Document Type : Original Article


1 Department of Nursing, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India

2 Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India


BACKGROUND: A structured physical activity program has many health benefits. Physical activity 
improves the functional ability of a patient with mental illness as an adjunctive treatment. This study 
aimed to evaluate the efficacy of a physical activity program on the level of functional ability of 
patients with mental illness.
MATERIALS AND METHODS: A pre‑experimental research design and one group pre‑post design 
were adopted. Thirty‑one in‑patients with mental illness who met the inclusion criteria were recruited 
for the study using convenient sampling. Baseline data were collected using sociodemographic and 
illness profiles developed by the researcher and validated by the experts. Functional ability and illness 
severity were assessed using the standardized World Health Organization Disability Assessment 
Schedule (WHODAS) (36‑item version) and the Clinical Global Improvement Scale. Pretest, i.e., 
intervention with structured physical activity, was administered for 40 consecutive days. A posttest 
was given 30 days after the intervention ended to assess the impact of the structured physical activity 
program on the level of functional ability among the study participants.
RESULTS: The impact of structured physical activity on functional ability was measured using the 
WHODAS 2.0, a 36‑item version. The paired Sample t‑test and the Wilcoxon Rank test analyzed the data. 
There was a significant improvement in the overall functional ability of study participants at P = 0. 001.
CONCLUSION: The study findings support that structured physical activity substantially impacts 
functional ability among patients with mental illnesses.


1. Steinerte V, Vetra A, editors. The World Health Organisation 
Disability Assessment Scale (WHODAS II): Links between 
Self‑Rated Health and Objectively Defined and Clinical 
Parameters in the Population of Spinal Cord Injury; 2016.
2. Vigo D, Thornicroft G, Atun R. Estimating the true global burden of mental illness. Lancet Psychiatry 2016;3:171‑8.
3. Rehm J, Shield KD. Global burden of disease and the impact of 
mental and addictive disorders. Curr Psychiatry Rep 2019;21:10.
4. Shankardass M. Mental health issues in India: Concerns and 
response. Indian Journal of Psychiatric Nursing 2018;15:58‑60.
5. Lawton E, Brymer E, Clough P, Denovan A. The relationship 
between the physical activity environment, nature relatedness, 
anxiety, and the psychological well‑being benefits of regular 
exercisers. Frontiers in psychology 2017;8:1058.
6. Nie Y, Ma Y, Wu Y, Li J, Liu T, Zhang C, et al. Association between 
physical exercise and mental health during the COVID‑19 
outbreak in China: A nationwide cross‑sectional study. Front 
Psychiatry 2021;12:722448.
7. Ng KH, Agius M, Zaman R. The global economic crisis: Effects on 
mental health and what can be done. J R Soc Med 2013;106:211‑4.
8. Ströhle A, Höfler M, Pfister H, Müller AG, HoyerJ, Wittchen HU,
et al. Physical activity and prevalence and incidence of mental 
disorders in adolescents and young adults. Psychol Med 
9. Pasco JA, Williams LJ, Jacka FN, Henry MJ, Coulson CE, 
Brennan SL, et al. Habitual physical activity and the risk for 
depressive and anxiety disorders among older men and women. 
Int Psychogeriatr 2011;23:292‑8.
10. Ten Have M, de Graaf R, Monshouwer K. Physical exercise in 
adults and mental health status findings from the Netherlands 
mental health survey and incidence study (NEMESIS). 
J Psychosom Res 2011;71:342‑8.
11. Trautmann S, Rehm J, Wittchen HU. The economic costs of mental 
disorders: Do our societies react appropriately to the burden of 
mental disorders? EMBO Rep 2016;17:1245‑9.
12. Marmot M. Fair society, healthy lives: A strategic review of 
inequalities in England. London: University College London. 
13. Stein DJ, Collins M, Daniels W, Noakes TD, Zigmond M. Mind 
and muscle: The cognitive‑affective neuroscience of exercise. CNS 
Spectr 2007;12:19‑22.
14. Oertel‑Knöchel V, Mehler P, Thiel C, Steinbrecher K, Malchow B, 
Tesky V, et al. Effects of aerobic exercise on cognitive performance 
and individual psychopathology in depressive and schizophrenia 
patients. Eur Arch Psychiatry Clin Neurosci 2014;264:589‑604.
15. Vaynman S, Gomez‑Pinilla F. Revenge of the “sit”: How lifestyle 
impacts neuronal and cognitive health through molecular systems 
that interface energy metabolism with neuronal plasticity. 
J Neurosci Res 2006;84:699‑715.
16. Rolland Y, Pillard F, Klapouszczak A, Reynish E, Thomas D, 
Andrieu S, et al. Exercise program for nursing home residents 
with Alzheimer’s disease: A 1‑year randomized, controlled trial. 
J Am Geriatr Soc 2007;55:158‑65.
17. DishmanRK, Berthoud HR, Booth FW, Cotman CW, Edgerton VR, 
Fleshner MR, et al. Neurobiology of exercise. Obesity 
(Silver Spring, Md) 2006;14:345‑56.
18. Duman RS. Neurotrophic factors and regulation of mood: 
Role of exercise, diet and metabolism. Neurobiol Aging 
2005;26 Suppl 1:88‑93.
19. Lin WC, Zhang J, Leung GY, Clark RE. Chronic physical 
conditions in older adults with mental illness and/or substance 
use disorders. J Am Geriatr Soc 2011;59:1913‑21.
20. Scott K, McGee MA, Schaaf D, Baxter J. Mental‑physical 
comorbidity in an ethnically diverse population. Soc Sci 
Med (1982) 2008;66:1165‑73.
21. Scott D, Happell B. The high prevalence of poor physical health 
and unhealthy lifestyle behaviours in individuals with severe 
mental illness. Issues Ment Health Nurs 2011;32:589‑97.
22. Chacón F, Mora F, Gervás‑Ríos A, Gilaberte I. Efficacy of lifestyle 
interventions in physical health management of patients with 
severe mental illness. Ann Gen Psychiatry 2011;10:22.
23. Schmitz N, Kruse J, Kugler J. The association between physical 
exercises and health‑related quality of life in subjects with mental 
disorders: Results from a cross‑sectional survey. Prev Med 
24. Penedo FJ, Dahn JR. Exercise and well‑being: A review of mental 
and physical health benefits associated with physical activity. 
Curr Opin Psychiatry 2005;18:189‑93.
25. Dauwan M, Begemann MJ, Heringa SM, Sommer IE. Exercise 
improves clinical symptoms, quality of life, global functioning, 
and depression in schizophrenia: A systematic review and 
meta‑analysis. Schizophr Bull 2016;42:588‑99.
26. Ranjbar E, Memari AH, Hafizi S, Shayestehfar M, Mirfazeli FS, 
Eshghi MA. Depression and exercise: A clinical review and 
management guideline. Asian J Sports Med 2015;6:e24055.
27. Beebe LH, Tian L, Morris N, Goodwin A, Allen SS, Kuldau J. 
Effects of exercise on mental and physical health parameters 
of persons with schizophrenia. Issues Ment Health Nurs 
28. Goodwin RD. Association between physical activity and 
mental disorders among adults in the United States. Prev Med 
29. Ganesh S, Mishra C. Physical activity and quality of life among 
adults with paraplegia in Odisha, India. Sultan Qaboos Univ Med 
J 2016;16:e54‑61.
30. Paul J, Govindan R, Manjunatha N, Kumar C, Math S. Mental 
healthcare Act 2017 –Role of nurse in enabling person with mental 
illness. Indian Journal of Psychiatric Nursing 2019;16:114‑7.
31. Happell B, Gaskin CJ. The attitudes of undergraduate nursing 
students towards mental health nursing: A systematic review. 
J Clin Nurs 2013;22:148‑58.
32. Happell B, Platania‑Phung C, Scott D. Placing physical activity 
in mental health care: A leadership role for mental health nurses. 
Int J Ment Health Nurs 2011;20:310‑8.
33. Hirsch L, Yang J, Bresee L, Jette N, Patten S, Pringsheim T. 
Second‑generation antipsychotics and metabolic side effects: 
A systematic review of population‑based studies. Drug Saf 
34. Reynolds GP, Kirk SL. Metabolic side effects of antipsychotic 
drug treatment – Pharmacological mechanisms. Pharmacol Ther