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| Authors; Country; Study design; Setting | Aim | Healthcare practitioner types1 and sample size/number of participants2 | Mental health conditions being treated | Data collection; outcome measures (quantitative) | Results | Limitations |
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Burton et al. [40] Australia
Quantitative: cross-sectional
Primary care | To assess psychologists’ attitudes and frequency of providing activity advice and counselling | Psychologists
N = 236 | Various mental illnesses | 14-page written questionnaire; Likert scale response | The most significant barriers were a lack of knowledge and/or confidence regarding the prescription of exercise.
The majority viewed PA as more relevant to physical health than MH, while also acknowledging that it could have MH benefits. 80% indicated they were confident to discuss general activity and identify problems;
75% reported engaging in regular PA which was the strongest predictor of providing advice;
only 12% indicated they had received undergraduate training, and just under 1/3 had postgraduate training; and
53% reported recommending activity most of the time, and 30% sometimes, even though 93% believed that PA would be beneficial to treatment | Participant pool is not representative of psychologists in general; self-reporting is potentially influenced by social desirability |
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Escobar-Roldan et al. [41] USA
Quantitative: cross-sectional Survey of
large tertiary care medical centre | The goal of this study was to characterize the exercise prescribing practices of healthcare providers from different subspecialties and evaluate factors that may influence their prescribing practices | Psychiatrist × 50
Doctor (family medicine) × 20
Doctor (internal medicine) × 50
Doctor (combined medicine and psychiatry) × 12
Psychologists × 40
Other HCPs × 13
N = 185 | Serious mental illness | 11-item survey developed by the authors | 35.7% reported insufficient knowledge or training;
29.2% reported their patients are not interested or will not adhere (27.6%);
60% reported they regularly recommend exercise to patients; and
a very high proportion recommended exercise for depression (84.9%);
Only 24% were prescribed with instructions on type, frequency, duration, and intensity. Only 12% wrote them down | All participants were from the same tertiary facility, and therefore may not represent the larger profession; response bias or recall bias may have had an effect |
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Harding [32] USA
Mixed-methods study: cross-sectional
Community group care homes | To examine the perceived barriers and resource needs related to PA in MH group homes from the perspective of direct care staff | Direct care MH staff having completed a minimum of 40 hours of training in mental healthcare
N = 73 | Serious mental illness | Seven-item survey; Likert scale response | The most significant barriers were a lack of knowledge and/or confidence regarding how to conduct PA programs and the perception that individuals do not want to engage in PA.
Despite participating in PA, staff believe that information on PA in SMI would be helpful.
Staff did not perceive time, fear of human rights violations, and fear of injury as significant barriers.
There was acceptance that promoting PA was a part of their role.
The barriers could be addressed through additional training | Investigator-design survey and potential misinformation; demographic information was not available; due to location, the results cannot be generalised |
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Kleemann et al. [42] Brazil
Quantitative: cross-sectional
Psychosocial care units for community-dwelling individuals | To understand the knowledge, beliefs, barriers, and behaviours of MH professionals about physical activity and exercise for people with mental illness | Psychiatrist or other specialist × 5
Psychologist × 10
GP × 4
OT or recreationist or physiotherapist × 1
Nurse × 25
Nurse technician × 21
Social worker × 6
Exercise professional × 1
N = 73 | Serious mental illness | Translated and modified version of EMIQ (Portuguese); Likert scale response | The most significant barriers were the belief that exercise prescription should be delivered by exercise professionals (72.6%); lack of prescription knowledge (38.3%); and potential injury risk (24.7%).
Barriers to patient participation were social stigma, medication side effects, and lack of family/friend support.
Other barriers included unclear diagnosis, lack of organisational and financial support, competing priorities, and integration of healthcare team.
92% of participants reported receiving no formal training in exercise prescription. Relevantly, in Brazil only those with a degree in physical education or physical therapy are legally permitted to prescribe exercise.
Exercise ranked fifth (n = 1) as the most beneficial treatment, with medication ranking first (n = 19).
41.1% (n = 30) reported they never prescribed exercise, and 12.3% (n = 9) reported they always prescribed it. Those participants who did not prescribe PA or exercise did not achieve the recommended PA levels themselves, and those who always did were more likely to achieve the PA recommendations. Therefore, encouraging lifestyle change in HCP may result in greater adherence | The psychometric properties of the Portuguese language were not tested in cultural translation and transcultural adaptation; geographical limitations may prevent generalisability; and we could not explore the differences between HCP classes due to sample size |
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Mailey et al. [43] USA
Mixed-method: quantitative (only included) cross-sectional
Private and community settings | The present study aimed to gather information about therapists’ current physical activity counselling practices related to ParkRx | Psychologists × 68
Family/marriage therapists × 27
Social workers × 16
Other therapists × 13
N = 125 (note breakdown of HCP roles in the study results in a total of 124) | Various mental illnesses | 10-item survey; 1–5 Likert scale | The most salient barriers were lack of clients’ willingness to engage in physical activity, lack of time to discuss physical activity with clients, and concerns about client safety.
59.7% also reported providing verbal physical activity recommendations to most or all clients. However, only 3.1% reported frequently providing a written physical activity recommendation, compared to 79% who rarely or never did | We cannot say with certainty that sampling saturation was achieved; although the researchers were mindful of their preexisting biases, they did not formally document their reflexivity insights, and acknowledge that their perspectives may have influenced the analyses and results |
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Radovic et al. [44] Australia
Quantitative and qualitative: cross-sectional
Inpatient, outpatient, primary care, and community healthcare | To examine the perspectives and practices of MH clinicians regarding the use of exercise in the treatment of adolescent depression | Psychologists × 69
Social workers × 17
Counsellors × 9
Youth workers × 6
GPs × 5
Nurse × 7
OT × 4
Psychiatrist × 3
Speech pathologist × 2
Other × 3N = 125 | Youth depression | Modified version of EMIQ; Likert scale response | The most significant barriers were lack of knowledge (24.6%), the belief that exercise prescriptions should be delivered by an EP (27.8%), and the perception that clients would not adhere to the program (23%).
Other barriers included systemic issues such as excessive workload.
Notwithstanding this, a significant percentage (42.8%) expressed confidence in their ability to prescribe exercise “most of the time,” with 43.4% prescribing “most of the time.”
A substantial portion (41.2%) were “aware” of the current public health recommendations, however, only 13.3% could accurately describe the current recommendations of 60 min of daily moderate to vigorous PA amongst adolescents.
50% of clinicians engaged in moderate PA; however, no significant relationship was found between this and prescription rates.
63.2% indicated that they were interested in further training in exercise prescription | Self-selecting nature of the modest-sized sample; possible recruitment bias toward those interested in exercise; analysis largely descriptive |
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Romain et al. [45] Canada
Quantitative: cross-sectional survey
Outpatient clinics | Investigate the factors and barriers associated with health promotion practice among mental health professionals
Note: findings with respect to barriers to promoting exercise were separately identifiable. Only this aspect was relevant to this scoping review | Psychiatrists/doctors × 20
Nurses × 29
OTs × 16
Social workers × 16
Psychologists × 5
Other mental health professionals × 14
N = 100 | Serious mental illness | Translated and modified version of EMIQ-HP; Likert scale response; stages of change questionnaire | Barriers include overwhelming workload (62%), low confidence, role confusion, and low priority.
88% believed that mental illness could not constitute as a barrier to HPP.
Professionals promoting HPP were less likely to endorse psychological barriers, more confident in their ability to do so, and more likely to give higher value to healthy behaviour.
About 11% had received formal training in PA promotion, and 47% reported they would definitely engage in further training.
60% engaged in PA promotion had higher levels of self-confidence, however, no significant relationship was found between this and the prescription of exercise.
75% of professionals considered antipsychotic medication more important than PA | Variability in professional patient load and location; small sample size; survey based on self-reporting |
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Shrestha et al. [38] Australia
Mixed-methods study: cross-sectional; social constructivism framework
Community healthcare | To explore the attitudes and practices of HCPs in recommending more PA and less sedentary behaviour to their clients | Nurse × 2
Psychologist × 12
Social worker × 1
Clinical lead/psychologist × 4
N = 17 | Various mental illnesses | Modified version of EMIQ; Likert scale response | The most significant barriers were lack of knowledge, low confidence, the belief that exercise prescription should be delivered by an EP, the perception that clients would not adhere to the program, and excessive workload.
A key perceived barrier was the concern that PA recommendations may detract and harm the therapeutic relationship.
Only 35.3% had undergone formal training in exercise prescription,
64.7% ranked PA among the top three treatments, and 94.1% agreed that PA is valuable for those hospitalised with MI.
Some health professionals believed it was inappropriate to discuss PA with more complex patients.
Recommendations were more directed toward what made them “feel better,” rather than specific intensity and duration | Small sample size; the study was conducted after an education course, indicating possible strong social bias to adhere; the author acknowledged her bias toward PA in participant interactions |
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Stanton et al. [28] Australia
Quantitative: cross-sectional
Inpatient MH facilities in regional towns | To examine the exercise prescription practices of nurses in relationship to their own PA levels. Also, to understand relevant barriers within the inpatient setting to exercise prescription and referrals | Nurses working in inpatient MH units
N = 34 | Serious mental illness | EMIQ; Likert scale response | The most significant barriers were a lack of knowledge and the belief that exercise prescriptions should be delivered by an EP.
72% reported prescribing exercise, 18% reported never prescribing, and 21% always prescribed to consumers.
Half (56%) of the participants reported achieving high levels of PA, and the remainder was classified as moderate.
Only n = 4 reported having formal training in exercise prescription and none specifically for SMI. However, almost all (94%) reported an interest in additional training in exercise prescription.
Self-reported PA participation in participants is not related to the frequency of exercise prescription working in MH settings.
Personal barriers were low confidence in exercise prescription, and systemic barriers were competing demands.
Only 21% of participants reported using referrals to exercise professionals and only 11% of participants recommended exercise at the intensity which makes them “feel good” | Not all settings were included from the hospital; only one geographical area and profession; small sample size |
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