Moving Toward Wellness: Exercise Augmentation of Affective Disorder Treatment in Inpatient Psychiatry

BACKGROUND: Depression is a leading cause of disability worldwide, increasing the risk for physical comorbidities and suicide. Around 25% of all psychiatric hospitalizations are for depression related complaints. Exercise is an effective adjunct therapy for depression but is rarely implemented in inpatient settings.

LOCAL PROBLEM: Inpatient depression treatment primarily relies on medication, which is associated with modest efficacy, side effects, delayed onset, and adherence issues. This project aimed to implement exercise as an augmentation strategy for depressed adults at an inpatient psychiatric facility in North Carolina, targeting 25% patient participation over 90 days.

METHODS: The Johns Hopkins Nursing Evidence-Based Practice Model (JHNEBP) guided project development and implementation. An exercise augmentation protocol was designed using the best practices taken from the evidence and tailored to the site. Measures included patient participation, session frequency, reasons for non-participation, and qualitative feedback via anonymous surveys.

INTERVENTIONS: Staff (behavioral health technicians, nurses, and providers) received a single educational session on the project and facilitated 30- to 45-minute strength and aerobic exercise groups three times per week. Qualitative data was collected through surveys and informal interviews. Monthly PDSA cycles informed implementation.

RESULTS: Over 90 days, staff conducted 43 exercise sessions, averaging three per week. The project saw 324 total participants and 193 of these were depressed. Out of the 445 potential depressed participants during the project period, the project achieved a 43.8% participation rate, surpassing its aims of 25%. Patients reported improved mood, increased motivation to continue exercising, and positive shifts in attitudes toward exercise.

CONCLUSIONS: Exercise augmentation was a feasible, safe, and sustainable practice change in an inpatient behavioral health hospital. The 43.8% participation rate exceeded project aims, and the program expanded to an additional unit during implementation. Plans for dissemination include internal meetings and mental health conferences.