Walk the Talk: VA Mental Health Care Professionals’ Role in Promoting Physical Activity

Peer support specialists (PSPs) also are in a unique position to effectively provide experiential physical activity interventions at VA facilities. These PSPs are veterans who have physical or mental health problems but are far enough along in recovery to provide helpful services to other veterans with similar challenges.⁶⁶ Recent organizational efforts have increased the presence of PSPs in VA clinics. Peer support specialists use aspects of their recovery to help other veterans, provide supportive counseling, and facilitate activity groups, such as walking, hiking, golfing, and photography groups. Further, PSPs may not have to deal with MHCPs’ concerns regarding scope of practice and clinical boundaries vis-à-vis exercise interventions.

Other VA and community programs provide ways for veterans to engage in experiential physical activities. Some VA facilities have pools and gyms that provide open hours for veterans; some even offer free HCP guidance. Clinics also occasionally provide transportation to community gyms that offer veterans discounted memberships. Team Red, White, and Blue (https://www.teamrwb.org), Veterans Expeditions, (https://www.vetexpeditions.com) and other community organizations promote veterans’ physical activity by organizing events, such as endurance races, fly fishing, and mountaineering. By staying up-to-date on local community services, MHCPs can facilitate opportunities for experiential exercise alongside the psychotherapy services they provide.

Although valuable resources exist, veterans nevertheless encounter obstacles to exercise. For instance, many VA HCPs do not include physical therapy as a standard part of the MOVE! program. Others offer physical therapy not as an integrated service but as a separate, optional service, and attendance requires more initiative. Often, veterans are referred for physical therapy only if they have sustained an injury. Even when physical therapy or exercise physiology services are offered, many veterans have difficulty following through. Reasons include anxiety, time constraints, difficulty managing multiple appointments, and negative beliefs about exercise and physical therapy (eg, it will make me hurt, physical therapy is only for people recovering from an injury). Last, some veterans are reluctant to engage in peer-led or non-VA exercise programs.

Future Research

This article highlights the need for research in several areas. First, it would be helpful to know the extent to which VA MHCPs are already promoting physical activity for their patients and the ways in which they are using experiential exercise interventions. Research also will help determine the extent to which experiential exercise interventions can be effective in treating mental and physical health conditions not listed in Table 2 and any conditions for which exercise interventions may be contraindicated. The effectiveness of exercise therapy, as described by Sime, also warrants more investigation with randomized clinical trials.⁶² Further, it would be useful to know more about the extent and effectiveness of other experiential exercise available to veterans, whether through the MOVE! program or through other VA or community resources. This would help HCPs understand how to best promote physical activity in veterans with chronic physical and mental health needs.

Conclusion

Most people fall short of recommended levels of physical activity, and this is especially true of veterans, who also are at higher risk for chronic physical and mental health problems.^23,24 VA MHCPs are in a unique position to promote physical activity, and therapy programs that include experiential exercise may be particularly effective in helping veterans become and stay active. Other providers are well suited to provide experiential exercise opportunities, but MHCPs can simultaneously address the psychological factors that prevent veterans from engaging in exercise. Although VA MHCPs should continue to collaborate with other resources that can provide experiential exercise, they should also consider the potential benefit of experiential exercise within psychotherapy.