The effectiveness of physical activity interventions that include both physical activity and psychosocial strategies in people living with a severe mental illness: a systematic review and meta-analysis

Individuals with a severe mental illness are at an increased risk of failing to meet physical activity guidelines. This study aimed to identify and describe the influence of a physical activity intervention that includes both physical activity and psychosocial strategies, on physical activity behaviour in a population living with a severe mental illness. A systematic search was conducted in July 2019 and updated August 2022. The search was conducted in PsycInfo, MEDLINE, PsycArticles, Psychology and Behavioural Sciences Collection, PUBMED, SportDiscus SCOPUS, and CINAHL. Inclusion criteria required studies to be peer reviewed research articles and published in English. Furthermore, studies had to include a physical activity intervention which involved a physical activity and psychosocial component. Included studies recruited participants diagnosed (DSM or ICD) with a severe mental illness and must have reported physical activity behaviours. Two reviewers independently completed data extraction based on the Cochrane data collection form for intervention reviews: RCTs and non-RCTs - Version 3, April 2014. Two reviewers independently assessed study quality and risk of bias. The systematic review included 16 studies (n = 868), with a comprehensive narrative review highlighting similarity and differences. Eight studies were included in the meta-analysis (n = 540), each of the included studies had a control condition (n = 252). The pooled analyses were based on random effects models. Overall, there was no difference (g = 0.17, 95% CI -0.20, 0.54, p = 0.36) in physical activity levels between intervention and control participants after a physical activity intervention that included both physical activity and psychosocial components. Further analyses investigated subgroups of studies based on participant, intervention and outcome characteristics. Subgroup analyses yielded one significant effect, with physical activity being higher in the intervention compared to the control condition when device-based measurement was used. The certainty of the evidence was determined to be 'very low,' as the current review identified issues with inconsistency, indirectness, and publication bias. Results of quality assessment and risk of bias assessment uncover numerous concerns regarding the quality of the studies including inadequate description of methods and the lack of adherence assessment. Current findings highlight significant methodological limitations in this area of research. Research must continue to investigate the use of combined physical activity and psychosocial strategies to better support those with a severe mental illness.