Physical Activity for Mental Health - Final Evaluation Report

Submitted by

Nancy Dubois
Evaluation Consultant
DU B Fit

March 2010

Download complete report (PDF)


Executive Summary

The purpose of the Minding Our Bodies: Physical Activity for Mental Health (MOB) program to increase capacity within the community mental health system to promote active living and to deliver integrated opportunities for physical activity for people with serious mental illness as an essential element for recovery. The intent is to create a provincial mental health promotion program that serves as an “incubator” to help mental health service providers in Ontario develop and deliver evidence-based physical activity programs in their local communities.  Minding Our Bodies is an initiative of the Canadian Mental Health Association, Ontario, in partnership with Mood Disorders Association of Ontario, Nutrition Resource Centre, YMCA Ontario, and York University's Faculty of Health with support from the Ontario Ministry of Health Promotion.

This program is important because people with serious mental illness are at high risk for chronic physical conditions associated with sedentary behaviour, including diabetes and cardiovascular disease. At the same time, mental illness can influence a person’s health behaviour. Studies indicate that depression, for example, negatively impacts a person’s nutritional choices, their commitment to exercise, and adherence to medical therapies. Choices around diet, exercise, smoking and treatment adherence can all have a serious impact on the state of one’s physical health. To compound the issue, psychiatric medications can cause significant weight gain, and a high percentage of people with serious mental illness are smokers, often as a means of combating the side-effects of medication.

Research evidence also shows that increased physical activity can have significant positive effects in preventing chronic disease, improving chronic disease outcomes and supporting recovery from mental illness. Exercise can alleviate primary symptoms of depression and anxiety, as well as secondary symptoms such as low self-esteem and social withdrawal. Yet despite the known benefits, physical activity interventions are not commonplace or well integrated with other services delivered by community mental health care providers in Ontario.

In response to this need, a multifaceted approach was developed that included the selection of six community settings that would each develop their own approach to implementing a six month pilot physical activity program, in conjunction with at least one community partner; the development of a toolkit and associated online resources to support the community programs; a one-day training session for staff, peer leaders and volunteers in each of the six pilot sites; a communication strategy to raise awareness of the project, engage the broader community and share project findings.  Three of the pilot communities received approximately $7500 to undertake their program (CMHA, Thunder Bay; Gerstein Centre, Toronto; Haldimand-Norfolk Resource Centre, Simcoe) while the other three did not receive funding (Community Resource Connections of Toronto; SEARCH Community Mental Health Services, Strathroy; Sunnybrook Health Sciences, Toronto). 

This report summarizes the evaluation aspect of the program beginning with the program objectives and indicators in Section 1.0, followed by a description of the five research questions and the seven data sources in Section 2.0: Evaluation Methodology.  Section 3.0 presents the results of the evaluation, organized into formative, process and outcome sections followed by a detailed case study for each of the six pilot programs implemented. Finally, Section 4.0 discusses the findings of the program and makes recommendations for the future of the program, organized by the five strategies of the MOB program – Communication, Training, Toolkit Development, Toolkit Implementation and Collaboration.  Several appendices are embedded that provide specific tools and instruments used in the evaluation, and many other documents that detail the process undertaken.

Although each of the six pilot programs was unique there were some cross-cutting lessons learned. 

  • Participants do not want to participate in activities for which they did not know the proper technique. One group brought in a bowling coach to help teach participants the proper technique.
  • Participants were less likely to participate when the activity was in a public setting. For some groups this resistance decreased once the skills were developed in a private setting and then the whole group went together into a public setting. 
  • Poor fitness level as a result of high body weight created a greater challenge to participation than the mental health issues. This was overcome by finding activities that did not rely on high levels of coordination, aerobic conditioning and flexibility. 
  • Transportation to the physical activity setting was more difficult in rural settings. Having physical activity programs close to other programs run by the organization (often in the same building) helped as did having a vehicle to pick up participants. 
  • Programs need to have a variety of activities so participants can choose appealing options.
  • Provide a variety of entry times to join the group.
  • Continue with an activity long enough to allow participants to build confidence in the activity and develop a relationship with each other.
  • Encourage the whole staff team to become physically active.
  • Incentives are a good motivational tool as they can be used to encourage people to start, to continue or to build group identity.
  • Programs were most successful when they were not first thing in the morning. Having programs in the late morning and the afternoon made it easier for participants to find transportation to the program and to eat and take their medication beforehand.
  • Participants were thriving with the social support they received from their peers in the group. It is important to keep a collegial atmosphere that is supportive and not too competitive.
  • Most groups had an interest in nutrition and diabetes prevention and treatment.  Program partners often took on that role.
  • Engage consumer and peer leads to take on leadership and organizational roles within the group.
  • Have a consistent schedule so that participants can incorporate it into their routine.
  • Training and providing an orientation for outside instructors can help to make sure instructors know what to expect and allows them time to think about possible modifications for various abilities. 
  • Need to have a supportive management because a staff person needs to be made responsible for the program and given time to coordinate it.
  • Realistic goal setting helps participants increase confidence and a sense of accomplishment.

These learnings have contributed, in part, to a successful application for funding to support Phase Two of the MOB program that will focus on healthy eating beginning in 2010.
 

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