Today, nurses observe that not many adult patients like to spend their time outdoors and be involved in physical activities. Thus, according to Hallal et al. (2012), about 43% of American people reported being physically inactive. Then research proves that there is a linear correlation of age and inactivity rate (Hallal et al., 2012). It should also be mentioned that people older than 50 and 60 in the Americas (region according to World Health Organization classification) are the most inactive in the world (Hallal et al., 2012, p. 35).
Gender differences are not so evident. However, older women are less active than men (Hallal et al., 2012, p. 36). Patients of nursing homes with mental health illnesses are the population of particular interest regarding the issue of inactivity. In American nursing homes, about 41% of all patients have moderate or severe cognitive impairment and various mental health problems (Galik, Resnick, Hammersla, & Brightwater, 2013). Mental disorders turn out to be a serious social and medical burden worldwide, including such diseases as schizophrenia, bipolar disorder, and Alzheimer’s disease (Happell, Platania‐Phung, & Scott, 2014).
As this type of health problem is defined as a burden, it may mean that treatment is not effective, or attempts are not appropriate. Outdoor physical activity may become a solution for adult patients. For example, a study by Kerr et al. revealed the fact that older adults “who were physically active only in outdoor locations” had minimum half an hour more moderate-to-vigorous physical activity per week than the ones who exercised indoors (2012, p. 3). It is necessary to focus the opinions of nurses, the attitudes of doctors, and the positions of patients and identify what achievements have been already made in this field, and what health care contributions may be expected.
Methodology for Searching Information
It is not enough to choose one source and use its information to prove the urgency of the offered topic. It is necessary to identify the methods with the help of which it is possible to investigate different areas of nursing and health care offered to adult patients. The main source of a searching process is Google Scholar, where it is possible to find articles from different peer-reviewed journals and academic books. The sources (no older than five years) have to be used to introduce up-to-date research and identify recent contributions.
The attention is also paid to such nursing databases as Medscape, EBSCO, and ProQuest. Only peer-reviewed articles should be used. The following key-words were used to search for information: “patients’ physical activity,” physical activity of older adults,” “outdoor physical activity,” “physical health of people with mental illnesses,” “outdoor spaces, and mental health.”
There are many peer-reviewed articles that can be found to discuss the topic of outdoor physical activities to be offered to adult patients who have some mental health problems and suffer from mental disorders in US nursing homes (Frühauff et al., 2012; Kerr et al., 2012; Korpela, Borodulin, Neuvonen, Paronen, & Tyrväinen, 2014; Triguero-Mas et al., 2015; Whear et al., 2014). The number of investigations dedicated to the physical activity of older adults with mental health problems can be explained by an increased interest in this topic. It is conditioned by the necessity to find the approaches on how to attract people to more activity, particularly outdoor, because it has a positive influence on health conditions.
The investigations in such countries as the United States, Australia, and Europe are used to prove that a geographical location is not a significant variable in this research. Adult people from different countries may have mental health problems and use physical activities and experiences as a treatment or a part of a treatment process. The role of nurses has to be investigated as well because adult patients may not be able to follow all prescriptions and activities without control and support.
Therefore, this research is characterized by the presence of such categories as health education (Happell, Scott, Platania-Phung, & Nankivell, 2012), types of training (Galik et al., 2013; Korpela et al., 2014; Zschucke, Gaudlitz, & Ströhle, 2013), nurse presence (Happell et al., 2014), effects of physical training (Frühauf et al., 2016; Kerr et al., 2012), outdoor/indoor environments (Triguero-Mas et al., 2015; Whear et al., 2014), and the reasons for acceptance or refusal of physical activities by adult patients (Fraser, Chapman, Brown, Whiteford, & Burton, 2015). Each source is a unique contribution to the discussion of a topic and the possibility to recognize what has been already discussed and what kind of work should be done to improve the development of physical activities among patients with mental disorders and recognize nurses’ roles.
Global Scope of the Problem
The importance of physical activities among patients with mental health problems is a frequently discussed topic in different countries. The current review is aimed at discovering the meaning of outdoor physical activity for the well-being of those patients worldwide. It will allow improving the situation with inactivity among older adults due to the successful experience of foreign countries. For example, in Finland, much attention is paid to the emotional well-being of people and the possibility to avoid risks of having mental disorders and improve physical health due to regular physical activities, recreational walking, and social coherence (Korpela et al., 2014).
These authors investigate the peculiarities of nature-based recreational activities and emotional well-being in regards to the company that can be offered to people, duration of activities, and restorative experiences. The investigations of Happel et al. (2012) and Happel et al. (2014) show that Australian concerns about the conditions of adult patients in nursing homes may depend on the number and quantity of physical activities offered by specially trained nurses. Australian researchers suggest implementing several nurse-based strategies to achieve positive outcomes in physical activities for adult patients.
In the USA, nurses find it necessary to use several interventions along with physical activities to improve physical conditions of cognitively impaired patients. An adult US population believes that physical activities may be associated with the possibility to prevent the development of depression, social phobia, and panic disorders (Zschucke et al., 2013). In general, regardless of the geographical location of patients, physical activities suppose to be effective treatment methods for people with mental disorders. Researchers find this method effective and worth attention for adults with dementia, Alzheimer’s disease, and schizophrenia.
Importance of Education and Appropriate Choices
Many researchers admit that physical activities cannot be offered to adult patients without appropriate education and training (Galik et al., 2013; Happell et al., 2012; Korpela et al., 2014; Zschucke et al., 2013). The delivery of physical activity programs has to be controlled by a general nurse, a gym instructor, a personal trainer, or a mental health nurse (Fraser et al., 2015). Besides, it is important to investigate the condition of patients and understand if outdoor activities are not harmful or should be replaced with indoor activities.
Frühauf et al. (2016) prove that patients achieve more positive results and improvements outdoors. Gardens and fresh air are also introduced as a part of physical treatment for patients suffering from dementia (Whear et al., 2014). Still, it is the decision that has to be made by a doctor or a nurse about an appropriateness of physical activities in case serious mental disorders are observed (Happell et al., 2012). Education of nurses and education of patient should not be neglected by health care providers because small details of such treating process may influence a human life and the development of a mental problem.
Barriers for and Outcomes of Physical Activities
Much attention is paid to the possible barriers adult patients may experience instead of taking physical experiences. For example, Fraser et al. (2015) describe such factors as a poor quality of life, physical or emotional fatigue, and lack of motivation as the main barriers for patients to cooperate with nurses. However, Frühauf et al. (2016) claim that physical activity is a good method to cope with depression and improve the quality of life. Therefore, it is necessary for patients to identify the benefits of the offered treatment and avoid threats using the help of nurses. Kerr et al. (2012) maintain the possibility to increase bone health and use Vitamin D received while physical training outdoors.
People with a mental disorder as their primary diagnosis may experience serious physical illnesses (Happell et al., 2014). Therefore, Vitamin D obtained outdoors and social support of nurses received indoors turn out to be an effective treatment for adult patients. Triguero-Mas et al. (2015) support almost the same position and underline the importance of physical activities as a chance to improve general and mental health. Self-perceived health is another improvement that can be observed.
The natural outdoor environment is closely connected to health in terms of socio-economic statuses of patients. In case people may afford to have a personal trainer or a nurse who can follow the physical condition of a patient, the effects of such treatment and physical activities may be positive. If patients cannot have an appropriate support for any reason or fail to learn the peculiarities of physical activities in their lives, they can increase psychological, physical, and emotional risks (Korpela et al., 2014).
In general, the analysis of the articles taken from specialized nursing journals and other sources helps to understand that physical activities have to be defined as a significant part of a treatment process. Adult patients with mental health problems from different countries have access to different health care methods. Cooperation with nurses or other caregivers is a crucial step that cannot be ignored. Medical personnel can promote effective patient education and training and identify the worth of outdoor and indoor physical exercises.
Fraser, S. J., Chapman, J. J., Brown, W. J., Whiteford, H. A., & Burton, N. W. (2015). Physical activity attitudes and preferences among inpatient adults with mental illness. International Journal of Mental Health Nursing, 24(5), 413-420.
Frühauf, A., Niedermeier, M., Elliott, L. R., Ledochowski, L., Marksteiner, J., & Kopp, M. (2016). Acute effects of outdoor physical activity on affect and psychological well-being in depressed patients–A preliminary study. Mental Health and Physical Activity, 10, 4-9.
Galik, E., Resnick, B., Hammersla, M., & Brightwater, J. (2013). Optimizing function and physical activity among nursing home residents with dementia: Testing the impact of function-focused care. The Gerontologist, 54(6), 930-943.
Hallal, P.C., Andersen, L.B., Bull, F., Guthold, R., Haskel, W., & Ekelund, U. (2012). Global physical activity levels: Surveillance progress, pitfalls, and prospects. The Lancet, 380, 247-257.
Happell, B., Platania‐Phung, C., & Scott, D. (2014). Proposed nurse‐led initiatives in improving physical health of people with serious mental illness: A survey of nurses in mental health. Journal of Clinical Nursing, 23(7-8), 1018-1029.
Happell, B., Scott, D., Platania-Phung, C., & Nankivell, J. (2012). Nurses’ views on physical activity for people with serious mental illness. Mental Health and Physical Activity, 5(1), 4-12.
Kerr, J., Sallis, J. F., Saelens, B. E., Cain, K. L., Conway, T. L., Frank, L. D., & King, A. C. (2012). Outdoor physical activity and self rated health in older adults living in two regions of the US. International Journal of Behavioral Nutrition and Physical Activity, 9(1), 89-93.
Korpela, K., Borodulin, K., Neuvonen, M., Paronen, O., & Tyrväinen, L. (2014). Analyzing the mediators between nature-based outdoor recreation and emotional well-being. Journal of Environmental Psychology, 37, 1-7.
Triguero-Mas, M., Dadvand, P., Cirach, M., Martínez, D., Medina, A., Mompart, A.,… Nieuwenhuijsen, M. J. (2015). Natural outdoor environments and mental and physical health: Relationships and mechanisms. Environment International, 77, 35-41.
Whear, R., Coon, J. T., Bethel, A., Abbott, R., Stein, K., & Garside, R. (2014). What is the impact of using outdoor spaces such as gardens on the physical and mental well-being of those with dementia? A systematic review of quantitative and qualitative evidence. Journal of the American Medical Directors Association, 15(10), 697-705.
Zschucke, E., Gaudlitz, K., & Ströhle, A. (2013). Exercise and physical activity in mental disorders: Clinical and experimental evidence. Journal of Preventive Medicine and Public Health, 46(1), 12-21.