Implementing an Exercise Referral Scheme for Promoting Physical Activity in University Mental Health Care

Introduction. Mental health symptoms and conditions are prevalent and increasing on college campuses with anxiety and depression having the highest increases in prevalence. Many college students are also physically inactive which is problematic as physical activity benefits mental health. Exercise referral schemes (ERS) can promote physical activity, though no studies have investigated the implementation of an ERS within a college counseling center. Purpose. The purpose of this dissertation was to investigate the implementation of an ERS for promoting physical activity in university mental health care. Methods. Study 1 used a qualitative descriptive design of 14 certified counselors to explore perceptions of counselors using physical activity in their therapeutic works. Study 2 utilized a cross-sectional design of 237 undergraduate students to examine relationships between personality traits, high school sports participation with physical activity to assist a physical activity specialist. Study 3 used a randomized controlled trial of 20 college students to assess the implementation and effectiveness of an exercise referral scheme (ERS) in a college’s counseling and psychological services (CAPS) on physical activity (PA) and health outcomes. Results. Study 1 demonstrated counselors recognized physical activity is important for treatment of mental health needs of their patients. Counselors also had supportive attitudes and presented specific barriers to both prescribing physical activity to patients and towards referring patients to a physical activity specialist. Study 2 showed Conscientiousness was positively related to all physical activity measures except for active transport, and High school sports participation was positively related to vigorous physical activity and leisure time physical activity. Conscientiousness was also the best predictor for physical inactivity, overall. Study 3 found the ERS had low reach within CAPS but generated more interest in the broader campus. Participants of the treatment group were supportive of the intervention and showed high adherence. There was no group and time interaction effect on device-based physical activity for the treatment group. However, there were significant and beneficial group and time interaction effects on percent body fat, VO2max, and mental health scores. Conclusion. Barriers of the implementation included low counselor buy-in and low buy-in of patients. The intervention that was originally planned to be within the ERS was still tested with the broader population of campus outside the counseling center. MI showed to have positive effects on fitness and mental health but did not demonstrate changes in objectively measured physical activity. Incorporating behavioral change techniques that promotes long term internal accountability and self-regulation may be more effective for increasing device-base physical activity over time. Future studies should continue to investigate the implementation of physical activity interventions within student mental health care to continue to promote positive physical activity habits to ultimately improve both physical and mental health on college campuses