The effectiveness of cognitive-behavioural interventions at increasing adherence to physical activity in mental health populations: a systematic review

Objective: There is growing global evidence for stark inequalities in the physical health status and life-expectancy of people with a mental health diagnosis. In most cases, physical activity (PA) is one of the most effective methods of maintaining physical and mental health. However, people with mental health challenges are less likely to adhere to recommended levels of PA, leading to a vicious cycle of poor physical and mental health. The objective of this paper is to assess if, and how cognitive-behavioural (CB) techniques increase adherence to PA in mental health populations. Method: Systematic review and narrative synthesis. Inclusion criteria were: a behavioural change intervention which targeted PA using CB approaches; Delivered to adults with a mental health condition as defined by DSM V or ICD-10; Report adherence to the intervention AND physical activity; RCT, cluster RCT, quasi-experimental, or controlled before and after study. Electronic searches conducted in MEDLINE, CINAHL, Cochrane Library (Trials), SPORTDiscus and PsycINFO. Results: Ten studies from seven countries were synthesised. Methodologically moderate to weak, all showed adherence to the intervention to be associated with increased levels of PA. All studies reported higher than average adherence to PA in the intervention groups. Discussion: CB interventions were associated with improved adherence to PA in international samples of people with mental health conditions. Studies adopting more robust designs are needed to quantify optimal interventions and impact, but this original synthesis is encouraging for researchers and clinicians alike looking to maximise the synergy between physical and mental health. Registration number: CRD42017057918