The use of physical exercise in forensic psychiatric care in Sweden: a nationwide survey

Figures & data

Table 1. Demographic description and physical activity levels of health professionals in forensic psychiatric care.

Characteristic	Absolute numbers (valid %)
Gender N = 237
Male	78 (32.9)
Female	158 (66.7)
Other	1 (0.4)
Years of age, mean (SD) N = 234	43.3 (SD 12.7)
Years of work, mean (SD) N = 237	12.9 (SD 9.0)
Profession N = 238
Health worker	5 (2.1)
Nurse	136 (57.1)
Occupational therapist	20 (8.4)
Physician	26 (10.9)
Physiotherapist	5 (2.1)
Psychologist	15 (6.3)
Social worker	21 (8.8)
Other	10 (4.2)
Academic degree N = 228
BSc	128 (56.1)
MSc (4 years)	37 (16.2)
MSc (5 years)	18 (7.9)
Licentiate	5 (2.2)
PhD	7 (3.1)
Other	33 (14.5)
Employment N = 236
Full time	209 (88.6)
Part time	12 (5.0)
Casual	8 (3.3)
Other	7 (3.0)
Mean level of physical activity N = 226	2799.8 METmin/week (SD 2159.3)
Level of physical activity:
Low	32 (14.1)
Moderate	85 (37.6)
High	109 (48.2)

Table 2. Knowledge (Q1–4) and behaviors (Q19–25) regarding exercise for patients with a mental illness of health professionals in forensic psychiatric care.

Item	Answer options	Number (valid %)
Q1 Have you had any formal training in exercise prescription (e.g. university degree in a related area, vocational training, In-service)? N = 239	Yes	39 (16.3)
	No	200 (83.7)
Q3 If ‘yes’ on Q1, how would you rate your knowledge of exercise prescription for people with a mental illness? N = 39	Very poor	1 (2.6)
	Poor	6 (15.4)
	Average	16 (41.0)
	Good	13 (33.3)
	Excellent	3 (7.7)
Q4 If ‘yes’ on Q1, how would you rate your confidence to prescribe exercise for people with mental illness? N = 39	Very poor	3 (7.7)
	Poor	7 (17.9)
	Average	12 (30.8)
	Good	14 (35.9)
	Excellent	3 (7.7)
Q19 Do you prescribe exercise to people with a mental illness? N = 236	Never	110 (46.6)
	Occasionally	57 (24.2)
(Participants who answered ‘Never’, were instructed to skip to Q26)	Most of the time	46 (19.5)
	Always	23 (9.7)
Q20 Do you undertake a formal assessment of the clients’ suitability for exercise prior to prescribing a program? N = 122	Yes	63 (51.6)
	No	59 (48,4)
Q21 When you prescribe exercise to people with a mental illness, what methods do you use? (Please tick all that apply) N = 119	Personal discussion	112 (94.1)
	FaR^a prescription	22 (18.5)
	Brochures or pamphlets	20 (16.8)
	Referral to gym or other exercise facility	56 (47.1)
	Referral to an exercise professional	62 (52.1)
	Nothing specific	9 (7.6)
Q22 When you prescribe exercise to people with a mental illness, how often do you recommend they exercise? (Please select only one response) N = 116	Every day	14 (12.1)
	Most days of the week	22 (19.0)
	Once to twice a week	22 (19.0)
	As often as they feel they can	36 (31.0)
	Other	22 (19.0)
Q23 When you prescribe exercise to people with a mental illness, how hard (what intensity) do you recommend they exercise? (Please select only one response) N = 114	Low intensity	8 (7.0)
	Moderate intensity	36 (31.6)
	Vigorous intensity	3 (2.6)
	At a level that makes them feel good	28 (24.6)
	I do not suggest an intensity	27 (23.7)
	Other	12 (10.5)
Q24 When you prescribe exercise to people with a mental illness, how long do you suggest people try to exercise for at any one time? (Please select only one response) N = 118	10 minutes per session	9 (7.6)
	20 min per session	14 (11.9)
	30 min per session	38 (32.2)
	60 min per session	1 (0.8)
	As long as they can	29 (24.6)
	Other	27 (22.9)
Q25 When you prescribe exercise to people with a mental illness, what type of exercise do you suggest? (Please tick all that apply) N = 121	Aerobic exercise	109 (45.6)
	Weight or resistance training	37 (15.5)
	Swimming	52 (21.8)
	Team sports	35 (14.6)
	Combat sports	2 (0.8)
	Relaxation activities (tai chi, Yoga)	56 (46.3)

^a Prescription according to the Swedish system of ‘Exercise on prescription’.

Figure 1. Prescription behaviors of the 126 health professionals in forensic psychiatric care, that stated that they do prescribe exercise, at least occasionally.

Figure 2. Levels of agreement to statements Q27 ‘I’m concerned exercise might make their condition worse’ and Q29 ‘I don’t believe exercise will help people with a mental illness’, by health professionals in forensic psychiatric care (n = 238).

Table 3. Levels of agreement by health professionals regarding barriers to exercise prescription (Q26–36) for patients with a mental illness in forensic psychiatric care.

	Absolute numbers (valid %)
Items	Strongly disagree	Disagree	Neither disagree nor agree	Agree	Strongly agree
Q26 Their mental health makes it impossible for them to participate in exercise N = 238	77 (32.2)	105 (43.9)	41 (17.2)	13 (5.4)	2 (0.8)
Q27 I am concerned exercise might make their condition worse N = 238	135 (56.5)	93 (38.9)	7 (2.9)	2 (0.8)	1 (0.4)
Q28 I am not interested in prescribing exercise for people with a mental illness N = 238	108 (45.2)	80 (33.5)	33 (13.8)	10 (4.2)	7 (2.9)
Q29 I do not believe exercise will help people with a mental illness N = 238	194 (81.2)	43 (18.0)	0 (0)	1 (0.4)	0 (0)
Q30 Their physical health makes it impossible for them to participate in exercise N = 237	114 (47.7)	100 (41.8)	19 (7.9)	4 (1.7)	0 (0)
Q31 I am concerned they might get injured while exercising N = 238	92 (38.5)	111 (46.4)	28 (11.7)	6 (2.5)	1 (0.4)
Q32 People with a mental illness will not adhere to an exercise program N = 237	28 (11.7)	84 (35.1)	101 (42.3)	23 (9.6)	1 (0.4)
Q33 My workload is already too excessive to include prescribing exercise to people with a mental illness N = 238	55 (23.0)	91 (38.1)	69 (28.9)	16 (6.7)	7 (2.9)
Q34 Prescribing exercise to people with a mental illness is not part of my job N = 238	45 (18.8)	77 (32.2)	52 (21.8)	35 (14.6)	30 (12.6)
Q35 I do not know how to prescribe exercise to people with a mental illness N = 238	40 (16.7)	63 (26.4)	56 (23.4)	52 (21.8)	27 (11.3)
Q36 Prescription of exercise to people with mental illness is best delivered by an exercise professional such as a physiotherapist N = 239	26 (10.9)	57 (23.8)	67 (28.0)	64 (26.8)	25 (10.5)