The Remote Exercise And Lifestyle (REAL) intervention for first-episode psychosis: feasibility and preliminary effects of online group fitness training

BACKGROUND: Lifestyle interventions, including exercise, can improve physical and mental health outcomes in first-episode psychosis (FEP), but availability of face-to-face programmes is limited. Teleconferencing software (such as Zoom) presents new opportunities for lifestyle interventions, at scale. Thus, this study assessed the feasibility and preliminary impact of remotely delivered, supervised exercise sessions for FEP. METHODS: A single-arm, eight-week feasibility study was conducted in two NHS Early Intervention Services (EIS) for FEP. Participants aged 18-35 years were offered twice-weekly live Zoom sessions, streaming body-weight exercise videos followed by a brief lifestyle discussion facilitated by the research team. Feasibility metrics were recruitment, retention, attendance and adverse events, along with pre-post self-report measures of physical activity, weight, psychological distress, functioning, life satisfaction, and self-efficacy. RESULTS: Of 45 participants approached, 32 (71%) consented, 27/32 (84%) commenced the intervention, and 21/27 (78%) completed the follow-up assessment. Participants attended an average of 7.6 live online exercise sessions (±5.1) over their 8 week intervention period. Over 90% of 70 exercise sessions offered had participants in live attendance, with no adverse events. After 8 weeks, significant increases were seen in physical activity (p < 0.01) and psychosocial functioning (p = 0.05). Psychological distress decreased, particularly among those attending ≥50% of sessions (n = 12). No significant changes were observed in other measures. CONCLUSIONS: Twice-weekly online sessions, using pre-existing exercise videos, appears feasible, safe and engaging for young adults with FEP, and potentially beneficial for psychological wellbeing and functioning. Further research is required includes RCTs with an embedded process and economic evaluations, and implementation studies.