Integrating physical activity as routine care for youth at-risk of mental illness

Youth at increased risk of developing psychosis i.e. at-risk mental states (ARMS), display lifestyle behaviours known to exacerbate mental health symptoms and impair physical health. Physical activity (PA) interventions are effective in improving the physical and mental health of individuals with established mental illness, however research is limited in youth with ARMS. The research undertaken for this dissertation examined the role of integrated PA interventions in ARMS populations, aiming to identify effective implementation strategies to enhance physical activity services for ARMS youth as part of routine mental health care. Altered sleep patterns are frequently reported by youth with ARMS. Firstly, the impact of PA interventions on sleep quality in people with mental illness was examined in a systematic review and meta-analysis. Across 8 RCTs, exercise had a large, statistically significant, positive effect on sleep quality (hedges g = 0.73, p-value = 0.01, n = 1,329). Secondly, a cross-sectional study in youth with ARMS, first-episode psychosis (FEP) and healthy volunteers was performed to determine the prevalence of and associations between modifiable cardiometabolic risk factors; sleep quality, PA and cardiorespiratory fitness. Thirty participants were recruited comprising youth with ARMS (n=10), FEP (n=10) and healthy volunteers (n=10). The ARMS group engaged in significantly less PA (p < 0.05) and had poorer sleep quality (p < 0.05) than healthy volunteers. Increased PA was significantly correlated with better fitness and sleep quality. Thirdly, a 12-week exercise intervention was developed and assessed for feasibility and acceptability in youth with ARMS. Over twelve months, 20 participants completed follow-up assessments. Participants found the program highly acceptable and experienced improvements in a range of physical and mental health outcomes. Finally, a Delphi consultation was conducted with exercise physiologists and mental health professionals to develop a consensus statement on the role of exercise physiologists in mental health treatment. The findings reported herein elucidate the relationships between sleep, physical activity and cardiometabolic health and benefits of adjunctive physical activity programs in youth with ARMS. Evidence-based physical activity interventions are effective in improving holistic health outcomes for youth with ARMS, and should be integrated as part of routine care