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VOL: 97, ISSUE: 47, PAGE NO: 34

Matthew Morrissey, MSc Psych, BSc, RMN, DipHE, PGCE, RNT, is senior lecturer in mental health

Jim Wiles, MPhil, BSc, CertEd, is senior lecturer in sports science, Canterbury Christchurch University College, Kent

Before the development of tranquillisers in the 1950s, exercise was an important part of inpatient care for people with mental health problems. The emphasis was on the patient's physical health and the relief of symptoms, and physical education or recreation was almost compulsory.

Before the development of tranquillisers in the 1950s, exercise was an important part of inpatient care for people with mental health problems. The emphasis was on the patient's physical health and the relief of symptoms, and physical education or recreation was almost compulsory.

Exercise was seen as a healthy way to channel patients' energies, encouraging normal sleep and providing an outlet for sexual and physical frustrations (Sheehan, 1991).

Research examining its effects has tended to focus primarily on its physical benefits (Adams, 1995; Scully et al, 1998). However, recent evidence indicates that exercise has many positive benefits for mental and emotional health (Morrissey, 1997; Krucoff, 1999; Carter-Morris, 2001). The use of moderate exercise programmes in the treatment and prevention of psychological illness is relatively safe, social and inexpensive, and has no side-effects provided that it is tailored to individual or group needs (Morrissey, 1997; Crone-Grant and Grant, 2000).

The benefits of physical exercise include:

- Helping patients express themselves through movement, posture and actions;

- Providing a socially acceptable outlet for anger and aggressive impulses;

- Promoting self-confidence;

- Improving feelings of control;

- Inspiring motivation;

- Enhancing body image;

- Reducing tension;

- Reducing boredom.

Exercise also distracts people from worry, relieves tension, aids relaxation, improves mood and creates a general feeling of well-being.

Immediately after exercising patients can find that they have increased energy levels, a feeling of achievement, increased motivation and feelings of happiness (Morrissey, 1997).

In light of this, it is surprising to note the diminishing role of exercise in the treatment of mental health problems over the past 30 years (Glenister, 1996). This may be due to its regimental and historic origins, the closure of many psychiatric hospitals, or an increasing reliance in drugs and other forms of therapy.

People who are receiving inpatient care for mental health problems have been shown to have a lower level of physical fitness than the average person (Morgan and Goldston, 1987). It is therefore important that some form of exercise is encouraged. Both non-aerobic and aerobic exercises offer similar benefits (Byrne and Byrne, 1993).

Introducing exercise
All patients should be assessed, taking into account their medical history. This should reveal any physical injuries or conditions that might affect their ability to participate in exercises. If the patient is found to be suitable for general exercise, you will then need to decide on the most appropriate type(s) of exercise.

Numerous factors, such as finances and human and physical resources, will affect the type of exercise chosen. However, a number of common principles should be applied to all but the easiest level of exercise therapy sessions (Bompa, 1999).

Preparing to exercise
Warming-up helps to ease the body from a resting to an active state, while minimising the stress on the muscles, including the most important muscle, the heart.

In practical terms, the warm-up should consist of gentle aerobic exercises such as brisk walking, jogging or cycling. It should aim to raise the body temperature by about 2oC (as indicated by a slight sweat) and increase the heart rate to about 120-130bpm.

After this, a number of general stretches (Box 1) should be used to ensure that the body is fully prepared for more vigorous exercise. The entire warm-up procedure usually takes 8-12 minutes.

Choosing the programme
It is essential that patients are exposed to a level of exercise appropriate to their age and fitness levels. The form of exercise chosen will depend largely on preference. However, for an example of a simple exercise circuit see Box 2 (Morrisey, 1997).

After any exertion it is advisable that the heart rate and other physical parameters are returned to resting levels before the exercise therapy session ends. A warm-down usually consists of gentle aerobic exercise to reduce the heart rate gradually while maintaining muscle action. The alternate contraction and relaxation of skeletal muscle facilitates venous return, reducing the likelihood cardiac muscle strain while clearing the active muscles of any metabolic waste products that may have accumulated during the exercise session.

Once it has been ascertained that patients are likely to benefit from exercise therapy, which can be done through a short questionnaire or a structured interview conducted the day after their first exercise session, a longer-term exercise therapy plan should be devised.

For maximum physical and mental benefit, exercise therapy sessions should be held two or three times a week, with at least one day's rest between sessions. Nurses should try to incorporate some variation into the exercise sessions every couple of weeks so that patients are continually stimulated and less likely to get bored.

In what often seems a sea of practical impossibilities, exercise may provide the kind of activity that can lift the spirits of staff while providing mental health services users with much-needed relief from emotional and mental distress.

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