"Just (Don't) do It?" Stakeholder Perspectives on Physical Activity Interventions in Adult Acute Mental Health Wards: A Qualitative Thematic Analysis.

Adult acute mental health wards operate under sustained pressure, characterised by high patient acuity, workforce shortages and a focus on risk management that can limit opportunities for therapeutic engagement. Although physical activity is increasingly recognised as beneficial for mental and physical health, there remains limited evidence to guide its implementation within acute inpatient settings. The purpose of this study was to generate practice-relevant insights to inform the design and implementation of feasible physical activity interventions in adult acute mental health wards. A qualitative study was conducted using focus groups across two National Health Service mental health trusts in England. Thirty participants took part, including mental health nurses, multidisciplinary staff and people with lived experience of acute ward care. Data were analysed using reflexive thematic analysis within a multidisciplinary and lived-experience-informed research team. Three interrelated themes were identified. Barriers to implementation reflected the interaction between patient acuity, medication effects, restrictive practices, workforce pressures and ward organisation. Enablers and opportunities included nursing leadership, flexible and relational delivery approaches, staff participation and active involvement of patients in the design of activities and care planning. Participants also highlighted the importance of evaluation approaches that balance feasibility with meaningful patient-centred and ward-level outcomes, including staff wellbeing and ward atmosphere. Physical activity was perceived as both desirable and achievable when adapted to the realities of acute ward environments. These findings address an important evidence gap and can inform the development of context-sensitive, recovery-oriented physical activity interventions aligned with acute inpatient mental health nursing practice.