Increasing activity and reducing sedentary behaviour for people with severe mental illness: what are the active ingredients for behaviour change? A systematic review

Increasing physical activity (PA) and reducing sedentary behaviour (SB) can improve health outcomes and reduce rates of premature mortality for people with severe mental illness (SMI). In this systematic review we aimed to explore the active ingredients of existing PA interventions for people with SMI. We reviewed intervention functions, behaviour change techniques (BCTs), contextual features and underpinning theories. We included 15 PA interventions, of which 4 were classed as effective (effect size >0.273). We identified the frequency of intervention functions and BCTs that were used in each study and compared the number of effective studies that featured a particular BCT or intervention function with the total number that featured those components. We used the TIDieR checklist to document contextual features that might be important within effective interventions including the theories that guided the development of interventions. The most frequently used functions were education and environmental restructuring, both of which were identified in effective interventions. The BCTs that were identified as potentially useful were framing and reframing, feedback on behaviour and self-monitoring. No discernible contextual features were unique to the effective interventions, but combinations of some features seemed to be (PA tracking, educational components and support delivered by community health teams). More high quality and better reported studies are required to strengthen this evidence base.Prospero registration: PROSPERO 2024 CRD42024541859 • Physical activity tracking alongside educational components is a common approach. • Behaviour change techniques framing/reframing, feedback on behaviour and self-monitoring were identified as potentially useful. • Evidence indicates combinations of components may contribute to effectiveness • Future studies should focus on clear reporting of intervention content.