Occupational Therapy News OTnews October 2019 | Page 46

FEATURE ACTIVITY
On the right track – activity
trackers in secure settings
Christopher Genter and Anita Bowser explain how they are increasing
patients’ participation in physical activity within a medium secure unit, using
activity trackers as a motivational tool
R
avenswood House is a medium secure
unit providing assessment, care and
treatment for adults with serious mental
illness. These individuals are detained
under the Mental Health Act (1983) and are
considered to be a risk of harm to others, typically
have complex mental disorders, with co-morbid
difficulties of substance misuse and/or personality
disorder, which are linked to offending or seriously
irresponsible behaviour.
Consequently, most individuals are involved with
the criminal justice system and many are subject to
Ministry of Justice restrictions.
Risk is carefully managed through a range of
physical, procedural and relational security measures.
A key principle is that individuals should be managed
in the least restrictive environment possible in order to
facilitate their safe recovery.
Obesity and associated health problems
On average, individuals with severe mental illness
die at least 10 years younger than the rest of the
population (Joukamaa et al 2001). The prevalence of
diabetes is also higher in people with schizophrenia, at
about 20 per cent (Busche and Leonard 2004).
Patients in secure units are at high risk of obesity
because of antipsychotic medication, restrictions on
freedom, and poor motivation to eat healthily and
exercise (Haw and Stubbs 2011).
Stubbs and Rosenbaum (2018) hypothesise four
reasons why the secure environment adversely affects
patients’ physical health. First, the restrictive nature
of secure environments limits access to exercise
opportunities and encourage sedentary behaviour.
Second, patients in secure services tend
to experience the most pronounced pervasive
symptoms, which requires multiple forms of
medication at high levels, contributing to increased risk
of cardiometabolic complications.
Third, patients in secure services tend to have
prolonged detentions and remain exposed to an
obesogenic environment for an extended period.
46 OTnews October 2019
And fourth, historically, smoking rates among
people with mental illness have been highest in
secure services, creating a predisposition to poor
health. However, the recent introduction of smoke free
hospital sites should begin to address this issue.
Given these circumstances it is understandable
why it is estimated that two to three out of four
patients in secure environments are classified as
‘obese’.
The issue is compounded by the lack of a
structured approach to managing obesity. For
example, Oakley et al (2013) noted more than half of
the medium secure units they studied did not have
an effective strategy for managing obesity, although
most had a reasonable range of weight management
options available. They recommend
that medium
© GettyImages/Mladen Zivkovic
secure services prioritise education and health
promotion.
In a practice guideline on the use of occupation-
focused practice in secure hospitals, the Royal
College of Occupational Therapists recommends that
‘occupational therapists consider the use of healthy
living programmes and exercise as activity to benefit
health and wellbeing’ (RCOT 2017).
This recommendation was made following a
literature review that included a study examining the
impact of exercise. It found statistically significant
improvements in heart rate rest and systolic blood
pressure post treadmill test, although there were no
statistically significant changes in body mass index.
Participants reported statistically significant changes in
feelings of wellbeing and safety.
Fitbit project
Based on the review of the literature and a
recognised need to increase patients’ physical activity
participation, an idea for using activity trackers within
the service was formed.
Wearable activity trackers are small electronic
devices worn either as a bracelet or on a clip, and
are becoming a popular way to monitor activity and
increase motivation to exercise.