Getting psychiatry on the move—Implementation and evaluation of Braining, a structured physical exercise intervention in outpatient psychiatry: A convergent-parallel mixed methods study

BACKGROUND: Physical exercise can improve mental health outcomes, yet patients with mental illness often require structured support. Braining is a 12-week structured physical exercise intervention developed within Swedish outpatient psychiatry as a clinical package. Although preliminary unpublished findings suggest positive patient outcomes, its implementation within psychiatric services has not previously been evaluated. This study aimed to explore and explain healthcare workers' perceptions of the acceptability, appropriateness, and feasibility of Braining in an outpatient psychiatric setting to inform future implementation efforts. METHODS: A convergent parallel mixed-methods design was used with healthcare workers from outpatient psychiatry units specialising in substance use disorders. Quantitative data from the Acceptability of Intervention Measure, Intervention Appropriateness Measure, and Feasibility of Intervention Measure were collected at 1, 4, and 12 months and analysed descriptively. Qualitative data from three focus group discussions with eight Braining team members at 4 and 12 months were analysed abductively using qualitative content analysis. RESULTS: Acceptability, appropriateness, and feasibility ratings remained favourable over 12 months (≥16/20). Qualitative findings reflected participants' positive views on Braining's relevance for patients, its fit with clinical workflows, and its support for interprofessional collaboration. Participants perceived improvements in patients' quality of life, benefits of joint staff-patient exercise sessions, and enhanced social connectedness. Reported barriers included variable engagement among healthcare workers outside the Braining team and challenges in reaching younger patients. CONCLUSIONS: Braining was perceived by healthcare workers as acceptable, appropriate, and feasible in outpatient psychiatry, with sustained implementation outcomes linked to its adaptable design, team delivery, and organisational support. As a formative evaluation, the findings reflect perceived relevance rather than effectiveness, highlighting the need for strategies to enhance equitable reach and sustainability. TRIAL REGISTRATION NUMBER: NCT05111756.