Title: Supporting Physical and Activity through Co-production in people with Severe Mental Illness (SPACES)
Funder: Department of Health and Social Care

Abstract: 1. Aims and Objectives To co-produce a feasible intervention to increase physical activity among people with severe mental illness (SMI), before testing its clinical and cost effectiveness. Key research questions are: 1. What are the barriers and facilitators to taking part in physical activity for people with SMI and how can behaviour change techniques be utilised in a co-produced intervention to increase physical activity in people with SMI? 2. Is it feasible and acceptable to deliver the intervention for people with SMI via the NHS? 3. Is the intervention clinically- and cost-effective? 4. What are the optimal implementation strategies to embed and deliver the intervention in NHS services? 2. Background and Rationale Life expectancy is reduced by around 15-20 years for people with SMI compared to people without SMI, and this health inequality is increasing. Furthermore, the majority of these early deaths are due to physical health problems which are partly preventable. Increasing physical activity can improve physical health in all sectors of the population including people with SMI. The World Health Organization has said that encouraging people to be more active can have as great an impact as quitting smoking. When compared to people without mental health problems, people with SMI have more sedentary lives and are less physically active. Therefore, supporting people with SMI to increase their levels of physical activity could help to reduce the mortality gap people with SMI currently experience. 3. Research Plan Workstream 1: Development and design of the intervention &ndash;Months 1-15 We will co-produce a theory-based intervention; combining existing evidence with new components. Workstream 2: Feasibility study &ndash; Months 16-36 The intervention and materials will be piloted and refined to maximise acceptability and impact. A randomised controlled feasibility trial will be conducted to address uncertainties in recruitment, retention, outcome measurement, randomisation, and resource use. Workstream 3: Randomised controlled trial &ndash; Months 36-72 The clinical effectiveness and cost-effectiveness of the intervention will be assessed relative to usual care. Workstream 4: Process Evaluation & Knowledge Mobilisation &ndash; Months 36-72 A process evaluation will be conducted alongside the main trial. This will be guided by core constructs of the Theoretical Domains Framework to identify barriers and facilitators to implementation. A knowledge mobilisation strategy will be developed to increase the prospects of uptake. 4. Anticipated IMPACT & Dissemination The SPACES programme will deliver an intervention aimed at increasing physical activity in people with SMI, with a realistic understanding of its clinical and cost-effectiveness. Based on a logic model, decision makers will understand the resources and outputs required for delivery. The chances of impact will be maximised via an understanding of how this intervention can be implemented. Innovative modes of dissemination include; Service User and third sector networks, Applied Research Collaborations and the UKRI Mental Health Network on inequalities in SMI, which is led by the SPACES consortium. The intervention will directly benefit people with SMI and has potential to save lives and NHS resources, and decrease health inequalities in a vulnerable and disadvantaged population.

Lay abstract: The Problem: People with severe mental health problems such as schizophrenia and bipolar disorder often die 15-20 years earlier than those without, and this difference is getting bigger. Most of these early deaths are caused by preventable health problems such as heart and lung disease. One change that can help people to live longer is being more physically active. This can lower the risk of major illnesses; such as stroke and cancer by up to half. Leading health organisations have said that encouraging people to be more active is as important as encouraging stopping smoking. People with mental illness spend more time sitting still than people without mental health problems. What We Will Do: We are a group of people with direct experience of mental ill health, working collaboratively with the Universities of York, Sheffield, Sheffield Hallam, Leeds, Kings College London and Northumbria together with the NHS to lower this difference in life expectancy. The study will help us understand the challenges faced by people with mental illness in becoming more active. In this project we will develop and test ways to support people with mental illness to become more active. We will ask people what types of physical activity suit them best, and the difficulties they encounter in moving more. We will then use this to work with NHS staff, service users and carers to develop a physical activity programme to help people become more active and spend less time sitting still. We will test the programme and change it where necessary. Finally, we will conduct a fair test (called a randomised controlled study) between the new physical activity programme and what we have now. This will tell us whether the programme can benefit people who use the NHS. We will also look at costs to see if the programme is good value for money. This will help people who decide priorities in the NHS to choose whether to invest in physical activity programmes. Involving The Public: People who use mental health services (and people who support them) have worked to develop this proposal, and they will work together throughout the SPACES programme. They will contribute to the running of the project and in designing an acceptable physical activity programme. Service users and carers will be involved in all stages of the project including communication of results to public, healthcare, research and physical activity staff. Impact: The SPACES programme has the potential to help people with mental ill health to live longer, happier and more equal lives. This could also mean that the NHS does not have to treat long term physical problems, which increasingly consumes a large portion of the small amount of money that it is allocated.

Research activity codes: 3.1 PRIMARY PREVENTION INTERVENTIONS TO MODIFY BEHAVIOURS OR PROMOTE WELL-BEING
Health categories: GENERIC HEALTH RELEVANCE;MENTAL HEALTH