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Description: Physical activity in adult users of inpatient mental health services: a scoping review Authors Garry Tew1 Emily Peckham2 Suzy Ker3 Jo Smith3 Philip Hodgson1, 3 Sarah Daniel3 1. York St John University 2. University of York 3. Tees Esk and Wear Valleys NHS Foundation Trust Abstract Objective: The objective of this scoping review is to understand the extent and type of evidence in relation to physical activity in adult users of inpatient mental health services. Introduction: People with severe mental ill health (SMI) engage in considerably less exercise and physical activity than their counterparts in the general population. People with SMI also experience a premature mortality of around 10–20 years. A large proportion of these premature deaths are attributed to potentially modifiable behaviours, including physical activity. The inpatient environment provides an opportunity to support people with SMI to become more physically active, however there is limited evidence on what interventions are most successful, and under what circumstances. This scoping review will help us to understand the extent and type of evidence in this area and identify research gaps. Inclusion criteria: We will include studies pertaining to physical activity in adult users of inpatient mental health services that were published in a peer-reviewed journal. Reviews and meta-analyses will be excluded from data analysis, as will papers focusing on eating disorder populations. Methods: We will search MEDLINE, CINAHL, PsycINFO, ASSIA and Web of Science databases and forward and backward citations for studies published in English since January 2007. Search terms will relate to psychiatric inpatients and physical activity. Record screening and data extraction will be performed independently by two reviewers. We will extract data on study design, participant characteristics, intervention and control conditions, and key findings. We will use a descriptive analytical approach with results being presented in tables and figures. Keywords Exercise; Physical activity; Psychiatric inpatients; Severe mental illness Introduction People with severe mental ill health (SMI) engage in considerably less exercise and physical activity than their counterparts in the general population. People with SMI also experience a premature mortality of around 10–20 years [1-3]. A large proportion of these premature deaths are attributed to potentially modifiable behaviours, including physical activity [4]. The inpatient environment provides an opportunity to support people with SMI to become more physically active, however there is limited evidence on what interventions work and under what circumstances. This scoping review will help us to understand the extent and type of evidence in this area and identify research gaps. Preliminary searches of MEDLINE and PROSPERO identified a published scoping review on physical activity in secure settings that was published in 2019 [5] and an ongoing systematic review on the efficacy of exercise interventions in inpatient mental health settings [6]. The current review has a broader remit than these existing reviews both in terms of the inpatient environment (e.g., not limited to secure psychiatric settings) and the aspects of physical activity considered (e.g., not limited to exploring efficacy of interventions). The overarching objective of this scoping review is to understand the extent and type of evidence in relation to physical activity in adult users of inpatient mental health services. Review questions 1. What are the characteristics and findings of studies of physical activity interventions for this population? 2. What physical activity support is offered to people after they have been discharged from the inpatient setting (up to 6 months post-discharge)? 3. What are the determinants of physical activity in adult users of inpatient mental health services? Eligibility criteria Participants/context We will include studies pertaining to adult (≥18 years) users of inpatient mental health services. This would include both studies where psychiatric inpatients are the participants and studies where other stakeholders are involved (e.g., healthcare professionals giving their views regarding services for psychiatric inpatients). Studies focusing on learning disability populations will be included whereas those focusing on eating disorder populations will be excluded. There will be no limits on the country of origin. Concept The phenomenon of interest is physical activity. Physical activity is defined as any bodily movement produced by skeletal muscles and requiring energy expenditure [7]. Exercise is a subset of physical activity that is defined as any structured and repetitive physical activity that has an objective of improving or maintaining physical fitness [7]. We will include studies that address the aforementioned review questions and will take a broad view of physical activity, including studies that have focused on supervised exercise or promotion of self-managed physical activity. We will exclude studies on physical activity that do not relate to the review questions. Types of Sources This scoping review will consider both experimental and quasi-experimental study designs including randomised controlled trials, non-randomised controlled trials, before and after studies and interrupted time-series studies. In addition, analytical observational studies including prospective and retrospective cohort studies, case-control studies and analytical cross-sectional studies will be considered for inclusion. This review will also consider descriptive observational study designs including case series, individual case reports and descriptive cross-sectional studies for inclusion. Qualitative studies will also be considered that focus on qualitative data including, but not limited to, designs such as phenomenology, grounded theory, ethnography, qualitative description, action research and feminist research. Review articles and meta-analyses will be used to identify primary studies, but will be excluded from data analysis. Conference abstracts and opinion papers will be excluded. Methods The proposed scoping review will be conducted in accordance with the JBI methodology for scoping reviews [8]. Search strategy The search strategy will aim to locate published studies only. An initial limited search of MEDLINE was undertaken to identify articles on the topic. The text words contained in the titles and abstracts of relevant articles, and the index terms used to describe the articles were used to develop a full search strategy for MEDLINE, CINAHL, PsycINFO, ASSIA and Web of Science databases (Appendix 1). The search strategy, including all identified keywords and index terms, will be adapted for each included database and/or information source. The reference list of all included sources of evidence, as well as that of any review articles or meta-analyses, will be screened for additional studies. We will also do forward citation tracking of included studies using Google Scholar. We will only include studies that were published in English language and from 2007 onwards. The latter relates to amendments in the 1983 Mental Health Act that were made in 2007; studies before this time may have used different clinical practices and patient populations. Study/Source of Evidence selection Following the search, all identified citations will be collated and uploaded into Rayyan [9] and duplicates removed. Following a pilot test, titles and abstracts will then be screened by two independent reviewers for assessment against the inclusion criteria for the review. Potentially relevant sources will be retrieved in full and assessed in detail against the inclusion criteria by two independent reviewers. Reasons for exclusion of sources of evidence at full text that do not meet the inclusion criteria will be recorded and reported in the scoping review. Any disagreements that arise between the reviewers at each stage of the selection process will be resolved through discussion, or with an additional reviewer/s. The results of the search and the study inclusion process will be reported in full in the final scoping review and presented in a Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for scoping review (PRISMA-ScR) flow diagram [10]. Data Extraction Data will be extracted from papers included in the scoping review by two or more independent reviewers using a data extraction tool developed by the reviewers. The data extracted will include specific details about the participants, concept, context, study methods and key findings relevant to the review questions. A draft data extraction tool [11] will be modified and revised as necessary during the process of extracting data from each included evidence source. Modifications will be detailed in the scoping review. Any disagreements that arise between the reviewers will be resolved through discussion, or with an additional reviewer. If appropriate, authors of papers will be contacted to request missing or additional data, where required. Data Analysis and Presentation A descriptive analytical approach will be used to summarise the contextual, process and outcome related data from the included studies. The aim will be to map the key concepts and available evidence, summarise existing research findings, and identify gaps in the literature. The analysis will be reported in accordance with the SWiM guideline [12], with data presented in tables and figures where appropriate. Funding This review is supported by a Research Capability grant from Tees, Esk and Wear Valleys NHS Foundation Trust and UK Research and Innovation (reference ES/S004459/1). Any views expressed here are those of the project investigators and do not necessarily represent the views of UK Research and Innovation. Conflicts of interest There is no conflict of interest in this project. References [1] Chesney E, Goodwin GM, Fazel S. Risks of all‐cause and suicide mortality in mental disorders: a meta‐review. World psychiatry. 2014 Jun;13(2):153-60. [2] Walker ER, McGee RE, Druss BG. Mortality in mental disorders and global disease burden implications: a systematic review and meta-analysis. JAMA psychiatry. 2015 Apr 1;72(4):334-41. [3] Brown S, Kim M, Mitchell C, Inskip H. Twenty-five year mortality of a community cohort with schizophrenia. The British journal of psychiatry. 2010 Feb;196(2):116-21. [4] Royal College of Psychiatrists. Working Group for Improving the Physical Health of People with SMI (2016) Improving the physical health of adults with severe mental illness: essential actions (OP100). London: Royal College of Psychiatrists. Available at: https://www.aomrc.org.uk/reports-guidance/improving-physical-health-adults-severe-mental-illness-essential-actions/. [5] Rogers E, Kinnafick FE, Papathomas A. Physical activity in secure settings: a scoping review of methods, theory and practise. Mental Health and Physical Activity. 2019 Mar 1;16:80-95. [6] Martland R, Stubbs B, Firth J, Vancampfort D. The efficacy of exercise interventions in inpatient mental health settings: a systematic review and meta-analysis. PROSPERO 2020 CRD42020183359 Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020183359 [7] Caspersen CJ, Powell KE, Christenson GM. Physical activity, exercise, and physical fitness: definitions and distinctions for health-related research. Public health reports. 1985 Mar;100(2):126. [8] Peters MDJ, Godfrey C, McInerney P, Munn Z, Tricco AC, Khalil, H. Chapter 11: Scoping Reviews (2020 version). In: Aromataris E, Munn Z (Editors). JBI Manual for Evidence Synthesis, JBI, 2020. Available from https://synthesismanual.jbi.global https://doi.org/10.46658/JBIMES-20-12 [9] Ouzzani M, Hammady H, Fedorowicz Z, Elmagarmid A. Rayyan — a web and mobile app for systematic reviews. Systematic Reviews (2016) 5:210, DOI: 10.1186/s13643-016-0384-4. [10] Tricco AC, Lillie E, Zarin W, O'Brien KK, Colquhoun H, Levac D, Moher D, Peters MD, Horsley T, Weeks L, Hempel S. PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. Annals of internal medicine. 2018 Oct 2;169(7):467-73. [11] JBI template source of evidence details, characteristics and results extraction instrument. https://jbi-global-wiki.refined.site/space/MANUAL/4687579 Accessed 20 Sept 2022. [12] Campbell M, McKenzie JE, Sowden A, Katikireddi SV, Brennan SE, Ellis S, Hartmann-Boyce J, Ryan R, Shepperd S, Thomas J, Welch V. Synthesis without meta-analysis (SWiM) in systematic reviews: reporting guideline. bmj. 2020 Jan 16;368. Appendices Appendix 1: Search strategy Mental health terms: title and abstract (Mental health or Mental well-being or Mental well being or Psychological well being or Psychological well-being or Mental disorder* or Mental illness* or Mental disease* or Anxiety disorder* or Delirium or Dissociative disorder* or Factitious disorder* or Mood disorder* or Affective disorder* or Depressive disorder* or Neurotic disorder* or Personality disorder* or Schizophreni* or Somatoform disorder* or Adjustment disorder* or Neuros?s or Psychos?s or Delusion* or Paranoia or Hallucination* or Depression or Panic disorder* or Phobia* or Health anxiet* or Bipolar disorder* or Obsessive compulsive disorder* or Obsessive thought* or Intrusive thought* or Post traumatic stress disorder* or Post-traumatic stress disorder* Inpatient setting terms: title and abstract (Hospital* or Acute care or Secondary care or Tertiary care or Low secure or Medium secure or High secure or Secure facilit* or Forensic* or Inpatient* or Triage or (Acute hospitals or Mental health hospitals or hospitals) or Inpatients or Unit* or Ward*)) Physical activity terms: title and abstract Exercis* or exercise or “physical exertion” or “physical fitness” or jog* or (physical* adj3 (activ* or fit*)) or Aerobics or swim* or gym* or sport* or workout or skip* or calisthenics or e-Exercise or Bicyc* or Cycling or Parkrun or Couch to 5k or Danc* Limits: - Date: 2007 onwards - English language only