Abstract
The scientific evidence for the effectiveness of regular moderate-intensity physical activity in alleviating anxiety and depression symptoms is well documented [1–3]. Low-risk exercise programmes such as walking (briskly) have been shown to be well-received in the general population [4]. Physical activity is also widely accepted by the public as a complementary treatment likely to be helpful for anxiety and depression [5]. Nonetheless, Australian mental health services do not routinely integrate physical activity into routine outpatient treatment regimens. Limited understanding about the efficacy of physical activity for mental illness may influence the clinics’ decision not to consider exercise. To identify strategies to support physical activity promotion in the mental health services setting, we conducted an e-survey to ascertain the prevailing perceptions and current practices relating to physical activity counselling among mental health therapists. The e-survey was carried out as formative research around a physical activity intervention trial for adults with generalized anxiety disorders [6].
Two-page questionnaires containing a series of statements about physical activity counselling were emailed to all mental health therapists listed in the southwest Sydney psychology register. The survey included 51 therapists (53% response rate): of these 74% were female, 66% worked in community health centres, and 16% in hospitals and the rest in private clinics, specialist centres, and schools. Approximately 51% of responders agreed that providing physical activity counselling was part of their job, and 40% had recommended physical activity to their patients. These estimates are lower than in earlier studies of US psychologists that reported a physical activity counselling rate of 83% [7] while another reported that 93% [8] would recommend exercise to their patients.
Seventy-one percent believed that conventional methods of treating mental health problems, such as cognitive behavioural therapy, were effective treatments, while 14% believed that their patients would not benefit from physical activity advice, and 12% believed that their patients were more likely to follow conventional treatment strategies. Only 12% of the responders believed that physical activity is important for chronic health problems (diabetes, obesity, heart disease), but not for managing mental illness. Approximately 57% indicated that they had a good knowledge about the therapeutic potential of physical activity.
Overall, the therapists surveyed indicated favourable attitudes to physical activity, although selection bias needs to be considered when interpreting these results. Nonetheless, the findings highlight three issues for consideration: first, therapists were generally aware of the importance of physical activity for mental health, but not as a priority as an adjunctive intervention. It is also debatable whether such awareness is translated into a counselling approach that would sustain physical activity behaviour change. Second, knowledge improvement about the therapeutic effects of physical activity on a range of mental health outcomes, not just depression, is required. Third, clinical time constraints, the severity of mental illness, and perceptions that patients prefer conventional rather than alternative or lifestyle recommendations might be some of the reasons preventing therapists from providing systematic physical activity advice to patients. These issues need to be examined before effective physical activity programmes can be successfully integrated into clinical settings.
To our knowledge this is the first attitudinal survey of mental health professionals in the Australian context regarding lifestyle issues. Although the present study did not identify whether therapists are interested in acquiring specific skills on physical activity promotion, their role in helping patients adopt and maintain health-enhancing physical activity behaviour is without question; how mental health services can best support this requires further investigation.