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Background The use of physical activity interventions in mental health care for adults has a large academic evidence base and numerous examples of real‐world implementation. However, the use of physical activity within mental health care for children and young people (CYP) has received less attention to date. Methods A narrative review was conducted to summarize the relevant literature in the area. Online databases were searched using terms synonymous with CYP, exercise, physical health, and mental health. Findings from existing systematic reviews, meta‐analyses, meta‐syntheses, and consensus statements were reviewed, and used alongside the authors' experience to inform clinical recommendations. Results We first discuss the importance of applying physical health interventions in early stages of mental illness for CYP to prevent physical comorbidities and premature mortality in the long term. We then provide a brief summary of the current evidence of the benefits of exercise interventions in CYP with mental illness. We then present our top five recommendations on the implementation of exercise interventions within CYP mental health care. Conclusion The key conclusions from this suggest there is an increasingly strong evidence base for the benefits of using physical activity interventions to improve, prevent, and manage physical and mental health outcomes in CYP with mental illness. However, more work needs to be done to improve the evidence base, refine its implementation into standard mental health care, and develop strategies for large‐scale dissemination of such interventions across various care and cultural contexts. There is an increasingly strong evidence base for the benefits of using physical activity interventions to improve physical and mental health outcomes in CYP with mental illness. However, more work needs to be done to improve this evidence, refine its implementation into standard mental healthcare, and develop strategies for large‐scale dissemination of such interventions across various care and cultural contexts.

Background Physical health inequalities of people with serious mental illness (SMI) have been labelled an international scandal; due to the 15–20-year reduction in life expectancy associated with poor physical health. This occurs at an early stage and evidence shows young people with and at risk for SMI are a particularly vulnerable group requiring intervention and support. However, most work has been conducted with adults and little is known about what affects physical health for young people, specifically those receiving inpatient care. Methods We conducted semi-structured qualitative interviews with 7 service users and 6 staff members (85% female, age 14–42) on a generic mental health inpatient unit for children and adolescents. Interviews aimed to identify how young people viewed theirphysical health and factors affecting physical health and lifestyle and identify any support needed to improve physical health. Thematic analysis was conducted. . Results Thematic analysis revealed the main factors affecting physical health and lifestyle for young people. Three main themes were individual factors (subthemes were mental health symptoms, knowledge, attitudes and beliefs), environmental factors (subthemes were opportunities in a restricted environment and food provision), and the influence of others (subthemes were peers, staff, family members). These factors often overlapped and could promote a healthy lifestyle or combine to increase the risk of poor physical health. Young people discussed their preferences for physical health initiatives and what would help them to live a healthier lifestyle. Conclusions Promoting physical health on inpatient units for young people is an important, yet neglected area of mental health research. We have identified a range of complex factors which have an impact on their physical health, and there is a pervasive need to address the barriers that young people experience to living a healthy lifestyle. There is an increasingly strong evidence base suggesting the benefits of physical health interventions to improve outcomes, and future work should identify ways to implement such interventions considering the barriers discussed in this article. Further collaborative research is needed with young people, clinical teams, caregivers, and commissioners to ensure improvements are made to clinical care provision and optimisation of the inpatient environment.

Aims: To explore the physical health of YP admitted to adolescent inpatient mental health units and reflect on any differences over the following 6 months. Research Questions: 1. To assess physical health of young people upon admission to adolescent inpatient services (cardiovascular risk factors e.g. BMI, blood pressure, blood glucose and lipids). 2. To assess current lifestyle behaviours of young people upon admission to adolescent inpatient wards (e.g. physical activity, diet, smoking rates). 3. To assess changes in physical health/lifestyle 3 months and 6 months post-admission. 4. To understand the impact of inpatient care environment on lifestyle behaviours and physical health of adolescents admitted to inpatient units. 5. To understand the experiences and beliefs about physical health in adolescents admitted to inpatient units. 6. To establish the feasibility of monitoring physical health in a cohort of young people upon admission to an adolescent inpatient unit. Methods: We aimed to recruit young people aged 14+ from each participating site within 6 weeks of admission to the unit. The young person needed to be able to give informed consent and be well enough to take part (severe anorexia/eating disorder excluded). Physical and mental health assessments were completed by a researcher in conjunction with the clinical team. Assessments completed at three time points: Baseline on admission; 3 months post admission; 6 months post admission. Participants given £10 voucher at each timepoint as a thank you (total £30). Measures collected included: Demographic information, e.g. age, gender, ethnicity, education, diagnoses, previous admissions, medication, length of admission; Physical Health Outcomes, e.g. BMI (centiles), BP, routinely collected blood tests (random glucose, lipids, etc), ECG; Behavioural Outcomes, e.g. physical activity levels, smoking status, diet, physical fitness (six-minute walk & questionnaire), substance use, comorbid physical health disorders and concurrent treatments; Mental Health Outcomes, e.g. Health of the Nation Outcome Scales for Children and Adolescents (HONOSCA), World Health Organization Wellbeing Index (WHO-WI). Results: Physical health outcome (Weight): Baseline – 64.5. 3 months – 67.7. 6 months – 69.3. Behavioural outcome: Low levels of physical activity (average 20 mins sport and 1 hour walking per day); High levels of sedentary behaviour; Most common substances used were alcohol (n=11, 44%), tobacco (n=10, 40%) and cannabis (n=6, 25%); Most YP self-reported average fitness levels; Consumed on average 1.8 meals per day (ranged from 1–5). HONOSCA outcome: 80% lack of concentration (68% severe); 75% self-harmed; 56% difficulties with relationships at home (30% severe); 88% anxious or low mood (44% severe); 64% impairments with educational ability; 64% stopped attending education. Qualitative interviews (thematic analysis): Outcomes on Young peoples knowledge, Autonomy, environment, sources of support, independence and facilitators. Conclusion: Young people on CAMHS inpatient units have multiple factors affecting their physical health; Already showing some signs of compromised physical health, likely to worsen; Observed lots of challenges with transitory care and barriers to following people up after discharge; Future work will focus on breaking down some of the barriers experienced to living well; Working on refining a physical health intervention.

Background Research has demonstrated the ability to identify and treat individuals at high risk of developing psychosis. It is possible to use a similar strategy to identify people who have an emergent risk of bipolar disorder (BD). Interventions during the early phase may improve outcomes and reduce risk of transition. Criteria have been established to identify individuals considered to be at high risk for developing BD, also known as Bipolar At Risk (BAR). Offering a psychological intervention may provide the possibility of prevention. Evaluating efficacy and the mechanisms by which this treatment works is now required. Methods A multicentre, rater-masked randomised controlled trial with two parallel arms will compare cognitive behaviour therapy (CBT) for young people meeting BAR criteria (CBT BAR ) + Treatment as Usual (TAU) vs. TAU alone. Participants will be recruited from five National Health Service (NHS) sites in the UK. Outcome and mediational variables will be collected at baseline, 17-weeks (in treatment), 27-weeks (post-CBT BAR /TAU), and 52-weeks. Qualitative work will examine the perceived mechanisms of change and implementation of CBT BAR in the NHS. Discussion Our efficacy hypotheses are CBT BAR  + TAU (compared to TAU alone) will lead to improvement in mood swings, a reduction in the likelihood of transition to BD, and improvements to functioning and quality of life. Our mechanistic hypothesis is CBT BAR  + TAU causes improvement in mood swings due to the reduction of extreme positive and negative appraisals of internal states which in turn improves subsequent behaviours used to control mood and then internal states. Our trial will explore the perceived mechanism of change via this novel intervention (CBT BAR ) and if the approach can be implemented within current services in the UK. Trial registration/Status The trial protocol is registered with ISRCTN (ISRCTN13363197, registered on 25th January 2023). Recruitment started in February 2023 and is ongoing.

Given the physical health disparities associated with mental illness, targeted lifestyle interventions are required to reduce the risk of cardiometabolic disease. Integrating physical health early in mental health treatment among young people is essential for preventing physical comorbidities, reducing health disparities, managing medication side effects, and improving overall health outcomes. Digital technology is increasingly used to promote fitness, lifestyle, and physical health among the general population. However, using these interventions to promote physical health within mental health care requires a nuanced understanding of the factors that affect their adoption and implementation. Using a qualitative design, we explored the attitudes of mental health care professionals (MHCPs) toward digital technologies for physical health with the goal of illuminating the opportunities, development, and implementation of the effective use of digital tools for promoting healthier lifestyles in mental health care. Semistructured interviews were conducted with MHCPs (N=13) using reflexive thematic analysis to explore their experiences and perspectives on using digital health to promote physical health in youth mental health care settings. Three overarching themes from the qualitative analysis are reported: (1) motivation will affect implementation, (2) patients' readiness and capability, and (3) reallocation of staff roles and responsibilities. The subthemes within, and supporting quotes, are described. The use of digital means presents many opportunities for improving the provision of physical health interventions in mental health care settings. However, given the limited experience of many MHCPs with these technologies, formal training and additional support may improve the likelihood of implementation. Factors such as patient symptomatology, safety, and access to technology, as well as the readiness, acceptability, and capability of both MHCPs and patients to engage with digital tools, must also be considered. In addition, the potential benefits of data integration must be carefully weighed against the associated risks.

Introduction People with severe mental illness have physical comorbidities which result in significant reductions in quality of life and premature mortality. Effective interventions are required that are suitable for people in secure forensic mental health services. We conducted pilot work of a multidisciplinary weight management intervention (Motiv8) which showed improvements in physical and mental health and high levels of satisfaction. We aim to test the feasibility of Motiv8 under cluster randomised conditions, with an aim to investigate the acceptability, feasibility and potential effectiveness of this intervention to supplement standard secure care. Methods and analysis A randomised waitlist-controlled feasibility trial of a lifestyle intervention (Motiv8) + TAU compared with TAU (+ Motiv8 waitlist) for adults on secure mental health units will be conducted. Thirty-two people (4 cohorts) will be recruited from secure services in Greater Manchester Mental Health NHS Foundation Trust. Participants will be randomly allocated to Motiv8 or TAU + Motiv8 waitlist. All participants will receive Motiv8 during the trial. Assessor-blinded physical/mental health and lifestyle assessments will be conducted at baseline, 10 weeks (post-intervention/waitlist), and after 12 weeks (post-waitlist intervention/follow-up). Motiv8 is a multidisciplinary intervention including exercise sessions, cooking/nutrition classes, physical health education, psychology sessions, sleep hygiene, peer support and medication review by pharmacy. A nested qualitative study will be conducted with a subsample of participants ( n  = 10) to explore their experiences of taking part. The analysis will focus on feasibility outcomes and tabulated success indicators of the study (e.g. Recruitment rates, retention rates, follow-up retention and response rates, attendance at sessions, the experience of involvement in the trial and delivery of the intervention, assessment of safety, development of a manualised intervention). Thematic analysis will be conducted through qualitative interviews. The analysis will aim to inform the development of a definitive trial. Ethics and dissemination The trial has been granted ethical approval from the NHS Health Research Authority and adopted onto the UK Clinical Research Network Portfolio. Findings will be disseminated via peer-reviewed publications, professional and public networks, conferences and clinical services. Trial registration ISRCTN13539285.

BackgroundThe At Risk Mental State (ARMS) (also known as the Ultra or Clinical High Risk) criteria identify individuals at high risk for psychotic disorder. However, there is a need to improve prediction as only about 18% of individuals meeting these criteria develop a psychosis with 12-months. We have developed and internally validated a prediction model using characteristics that could be used in routine practice.MethodsWe conducted a systematic review and individual participant data meta-analysis, followed by focus groups with clinicians and service users to ensure that identified factors were suitable for routine practice. The model was developed using logistic regression with backwards selection and an individual participant dataset. Model performance was evaluated via discrimination and calibration. Bootstrap resampling was used for internal validation.ResultsWe received data from 26 studies contributing 3739 individuals; 2909 from 20 of these studies, of whom 359 developed psychosis, were available for model building. Age, functioning, disorders of thought content, perceptual abnormalities, disorganised speech, antipsychotic medication, cognitive behavioural therapy, depression and negative symptoms were associated with transition to psychosis. The final prediction model included disorders of thought content, disorganised speech and functioning. Discrimination of 0.68 (0.5-1 scale; 1=perfect discrimination) and calibration of 0.91 (0-1 scale; 1=perfect calibration) showed the model had fairly good predictive ability.DiscussionThe statistically robust prediction model, built using the largest dataset in the field to date, could be used to guide frequency of monitoring and enable rational use of health resources following assessment of external validity and clinical utility.

Background Exercise may improve neuropsychiatric and cognitive symptoms in people with mental disorders, but the totality of the evidence is unclear. We conducted a meta-review of exercise in (1) serious mental illness (schizophrenia spectrum, bipolar disorder and major depression (MDD)); (2) anxiety and stress disorders; (3) alcohol and substance use disorders; (4) eating disorders (anorexia nervosa bulimia nervosa, binge eating disorders, and (5) other mental disorders (including ADHD, pre/post-natal depression). Methods Systematic searches of major databases from inception until 1/10/2018 were undertaken to identify meta-analyses of randomised controlled trials (RCTs) of exercise in people with clinically diagnosed mental disorders. In the absence of available meta-analyses for a mental disorder, we identified systematic reviews of exercise interventions in people with elevated mental health symptoms that included non-RCTs. Meta-analysis quality was assessed with the AMSTAR/+. Results Overall, we identified 27 systematic reviews (including 16 meta-analyses representing 152 RCTs). Among those with MDD, we found consistent evidence (meta-analyses = 8) that exercise reduced depression in children, adults and older adults. Evidence also indicates that exercise was more effective than control conditions in reducing anxiety symptoms (meta-analyses = 3), and as an adjunctive treatment for reducing positive and negative symptoms of schizophrenia (meta-analyses = 2). Regarding neurocognitive effects, exercise improved global cognition in schizophrenia (meta-analyses = 1), children with ADHD (meta-analyses = 1), but not in MDD (meta-analyses = 1). Among those with elevated symptoms, positive mental health benefits were observed for exercise in people with pre/post-natal depression, anorexia nervosa/bulimia nervosa, binge eating disorder, post-traumatic stress disorder and alcohol use disorders/substance use disorders. Adverse events were sparsely reported. Conclusion Our panoramic meta-overview suggests that exercise can be an effective adjunctive treatment for improving symptoms across a broad range of mental disorders.

Diet is increasingly recognized as a potentially modifiable factor influencing the onset and outcomes of psychiatric disorders. Whereas, previous research has shown long-term schizophrenia is associated with various nutritional deficiencies, this meta-analysis aimed to determine the prevalence and extent of nutritional deficits in first-episode psychosis (FEP). A search of electronic databases conducted in July 2017 identified 28 eligible studies, examining blood levels of 6 vitamins and 10 minerals across 2612 individuals: 1221 individuals with FEP and 1391 control subjects. Meta-analyses compared nutrient levels in FEP to nonpsychiatric controls. Clinical correlates of nutritional status in patient samples were systematically reviewed. Significantly lower blood levels of folate (N = 6, n = 827, g = -0.624, 95% confidence interval [CI] = -1.176 to -0.072, P = .027) and vitamin D (N = 7, n = 906, g = -1.055, 95% CI = -1.99 to -0.119, P = .027) were found in FEP compared to healthy controls. Synthesis of clinical correlates found both folate and vitamin D held significant inverse relationships with psychiatric symptoms in FEP. There was also limited evidence for serum level reductions of vitamin C (N = 2, n = 96, g = -2.207, 95% CI = -3.71 to -0.71, P = .004). No differences were found for other vitamins or minerals. Deficits in vitamin D and folate previously observed in long-term schizophrenia appear to exist from illness onset, and are associated with worse symptomology. Further research must examine the direction and nature of these relationships (ie, mediator, moderator, or marker) with clinical status in FEP. Future trials assessing efficacy of nutrient supplementation in FEP samples should consider targeting and stratifying for baseline deficiency.

Background Previous qualitative studies have found that exercise may facilitate symptomatic and functional recovery in people with long-term schizophrenia. This study examined the perceived effects of exercise as experienced by people in the early stages of psychosis, and explored which aspects of an exercise intervention facilitated or hindered their engagement. Methods Nineteen semi-structured interviews were conducted with early intervention service users who had participated in a 10-week exercise intervention. Interviews discussed people’s incentives and barriers to exercise, short- and long-term effects, and opinions on optimal interventions. A thematic analysis was applied to determine the prevailing themes. Results The intervention was perceived as beneficial and engaging for participants. The main themes were (a) exercise alleviating psychiatric symptoms, (b) improved self-perceptions following exercise, and (c) factors determining exercise participation, with three respective sub-themes for each. Conclusions Participants explained how exercise had improved their mental health, improved their confidence and given them a sense of achievement. Autonomy and social support were identified as critical factors for effectively engaging people with first-episode psychosis in moderate-to-vigorous exercise. Implementing such programs in early intervention services may lead to better physical health, symptom management and social functioning among service users. Trial registration Current Controlled Trials ISRCTN09150095 . Registered 10 December 2013.