Required elements for an educational program for lay exercise instructors in charge of community-based exercise targeting young adults with schizophrenia spectrum disorders – A stakeholder focus group study

Background: Exercise can be a preventive means for the increased prevalence of cardiometabolic morbidity and premature mortality in people with schizophrenia spectrum disorder (SSD). When delivered in community-based settings, exercise may also serve as an opportunity to provide life-skill training and reduce loneliness and stigma while promoting overall physically active behaviors in one single intervention. However, long-term engagement in community-based exercise among people with SSD requires intensive practical and emotional support. Hence, instructors delivering and supervising community-based exercise are essential; however, knowledge about their roles and required training is lacking. We investigated stakeholders’ perspectives on components needed for an educational program for non-health professional exercise instructors delivering community-based exercise targeting young adults SSD.Methods: We conducted six focus groups comprising a total of 30 individuals representing five different stakeholder groups, namely clinical staff within mental health, physiotherapists, exercise instructors, young adults in antipsychotic treatment, and relatives to young adults in antipsychotic treatment. Qualitative content analysis as described by Graneheim and Lundman, was applied to analyze the data using Nvivo 12 software.Results: We identified the following three main categories to be considered in an educational program for exercise instructors delivering community-based exercise to young adults with SSD: (i) acknowledging mental illness, (ii) applying a resource-oriented approach, and (iii) promoting exercise as a shared activity. Furthermore, the analysis comprised an overarching theme, entitled, Instructors as guardians of an inclusive culture. The finding contributed to developing an educational program for non-health professional exercise instructors delivering community-based exercise targeting young adults SSD, which is currently implemented in the Vega Exercise Community trial (ClinicalTrials.gov ID: NCT05461885) The educational program encompasses: a) a written exercise instructor manual, b) a one-day educational course, and c) the possibility of a continuous exchange of experiences between instructors.Discussion: An educational program for exercise instructors delivering community-based exercise targeting young adults with SSD includes educational content that enables instructors to promote exercise as a shared activity while acknowledging mental illness and having a resource-oriented approach. Indeed, instructors must act as guardians of an inclusive culture supporting personal recovery. Our results may be transferable to the education of non-health professional exercise instructors in other areas of mental health care where the aim is to facilitate sustainable, recreational, community-based activities.