Motivational factors associated with physical activity and quality of life in people with severe mental illness

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Over the last 40–50 years, there has been a change in ideology and organisation in mental health care. From inpatient treatment towards community‐based care and from symptom control towards a greater emphasise on helping individuals manage their illness, become independent, achieve success in relationships and participate in meaningful community activities 1. As a consequence of the changes in mental health care, preventive actions have become more important for improving the health of people with severe mental illness (SMI) 3. In Norway, the significance of both preventive and community health care is emphasised in a recent large health sector reform and public health law 4. A type of add‐on treatment that can make a valuable contribution within this organisation of mental health care is physical activity. Physical activity can be an arena for establishing social relationships and obtaining mastery experiences 6, and it can be organised as low‐cost group activities. The latter aspect may be particularly prominent in community settings that have limited resources and infrastructure. Finally, the evidence of the beneficial effects of regular physical activity and exercise on both mental and physical health, as well as on quality of life in individuals with SMI, are well documented 7.
Unfortunately, people with SMI engage in little physical activity 9. This low involvement may be due to several barriers. Structural factors such as access to effective interventions and lack of physical health‐care provision can be part of the explanation 1. Likewise, individual barriers such as illness symptoms, side effects of medication, physical comorbidities and lack of support can also contribute to the low levels of physical activity 12. Another reason could be related to motivation, which has been reported as a major barrier by health‐care staff when introducing physical activity as an adjunct part of treatment 15. Recently, there has been increasing interest for investigating the role of motivation in treatment outcomes in general 16 and for physical activity in particular 19. One prominent macrotheory of motivation that can be used as a framework to understand human behaviour and help to identify environmental factors affecting motivation is self‐determination theory (SDT: 20).
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