Clinical Exercise in a Forensic Mental Health Medium Secure Unit: Building Team Resilience
Professional Journey
I’ve worked in forensic mental health for 17 years. Starting as part of a small clinical exercise team of three at River House, we built the service from scratch. Over time, it grew stronger, and after six years I took sole responsibility for delivering clinical exercise across the unit. That period demanded adaptability, resilience, and a commitment to embedding exercise into the daily rhythm of secure care.
Now, as Clinical Exercise Lead managing a team of three, I’ve seen firsthand how collaboration and consistency shape patient ‑ centred care. Enrolling in the Building Team Resilience course was a natural step, a chance to strengthen my leadership and the resilience of the team I guide.
Perceptions and Misconceptions of the Role
The role of a clinical exercise instructor in secure care is often misunderstood. Too often, it’s seen as equivalent to a fitness trainer rather than a clinical professional with expertise in mental health, medication side effects, and therapeutic exercise.
Another common misconception is that exercise alone will lead to weight loss. In reality, exercise is most effective when it is part of a broader, collaborative approach including diet and lifestyle. Unlike mental health care, which is often highly structured and multidisciplinary, physical health planning tends to lack the same visibility. This imbalance can make exercise appear less central to recovery, unless patients, often those functioning at a higher level, actively advocate for its role. By embedding exercise more fully into care planning, services can ensure physical health is addressed alongside psychological and social recovery, creating a more balanced model of care.
Obesity in Medium Secure Units
Obesity is a major challenge in secure mental health settings. Rates are significantly higher than in the general population, partly due to the side effects of antipsychotic medication. Research shows that some medications can lead to weight gain of 4–5 kg in the first year of treatment (De Hert et al., 2011). This contributes to increased risks of diabetes and cardiovascular disease, and ultimately to the reduced life expectancy seen in people with severe mental illness.
Professor Brendon Stubbs has highlighted that people with severe mental illness are two to three times more likely to be obese compared to the general population. His work shows that structured exercise programmes, especially when combined with dietary counselling, are far more effective than either intervention alone (Stubbs et al., 2016).
Exercise and Nutrition Interventions
Evidence is clear: structured exercise and nutrition interventions reduce obesity rates and improve metabolic health. Exercise supports insulin sensitivity, cardiovascular health, and mood regulation, while nutrition interventions, portion control, balanced diets, education, reinforce these outcomes.
Stubbs’ research underscores the importance of multidisciplinary collaboration, showing that tackling obesity requires integrated strategies that embed both exercise and nutrition into patient pathways (Stubbs et al., 2016).
Overlap with Physiotherapy
Clinical exercise shares significant overlap with physiotherapy. While physiotherapists diagnose and treat injuries, clinical exercise professionals focus on movement patterns, rehabilitation, and long ‑ term conditioning. Corrective exercise bridges these domains, addressing muscle imbalances and postural dysfunctions.
Recent research has shown that corrective exercise can improve disability, function, and psychological wellbeing in older adults with chronic pain (Khabiri et al., 2025). This reinforces the value of clinical exercise in extending physiotherapy outcomes and sustaining rehabilitation beyond the treatment room.
Overlap with Dietetics and Nutrition
Clinical exercise also complements dietetic practice. Dietitians provide medical nutrition therapy, while clinical exercise professionals reinforce these strategies through education and lifestyle coaching. By embedding nutrition guidance into exercise programmes, patients can translate dietetic recommendations into daily routines, ensuring continuity of care.
This collaborative approach is especially important in secure units, where multidisciplinary interventions combining diet and exercise have been shown to be more effective than single ‑ component programmes (Stubbs et al., 2016).
Supporting Small Departments
Physiotherapy and dietetics departments in medium secure units are often small and resource ‑ limited. Clinical exercise can act as a supportive extension, amplifying their impact. By embedding exercise into daily schedules and reinforcing dietary advice, clinical exercise professionals contribute to continuity of care. This collaborative approach not only reduces obesity but also fosters resilience, enabling patients to manage their health proactively while staff work together across disciplines.
Conclusion
Clinical exercise in forensic mental health is more than physical activity it’s a clinical, therapeutic, and collaborative practice. It addresses obesity, mitigates medication side effects, and strengthens the bridge between physiotherapy and dietetics. Most importantly, it builds resilience: for patients striving toward recovery and for teams working together in challenging environments.
Looking ahead, Clinical Exercise must become a consistent feature of multidisciplinary care. Early interventions around medication side effects, tailored plans for obese patients, and integrated pathways that combine exercise and nutrition are essential. Clinical exercise professionals, working alongside dietitians, physiotherapists, and psychologists, provide the motivation, structure, and support needed to help patients achieve their physical health goals. Embedding these approaches into secure unit pathways is key to tackling obesity and improving long ‑ term wellbeing in forensic mental health.
About the Author
Gareth Price is the Clinical Exercise Lead at River House Medium Secure Unit, Royal Bethlem Hospital. He has 17 years of experience in forensic mental health services. Having built the clinical exercise programme from its inception, he now leads a dedicated team delivering patient ‑ centred interventions that integrate physical health into secure care pathways. His work focuses on tackling obesity, mitigating medication side effects, and providing sporting opportunities. Passionate about collaboration, Gareth and his team continue to champion exercise as a therapeutic tool that strengthens recovery and wellbeing in secure care.
