Moving the Body to Treat the Mind: Physical Health and Physical Activity as Targets for Mental Health Care in Secure Psychiatric Settings

Individuals with severe mental illness (SMI) have a life expectancy 10–20 years shorter than the general population, with a significant portion of this gap attributable to preventable physical disease. This problem is exacerbated in secure psychiatric settings where prolonged detention in environments with restricted movement, in conjunction with high-dose psychotropic medication, can contribute to high rates of obesity and type 2 diabetes. Physical activity (PA) is a modifiable determinant of cardiometabolic risk and an evidence-based therapeutic approach that can improve depressive and negative symptoms of cognition, sleep and quality of life. This commentary discusses the evidence of the relationship between physical health, PA and mental health with particular attention to adults and adolescents detained in secure care. Using specific examples from the author, it summarises potential mechanisms through which PA may impact mental health, examines the potential barriers that make its translation into secure services challenging and considers sleep and sedentary behaviour as complementary targets. There is a growing body of evidence to suggest that the limiting factor is no longer efficacy but rather implementation. Practical recommendations are offered for clinicians, service managers and commissioners seeking to embed PA into routine secure care.