People with severe mental illness die 15–20 years younger than the general population, mostly from preventable physical health problems, and this project aims to close that gap by getting them moving more. The problem is stark: people with severe mental illness (SMI) such as schizophrenia or bipolar disorder live far more sedentary lives than others, and their mortality gap is widening. Physical activity can improve physical health as much as quitting smoking, yet no evidence-based, NHS-ready programme exists to help this group become more active. The SPACES programme will co-design an intervention with service users themselves, identifying what stops them from exercising and what behaviour-change techniques actually work. If successful, the programme will deliver a clinically and cost-effective intervention that the NHS can implement at scale. That could save lives, reduce health inequalities, and save NHS resources by preventing the heart disease, diabetes, and other conditions that kill people with SMI decades early. The team will also produce a clear implementation guide so decision-makers know exactly what staff, time, and money are needed to roll it out. The ultimate prize is narrowing—and eventually closing—the mortality gap for one of the most disadvantaged groups in the UK.
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1. Aims and Objectives To co-produce a feasible intervention to increase physical activity among people with severe mental illness (SMI), before testing its clinical and cost effectiveness. Key research questions are: 1. What are the barriers and facilitators to taking part in physical activity for people with SMI and how can behaviour change techniques be utilised in a co-produced intervention to increase physical activity in people with SMI? 2. Is it feasible and acceptable to deliver the intervention for people with SMI via the NHS? 3. Is the intervention clinically- and cost-effective? 4. What are the optimal implementation strategies to embed and deliver the intervention in NHS services? 2. Background and Rationale Life expectancy is reduced by around 15-20 years for people with SMI compared to people without SMI, and this health inequality is increasing. Furthermore, the majority of these early deaths are due to physical health problems which are partly preventable. Increasing physical activity can improve physical health in all sectors of the population including people with SMI. The World Health Organization has said that encouraging people to be more active can have as great an impact as quitting smoking. When compared to people without mental health problems, people with SMI have more sedentary lives and are less physically active. Therefore, supporting people with SMI to increase their levels of physical activity could help to reduce the mortality gap people with SMI currently experience. 3. Research Plan Workstream 1: Development and design of the intervention –Months 1-15 We will co-produce a theory-based intervention; combining existing evidence with new components. Workstream 2: Feasibility study – Months 16-36 The intervention and materials will be piloted and refined to maximise acceptability and impact. A randomised controlled feasibility trial will be conducted to address uncertainties in recruitment, retention, outcome measurement, randomisation, and resource use. Workstream 3: Randomised controlled trial – Months 36-72 The clinical effectiveness and cost-effectiveness of the intervention will be assessed relative to usual care. Workstream 4: Process Evaluation & Knowledge Mobilisation – Months 36-72 A process evaluation will be conducted alongside the main trial. This will be guided by core constructs of the Theoretical Domains Framework to identify barriers and facilitators to implementation. A knowledge mobilisation strategy will be developed to increase the prospects of uptake. 4. Anticipated IMPACT & Dissemination The SPACES programme will deliver an intervention aimed at increasing physical activity in people with SMI, with a realistic understanding of its clinical and cost-effectiveness. Based on a logic model, decision makers will understand the resources and outputs required for delivery. The chances of impact will be maximised via an understanding of how this intervention can be implemented. Innovative modes of dissemination include; Service User and third sector networks, Applied Research Collaborations and the UKRI Mental Health Network on inequalities in SMI, which is led by the SPACES consortium. The intervention will directly benefit people with SMI and has potential to save lives and NHS resources, and decrease health inequalities in a vulnerable and disadvantaged population.
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