Elements of a successful program of physical activity

Val Mayes (2006) draws upon her experience as the executive director of the Edmonton Chamber of Voluntary Organizations to recommend affordable (preferably free) physical activity programs that are accessible, close to public transportation, and non-threatening (in the sense that no special skills are required for participation). She also maintains that the importance of appropriately trained staff who know how to support and motivate mentally ill clients (e.g., by using reinforcements such as prizes) cannot be underestimated. In terms of the psychoeducational component of such a program, she promotes the use of plain language and visual models. Another identified doorway to success is to partner with other mental health organizations: “Collaborations do bring more resources to the table and do enrich those who take part” (Mayes, 2006, PowerPoint slide 17).
Mayes (2006) and Camann (2001) both mention that a program that takes into consideration Prochaska and Diclemente’s (1992) stages-of-change model and its various facilitative processes (consciousness-raising, social liberation/societal support, dramatic relief, and stimulus control) is a step closer to success.
In harmony with that model, Camann (2001) advocates that making the program voluntary would be vital to its success. Richardson and colleagues (2005) summarize several additional factors (p. 327):

• "Programs that deliver exercise prescriptions or motivational messages in printed form or by computer are more effective than face-to-face counselling alone."
• "Participants need to set goals and self-monitor achievement in order to successfully change their behaviour — use daily paper longs, Web-based logging systems, plus objective monitoring devices such as pedometers and heart rate monitors.... Feedback is a critical component of self-monitoring and self-regulation."
• Facilitators need to take advantage of "opportunities for some individualized attention and recognition."
• "Enthusiastic, knowledgeable and supportive exercise leaders are as important as the actual exercise program."
• Decreasing the perceived risk of injury can improve attendance.

When formulating community-based interventions, it is also worthwhile to take into account "the infrastructure and social structures around individuals that greatly affect both collective and individual change" (Edwards, 2000, p. 22). Indeed, change interventions are more successful when individual, network, organizational, community and societal levels are supportive of the new program (also p. 22).

Issues of adherence

In the general population, adherence to physical activity programs drops off after six months to half of the original number of participants. It would be unreasonable to expect better from programs for mentally ill persons, who have additional barriers to regular attendance (e.g., illness exacerbation, issues surrounding autonomy/independence, increased motivational problems) (Richardson et al., 2005, p. 328). Martinsen (1993) found that if physical activity programs are integrated into psychiatric services, then the adherence rate is similar to that of the general public.