The impact of exercise training complementary to early intervention in patients with first-episode psychosis: a qualitative sub-study from a randomized controlled feasibility trial

Abstract

Background Burgeoning evidence suggests that exercise improves physical and mental health in people with schizophrenia. However, little is known about the feasibility and acceptability of high-intensity training in patients with first-episode psychosis. This qualitative study explored motivation, social interaction and experiences of participants and instructors in relation to an eight-week moderate to high intensity exercise training programme in a clinical trial including patients with first-episode psychosis. Methods The study used a combination of method, source and investigator triangulation. Data were collected by means of semi-structured individual interviews with participants at baseline ( n = 16) and at follow-up ( n = 9), as well as by means of participant observations during the programme (8 sessions × 1.5 h, 12 h in total) and focus group discussions with participants ( n = 3) and instructors ( n = 4), respectively, after the programme. Data were analysed using thematic analysis as described by Braun and Clarke. Results Three main themes and ten subthemes emerged during the analysis: 1) motivation and expectations for enrolment (subthemes: routines and structure, social obligation, goal setting and self-worth); 2) new demands and opportunities (subthemes: practicalities of the training, an understanding exercise setting, and alone and together); and 3) looking ahead – reflections on impact (subthemes: restored sleep and circadian rhythm, energy and sense of achievement, changed everyday life, and hope of finding a new path). Findings suggest that the programme was appealing to, and appreciated by, the participants because of its potential to create an equally challenging and caring non-clinical environment. Conclusions This study indicates that supervised, group-based, moderate to high intensity exercise training complementary to early intervention in psychosis is acceptable. Specifically, the intervention appeared to provide patients an opportunity to integrate the notion of being a young individual along with being a patient with a psychiatric diagnosis, thus supporting and promoting recovery. Trial registration ClinicalTrials.gov identifier: NCT03409393. Registered January 24, 2018.

Early Intervention in Psychosis: Effectiveness and Implementation of a Combined Exercise and Health Behavior Intervention Within Routine Care

“…Focus group interviews also allowed exploration of factors affecting program adherence and barriers to participation, which were both logistical (cost, distance, and transport ease) as well as psychological (anxiety, low motivation, poor concentration, coping, and confidence related to mental health). These findings are consistent with several recent qualitative evaluations of health behavior programs with FEP groups which identified common features that were valued by participants and reported similar benefits from and barriers affecting participation and adherence (31,32,34,41,91,92).…”

“…Participants were provided with a program tshirt, drinks bottle, pedometer, and tape measure embossed with the SHAPE logo to foster social identity and identification with the group. The program was delivered at a universitycommunity fitness center, instead of a clinical setting, to provide social engagement with other young people in an ageappropriate environment while still providing a clinical and research infra-structure (41).…”

“…As far as we are aware, there are only five small-scale studies internationally (16,17,21,24,41) which have specifically recruited from EIP services. Our findings concur with similar combined interventions in FEP in Australia, which also demonstrated attenuation of weight gain and lower BMI than controls at 3 months post-intervention (16,21) as well as selfreported positive health behavior changes in PA, fitness, and diet (21).…”

“…PA levels decreased significantly, and symptomatic improvements were only maintained for those who continued to exercise at 6-month follow-up (25). The remaining EIP intervention study in Denmark has only published a qualitative analysis to date (41). More research is needed to understand the sustained effectiveness of combined health behavior modification and exercise behavior change on weight maintenance and BMI in reducing cardiometabolic risk in FEP (21) and how changes in exercise and health risk behaviors may mediate these effects and can be successfully maintained in the longer term.…”

Exercise training complementary to specialised early intervention in patients with first-episode psychosis: a feasibility randomised trial

“…The study was carried out in accordance with the CONSORT Extension to Pilot and Feasibility Trials, and an additional le provides a completed checklist (See Additional le 1). Results of a qualitative investigation including participant experiences have been published elsewhere (20). The ClinicalTrials.gov identi er is NCT03409393.…”