What should be included in an educational programme for non-health professional exercise instructors in charge of community-based exercise targeting young adults in antipsychotic treatment – A focus group study of stakeholder perspectives

Background Exercise plays a crucial role in addressing the increased cardiometabolic morbidity and premature mortality in people with schizophrenia. When delivered in community-based settings, exercise may also reduce loneliness, while promoting overall physical active behaviours. Skilled instructors are essential to deliver effective community-based exercise; however, knowledge about their roles and required training is lacking. We investigated stakeholders’ perspectives on components needed for an educational programme for non-health professional exercise instructors delivering community-based exercise targeting young adults in antipsychotic treatment. 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. Data were analysed using qualitative content analysis, as described by Graneheim and Lundman. Results The analysis identified three categories: (i) acknowledging mental illness , (ii) applying a resource-oriented approach , and (iii) promoting exercise as a shared activity , and one overarching theme: instructors as guardians of an inclusive culture . Conclusions An educational programme for exercise instructors delivering community-based exercise to young adults in antipsychotic treatment should focus on securing an inclusive culture that embraces an anti-stigmatising approach. Results of the current study informed the development of an educational programme consisting of an instructor manual, a one-day educational programme for instructors, and a continuous exchange of experiences between instructors. ### Competing Interest Statement BHE is part of the Advisory Board of Eli Lilly Denmark A/S, Janssen-Cilag, Lundbeck Pharma A/S, and Takeda Pharmaceutical Company Ltd; and has received lecture fees from Bristol-Myers Squibb, Boehringer Ingelheim, Otsuka Pharma Scandinavia AB, Eli Lilly Company, and Lundbeck Pharma A/S. MFA, KR, VS, AR, BSR and JM declare no competing interests. ### Funding Statement The study was funded by TrygFonden (Grant No.: 151603) ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The Regional Ethics Committee of Northern Denmark has confirmed that no formal ethical approval was required (Case No. 2023000206) for the current study. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as [ClinicalTrials.gov][1]. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors [1]: https://ClinicalTrials.gov