Exercise engagement of people with mental health problems: motivational aspects

Background Physical activity (PA) has been recognized to positively affect prevention and treatment of mental disorders (Faulkner & Biddle, 2002), unfortunately PA levels and fitness of psychiatric patients are usually very low (Vancampfort et al., 2011). Active lifestyle and regular exercise need to be supported by personal motivation, and people with mental diseases are often characterized by lack of motivation and poorer networks that negatively influence personal volition and coping abilities. Recent studies underlined the importance to promote intrinsic motivation to engage individuals in targeted behaviors, stimulating enjoyment and personal satisfaction rather than external reward (Choi et al., 2010). The aim of this study was to evaluate the effect of a multidimensional approach on motivation, enjoyment and perceived benefits and barriers toward exercise, in a group of psychiatric inpatients. Materials and Method Participants were a mixed-gender sample of 53 psychiatric inpatients (men n = 21; women n =32; mean age = 47.7 years, SD = 10.4 years; mean BMI = 26.5, SD =5.4) attending a multidimensional treatment program including group-based exercise programs. Before to enter the study participants completed the International Physical Activity Questionnaire (IPAQ), 58.5% of them reported a low level of habitual PA, 20.8% a moderate and 20,8% a high PA level. They filled in a package of questionnaires before and at the end of the intervention (corresponding with the discharge from the hospital). The Physical Activity Enjoyment Scale (PACES) was used to assess enjoyment. The Situational Motivation Scale (SIMS) was used to test motivational aspects. Perceived benefits and barriers of PA were investigated with the Decisional Balance Scale (DBS). Results At baseline participants did not report significant differences in questionnaires values, neither by gender nor by IPAQ categories. At baseline, significant negative associations were found between BMI and positive scales (p < .01), in particular with PACES (pros scores), DBS and SIMS intrinsic motivation and identified regulation subscales. Positive associations were found between BMI and the negative subscales: SIMS amotivation and PACES-cons. Paired t-test shown significant differences in post versus pre scores of SIMS amotivation subscale (t(52) = -2.68, p < .05) and DBS (t(52) = 3.36, p < .01). Discussion Data underlined that high BMI is associated with low level of enjoyment, perceived benefits, and intrinsic motivation toward exercise. Moreover, results suggested that a multidimensional approach, also when corresponding to a short-time intervention (hospitalization reported a 33-day mean length), could improve motivational attitude and the perception of benefits toward exercise among people with mental health problems. Further research is necessary to understanding long-term effect of exercise training by means of follow-up evaluations and objective measure of leisure time PA levels.