PowerONyou: enhancing well-being through exercise for individuals with severe mental disorders in ambulatory mental health clinics in Southern Spain

1 Lopez- MoralA, etal. Br J Sports Med Month 2025 Vol 0 No 0 PowerONyou: enhancing wellbeing through exercise for individuals with severe mental disorders in ambulatory mental health clinics in SouthernSpain Alvaro Lopez- Moral ,1,2 Diego Munguia- Izquierdo,1 Jesus Borrueco- Sanchez,1 Camilo Lopez- Sanchez,1 Javier Bueno- Antequera1 BACKGROUND AND PURPOSE Severe mental disorders (SMDs), such as psychotic disorders, bipolar disorder and major depression, are among the leading causes of global mortality and disability.1 Individuals with SMD have a life expectancy of 10–20 years shorter than the general population, primarily due to preventable cardiometabolic conditions, such as diabetes and cardiovascular diseases.2 This risk is heightened by unhealthy lifestyles including low physical activity and prolonged sedentary behaviour, which significantly contribute to these outcomes.3 Interventions supervised by exercise professionals have proven to be effective strategies for enhancing overall wellbeing and quality of life. These interventions offer a range of benefits, including increased physical activity, improved fitness and strengthened social connections, addressing the physical, psychological and social challenges faced by individuals with SMD.4 However, access to such interventions remains limited by psychosocial and structural barriers such as insufficient resources, support and motivation, hindering their implementation and integration into patient care. To address this need, PowerONyou was started in 2013 at the University Pablo de Olavide, as a research project by the CTS- 948 group, ‘Physical Activity, Health and Sports’. Over time, it has evolved into a community intervention programme, implemented in mental health centres and sociohealth environments in collaboration with healthcare professionals. The programme aims to enhance the health, quality of life and social integration of individuals with SMD through exercise as a therapeutic strategy. A distinctive feature of PowerONyou is its comprehensive approach. The programme not only designs exercise protocols to meet the specific needs of each individual but also provides training for healthcare professionals, caregivers and patients to integrate physical activity into treatment plans and daily routines, thereby ensuring that the benefits extend beyond direct intervention. Moreover, the programme emphasises the refinement of diagnostic and health assessment methods and the development of lowcost, practical solutions to identify vulnerabilities and prioritise interventions. PowerONyou is led by an interdisciplinary team of researchers, healthcare professionals and volunteers. Operating on a nonprofit basis, the programme is funded through both public and private research projects. The programme seeks to improve access to exercise for individuals with severe mental health conditions, promoting therapeutic benefits and fostering social change. By creating accessible spaces and encouraging community participation, PowerONyou demonstrates how research can translate into meaningful social impact. CHALLENGES AND INNOVATIVE SOLUTIONS Individuals with SMD face significant barriers to adhering to exercise programmes, with high dropout rates often attributed to a lack of support, motivation and challenges arising from their symptoms.5 This problem is further exacerbated by the limited training and resources available to mental health professionals, hindering the effective incorporation of exercise as a therapeutic intervention. PowerONyou addresses these challenges with an innovative, multidisciplinary approach led by exercise professionals. This team codesigned interventions tailored to the specific needs and resources of each mental health centre (figure 1). Patients defined their individual goals, healthcare workers structured the schedules and integrated behaviour change techniques and exercise professionals adapted activities to align with patients’ preferences and interests. Additionally, PowerONyou applies behaviourchange techniques that enhance adherence, strengthen social support and establish exercise as an effective tool for improving patients’ health and quality of life. This comprehensive collaborative model has been effective in increasing adherence, reducing dropout rates and sustainably integrating exercise into mental health centres. IMPACT ON MENTAL HEALTH As part of the PsychiActive project in collaboration with the Southern Andalusian Health Management Area, Power- ONyou has implemented over six exercise programmes in hospitals and therapeutic mental health communities. These programmes have improved participants’ physical health, including weight reduction, increased muscle mass and enhanced cardiometabolic health.6 Moreover, they positively influenced mental wellbeing and enhanced mood, selfesteem and patient empowerment. These programmes have also addressed social isolation by fostering interaction and experience sharing among participants, strengthening support networks and promoting social integration. This has led to greater autonomy and independence in the patients’ daily activities. Additionally, the project has transformed professionals’ perceptions of exercise and firmly established it as an effective therapeutic tool. Scientific evidence being gathered by the initiative underscores the critical role of exercise in SMD treatment, potentially driving a paradigm shift in traditional mental healthcare approaches. SUSTAINABILITY AND FUTURE PLANS PowerONyou advances the integration of exercise into SMD treatment through practical resources, such as guides to encourage patients to incorporate physical activity into their routines and motivate them to start exercising. The initiative also offers training courses, such as Improving the Health of People with Severe Mental Disorders, endorsed by the University of Pablo de Olavide. Its YouTube channel (https:// www.youtube.com/@PowerONyou) has garnered over 260 000 views and features nearly 700 videos, providing 1Physical Performance & Sports Research Center (CIRFD), Universidad Pablo de Olavide, Seville, Spain 2Department of Physical Education and Sport, Universidad de Sevilla, Seville, Spain Correspondence to Dr Diego Munguia- Izquierdo; dmunizq@ upo. es Service spotlight Protected by copyright, including for uses related to text and data mining, AI training, and similar technologies. . Biblioteca FME at USE/Fac Medicina on February 10, 2025 http://bjsm.bmj.com/Downloaded from 19 January 2025. 10.1136/bjsports-2024-109533 on Br J Sports Med: first published as 2Lopez- MoralA, etal. Br J Sports Med Month 2025 Vol 0 No 0 Service spotlight testimonials from patients and professionals, as well as evidencebased insights and practical guidance on the therapeutic application of exercise in individuals with SMD. The project has also contributed to highimpact scientific publications, focusing on tools to assess patients’ physical health, identifying barriers and facilitators for implementing exercise programmes and evaluating their outcomes. In the future, PowerONyou plans to transition into a formal organisational structure with a clear mission, vision and ongoing partnerships. The programme aims to expand its impact both nationally and internationally, focusing on collaboration with public health services to develop guidelines for integrating exercise into mental healthcare. It will also prioritise training healthcare professionals, nurses and caregivers while exploring new interventions through Lifestyle Psychiatry to reduce risk factors and foster social inclusion. This strategic plan will ensure sustainability and broader impact of PowerONyou, reinforcing its role in advancing mental healthcare through exercise. X Alvaro Lopez- Moral @alvlopmor, Jesus Borrueco- Sanchez @borrueco_jesus, Camilo Lopez- Sanchez @LopezSanchezC and Javier Bueno- Antequera @JaviBueAnt Acknowledgements The authors thank all participants, Fundación Andaluza para la Integración Social de Personas con Enfermedad Mental (FAISEM) and Hospital Virgen de Valme for their support. Contributors AL drafted the manuscript and is the guarantor of the work, assuming full responsibility for the integrity of the data. DM- I, JB- S, CL- S and JB- A contributed to the critical review and revision of the manuscript. Funding This work was funded by Proyectos I+D+i 2020 (ref. PID2020- 118262RB- I00) and JBS (FPU23/01917) from the Spanish Ministry of Science and Innovation. It was also supported by the CTS- 948 Research Group, Pablo de Olavide University, Junta de Andalucía and FEDER Programme 2014- 2020 (ref. UPO- 1262802).Universidad Pablo de Olavide supported ALM (Ref. PPI1803), JBS (Ref. PPI2104 and PPC2401), and CLS (Ref. PPI2306). JBA was supported by the Operational Programme FEDER Andalucía 2014- 2020 (ref. PAC2042) and the Junta de Andalucía through the Consejería de Transformación Económica, Industria, Conocimiento y Universidades (ref. POSTDOC_21_00059). Disclaimer The funders were not involved in the design of the study, the collection, analysis and interpretation of the data, the writing of the report or the decision to publish. Competing interests None declared. Patient consent for publication Not applicable. Ethics approval The authors assert that all procedures contributing to this work comply with the ethical standards of the relevant national and institutional committees on human experimentation and with the Declaration of Helsinki of 1975, as revised in 2013. All procedures involving human subjects/ patients were approved by the ethics committees of the Virgen Macarena and Virgen del Rocío University hospitals (1674- N- 17). Participants gave informed consent to participate in the study before taking part. Provenance and peer review Not commissioned; externally peer reviewed. © Author(s) (or their employer(s)) 2025. No commercial reuse. See rights and permissions. Published by BMJ Group. To cite Lopez- MoralA, Munguia- IzquierdoD, Borrueco- SanchezJ, etal. Br J Sports Med Epub ahead of print: [please include Day Month Year]. doi:10.1136/ bjsports-2024-109533 Accepted 7 January 2025 Br J Sports Med 2025;0:1–3. doi:10.1136/bjsports-2024-109533 ORCID iD AlvaroLopez- Moral http://orcid.org/0000-0003-0862- 8655 REFERENCES 1 Walker ER, McGee RE, Druss BG. Mortality in Mental Disorders and Global Disease Burden Implications. JAMA Psychiatry 2015;72:334. Figure 1 PowerOnYou representatives delivering equipment for a gym at a mental health day care centre. Protected by copyright, including for uses related to text and data mining, AI training, and similar technologies. . Biblioteca FME at USE/Fac Medicina on February 10, 2025 http://bjsm.bmj.com/Downloaded from 19 January 2025. 10.1136/bjsports-2024-109533 on Br J Sports Med: first published as 3 Lopez- MoralA, etal. Br J Sports Med Month 2025 Vol 0 No 0 Service spotlight 2 Vancampfort D, Stubbs B, Mitchell AJ, etal. 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