Embedding Physical Activity into Community-Based Peer Support Groups for those Severely Affected by Mental Illness

The study addresses the limited focus on individuals with severe mental illness (SMI) within community-based physical activity research, despite their higher rates of physical inactivity, poorer physical health, and elevated mortality. Prior literature highlights physical and psychosocial benefits of physical activity, the importance of settings and social context, and the role of peer support in recovery (e.g., CHIME framework). Barriers to activity among those with SMI include psychological and socio-ecological factors, notably limited support. The project, delivered by Rethink Mental Illness and funded by Sport England, embedded physical activity into peer support groups nationwide to support inactive individuals to achieve at least 30 minutes of weekly activity over 12 months. Evaluation aims: (1) investigate the impact of peer support and social interaction on physical activity and physical/mental health for those affected by SMI; (2) understand benefits for those affected by SMI; and (3) understand processes facilitating or hindering project delivery.

The paper situates the study within literature emphasizing the influence of context, culture, and setting on physical activity outcomes for people with mental health challenges. Benefits of physical activity include improved cardiometabolic health and mitigation of social isolation, with social identity processes facilitating engagement. Recovery literature (CHIME: Connectedness, Hope, Identity, Meaning, Empowerment) supports the value of social and meaningful activities. Evidence in SMI populations shows benefits but also barriers, including stress, depression, and lack of support/peer support. Community programmes (e.g., football, walking, peer-led initiatives) demonstrate psychosocial gains and contributions to recovery. However, there is a scarcity of large-scale, community-led interventions specifically targeting SMI and limited exploration of peer support within such interventions, indicating a need for evaluations that combine national delivery with sensitivity to local contexts and co-production.

Design: Qualitative component of a mixed-methods evaluation, underpinned by a relativist ontology and constructionist epistemology to capture multiple subjective experiences across diverse settings. Data collection: Semi-structured focus groups and interviews with multiple stakeholder groups to explore experiences of embedding physical activity into peer support groups. - Participants and sessions presented: 26 interviews total. • Peer support group members: 5 in-person focus groups (28 participants total; mean 5.6, range 3–11) across South-East England (3 groups), London (1), South-West England (1), conducted May 2019–Feb 2020 (~3 months after embedding began). • Group leads: 16 individual interviews and 2 focus groups (7 participants; one FG n=3, one FG n=4) spanning London, South-East, South-West, East Midlands, East England, North-East; mostly remote via phone/video, one in-person; interviews May 2019–Aug 2021. • Group Development Officers (GDOs): 1 focus group (3 participants). • Project managers: 2 individual interviews at project end. Procedures: Informed consent obtained; no compensation. Member focus groups held in familiar group settings; other interviews primarily remote (pragmatic and safe across geographical spread). All sessions audio-recorded and transcribed verbatim. Peer researcher involvement: Individuals with lived SMI experience were recruited via Rethink networks, trained through two workshops (ethics, data collection, analysis), supported fieldwork and analysis, and are co-authors. Instruments: Semi-structured guides tailored to each group, covering experiences with peer support groups, physical activity views and engagement, impacts on health and wellbeing, delivery processes, toolkit utility, facilitators and barriers, and (post-March 2020) COVID-19 impacts (see Supplementary File S1). Ethics: Approved by Non-invasive Human Ethics committee at first author’s institution (ref 18/19-52). Analysis: Reflexive thematic analysis per Braun and Clarke. Inductive coding by authors 1–4, iterative theme development, and team meetings (including peer researchers) as ‘critical friends’ to refine and interrogate interpretations; emphasis on rigor through reflexivity and dialogic validation rather than consensus.

Four overarching themes emerged: 1) Social aspects are central: The social environment of peer support groups was as valuable as the activity itself, fostering trust, encouragement, reduced isolation, improved confidence in social situations, and connectedness. Group membership and mutual encouragement were key to sustaining participation. 2) Peer support and informal physical activity preferred over organized sport: Activities like ‘walk and talk’, yoga, tai chi, and chair-based exercises were more accessible, flexible, and sustainable given fluctuating attendance and varied fitness levels. Organized sport posed logistical challenges (e.g., numbers required). Group leaders’ local knowledge and responsiveness to members’ preferences were crucial. Co-production and realistic targets were highlighted; some KPIs were seen as overly ambitious, and early involvement of on-the-ground staff was recommended. 3) Doing things differently—lessons learned: Calls for longer initiation/pre-delivery phases to build collaboration, co-design, and enthusiasm; tailored resources (toolkits, training) for leaders; sustainable practical support (equipment, funding). Recognition of group diversity (language, abilities, contexts) meant one-size-fits-all approaches were unsuitable; partnerships and local tailoring were beneficial. Diversity within groups also brought positives (broader social mix). 4) Impact of COVID-19: The pandemic disrupted delivery, reduced face-to-face contact, and lowered physical activity for many. Digital exclusion (access, affordability, skills, confidence) hindered a pivot to online. The experience underscored the vital role of in-person peer support for combating isolation and maintaining motivation, and highlighted communication challenges across project tiers during restrictions.

Findings directly address the evaluation aims by demonstrating that embedding physical activity within peer support structures benefits individuals affected by SMI primarily through social mechanisms that facilitate engagement, adherence, and perceived wellbeing gains. The results reinforce that social connectedness can be a more compelling driver than the specific activity, aligning with recovery frameworks and prior community sport literature. Effective delivery depends on local tailoring, empowered and supported group leaders, and genuine co-production throughout conception, implementation, and evaluation. Organizational processes (realistic timelines and KPIs, early stakeholder engagement, and flexible expectations) are critical enablers. COVID-19 highlighted the fragility of delivery under disruption, the importance of face-to-face interaction, and the need to anticipate digital exclusion. Overall, peer-supported, informal, context-sensitive physical activity appears particularly suitable for SMI populations compared with formal sport models.

Embedding physical activity into community-based peer support groups for people severely affected by mental illness is feasible and valued, with social elements driving engagement and perceived benefits. Key recommendations include: prioritize and resource the social fabric of groups; equip and support group leaders in physical activity facilitation; ensure comprehensive co-production with all stakeholders from design through evaluation; and establish realistic timelines and continuous communication between strategic and delivery levels. Future research should disentangle the relative contributions of physical activity and peer support, and their interaction, to physical and mental health outcomes in SMI, while maintaining ecological validity in real-world community contexts.

- Access and engagement: Recruitment and data collection with group members largely mediated by group leads, potentially limiting reach to non-attenders and introducing gatekeeping bias. - COVID-19 disruption: Halted in-person member focus groups after Feb 2020 and constrained data collection; reliance on indirect contact post-onset. - Digital exclusion: Limited ability to transition engagement online, affecting both programme delivery and evaluation participation. - Generalizability: Qualitative design within diverse, context-specific groups; transferability supported by peer researcher resonance and multi-stakeholder perspectives, but not statistical generalization.