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Active Hospitals

Mental Health Exercise Therapy Pathway

Working within adult mental health, in-patient services for Cumbria, Northumberland, Tyne and Wear (CNTW) NHS Foundation Trust, the Exercise Therapy Service provide physical activity opportunities for all and a structured exercise programme for those who have a physical or mental health need and/or specific exercise related goals.

Mental Health Exercise Therapy Pathway Overview

Physical Activity Plan or Structured Exercise Classes
Review appointment

More minutes conversation

Patient Information Leaflets

Goal Setting Workbook

Either physical activity plan or structured exercise classes

Gym induction

Gym programme review/ progression

Care plan update

Disuss local opportunities

Physical Activity Calculator



Training – Active Conversations

Governance Framework

Environment changes

Culture change

Continual review of care plan


  • On admission the exercise therapy department review every patients’ physical health monitoring documentation and make recommendations regarding engagement with the department.
  • Exercise therapy is an opt-in service and therefore patients must agree to engagement prior to assessment. Exercise therapy staff offer interventions to all patients at the beginning and throughout their admission. At this stage exercise therapy staff will discuss exercise/physical activity opportunities and the benefits associated with maintaining activity levels during admission. Following this conversation and depending on their physical health needs and exercise/activity related goals, we will discuss which pathway (physical activity or structured exercise) is best suited.
  • The aim of the physical activity pathway is to; provide opportunities to engage in physical activity and reduce sedentary time during admission.  This pathway also allows us to build rapport with servicers who would not normally engage in structured exercise and allows us the opportunity to discuss the benefits and breakdown barriers associated with exercise/physical activity.
  • The main focus of the department continues to be providing a tailored exercise intervention to meet the physical and mental health needs of our service users. Therefore the aim of the structured exercise pathway is to; provide evidence based, exercise interventions dependent on individual’s goals and physical/mental health needs.

Click on the boxes below to find out more information about the interventions used in this pathway.

Exercise Therapists

Exercise Therapists are trained to deliver brief advice on physical activity and are also trained gym instructors. They can support the patient to become and remain active.

A Weight Off Your Mind (AWOYM) strategy

The website has a number of helpful resources regarding behaviour change.

Brief interventions – MECC

Brief conversations  about physical activity, nutrition, smoking.

MECC training was introduced via the AWOYM strategy and MECC trainers from PHE attended the trust to deliver trainer the trainer session – over 70 staff completed the train the trainer training).

You could use the Moving Medicine Depression 1 minute conversation

Motivational Interviewing

Motivational interviewing  was used during the assessment stage. This was completed by qualified exercise professionals to engage clients and establish their own motivations for change.

You could use the Moving Medicine Depression more minutes conversation to support this.

Motivational training was delivered as in-house training by the trust.  You can also access motivation interviewing training via the Moving Medicine Active Conversations online course

Goal setting

We are an evidence based service therefore for any physical health conditions qualified staff use ACSM guidelines for principles for exercise prescription.





Weekly or Monthly gym challenges

The monthly gym challenges are delivered by the exercise therapy team and supported by the MDT. We usually devise a challenge based on Trust or national health campaigns or sports events.

During the first lockdown in March we teamed up with Sunderland foundation of light and completed the 30 day fitness challenge . The team produced daily videos of the challenge exercises to support staff and patient involvement. The videos were posted on the Trust YouTube channel.

More recently we have devised a Mile a day your way for during the latest lockdown and promoted use of the trust health walks.

During national sports week which incorporated national fitness day we set a timetable of different activities  for staff and patients to participate in.

Healthy lifestyle and nutrition group
  • These groups provide general lifestyle and healthy eating advice topics include, exercise, calories, fat, sugar, portion sizes, smoking. We try to make these sessions as interactive as possible and often use library resources (models) or playing cards etc to support engagement from our patient group
  • These groups are generally delivered by the exercise therapy team however we are encouraging the development of an MDT approach to this including OT, dieticians and peer support workers, this new model will include some practical (exercise /cooking) and learning sessions.
  • We also proactively support the trusts ‘A weight off your mind’ (AWOYM) strategy. Which was developed in conjunction with our service users to support them to achieve and maintain a healthy weight, the website has a number of helpful resources to support the delivery of healthy lifestyle session like ‘fake-away’ menus and links to physical activity opportunities in the community and exercise videos.

Group sports (football/badminton)

We have developed strong links with Sunderland Foundation of Light (associated to Sunderland AFC). The Foundation of Light was set up in 2001 with the purpose of changing local lives through the power of football.  Now more than 15 years later, they have grown to become one of the most pioneering organisations within their field, winning multiple awards for our ground-breaking work.

The ‘Your health’ sessions, happen twice a week; 1x football group and 1x multi-sport group (various activities from basketball, badminton, soft ball/cricket, volley ball etc). We have also worked together to register a 7 a-side team which takes part in a monthly inclusion league organised by Durham F.A called Beacon F.C. (they reached second round of people F.A cup last year). The foundation also run a number of other sessions including, family learning, health promotions, employability.


Walking Groups

Walking Groups  – all staff are walk leader qualified – we use local walking/cycling routes and monthly go further afield and visit local parks/coast or nature reserves for our walk and talk sessions.

  • We have developed guided health walks on a number of trust sites. Walks range from 1km to 2km depending on the site, all routes are accessible and safe for all abilities and make use of the green space available on the sites.

Information leaflets are available on the trust internet and AWOYM website. They provide a map of the route, useful tips, guidance to achieve the correct walking pace and links to local walking groups in the area.


Exercise Classes (Zumba, core conditioning, box-fit, circuit training, kettlebells etc)
  • Exercise groups are primarily delivered by our exercise therapy assistants (qualified to L3 in exercise prescription) who have a variety of qualifications in exercise group activities. We also regularly complete in-house training session to develop skills and learning.
  • Groups take place either in our gym departments we also have access to group activity rooms. We also have access to outdoor space (football pitch, tennis court and local walking/cycle routes – not all available at all sites)

Gym sessions

Picture above is from ST Georges park gym one of our 3 department gym facilities. This is the largest of the facilities but all have similar a standard of exercise equipment


–          Exercise and/or health goals are discussed during health screening process, if appropriate a gym induction is completed with our qualified exercise therapist who will prescribed exercise intervention related to agreed goals. Following completion of a gym induction patients are supervised in the gym by our exercise therapy assistants. Gym programmes are reviewed every 2-3weeks by our qualified any progression are agreed and documented.

–          Prior to COVID gym sessions were open session for patients to attend – exercise therapy staff would also attend each ward to round up patients for the sessions Gym sessions would be programmed at least daily (sometimes twice day depending what other sessions are planned).


In this section you will find some of the outcomes from the pathway.

In 2019, we supported over 4500 hours of physical activity opportunities for our service users and had over 13700 attendances in the department activities.

In 2020 this increased to supporting over 6200 hours of physical activity opportunities and had 14862 attendances in the department activities.

100% of all in-patient admissions offered exercise therapy as an intervention for their physical and mental health.

Qualitative Outcomes

Qualitative data was collected from this pathway, including patient and staff feedback and quotes;

“I enjoy my fitness programme and regularly attend sessions and reviews so that my weight and BP can be checked. Using the gym gives me drive and insight into my personal health”

“If it wasn’t for the gym my experience in hospital would have been a lot worse.”

“Keeps you focused on positive activities and I get the feel good factor after exercise”

Mental health exercise therapy pathway patient feedback

“Exercise therapy is an extremely valuable service and a big part of our patients day to day activities”

“Metabolic syndrome, diabetes and general chronic ill health are major consequences of obesity. It is beyond debate that our patients have increased rates of obesity due to a variety of factors related to their lifestyles and our treatments for their illnesses. It is crucial that we help or patients to reduce their risks, the exercise therapy teams are key to achieving this.”

“I wholeheartedly support the work that the exercise therapy teams do and in my view it is crucial that they continue to do so if we are to meet our vision of being a leader in the delivery of high quality care and a champion for those we serve.”

Mental health exercise therapy pathway staff feedback

Improving the Physical Activity of Mental Health inpatients in Cumbria


Physical health – The data was been taken at random from progress reviews of 36 service users, who were regularly engaging with the service as prescribed during their initial assessment

Systolic BP  50% of participants showed a decrease
Diastolic BP  61% of participants showed as decrease
Resting HR  50% of participants lowered resting HR
BMI39% of participants lowered their BMI
Activity levels  56% of participants significantly increased the activity levels.


Click on the numbers below for some tips from our Active Hospital team

Ensure the right services are in the right place at the right time to meet all your health and wellbeing needs.

One of the Trust values is; ensuring the right services are in the right place at the right time to meet all your health and wellbeing needs. Employing appropriately qualified exercise professionals to manage and deliver the service, ensures the quality and effectiveness of the service. (See attachments for job descriptions).  Our qualified staff all have sports science/exercise physiology degree’s and appropriate exercise prescription qualifications (level 4 and above) they are also register with BASES as Certified exercise professionals and our assistants are qualified to at least level 3 in exercise prescription (personal trainer/ exercise referral).

Have a simple but consistent message

Have a simple but consistent message (e.g. MECC training) for all staff to deliver. – promoting physical health, physical activity and benefits of exercise is not just a job for exercise professionals. It should be discussed at every opportunity including by the consultants, medical staff, nurses, MDT professionals, housekeeping staff, admin staff, everyone.

Set expectations

Set expectations – discuss what the nursing team and medical teams can expect from you, as an exercise professional/team and what you expect from them.

Set goals

Set and review team goals and objectives on a regular basis.

Provide an evidence based service

Provide an evidence-based service based on up to date research, guidelines and health campaigns/strategies


Exercise Therapist Job role
30 day challenge
Mile a day your way
Goal setting Booklet
Patient information leaflet – Depression