Systematic review of physical activity interventions assessing physical and mental health outcomes on patients with severe mental illness (SMI) within secure forensic settings

Introduction
Participating in physical activity has many benefits, yet those with severe mental illness (SMI) living in forensic settings are less likely to be active, and more likely to experience ill-health. The aim of this study was to systematically review the effectiveness of physical activity programmes on mental and physical health and specifically on reducing symptoms of SMI in forensic settings.

Method
A systematic search of six databases was conducted, in addition to a grey literature search. Studies were included if they: had participants with SMI; were based in a forensic setting; involved a physical activity programme; and reported physical and mental health outcomes.

Results
A total of 112 participants were included in four studies. One study showed a significant improvement in negative symptom scores in the exercise group compared to a treatment as usual group. Two studies reported improvements in psychiatric symptoms with no significant difference between groups, however, statistically significant changes in weight and waist circumference were evident (p <0.001). No adverse effects were reported.

Conclusion
Only a small number of studies were included and of limited design and quality, with no follow-up assessments, therefore more research is needed to determine the true effects of physical activity for improving SMI symptoms in a forensic setting. This review highlights the need for further studies exploring the barriers and facilitators of physical activity in secure forensic settings. Studies are required that include a more thorough research design. Furthermore, interventions if designed with patients and caring staff in mind may lead to lowered psychiatric symptoms and increased physical health benefits for all in forensic settings.