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- Alyna Punjwani
Mentally ill people not only suffers from psychological distress, but “they often experience significant physical, social, and cognitive disability” (Kaur, Masaun, & Bhatia, 2013, p.404). To help patients cope up with these issues, along with psychological treatment, physical activity plays a therapeutic role. According to Moodie (2001), “Physical activity refers to virtually any sustained bodily movement that expends energy” (p.02). It ranges from simple tasks, like activities of daily living, to complex tasks like competitive sports (Doh, 2004 as cited in Creek, 2008). Participating in Physical activity helps an individual to improve physical, psychological as well as emotional health (Mcguirk, 2012).
Sedentary lifestyle among the mentally ill clients is the significant problem among all psychiatric care (Happell, Scott, Platania-Phung & Nankivell, 2012). Consequently, physical activity is the initial step to reduce their dependency on others. It conveys a sense of hope, power, and control towards their lives which encourages them to actively participate in daily living activites. Therefore, when these clients move back to their community, they would not be dependent on others and would be self-sufficient to care for themselves.
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During my mental health clinical, I and my group members conducted a morning session for all the patients in Karwan-e-Hayat psychiatric hospital. While interacting with the patients, I felt that they are distressed, and not communicating their feelings and thoughts to the fullest. After 15 minutes of unhealthy communication, the group members thought to start some physical activity. We played music and instructed everyone to participate. Most of the patients participated and it was clearly evident that they are thoroughly enjoying it. Even those patients who were not communicating initially, also joined in for the physical activity. After 10 minutes of this activity, we resumed our communication. I observed that now everyone is expressing their views and thoughts. One of the patient, who was primarily not contributing at all in the communication, shared with us the beautiful poetry in Urdu. This drastic change in the patients urged me to think about the impact of physical activity on client’s wellbeing.
On analyzing the case scenario, CARE framework could be integrated effectively. Engagement is found to be the most appropriate component of this framework, whereby the physical activity could be applied. One of the goal of this component is to offer opportunities to the client in order to move together towards a therapeutic change in the client (Mcallister & Walsh, 2003). As in the case scenario, activities were demonstrated first and the clients were expected to model those acts. Hence, demonstrating, providing support, and providing a motivation that there is a possibility to enact a positive change helps achieve this goal.
Every person with mental disorder is different from the other, but they have one thing in common i.e. low level of physical activity (Dunn & Jwell 2010). Physical activity is useful as it increases cognitive function. According to Ratey and Loehr (2011), exercise causes angiogenesis in temporal lobe, frontal lobe, and parietal cortex leading to increase blood flow towards these parts of the brain which in turn results in escalation of memory, learning, and attention. As highlighted in the case scenario, the client shared an amazing poetry in Urdu which indicates that physical activity had an effect in his cognitive functioning and memory. Moreover, exercise increases the uptake of insulin-like-growth factor (IGF-1), it crosses the blood brain barrier, and increases neurogenesis in a specific part of brain called hippocampus. Hence, further enhancing the cognitive function (Trejo, Carro, & Torres, 2001 as cited in Ratey & Loehr, 2011). In addition, Cohen and Shamas (2009) states that during physical activity, the body releases high amount of nor-adrenaline, dopamine and serotonin which effects the part of brain dealing with arousal and attention. As highlighted in the case that all the clients were more focused, and more involved in communication after the period of physical activity.
In addition, physical activity also serves as a coping mechanism. As schizophrenic patients engage themselves in different activities, it diverts their mind and distracts them from hallucinations (Richardson et al., 2005). Similarly, it can be an adaptive coping strategy for aggressive patients. For example one client verbalized that whenever he gets angry or frustrated, he goes outside and walks for about 5 minutes which gives him a sense of relaxation, and the feeling of anger diminishes eventually. Moreover, Physical activity is also useful in order to boost up self-esteem of the client. The successful completion of particular task may lead to increase self-confidence and self-efficiency (Crone, Smith, & Gough 2006). Hence, it is important to analyze the ability of the client to accomplish a task before involving them in activity. For example, during our exercise session, one patient was having difficulty performing the exercise due to his asthmatic condition. As we used directive approach for the exercise, everyone was doing it but the asthmatic client had to give-up and sit back in order to stabilize his condition. The client verbalized “I cannot do it anymore”. This would have created a doubt within him regarding his abilities and competency to achieve that goal. Apart from that, clients were talking to each other, and learning from others by observing them. Hence, physical activity provides a platform to bring people together, to promote interaction, and to contribute towards community cohesion in culturally diverse group. It creates a sense of belonging among other clients thereby promoting social inclusion (Trimble, 2012).
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The socio-cultural barrier I found was that the activity was done with all the male and female clients together, which was an inappropriate intervention in respect to the Pakistani culture. This was one the major hindering factor in promoting the physical activities in psychiatric setting. Hence, this practice has to be avoided in order to encourage the client to participate in these activities
As a nurse, it is very important to assess the patient’s ability to perform physical activities and recommend them accordingly. Societal, cultural and personal factors which hinders their ability to involve in activities must also be identified and addressed. Moreover, those patients who are unable to gather in activity area due to their disease process then separate activities should be planned for them to be performed in their own private space. The environment should be supportive and non-competitive to have a positive impact on client’s wellbeing. 15 to 30 minutes of moderate exercise for at-least 4 days a week is recommended for mentally ill clients (Richardson et al., 2005). It could be further adjusted according to client’s abilities. Intense physical activity at first should be avoided because it creates a sense of frustration and distress, further disrupting the patient’s condition. . It is necessary to reinforce the patients which gives a sense of achievement and boosts up their confidence level
At institutional level, integrating physical activities as part of the treatment therapy would increase adherence towards these activities. Moreover, goals should be planned collaboratively with psychologist, therapist, and other medical health care workers to ensure effective approach towards health promotion. Institution should make sure that physical activities are done on continuous basis because fragmented, inadequate, and unsupported activities are of no worth (Richardson et al., 2005).
At community, awareness sessions could be conducted to teach people about the impacts of physical activity on client’s well-being. This awareness could help mentally-ill patients in community to reduce their dependency
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