Jackie Hepples
Supervisors: Professor Mike Lucock, Malcolm
Cliff, Dr Alison Rodriguez
 Background
to physical activity (PA) and
quality of life (QoL)
 Focus group questions in two’s or threes
 Results
 Questions
 QoL
is poor in people with psychosis
 White Paper: Choosing Health
(Department of Health, 2004)
 From
Values to Action: The Chief Nursing
Officers Review of Mental Health Nursing
(Department of Health, 2006)
 Recovery
model
Physical activity:
‘any bodily movement produced by muscles that
results in energy expenditure’
Barry on swimming:
“ Well, it got me out, for a start. Something new,
something I hadn’t done in a long time. And I felt
better for it, felt I benefited from it a bit, you
know. I felt a bit more mobile, getting around in
general seemed to be a bit easier….I felt a bit selfstimulated, a bit proud of myself. I was actually
doing something that was worthwhile and slightly
constructive”
(Faulkner & Sparkes, 1999).
 Physical
health
 Mental health
 Social health
 Limited
research
 Difficulties with population
 Limited cross-sectional research
 Limited exploratory research
To investigate if and how physical activity is
beneficial to quality of life in people with
psychosis.
 1) To investigate the relationship between
physical activity and quality of life in people
with psychosis.
 2) To explore the experiences of physical
activity in people with psychosis
 3) To explore the perceptions and
experiences of mental health staff with
regard to physical activity and quality of life
in people with psychosis.
Study 1
Is there a relationship
between physical
activity and quality of
life?
How does this relate to
Self-Determination
Theory?
Quantitative
If there is a
relationship between
PA and QOL what
are the reasons for
this? What are the
benefits and
barriers? Why do
Are the
people do physical
results of
activity?
the studies
similar or
do they
differ?
Study 2
Explore the lifeworld
of people with
psychosis and their
experiences with
physical activity
Qualitative
Physical
activity and
quality of life
in people with
psychosis
Do staff and service
users have the same or
different perspectives
of physical activity?
What reasons do staff
give to any potential
relationship? What are
the perceived benefits
and barriers of PA and
interventions? How can
PA be implemented?
What is the rationale for
providing PA
interventions?
Study 3
What are the
experiences and
perceptions of staff
with regards to
physical activity and
quality of life.
Qualitative

Study 1:
Self-report measures of PA, QoL, SDT & depression
 Convenience sample through CMHTs, Assertive
Outreach, Early Intervention, Outpatient clinics
 Multiple Regressions


Study 2:
Interviews with active people with psychosis
 Template Analysis
 Interpretive phenomenology


Study 3:



Focus groups
Template Analysis
Interpretive phenomenology
Right hand side of
the room
Centre of the room
Left hand side of
the room
What PA services do
you know of?
How do you think PA
would affect
somebody with
psychosis?
Problems of
implementing PA in
people with
psychosis?
Why do you think
these services are
provided?
Any benefits of
introducing PA
services?
Would PA
benefit/worsen the
service you provide?
What are your
experiences of PA in
people with
psychosis?
How?
What do you thin
prevents people from
being active?
72 participants
Physical
QoL
Mental
QoL
Physical
Activity
r = 0.389 r = 0.161
p = 0.001* p = 0.100
Physical
QoL
r = -0.098
p = 0.209
Autonomy
Competence Relatedness
r = 0.237
p = 0.028*
r = 0.225
p = 0.035*
r = 0.260
p = 0.018*
r = 0.197
p = 0.52
r = 0.166
p = 0.087
r = 0.27
p = 0.412
 Participants
Male
Female
Bipolar Disorder
2
2
Schizophrenia
3
1
 Semi-structured
 45
interviews
– 70 minutes
 Confidential room
Physical activity (PA) and Quality of Life
1. Empowerment and strive for normality
1.1. Cope with symptoms
1.2. Cope with medications
1.3. Day-to-day life
2. Confidence
2.1. Body image
2.2. Achievement
2.3. Platform for future aspirations
Mike and Tina
21 years old
 Schizophrenia
 Never engaged in structured physical activity
before diagnosis.
 Illness drove physical activity
Empowerment and strive for normality

 PA
and coping with symptoms
‘me favourite one for doing me good is boxing.
I hear voices all the time and when I do I go
boxing for an hour and a half, I don’t hear
one voice I think it’s really weird cos they
say relaxing can help, when I relax they get
louder, the voices and when I do boxing on a
punch bag they go completely so that’s my
favourite one, I seem to come out with a
really clear head, like I haven’t even got a
mental illness’
 PA
and coping with medication
‘it’s better than feeling lethargic I find, it’s
just better than feeling lethargic, that’s all I
can think really, you feel just about like
everyone else feels when you’ve done
exercise you know what I mean, I don’t know
how you feel, a bit of adrenaline maybe,
clear head it seems to clear your head a bit
doesn’t it’
“I were doing some press-ups actually in
hospital and they said you can stop them
you’re here to rest, so I stopped doing that
and erm rested up and it just made me worse
you know what I mean, just sinking back into
chair it just felt like I was sinking back into
chair, I was getting depressed, I went really
lethargic and I didn’t like it one bit”
 However...........
 Chose
to undertake physical activity
 Meaningful activity in control of illness
 ‘like I haven’t even got a mental illness’.
Tina
34 years old
 Bipolar Disorder
 Consistently struggled with weight and
participated in physical activity on and off
 Weight loss was motivation for physical activity
Confidence


PA and body image
‘I feel as though I’m working towards looking good
in my clothes. Looking good when I go out,
people don’t look at me and think ‘god isn’t she
fat’ you know what I mean which is what they
used to do before which has added to my bipolar
syndromes because it made me feel like down
here because people were looking at me and
judging me and they didn’t even know me do you
see what I mean, but now when I look in the
mirror and I like what I see and it’s been hard
but I’ve done it’

PA and platform for the future
“because I feel good about myself I want to more, does
that make sense? like I’m looking at things like I’ve
always wanted to do, like car body parts...I think I’m
going to do it and my boyfriend’s like ‘are you sure?,
you know it’s at night during the week in September
and you’d have to go and mix with others’ cos I’m not
good with groups and stuff and I’m like ‘I really want
to do it’, I look good, I want to do it I feel better, I’m
exercising I feel as though I’m at a stage of me life
where everything’s coming together I want to do it
and I’m getting to that stage now where I’m getting a
little bit more adventurous, that’s because I feel
good though, does that make sense?”
Improved self-perception
More confidence
Recovery & enhanced quality of life
 Frequency
 Intensity
 Type
 Time
 Experience



providing meaning and purpose
Mike: purpose was to control illness
Tina: purpose was to improve self
For others part of a former self was recovererd
 Autonomous
 Stage
of illness
 Balance of medications
 Meaningful


Environment
Type
9
participants
 2 focus groups


Early Intervention team
Mix of service leads, psychiatrist & support
worker
 Results.........
 Key




points:
PA is seen as beneficial
Difficult to promote because of time constraints
PA is implemented bottom-up
Would worry if it became top-down
 Physical
activity is related to physical quality
of life
 Could be explained through change in body
image/fitness
 Quant study found no relationship between
PA and mental quality of life
 Qual study found that PA is beneficial to
mental quality of life
 Difficult to separate the mind and body;
Treat one you treat the other.