Research has consistently shown that people with mental health conditions experience significant physical health inequalities compared to the general population (Correll et al., 2017; De Hert et al., 2009; Firth et al., 2019). Secure psychiatric hospitals are often considered to exacerbate this inequality due to a multitude of factors, including restricted living space and issues of service user risk and safety (Faulkner et al., 2009; Gorczynski et al., 2013; Rogers et al., 2021).
In this CYPMHS EveryExpert article, we explore the effects of a specialist physical exercise therapy programme for young people within a low secure unit, considering how it improved mental wellbeing and participation in therapy. We talk with programme lead Dr. Carolina Schneider, CYPMHS Medical Director at Elysium Healthcare and a specialist in child and adolescent psychopharmacology, about its success and how physical exercise therapy in CYPMHS can be used as part of enhanced care provision to support a recovery pathway.
Evidence-based benefits of physical exercise
The positive effect of physical activity on mental health and wellbeing has been thoroughly researched, highlighting the importance of physical exercise therapy as part of a holistic recovery pathway (Firth et al., 2019; Li et al., 2022; Li & Liu, 2014; Liu et al., 2024; Vancampfort et al., 2017). However, despite the robust evidence base, participation in a tailored physical exercise programme is not prescribed as standard for CYPMHS residential or low secure settings. For the multidisciplinary team (MDT) at Potters Bar Clinic, this had been something that they were keen to change for the young people they support.
Potters Bar Clinic offers a CYPMHS Tier 4 low secure service for young people aged 13-18 with a wide range of mental health disorders and complex needs. The 18-bed inpatient unit is set over two wards and offers a safe and nurturing environment to support and aid recovery. Dr. Schneider explains why the team at Potters Bar felt that physical exercise therapy in CYPMHS was such an important therapeutic offering to explore.
Carolina says, “The majority of young people at Potters Bar receive support over an extended period, which is typical for a low secure unit. Unfortunately, this can result in limited access to physical activity, which in turn can have other detrimental effects on wellbeing, and we wanted to change that.
“There are, of course, risks when working with this particular patient group. However, we felt that with the right programme in place, delivered by a specialist partner, the young people would not only receive physical and wellbeing benefits, but there could be a wider positive impact on their recovery.”
Partnership with Psychesoma
Potters Bar Clinic collaborated with Psychesoma, a specialist physical exercise therapy provider, to create a tailored programme of group physical exercise therapy sessions over 19 months (December 2022 – June 2024). The exercises were adjusted to the environment and potential risks, and trainers from Psychesoma worked closely with the MDT to understand the challenges that the young people were going through. The programme aimed to improve health, mood and relieve stress and anxiety. If an improvement of overall functioning was achieved, then the aim was also to enhance participation in all therapies and support a recovery pathway.
Twelve young people (<18 years old), each with an ICD diagnosis of a mental health disorder, participated in the programme. The sessions, held either in the morning or afternoon, consisted of both conventional and non-conventional approaches to help boost engagement. Morning sessions typically focused on lower-intensity activities such as yoga and Pilates, plus less conventional ‘reactionary games’ to improve alertness and processing speed. The afternoon sessions adopted a more conventional approach, with a ‘circuit training’ style session with free weights and resistance bands, or other sport-based activities such as tennis, badminton, basketball, volleyball and racket ball. Each participant was included in the design and implementation of their own physical exercise therapy programme.
Carolina explains why this was so important: “Every young person has their own strengths, in terms of abilities and also what drives and motivates them. So, the best way to ensure that the programme was engaging and that the young person connected with it was to involve them in its design.
“As a consequence, it made them feel part of the programme and it gave them ownership – it was not just something that they were being told to do. I was very pleased to see how successful their involvement was, because it meant that the programme was truly tailored to their individual needs.”
Data Collection and Findings
During the programme, the Psychesoma trainers collected data from the participants using the Subjective Exercise Experience Scale (SEES; McAuley & Courneya, 1994), a standardised measure of global psychological responses to exercise stimuli. The SEES assesses three general categories of subjective responses to exercise stimuli: positive well-being, psychological distress, and fatigue. SEES was completed 75 times in total by participants, before and after Psychesoma sessions, and the results were very promising.
On the positive wellbeing subscale, the cohort had a mean pre-session score of 11.05, and a mean post-session score of 16.06, representing a 5.01 increase in positive wellbeing.
For the psychological distress subscale, the cohort had a mean pre-session score of 9.91 and a mean post-session score of 7.71, representing a 2.20 decrease in psychological distress.
Then, on the third category, the fatigue sub-scale, the cohort had a mean pre-session score of 15.32 and a mean post-session score of 11.14, representing a 4.18 decrease in fatigue.
The data shows that the young people experienced an increase in positive well-being and a decrease in psychological distress and fatigue immediately following Psychesoma sessions. For Dr. Carolina Schneider, the next step is to explore the duration of these positive effects.
Carolina says: “We were very pleased by how the young people responded to the CYPMHS physical exercise therapy programme. There was a clear increase in positive well-being and a reduction in distress and fatigue. The increase in well-being also led to an improvement in the young people’s overall functioning and an increase in levels of overall engagement with the rest of the treatment plan.
“The results show that the programme had wider benefits than just well-being improvements, and, in the future, we hope to explore the long-term duration of these positive effects, to see if they can have a sustained impact. It would also be interesting to evaluate the effects on physical health markers, such as weight and blood test changes as a result of physical exercise therapy. Currently, I am exploring opportunities for further research through grant funding and possible partnerships with academic institutions so that we can extend this project and the research.
“Many studies show how physical exercise has a positive impact on our brains in terms of emotions, cognition and behaviours. I particularly want to research how physical exercise therapy in CYPMHS improves a young person’s overall wellbeing, mental health and overall functioning. An example is how certain types of exercise trigger the release of a hormone from bones called osteocalcin, as well as brain-derived neurotrophic factor. Together, these substances increase neuroplasticity and enhance learning, and I would like to expand this work, showing the neuroscience behind it.”
This work is part of a wider project at Potters Bar CYPMHS LSU: Tackling Obesity CYPMHS LSU Project
Research team:
Dr Carolina Schneider, CYPMHS Consultant Psychiatrist
Elise Stephen, Consultant Clinical Psychologist
Charlotte Laver, Assistant Psychologist
Julian Ivory, Psychesoma Team Lead
Shailini Ponnou, Registered Dietitian
Caroline Paez, Physical Health Nurse
Andrea Papamichael, Assistant Psychologist
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