Review Article

Healthcare Practitioners’ Perceptions of the Barriers to Prescribing or Promoting Exercise in the Treatment of People with Mental Illness: A Scoping Review

Table 2

Key methodological features and findings (qualitative).

Authors; CountryAimHealthcare practitioner types1 and sample size/number of participants2SettingMental health conditions being treatedData collection and saturationBarriers identified in the study (using the terminology adopted for coding in this review)Limitations

Ball et al. [29] United KingdomTo explore multidisciplinary staff attitudes towards exercise promotion and facilitation in British National Health Service (NHS) inpatient mental health servicesOccupational therapist × 6
Nurse (various) × 8
Psychiatrist × 2
Psychologist × 3
Support worker × 2
Nursing assistant × 4
N = 25
Inpatient mental health servicesSerious mental illnessIndividual semistructured interviews;
data saturation achieved
Lack of awareness of evidence base (implied); insufficient staff; someone else’s responsibility; perceived physical health risk; lack of knowledge and confidence on how to prescribe exercise; lack of physical resources; perceived unwillingness of person with mental illnessSome professions were underrepresented (e.g., clinical psychology and psychiatry); limited participants from other professions prohibited conclusions about differences in attitudes across disciplines; although efforts were made to ensure methodological rigour, member checking would have improved this

Carlbo et al. [30] SwedenTo describe nurses’ experience, including personal motivation, in using physical activity as a complementary treatment in patients with schizophreniaNurses and nursing assistants
N = 12
Inpatient unit and associated outpatient unit for adult patients with schizophreniaSchizophreniaFocus group interviewsLack of awareness of evidence base; lack of knowledge and confidence on how to prescribe exercise; insufficient staff; lack of time; lack of leadership; perceived risk to mental health; perceived unwillingness of person with mental illness; structural issues; someone else’s responsibilitySmall number of participants may limit generalisability; responses possibly affected as authors worked in the same organisation as participants

Garvey et al. [31] AustraliaTo investigate: (i) mental health clinicians’ understanding of the relationship between exercise and mental health, (ii) if and how exercise is used in their treatment approach of consumers with depression and anxiety, and (iii) the barriers to prescription of exerciseMental health nurses × 3
Social workers × 2
Psychologists × 4
Mental health general practitioner × 1
N = 10
Community health organisation providing a range of mental health services to young peopleVarious mental illnessesIndividual semistructured interviews;
data saturation achieved
Lack of knowledge and confidence on how to prescribe exercise; lack of knowledge rerole of EPs and referral pathways; perceived risk to physical and mental health; someone else’s responsibilityResults may not be generalisable beyond the community context; the study was undertaken during the COVID-19 pandemic impacting recruitment of HCPs

Harding [32] USA
Mixed method-qualitative aspect
To examine the perceived barriers and resource needs related to physical activity in mental health group homes from the perspective of direct care staffDirect care staff (healthcare assistants) working in mental health group homes at least one shift a week with at least 40 hours of mental health training
N = 73
Community group care homesSerious mental illnessPaper-based survey;
qualitative aspect asked open-ended questions
Insufficient staff; lack of time; someone else’s responsibility; lack of knowledge or confidence on how to prescribe exercise (in particular remotivational strategies); lack of physical resourcesDemographic information was not available; due to the setting, the results may not be generalisable

Kinnafick et al. [33]
United Kingdom
To explore healthcare assistants’ perceptions of exercise and attitudes to its promotion for adult patients in a secure mental health hospitalHealthcare assistants who had worked in the institution for a minimum of 6 months
N = 11
Secure mental health hospitalSerious mental illnessIndividual semistructured interviewsLack of awareness of evidence base (implied); insufficient staff; lack of time; lack of knowledge or confidence on how to prescribe exercise; someone else’s responsibility; perceived risk to physical and mental health; perceived unwillingness of person with mental illness; lack of leadership; structural issuesPossible influence of interviews being conducted at participants’ place of work; possible participation bias

Leyland et al. [34] United KingdomTo use the theory of planned behaviour to identify the beliefs of mental healthcare professionals working in community settings regarding motivation for advising health-related physical activityNurse × 13
Support worker × 10
Clinical psychologist × 4
Team leader (member of healthcare staff) × 3
Psychiatrist × 2
N = 32
N (HCP) = 29
Community mental health teamsSerious mental illnessFocus group interviews;
data saturation achieved
Insufficient staff; lack of time; lack of physical resources; someone else’s responsibility; lack of knowledge or confidence on how to prescribe exercise; lack of leadership; perceived risk to physical and mental health; perceived unwillingness of person with mental illness; structural issuesSmall number of participants; however, “data saturation” was achieved after the first two focus groups completed

Martland et al. [35] United KingdomTo qualitatively investigate, inpatient, carer, and staff groups, perspectives on implementing HIIT interventions for service users in inpatient settings, including perceived barriers and enablersPsychiatrist × 1
Mental health nurse × 7
Healthcare assistant × 1
Undisclosed × 1
N = 39
N (HCP) = 10
Inpatient mental health servicesSerious mental illnessFocus group interviews;
data saturation achieved
Perceived impact of patient choice and control; insufficient staff; lack of time; lack of physical resources; perceived risk to physical and mental health; perceived unwillingness of person with mental illnessData possibly missed due to lack of audio recording of focus groups; possible participation bias

Matthews et al. [36] IrelandTo carry out a multistakeholder exploration of structured and unstructured PA experiences in outpatient rehabilitation and recovery mental health servicesMental health nurse × 4
Prescribing psychiatric doctor × 1
Occupational therapist × 1
N = 15
N (HCP) = 6
Rehabilitation and recovery mental health servicesSerious mental illnessIndividual interviews using photo elicitation and open-ended questionsInsufficient staff; lack of time; lack of knowledge or confidence on how to prescribe exercise; perceived risk to physical and mental health; perceived unwillingness of person with mental illness; lack of leadershipOnly one participant from some disciplines and small numbers from others reduced the potential generalisability of findings

Searle et al. [37] United KingdomTo determine general practitioners’ views of physical activity for managing depression and the extent that GPs promote and legitimise engagement in physical activity as a potential treatment option and their awareness of evidence and guidelines to support its useGeneral practitioners
N = 15
General practices in the Bristol and Exeter areasDepressionIndividual semistructured interviewsLack of awareness of evidence base; lack of physical resources; perceived risk to mental health; perceived unwillingness of person with mental illnessConcurrence with patient intervention and possible participant interaction with those patients may have affected HCP’s responses; possible participation bias; brevity of interviews

Shrestha et al. [38] AustraliaTo explore the attitudes and practices of mental health professionals in recommending more physical activity and less sedentary behaviour to their clientsNurse × 2
Psychologist × 12
Social worker × 1
Clinical lead/psychologist × 4
N = 17
Australia’s national youth mental health service network (headspace)Various mental illnessesSemistructured focus group interviews;
data saturation achieved
Lack of knowledge or confidence on how to prescribe exercise; lack of awareness of evidence base (implied)Small number of participants from a specific setting, may not be generalisable; focus groups took place after the HCPs received an intervention to increase their own PA; possible researcher interpretation bias, mitigated through reflexivity component and involvement or researchers from outside the specialty area

Way et al. [39] Australia and New ZealandTo further investigate self-reported barriers to the prescription of exercise for mental health, faced by a range of HCPs in Australia and New ZealandPsychologist × 136
Social worker × 72
General practitioner × 25
Mental health nurses × 20
Occupational therapist × 12
Psychiatrist × 8
Mental health manager × 8
Support workers × 22
Counsellors × 20
Other × 2
N = 325
N (HCP) = 318
Various mental health settingsVarious mental illnessesQualitative aspect elicited individual written responses to the question “what reasons do you consider to prevent you from prescribing exercise to manage mental health concerns”Lack of knowledge or confidence on how to prescribe exercise; perceived risk of damage to therapeutic relationship; perceived unwillingness of person with mental illness; lack of physical resources; perceived risk to physical and mental health; lack of leadership; insufficient staff; lack of time; lack of awareness of evidence base; someone else’s responsibilityRelatively small representations in the participants’ number for general practitioners, mental health nurses, occupational therapists, and psychiatrists reducing generalisability; social desirability bias may have been a confound; likely that due to the self-selection nature of the survey, sample biased towards HCPs with an interest in and appreciation of exercise

1In some studies, participants included persons other than HCPs. In those instances, only the HCPs are listed in this column. 2In studies with participants other than HCPs, both the total sample size and HCP sample size are listed.