The physical health gap in mental illness – and what walking could do about it

People living with severe mental health conditions are far less physically active than the general population and they face a significantly higher risk of heart disease and diabetes, dying on average 15 to 20 years earlier. This gap is largely preventable yet supports to help people develop the skills to become independently more active are rarely built into everyday mental health services. New research from RCSI School of Physiotherapy suggests how this could change.

Here, Professor Suzanne McDonough, Professor and Head of RCSI's School of Physiotherapy, outlines the findings of the WORtH study, a new feasibility trial published in BMJ Open.

Before testing whether a programme works by running a large clinical trial, researchers first need to answer some fundamental questions: Can this programme be delivered in real-world settings? Will people join and stay involved? Will they find it worthwhile? To explore this, we conducted a feasibility trial of our WORtH (Walking fOR Health) programme. The early results are encouraging with over 80% of participants engaging with all key parts of the 13-week programme, and those in the WORtH group increasing their weekly physical activity by around one hour.

How the programme worked

Participants were randomly assigned to one of two groups. One group received a single education session with one of the research team while the WORtH group received a structured programme combining an education session about physical activity, a wrist-worn activity tracker to monitor daily steps, and regular one-to-one health coaching with a member of their own mental health team.

Walking was a deliberate choice: it is low cost, requires no specialist venue or equipment, and there is good evidence that it can be woven into daily life in a way that gym-based or group programmes often cannot. The intervention was designed to build lasting habits rather than short-term participation.

Bringing the whole team along

Because community mental health staff are not typically trained as physical activity coaches, we provided structured training in motivational communication, goal-setting and using activity tracker data in coaching conversations, along with ongoing supervision throughout the study.

A key lesson from this study was how much tailored support participants needed to take part fully. Many benefited from help with written tasks, technology, and navigating study procedures, which led us to introduce of practical supports such as home visits, reminder calls, telephone check-ins, and simplified resources.

The team also adapted how we conducted interviews, sharing questions in advance and using visual cues, to support richer discussion. These experiences reinforced something important: that flexible, person-centred support is a necessity when designing both research and behaviour-change interventions for this group.

What the findings mean

Despite more than 60% of participants having some degree of cognitive impairment, engagement and satisfaction were high, a finding that matters as much as the activity data itself. Programmes that are burdensome or difficult to access will not succeed in the real world, regardless of their effectiveness in controlled trials.

The one-hour weekly increase in moderate to vigorous physical activity seen in the WORtH group is important as it is helping people with severe mental health conditions get closer to the National Physical Activity Guidelines and at a population level, even small increases in physical activity are associated with meaningful reductions in cardiovascular risk. While this study was not designed to prove the programme works, these early signs are very promising.

Feedback from those involved, alongside ongoing engagement with key stakeholders, will shape an improved programme for a larger, definitive trial, one capable of determining whether WORtH can help close the physical health gap for people living with severe mental health conditions.

The WORtH feasibility trial is published in BMJ Open here. The study was funded by the European Union's INTERREG VA Programme and the Northern Ireland Public Health Agency HSC R&D division.