“We’re Not Just Sitting on the Periphery”: A Staff Perspective of Physical Activity in Older Adults With Schizophrenia

The number of older adults with a serious mental illness, such as schizophrenia, is predicted to more than double to 15 million by the year 2030 (Bartels, 2004). People with schizophrenia are the largest group of older people with severe mental health problems (Cohen et al., 2000). Schizophrenia is a chronic, severe, and disabling psychotic disorder characterized by hallucinations, delusions, thought and movement disorders, negative symptoms, and cognitive impairment (National Institute of Mental Health, 2007). Data suggest that the physical function of older adults with schizophrenia is poor (Chafetz, White, Collins-Bride, Nickens, & Cooper, 2006; Kilbourne et al., 2005). Research among younger people with serious mental illness, such as schizophrenia, shows that their physical function may resemble that of someone 10–20 years older (Chafetz, White, Collins-Bride, & Nickens, 2005). Physical function can be defined as a multilevel concept that includes the body functions and structures of people, the activities people conduct and life areas they participate in, and the environmental factors that affect these experiences (Jette, 2006). Decrements in physical function may contribute to poor health outcomes, increased use of health services, and decreased quality of life in this population. Physical activity may be a critical component to target in older adults with schizophrenia in order to improve physical function. Physical activity is defined as any bodily movement that enhances health (U.S. Department of Health and Human Services, 2008). Optimization of physical activity may help delay disability and maintain independent life in older adults (Tirodkar, Song, Chang, Dunlop, & Chang, 2008). Impairments in physical activity may hinder a person’s ability to care for their health needs. The multitude of chronic medical conditions experienced by people with schizophrenia, such as chronic obstructive pulmonary disease, can jeopardize optimal physical activity. Furthermore, older adults with schizophrenia are susceptible to limitations in physical activity due to the aging process (Gallo, 2006). Physical activity improves physical function, gait speed, balance, and activities of daily living (ADLs) in older adults (Manini & Pahor 2009; Chou, Hwang, & Wu, 2012). Improved mood and enhanced cognition have been associated positively with physical activity (Deslandes et al., 2009). Physical activity may be an effective and economical adjunct treatment for age-related neurodegenerative processes (Deslandes et al., 2009). Exercise is planned, structured, and repetitive movement done to improve or maintain one or more component of physical fitness (Chodzko-Zajko et al., 2009). Exercise may provide a way for patients with serious mental illness, such as schizophrenia, to socially integrate (Knochel et al., 2012). Despite the obvious need for research to improve the health of this especially vulnerable population, less than 10% of published research in schizophrenia focuses on older adults (Mittal et al., 2006). In order to improve the physical function of older adults with schizophrenia, interventions are needed that target their unique needs. Currently, no published data are available on physical activity interventions that promote physical function in this population. However, before physical activity interventions can be designed and tested to improve the physical function of older adults with schizophrenia, additional research is needed on the factors that contribute to engage in physical activity. Only six studies (Archie, Wilson, Osborne, Hobbs, & McNiven, 2003; Beebe & Smith, 2010; Daumit et al., 2005; Fogarty & Happell, 2005; McDevitt, Snyder, Miller, & Wilbur, 2006; Weissman, Moot, & Essock, 2006) that included a total of 275 participants, who ranged in age from 16 to 65, have evaluated the barriers and facilitators to engage in physical activities in younger people with schizophrenia. No studies were identified that evaluated facilitators and barriers in older adults with schizophrenia. An examination of perceived barriers and facilitators to engage in physical activities that promote physical function may provide insights into the factors associated with poor physical function and provide a foundation for intervention research. The involvement of mental health staff in the design and implementation of a physical activity intervention may ensure that the promotion of physical activity reinforces other efforts to improve overall health and well-being (Richardson et al., 2005). In addition to their specific knowledge of this population, the staff have a uniquely informed perspective on what might successfully be implemented within specific mental health programs. In this article, we present the findings from a qualitative grounded theory study that explored mental health staff perceptions about barriers and facilitators to engage in physical activity among older adults with schizophrenia.