An exploration of physical activity and quality in life of people with psychosis

Background: Quality of life (QoL) is known to be lower in people with psychosis than the general population. Physical activity (PA) has been suggested as one way to improve QoL, but little is known about the relationship between PA and QoL in people with psychosis. No known research has implemented mixed methods (MM) to explore PA and QoL in people with psychosis. Aim: To explore if and how PA is associated with QoL in people with psychosis. Methodology: A MM design was implemented which consisted of three studies. Study one was a cross-sectional survey design, which assessed the relationship between PA and QoL (n=79). Study two was a phenomenological study which involved conducting semi-structured interviews with people who were perceived to be active by professionals or themselves (n=8). Study three entailed conducting focus groups with mental health professionals which were analysed using thematic analysis (n=10). Results: Study one: Those achieving PA guidelines scored significantly higher on physical QoL than those who did not meet the guidelines. Moderate and vigorous intensity PA were related to physical QoL and walking was associated with better social functioning. No PA variables were related to mental QoL. Study two: Four major themes emerged: 1) cocooned in a web of lethargy and tangled thoughts, 2) Experiencing a snapshot of reality, 3) Being ‘normal’, 4) Dance as if no-one is watching. Study three: Four major themes were found: 1) Service provision, 2) Professional interpretation of policy, 3) Professional personal experiences and beliefs, 4).Negative experiences. Upon synthesising the outcomes of the studies it was concluded that if PA was seen as meaningful to the individual it was beneficial for QoL. PA emerged as meaningful for the participants for the following reasons: it was perceived to develop self; provide time-out from symptomology; present the opportunity to break free into a real and social world; and enable self, mind and body to feel they belong and therefore feel ‘normal’. However, the type, intensity, amount of PA and the stage of the participants’ illness were all seen to influence the perceived impact on QoL. A number of implications for supporting PA services within Mental Health Trusts were suggested. The main finding in relation to service implications was that PA needs to be provided consistently and not in an ad-hoc manner which was found to be detrimental to Service Users routine and autonomy. Further, it is suggested that a broader range of PA provision should be available for those with psychosis to suit individual needs. However, consideration should be given to the intensity, amount and type of PA as well as the perceived severity of the illness. Conclusion: The findings from this thesis add support to the proposition that PA can be used to enhance QoL in people with psychosis. Professionals are encouraged to promote PA, with the caveat that it should be perceived to be meaningful by the individuals with psychosis.