I am working in a psychiatric ward and I found that most of the patients do not have the habit of physical activity. Some of them even refuse to participate in the ward morning exercise and prefer to have a bed rest. One of common reason is they do not perceive the benefit of physical activity to their physical and mental health. This paper would illustrate my nursing intervention by helping some of the psychiatric inpatients to increase physical activity in a self-motivated format.

Physical activity is one of the ten leading health indicators used by United States government since 2000 to promote public health. It is highlighted that regular physical activity throughout life is important for maintaining a healthy body, enhancing psychological well-being, and preventing premature death. Two of the public health objectives about physical activity are to increase the proportion of adolescents who engage in vigorous physical activity that promotes cardio-respiratory fitness 3 or more days per week for 20 or more minutes per occasion and increase the proportion of adults who engage regularly, preferably daily, in moderate physical activity for at least 30 minutes per day (U.S. Department of Health and Human Services, 2000). On the other hand, Hansen, Stevens & Coast (2001) found in their research that subjects exercising (bicycle ergometer) for 10 minutes at an aerobic level of 60% is sufficient for increasing vigor, decreasing fatigue, and decreasing total negative mood state.

There is already much evidence for reducing disability in ageing relates to the beneficial effects of regular physical activity. Increased physical activity is associated with a reduced incidence of coronary heart disease, hypertension, non-insulin dependent diabetes mellitus, colon cancer, and depression and anxiety. In addition, increased physical activity reduces the development of osteoporosis, helps to maintain appropriate body weight, and increases longevity (Andrews, 2001).

In addition, research found that physical activity induces positive moods, such as positive feelings towards others, positive feelings about life, enjoyable interaction with others, joy, elation, bodily well-being, positive body image, self-esteem, achievement, and excitement; and appeared to result in increased happiness (Hills & Argyle, 1998).

Researches found that exercise is associated to a relief in symptoms of depression and anxiety and it also seems to be beneficial in enhancing self-esteem, producing more restful sleep, and helping people recover more quickly from psychosocial stressors (Landers, n.d.).

Fox (1999) even suggested that moderate regular exercise should be considered as a viable means of treating depression and anxiety. Physical activity was also used as a nursing intervention, a 16-week walking program for outpatients diagnosed with schizophrenia found that participants experienced significant reductions in body fat, also had greater aerobic fitness, lower body mass indexes, and fewer psychiatric symptoms than controls at the conclusion of the program (Beebe, et al., 2005).

In the psychiatric ward, it is a challenging task to promote therapeutic physical activity as some of the patients are in the acute phase and they have the difficulty to communicate with others; some of them are being sedated after taking medication; some of them are too depressed to participate in any kind of activity. In spite of the difficulty, I have taught patients Chinese physical exercise (八段錦) in the morning for more than ten years. Some patients enjoy it but they seldom develop it into a habit of physical activity. Therefore, individualized intervention is required to help patient for developing a habit of physical activity. The intervention should facilitate individual’s autonomy and self-efficacy by giving them a sense of self-mastery in the process of intervention.

Information about physical activity was searched from internet e.g. how to determine the target exercising heart rate for physical activity (see table 1). A physical activity and mental health record (運動與精神健康記錄) (see appendix) was designed for facilitating inpatients to increase their physical activity.

Table 1

Target Exercising Heart Rate (60% intensity)

Age	Pulse Rate (bpm)
20	120
25	117
30	114
35	111
40	108
45	105
50	102
55	99
60	96
65	93

Individualized intervention was given to four patients, one was diagnosed as depression and the others were schizophrenia. They were interviewed separately and explanation was given to them for how to use the physical activity and mental health record (運動與精神健康記錄). They were asked to select one kind of physical activity and to set their own goal. They could increase the time and intensity of physical activity according to their own pace. Warm-up exercise was instructed. All of them wanted to use bicycle ergometer for exercising and they were taught how to use the bicycle ergometer. The profiles of the patients and their initial goals were summarized in the following table (see Table 2). Prompting was given to them at times. Praise and verbal encouragement were given to them after they finished the exercise. Evaluation was made with the patient together.

Table 2

Patient Profile and Goal

After one week, an evaluation was made and the outcomes were summarized in the table (see Table 3).

Table 3

Psychical Activity Outcomes (one week)

It was found that the frequency and intensity of physical activity associated positively with positive mood states. Patient A and B showed better motivation because they experienced the beneficial effect of physical activity to their physical and psychological well-being. Patient A and B also showed a decreasing trend in their depression and anxiety scores.

Only one bicycle ergometer was available and it would be locked in a room at night time. Some patient need more time and patience to establish rapport in order to motivate them participate in physical activity e.g. patient D. It may not be possible to involve all patients because of limited manpower, resource, and sometime unpredictable ward situations. The program needs more time to see the therapeutic effect but some patients would leave hospital earlier e.g. patient C. After discharge, patient may have personal difficulties and environmental constraint to continue the physical activity.

Different types of equipment for physical activity, e.g. treadmill, should be provided in order to let patient have more choice, on the other hand it would arouse their interest in physical activity. A more comprehensive assessment of individual needs and obstacles of physical activity should be done. More written information about physical activity should be provided to patient so that they could continue it after discharge.

Physical activity should become a standard positive intervention in clinical setting by helping patient to perceive the benefit of physical activity to their physical and psychological well-being. As a result, the chance of developing into a habit would be greater when they return to the community.

(1310 words)

Andrews, G. (2001). Care of older people: promoting health and function in ageing population. BMJ, 322, 728-729.

Beebe, L., Tian, L., Morris, N., Goodwin, A., Allen, S. & Kuldau, J. (2005). Effects of exercise on mental and physical health parameters of persons with schizophrenia. Issues in Mental Health Nursing, 26, 661-676.

Hansen, C., Stevens, L. & Coast, R. (2001). Exercise duration and mood state: how much is enough to feel better. Health Psychology, 20(4), 267-275.

Hills, P. & Argyle, M. (1998). Positive moods derived from leisure and their relationship to happiness and personality. Personality and Individual Differences, 25, 523-535.

Kwok, P. & Tse, L. (2004). Overweight and obesity in Hong Kong – what do we know? Public Health and Epidemiology Bulletin, 13(4). Retrieved November 8, 2005 from http://www.info.gov.hk/dh/diseases/ph&eb/v13n4.htm#1

Landers, D. M. (n.d.). The influence of exercise on mental health. Retrieved

November 11, 2005, from http://www.fitness.gov/mentalhealth.htm

U.S. Department of Health and Human Services. (2000). Healthy People 2010: Understanding and Improving Health. 2nd ed. Washington, DC: U.S. Government Printing Office.

Appendix

我

C 我希望透過經常運動去促進我的精神健康，從而享受美好的人生。

C 我會量力而為並逐漸增加運動的難度和時間。

C 我決定每天運動及記錄我的進展。

C 我的第一個目標是每天 (運動方式) 分鐘。運動時最高脈搏達到每分鐘 。

我已經努力了一個星期，給自己的評語是：我做得好好 ／ 我做得不錯 ／ 我做得到 ／ 我會繼續努力。(請圈出你的選擇)

我的下一個目標是每天 (運動方式) 分鐘。運動時最高脈搏達到每分鐘 。