Determinants of physical activity and exercise in individuals with mental illness: results from a large cross-sectional online survey

Objective Regular exercise significantly benefits mental health, yet its therapeutic potential in psychiatric care remains underutilised. Understanding the factors influencing physical activity in individuals with mental illness is crucial to realising its full therapeutic potential. Our study seeks to explore motivational and socio-demographic determinants affecting exercise habits in individuals with mental illness and compare them to those without mental illness. Design and setting Distribution of the link to a cross-sectional online survey at psychiatric clinics, practices, university events and sports clubs, via self-help group email lists and on social media. Methods An online survey using validated questionnaires supplemented with self-developed items was conducted. Statistical analysis encompassed unpaired t-tests and chi(2) tests to compare individuals with and without mental illness, as well as multiple linear regression to investigate the relationship between childhood exercise experience, psychometrics and current physical activity behaviour in individuals with mental illness. Participants 1564 individuals (66.5% female) including 417 diagnosed with any kind of mental illness. Results In comparison with mentally healthy participants, individuals diagnosed with mental illness displayed notably lower activity levels (eg, engaging in regular physical activity 55.6% vs 69.3%, x2(1, n=1458) = 26.03, p<0.001), autonomous motivation (sport- und bewegungsbezogene Selbstkonkordanzskala Index: M=3.62, SD=3.07 vs M=4.62, SD=2.74, t(594.58)=5.4, p=0.009), self-efficacy expectancies (Allgemeine Selbstwirksamkeit Kurzskala: M=3.65, SD=0.81 vs M=4.10, SD=0.59, t(505.39)=9.76, p<0.001), and resilience (Brief Resilience Scale: M=2.81, SD=0.83 vs M=3.46, SD=0.70, t(555.52)=13.28, p<0.001), and a greater external locus of control (Internale-Externale-Kontroll & uuml;berzugung Scale: M=2.53, SD=0.89 vs M=2.13, SD=0.76, t(565.43)=-7.78, p<0.001). Throughout childhood and adolescence, they reported less activity (66.9% vs 78.0%, x2(1, n=1549) = 18.22, p<0.001) and lower grades in physical education (M=2.1, SD=0.8 vs M=1.8, SD=0.8, U=1 888 071.00, Z=-6.19, p<0.001). Individuals with mental illness favoured a structured sports programme led by professionals. Factors like self-concordance (ss=0.29, p<0.001), intrinsic motivation (ss=0.22, p=0.02), and self-efficacy expectations (ss=0.35, p<0.001) were strong predictors of current physical activity levels (eg, measured as training sessions per week) in this group. Conclusion There is a dire need for professionally supervised, small group exercise programmes for people with mental illness incorporating cognitive-behavioural elements, to better address their individual needs and to positively influence previously mentioned psychometric determinants. Furthermore, the importance of sport and physical activity in childhood, and especially in adolescence, was reaffirmed, underlining the paramount importance of youth sport programmes in long-term health promotion from a public health perspective.