A whole systems approach to integrating physical activity to aid mental health recovery-Translating theory into practice

Improving health outcomes for people with severe mental illness (SMI) through increased physical activity (PA) on a large scale remains an elusive goal. There is promising evidence that increasing levels of PA in people with SMI can improve psychological and physical health outcomes. However, SMI is associated with reduced levels of physical activity and more sedentary behaviour than is usual in people without SMI.Increasing PA and reducing sedentary behaviour among people with SMI is a complex process, as there are drivers of these behaviours at the individual, household, community and policy levels. Examples of these include the symptoms associated with SMI, poverty, unemployment, social isolation and stigma. Such drivers affect opportunities to take part in PA and individuals' abilities to do so, creating negative reinforcing loops of be-haviours and health outcomes.Most previous approaches to PA for this population have focused largely on individual behaviour change, with limited success. To increase levels of PA effectively for people with SMI at scale also requires consideration of the wider determinants and complex dynamic drivers of PA behaviour in this population.This position paper sets out a rationale and recommendations for the utilisation of whole systems approaches to PA in people with SMI and the improvement of physical and psychological outcomes. Such approaches should be delivered in conjunction with bespoke, individual-level interventions which address the unique needs of those with SMI.