Do not stop me now: A feasibility study for a personalized, phased psychomotor sports intervention to promote social integration in people with early psychosis.

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Merel Karlijn Muller, Akke-Marij D. Ariesen, Jooske T. Busschbach, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7992569/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Purpose: This study examines the feasibility of a personalised and phased psychomotor sports intervention in preparation for a larger multiple-baseline single-case design study aimed at enhancing social integration in adults with early psychosis. The aim is to evaluate the recruitment strategy, the suitability of selected outcome measures, and the applicability of the intervention for the target population. Methods: Three participants engaged in a 20-week intervention designed to promote social (re-) integration through sports participation, with three phases 1) individual psychomotor therapy, (2) group psychomotor therapy, both offered within a mental health care setting and (3) community-based sports participation. Next to (qualitative) interviews, a multiple-baseline design was used, incorporating the Experience Sampling Method (ESM), ActiGraph GT9X + accelerometers, and questionnaires. Results: Recruitment proved challenging, with only three participants included out of twenty potentially suitable candidates. The selected outcome measures were largely feasible, with some adjustments made, particularly in the ESM procedure. The intervention was evaluated positively in terms of acceptability, applicability, and potential individual benefits, with several recommendations made regarding its duration and the roles of the peer support worker and the coach. All participants engaged in some kind of physical activity by the end of the study (yoga, boxing or regular walking). Conclusion: With broader inclusion criteria and flexibility in the data gathering procedure to tailor individual needs, this feasibility study supports the potential of a personalised, phased sports intervention to enhance social integration in early psychosis and informs methodological refinements for a future, larger single-case multiple-baseline study. personalized sports intervention psychomotor therapy social (re)integration psychosis Figures Figure 1 Figure 2 Introduction A first psychotic episode is often associated with significant personal and societal consequences [ 1 – 3 ]. Already in the early phases of a psychotic disorder, social integration becomes challenging [ 4 ]. Social integration is a multidimensional concept that can be defined as the participation of an individual in the key dimensions of the society in which he or she lives [ 5 ]. Individuals with early psychosis often need to (temporarily) stop working, studying and/or engaging in leisurely activities. As a result, many of them report low social support, a lack of contact with peers and loneliness after a psychotic episode [ 3 ]. Overall, the evidence demonstrates that social participation becomes increasingly difficult after a psychotic episode. In contrast, a higher frequency of social interactions [ 1 ] and a larger size of the social network [ 2 ] increase chances of recovery, emphasizing the need to provide support towards better social (re)integration for this group. Standard therapy to treat symptoms of psychosis is antipsychotic medication in combination with cognitive behavioral therapy (CBT) [ 6 – 7 ]. Although this has been shown to be effective in treating especially the positive symptoms of psychosis [ 6 – 7 ] little to no effect on social outcomes was found [ 8 – 9 ]. Evidence shows that providing support to individuals with psychosis in social activities in the community is effective in increasing their social networks, through initiatives such as befriending, employment and education or peer support [ 10 ]. However, only some of these promising efforts are currently included in standard treatments and there is an overall need to focus on providing initiatives integrated into the community [ 11 ]. As such, research examining new interventions are needed. In these new interventions attention should be paid to the factors that play a role in the diminished social integration in early psychosis. First, the presence of negative symptoms, especially a lack of initiative, makes it challenging to actively engage in social situations [ 12 , 13 ]. Self-stigma, or the anticipation of discrimination because of one’s mental illness, can significantly lower the motivation to engage in social interactions and to participate in the community [ 2 , 14 ]. Research confirms the association between lower social functioning and increased self-stigma in participants with a psychotic disorder [ 15 ]. Low self-esteem has also been suggested to contribute to a lack of social participation and role functioning in individuals with severe mental illness [ 16 – 17 ]. Moreover, increased sedentary behaviour makes social (re)integration more difficult, as it impairs restricts the ability to seek out and engage in activities within one’s own social network and in the community [ 18 ]. Also, a negative body image, as a consequence of weight gain through medication and sedentary life style can contributes to withdrawal from social relationships and activities [ 19 ]. Based on the findings, we developed a sports based intervention “Don’t Stop me Now” to increase social integration in early psychosis by targeting the factors negative symptoms [ 12 ], self-stigma [ 2 , 14 ], low self-esteem [ 16 – 17 ] sedentary behaviour [ 20 ] and a negative body image [ 19 ]. The aim of the current study is to examine the feasibility of, this personalized, phased sports intervention for individuals with early psychosis, targeted to improve social integration through sports. The intervention comprises three phases; an individual and a group phase with Psychomotor Therapy (PMT) offered in a mental health context and a phase with a sports coach in the community. PMT is an experience-oriented therapy that utilizes movement and physical activity to address psychological and psychiatric complaints [ 21 – 26 ]. By integrating PMT with community sports, our intervention purposes to harness the unique benefits of sport-based approaches, which are non-stigmatizing and can positively affect both physical and mental health, while also facilitating improvements in social functioning [ 26 – 29 ]. Objective The current study examines the feasibility of the intervention in preparation for a larger multiple baseline single-case design study. The aim is three-fold: to assess 1) appropriateness of the recruitment strategy (clinician and patient willingness, adherence rate), 2) feasibility of measuring intervention effects using the chosen outcome measures, and 3) applicability of the intervention for the target group. Methods This feasibility study is part of a larger research project (ISRCTN14328965, August 2022). Design Data were collected using a multiple baseline single-case design [30], with each participant serving as their own control. Participants started with randomly varied baseline periods (12–21 days) and commenced simultaneously at phase 1. Figure 1 outlines design and procedure. Participants & Procedure Participants were recruited at a specialized early intervention psychosis team. Eligible participants were informed by their clinician. After an informative contact by phone, participants were provided with written information and an informed consent form. They were given two weeks to consider participation. It was our goal to recruit five participants supplementary to their treatment. Inclusion criteria consisted of: a) 18–35 years, b) a diagnosis of a first psychotic disorder no more than five years ago, c) the desire to be (more) physically active d) subjective experiences of reduced (social) participation, e) not currently practicing sports with others in the community, f) read and speak Dutch fluently, g) capable of following the research procedures, h) willing and able to provide informed consent. The exclusion criteria were: a) significant hearing or visual problems, b) no internet connection at home or on mobile phone, c) physical conditions (e.g., handicaps, illnesses or pregnancy), that make sports unwise or impossible. Intervention Before developing the intervention, a qualitative study was conducted to assess the needs and barriers to sports participation for the target population ( in prep). The intervention's current design is based on the interview outcomes. In phase 1, participants focus on identifying personal goals and regaining trust in their physical abilities through weekly individual PMT sessions. With the therapist's assistance, they select goals that remain central throughout the intervention, along with exercises from a specially developed Toolbox (see Table 1; (see Supplementary Information (SI) Table 1 for the different modules with PMT exercises aligning with the modifiable factors underlying social integration) Toolbox available on request). During phase 2, participants transition to group-based PMT with the other study participants. While continuing to work on personal goals, the focus here lies on fostering social connections, practicing social behavior in a safe environment and deciding on what sport to try. In phase 3, participants work outside the mental health setting with a community sports coach, who provides tailored support, making steps towards independent sports activities in the community. Description of the three phases of the sport-intervention. Table 1 Phase 1 Individual psychomotor therapy Phase 2 Groups sports therapy Phase 3 Community sport coach General objectives Goal setting and regaining trust in one’s own physical capabilities Social connectedness Social (re)integration General goals Working on wishes and goals and getting used to physical activity Making and maintaining social contact Maintaining an active lifestyle Getting acquainted with sports activities by making use of a ‘toolbox’ Establishing a social connection within the group and discussing shared difficulties (such as self-stigma) Joining a sports association in the community Formulate work goals for phase 2 and 3 Continue to practice with the work goals in a group setting Reducing self-stigma and increase of self-esteem Duration phase 6 weeks 6 weeks 6 to 8 weeks Duration session 45 minutes 75 minutes 60 minutes on average (depending on the type of sport) Frequency Minimum of 4 and a maximum of 6 Minimum of 4 and a maximum of 6 Minimum of 6 and a maximum of 8 Location Psychomotor center in the Mental health institution Psychomotor center in the Mental health institution Various locations in the region where the participant lives. Measures Experience sampling method (ESM) ESM was used to monitor participants real-world experiences [31] three times daily (morning, afternoon, and evening) at scheduled intervals for five consecutive days at the beginning and end of each phase. The ESM questions were selected on the basis of validated questionnaires (e.g. PANSS [32]; ISMI [33]), the ESM database (https://esmitemrepositoryinfo.com/), and previous ESM studies (e.g. Mirorr study [34], Trails Trans-id study [35], and was reviewed by an expert-by-experience pool, leading to the final version. The ESM questions covered daily variations of the factors proposed to underlie social integration, namely negative symptoms, self-stigma, self-esteem, sedentary behaviour and negative body image, in addition to social integration itself. Participants also had the option to select two personal items matching their personal goals. Interviews During the baseline and after the intervention two semi structured interviews were administered. The Positive and Negative Syndrome Scale (PANSS [23]) was used, a 30-item rating scale based on a semi-structured interview aimed at assessing symptom severity with adequate psychometric quality (test–retest reliability 0.77–0.89; internal consistency overall: α = .79, SD = 13.6 [23]). Next, the Brief Negative Symptom Scale (BNSS [36–37]) was completed, a 13-item instrument that assesses negative symptoms across six domains: anhedonia, asociality, avolition, blunted affect, alogia, and lack of normal suffering (α = .79, SD = 12.49). A qualitative baseline interview assessed participants' expectations of the intervention and reasons for participation, while a post-intervention interview evaluated overall experiences (e.g. goals attained, and opinions on the intervention design). To quantify satisfaction, participants rated the intervention on a client ‘satisfaction’ thermometer. The intervention protocol was considered feasible if the average satisfaction score was at least 5 out of 10 [38]. At the end of phase 2, a joint evaluation was held with all participants, researchers, and the psychomotor therapist, reviewing the intervention's strengths and areas for improvement. Interview were audiotaped with the consent of participants and transcribed verbatim. Questionnaires Participants also completed online questionnaires prior to the baseline and post-intervention interviews. Social Integration. The Assessment of Life Habits (LIFE-H [39] evaluates how individuals accomplish daily living activities and social roles using 69 questions covering domains such as fitness, housing, interpersonal relationships, community life, and employment (Overall α = .78, Dutch LIFE H 3.0 [40]). Social Functioning. The Groningen Social Behaviour Questionnaire (GVSG) assesses the degree of social functioning [41] with 45 items that evaluate social relations, work, school, household, and leisure activities. (α = .83 [42]). Social Network. The Social Network Questionnaire (SNQ [43]) consists of 15 items divided into four domains: quality and frequency of social contacts, practical social support, emotional support, and the presence and quality of an intimate supportive relationship (overall reliability moderate to good [44]). Social Exclusion. Social exclusion was assessed with one item based on Lincoln et al. [45], asking, “I feel excluded, rejected, like an outsider.” (1 ‘not applicable’ to 11 ‘fully applicable’). Self-Stigma. The Internalized Stigma of Mental Illness (ISMI) assesses self-stigma among individuals with psychiatric disorders [46] using 29 items across four subscales with higher scores indicating more self-stigma: alienation (A), stereotype endorsement (SE), discrimination experience (DE), social withdrawal (SW), and one subscale with higher scores indicating more stigma resistance (SR). Overall reliability is moderate to good (α = .90; A: SD = .70; SE: SD = 0.53; DE: SD = .61; SW: SD = 0.66). Self-Esteem. The Rosenberg Self-Esteem Scale (RSES) consists of 10 items assessing global self-esteem, defined as an individual's overall evaluation of their worth [47] (α = .87; SD = 4.48 [48]). Body Image. The Dutch version of the Dresden Body Image Questionnaire [49] ((DBIQ-NL; α = .88) consists of 35 items across five subscales: body acceptance (BA), sexual fulfillment (SF), physical contact (PC), vitality (V), and self-aggrandizement (SA). The validity of the Dutch version in a non-clinical population is very good (BA: ICC .80, SD = 1.22, SF: ICC. 79, SD = 1.34, PC: ICC.64, SD = 1.23, V: ICC .82, SD = 1.04, SA: ICC .78, SD = 1.05 [50]). Physical Activity/Sedentary Behavior. The International Physical Activity Questionnaire (IPAQ [51–52]) assesses physical activity through 31 questions divided into five subscales: job-related physical activities, transportation, housework and family care, leisure-time activities, and time spent sitting (α = .91). Participants reported the duration of each activity over the past week. ActiGraph GT9X + accelerometers ActiGraph GT9X + accelerometers were used to provide an objective assessment of sedentary behavior and physical activity. They were worn on the wrist of the non-dominant hand for five days at the beginning of each phase. Statistical analyses 1) Appropriateness of the recruitment strategy Clinician and patient willingness, and adherence rate, was examined descriptively by providing the total of potential participants that were approached, how many were interested in partaking in the study and how many completed the intervention. Drop-out (n, %) was determined for the included participants. 2) Feasibility of measuring intervention effects using the chosen outcome measures ESM The continuous rating scale questions were analyzed per parameter using R [53]. Responses to negatively framed questions were reversed. For outcomes with multiple questions, symptoms, social integration, self-esteem, and sedentary behavior, responses were averaged. All responses were plotted in separate graphs to visually examine trends across the baseline and intervention phases [30, 54]. Additionally, dichotomous questions (e.g., "Have you been in contact with anyone?") were presented descriptively. The data were then analyzed using the Percentage of Data Points Exceeding the Median (PEM [55]), an effect measure that mitigates the impact of outliers and floor and ceiling effects [56]. PEM is the percentage of data points in the last phase (3) that fall above or below the median of baseline data, reflecting change and stability after the intervention. A PEM between .70 and .89 is considered to reflect moderate effectiveness, higher than .90 effective and possibly clinically relevant [55, 57]. As a third step, the Tau-U method was calculated (singlecaseresearch.org/calculators/tau-u), combining nonoverlap between adjacent phases with the intervention phase trend while controlling for baseline trends [56]. Questionnaires and semi structured interviews Data from the questionnaires, assessed before baseline and post-intervention, were compared using Reliable Change Index (RCI) measures. RCI ‘s were calculated in excel by dividing the difference between baseline and post-intervention scores by the standard error of the difference, based on published standard deviation (SD) and test-retest reliability (ICC) or internal consistency α’s [58–59]. The RCI could not be computed for the GVSG 45 Total Score, the SNV Total Score and the 1 item for social exclusion 1-item since information on ICC or α and SD is lacking. ActiGraph GT9X + accelerometers Analyses of ActiGraph data were done in excel. In line with previous research [60–61] the following outcomes were described: time per day spent in sedentary behavior (SB: Total SB periods with < 150 counts/min, SBzero: 0 counts/min, SB: 1-150 counts/min), light-intensity physical activity (LPA: 151–3207 counts/min), and moderate to vigorous physical activity (MVPA: ≥3208 counts/min) with changes operationalized as percentage differences between baseline and final assessment. The number of hours of rest within a 24-hour cycle was excluded from calculations and analyses focused on valid measurements with more than six hours of wear time per day for at least three days. The number of steps were registered. 3) Applicability of the intervention for the target group Qualitative interviews The qualitative data were descriptively analyzed by two of the authors (MKM, SS) individually, to evaluate participants' perceptions of the intervention and to identify emerging themes. After individual analysis, the final key themes were identified and agreed upon. Results 1) Appropriateness of the recruitment strategy Over a period of five months, 20 eligible participants were approached of whom three (15%) agreed to participate in the study. Reasons for declining participation were: the perceived burden of participation (in addition to treatment), physical injuries, a preference for individual sports or already doing sports, working or studying. During the recruitment process two adjustments were made based on feedback from the mental health team: the maximum age restriction was expanded to 65 years and “no history of psychotic episodes before the current, according to the DSM-5 criteria” was adjusted to “within five years after the first diagnosis”. The three participants, one man and two women all below the age of 35, completed all three phases of the intervention (100%). Participant 1 was a young adult receiving outpatient care following an earlier episode of psychosis. This person was already physically active on an individual level but expressed a desire to engage in more regular, group-based sports activities. Participant 2 was a young adult living in supported housing and receiving a combination of pharmacological treatment and structured daytime activities. Initially, the main goal was to become more physically active, as most time was spent in sedentary activities such as gaming. Over time, the focus shifted toward participating in physical activity with others. Participant 3 was a young adult living independently while taking part in a reintegration program alongside outpatient care. This participant hoped the intervention would help in engaging with more social forms of physical activity, but felt unable to initiate this independently. Concerns around body image played a role in this hesitation to initiate such activities independently. 2) Feasibility of measuring intervention effects using the chosen outcome ESM analyses Completion rates for the ESM varied between participants: 43%, 81% and 31% for respectively participant 1, 2, and 3. Participant 1 had a restart in phase 3 due to a technical issue, resulting in a low completion rate. Participant 3 experienced several life events in phase 3, making it difficult to complete the ESM assessments in the last phase. Figure 2 demonstrates the visual analysis and the PEM scores on all outcomes for each participant. For all complete PEM and TAU calculation see SI Table 2. Participant 1 Visual and descriptive analyses (PEM): For participant 1 figure 2 demonstrates a visual decrease in negative symptoms 1, self-stigma and sedentary behavior, and an increase in the personal goal. No visual changes are observed for social inclusion or self-esteem. The PEM scores demonstrate a moderate positive effect on sedentary behavior. The categorical variables demonstrated that participant 1 engaged in 12 activities (0% sports-related) at baseline, increasing to 13 activities (7.7% sports-related) at post-treatment. At baseline 13 social contacts were reported (0% sports-related), increasing to 14 social contacts (14.3% sports-related) at post-treatment. Inferential (TAU) analyses: Negative symptoms decreased significantly from baseline to the end of the intervention ( p <0.05). No significant changes were demonstrated in the TAU-U analyses for the other factors (self-stigma, , social inclusion, self-esteem or personal goal). Participant 2 Visual and descriptive analyses (PEM): Figure 3 demonstrates a visual increase in negative symptoms, self-stigma and sedentary behavior. No changes are observed for social inclusion and self-esteem. The PEM scores indicate a strong positive effect on symptoms, (self)stigma and self esteem. Categorical variables demonstrate that participant 2 engaged in 10 activities (20% sports-related) at baseline, decreasing to 8 activities (25% sports-related) at post-treatment. At baseline 8 social contacts (12.5% sports-related) were reported, which increased to 16 social contacts (18.8% sports-related) at post-treatment. Inferential (TAU) analyses: Social inclusion significantly decreased from baseline to post-treatment ( p < 0.05) and self-esteem significantly increased from baseline to post-treatment ( p <0.05). No significant changes were demonstrated in the TAU-U analyses for the other factors (negative symptoms or self-stigma). Participant 3 Visual and descriptive analyses (PEM): Figure 4 demonstrates a visual increase in social inclusion. No visual changes are observed for negative symptoms, self-stigma, sedentary behavior and self-esteem. Due to missing data in phase 3, PEM scores and changes in categorical data are now presented are based on comparison between baseline and phase 2 and show moderate effects on symptoms and self esteem, a strong effect on social inclusion and no effect on (self)stigma and personal goals. Inferential (TAU) analyses: Social inclusion significantly increased from baseline to post-treatment ( p< 0.01, Supplement 2) and the personal goal significantly decreased from baseline to post-treatment ( p< 0.01, Supplement 2). No significant changes were demonstrated in the TAU-U analyses for the other factors (negative symptoms, self-stigma, or self-esteem). ActiGraph GT9X+ accelerometers: The data are summarized in Table 2. For Participant 1, findings indicate improvements in LPA and daily step counts, with a reduction in SB from baseline to phase 2. Data from phase 1 and 3, and the study end, were unavailable due to a technical error for this participant. Participant 2 showed improvements in LPA and daily step counts, along with a slight decrease in SB. Participant 3 showed no notable changes during the study. Table 2 ActiGraph GT9X+ accelerometers, measures of physical activity and sedentary behavior (minutes per day) Participant 1 Baseline Phase 1 Phase 2 Phase 3 End of study % Dif. Moderate to Vigorous Physical Activity (MVPA) 0 1 ~ 2 3 ~ ~ # Light Physical Activity (LPA) 337 1 ~ 420 3 ~ ~ # Sedentary Behavior (SB) 232 1 ~ 190 3 ~ ~ # Zero Activity Sedentary Behavior (SB zero) 198 1 ~ 124 3 ~ ~ # Total Sedentary Behavior (Total SB) 430 1 ~ 314 3 ~ ~ # Steps 14417 1 ~ 19098 3 ~ ~ # Hours of Rest within a 24-Hour Cycle 10:06 ~ 09:13 4 ~ ~ # Participant 2 Baseline Phase 1 Phase 2 Phase 3 End of study % Dif. Moderate to Vigorous Physical Activity (MVPA) 4 2 0 5 4 0% Light Physical Activity (LPA) 183 271 174 251 301 64.5% Sedentary Behavior (SB) 431 424 450 602 458 6.3% Zero Activity Sedentary Behavior (SB zero) 350 125 189 148 77 -77.9% Total Sedentary Behavior (Total SB) 781 549 639 749 535 -31.5% Steps 10599 13973 10495 14790 15066 42.2% Hours of Rest within a 24-Hour Cycle 09:49 ‡ 08:43 2 09:02 2 06:51 08:13 2 -16.3% Participant 3 Baseline Phase 1 Phase 2 Phase 3 End of study % Dif. Moderate to Vigorous Physical Activity (MVPA) 0 1 1 0 0 0% Light Physical Activity (LPA) 248 216 169 223 196 -20.9% Sedentary Behavior (SB) 444 416 475 537 377 -15.1% Zero Activity Sedentary Behavior (SB zero) 238 191 239 242 351 47.4% Total Sedentary Behavior (Total SB) 682 607 714 779 728 6.8% Steps 127389 11926 9809 13008 10146 -92.0% Hours of Rest within a 24-Hour Cycle 08:29 08:48 2 07:27 2 08:42 08:55 3 5.1% Note: % Dif. = percentage differences between the baseline and end of study. # Calculations were not possible due to missing data. 1 Calculated over 3 days instead of 5 due to the non-wearing of the activity monitor. 2. Calculated over 4 nights instead of 5 because the measurement started on the day itself instead of at 00:00. 3. Calculated over 4 days instead of 5 due to the non-wearing of the activity monitor. 4. Calculated over 3 nights, as the measurement only started on the day itself instead of at 00:00, and the activity monitor was not worn on the last day. ~The criteria were unmet: wear time was less than six hours per day, making the measurement invalid. Questionnaires Clinical background scores, along with descriptive statistics and RCI’s, are presented in Table 3. For Participant 1, RCI’s for the DBIQ SF PC and SA subscales indicate a negative change in body experience and the same holds true for the total RSES RCI. The ISMI Stigma Resistance RCI indicated a significant positive change. For Participant 2, both RCI for total RSES score and ISMI Stigma Resistance indicate negative change. For Participant 3, RCI’s of the RSES scores and the ISMI Stigma Resistance indicated positive change but for the subscales of Alienation, Discrimination Experience, and Social Withdrawal an increase was found. The significant RCI’s for the DBIQ subscale of Sexual Fulfilment and Self-aggrandizement indicate an increase, thus positive change in body experience. Table 3. Outcomes baseline and post intervention and Relevant Change Indices (n=3) Participant 1 Participant 2 Participant 3 Baseline Post Dif. RCI Baseline Post Dif. RCI Baseline Post Diff. RCI Symptoms PANSS Total score 42 45 -3 -0.34 51 52 -1 -0.11 60 55 5 0.57 Positive subscale 11 12 -1 -0.18 9 8 1 0.18 7 9 -2 -0.36 Negative subscale 11 10 1 0.15 17 13 4 0.59 23 20 3 0.44 Cognitive subscale 20 23 -3 -0.33 25 31 -6 -0.67 30 26 4 0.44 BNSS Total Score 3 3 0 0 25 19 6 0.74 26 26 0 0 Social (re-) integration GVSG 45 Total Score 17.8 17 -0.8 ~ 17 11.2 -5.8 ~ 15 16.3 1.3 ~ SNV Total Score 3.1 2.9 -0.2 ~ 3.3 2.4 -0.9 ~ 2.2 3 0.8 ~ Social exclusion 1-item 1 1 0 ~ 4 11 -7 ~ 3 1 2 ~ (Self)-stigma ISMI Alienation 2.0 2.2 0.2 -0.64 2.3 2.5 0.2 -0.64 1.0 2.0 1 -3.19* Stereotype Endorsement 2.0 2.0 0 0 1.1 1.0 -0.1 0.42 1.0 1.0 0 0 Discrimination Experience 2.0 2.2 0.2 -0.73 1.0 1.0 0 0 1.0 2.6 1.6 -5.87* Social Withdrawal 2.0 2.0 0 0 1.3 1.3 0 0 1.3 2.2 0.9 -3.05* Stigma Resistance 2.0 2.4 0.4 -1.75** 2.2 1.6 -0.6 2.63* 1.6 2.0 0.4 -1.75* Self-esteem RSES Total Score 20 17 -3 1.31** 30 18 -12 5.25* 13 13 0 -5.25* Body image DBIQ Body Acceptance 4.14 4.14 0 0 2.57 3.43 0.86 -1.44 4.29 4.71 0.42 -0.70 Vitality 4.25 4.13 -0.12 0.24 2.88 3.38 0.5 -0.98 3.0 2.88 -0.12 0.24 Sexual Fulfilment 3.5 2.0 -1.5 2.28* 4.0 3.67 -0.33 0.50 3.33 2.00 -1.33 2.03* Physical Contact 4.33 2.67 -1.66 2.75* 3.5 4.17 0.67 -1.11 3.67 4.00 0.33 -0.55 Self-aggrandizement 3.38 1.75 -1.63 3.17* 2.13 2.13 0 0 2.13 1.25 -0.88 1.71** Note: Baseline = baseline measurement, post = after the intervention measurement, Dif. = difference in scores; Positive difference scores indicate a decrease in symptoms post-intervention, while negative scores indicate an increase, RCI = Reliable Change Index. For abbreviations, see the "Measures" section under "Online Questionnaires" in the Methods. * RCI > 1.96 or 1.64 or < -1.64 indicates significance at p = 0.10 (90% CI). ~RCI could not be calculated due to missing data on alpha scores and test-retest reliability. 2) Applicability of the intervention for the target group All participants completed the intervention. They reported to be highly satisfied with the intervention, demonstrated by an average score of 8,3 on the client thermometer at the end of the intervention. They indicated that the intervention provided them with the opportunity to become physically active through sports, to rebuild self-confidence, to maintain a routine and to experience meaningful social interaction. All participants engaged in some kind of physical activity by the end of the study (yoga, boxing or regular walking). Experienced difficulties consisted of confrontation with past vulnerabilities and the use of medication (yielding side-effects such as nausea and abdominal pain). The recommendations made in the group discussion and interviews resulted in several changes to the intervention. Changes consisted of an increase in the length of phases (phase 1: 6 to 8 weeks, phase 3: 8 to 10 weeks) and individual session length (45 minutes to 60 minutes). The psychomotor therapy toolbox was expanded with additional themes, such as self-stigma and individual recovery. The role of the expert-by-experience was greatly appreciated and therefore became more pronounced in the intervention protocol. In line with comments of participants, the coach will be introduced earlier on in phase 2 (partaking in the last 2 sessions) as to ensure a smoother transition to phase 3. Based on feedback from the participants we removed the LIFE-H questionnaire from the protocol, since they felt the questions were not applicable. Also, based on the difficulty to calculate relevant change, the GVSG will have to be replaced. Finally, participants suggested to make ESM assessments more flexible to complete, with a minimum completion requirement of once a day, and an increase in response time from one to two hours. Discussion This study assessed the feasibility of a personalized phased sports intervention in preparation for a larger multiple baseline single-case design study. The objectives were to assess the recruitment strategy, the feasibility of outcome instruments in measuring intervention effects and the applicability of the intervention for individuals with early psychosis. As a preparatory step, this study aimed to offer insights to improve the execution of future research. Evaluation of Recruitment Strategy Recruitment proved to be more challenging than anticipated, even with adjustments made. Participants however appreciated the small group size. In the larger study we decided to form groups with three to five participants. Recruitment efforts will be intensified and flyers and posters will be improved with the help of an expert-by-experience who will also have a more extensive role in providing information to teams and potential participants. Suitability of outcome measures The feasibility of the chosen outcome measures showed mixed results. While all participants completed the full intervention and provided data on multiple measures, ESM completion rates varied widely, with technical issues and personal life events impacting data collection. Conform suggestions of participants, flexible adaptations to the ESM protocol, such as longer response windows and lower frequency requirements, have therefore been proposed [ 62 ]. Despite variability in ESM data quality, both visual and statistical analyses revealed meaningful individual-level changes. For example, participant 1 showed significant improvements in negative symptoms and increased activity levels, while participant 2 experienced a significant increase in self-esteem. For participant 3 data indicated an improvement on social inclusion. Actigraph accelerometer data largely confirmed these trends, with participants 1 and 2 showing increases in light physical activity and daily step counts. Data from the larger questionnaires reveal that participants had different experiences where both body image and stigma are concerned. One participant reported reduced stigma and a more positive body image, while another (possibly due to the confrontation of exercising with individuals outside of mental health care) experienced increased stigma and a more negative body image. Two of the three participants reported a greater resistance to stigma. The diversity in outcomes and response patterns further underlines the importance of a personalized, idiographic approach. We also learned that some outcome measures were not well received (LIFE-H) or usable (GVSG), prompting replacement with better instruments in the next study phase. Evaluation of Intervention Protocol The intervention was positively evaluated by all participants, who qualitatively reported increased self-confidence, physical activity, and meaningful social contacts. All three were engaged in some sort of sport activity outside of mental health care services after completing the intervention. This suggests that the intervention is acceptable and potentially valuable for the target group. At the same time, participants noted emotional challenges and physical side effects, which highlight the need for close monitoring and flexible adaptation of content and pacing. Protocol adjustments were made to better align with participant preferences and needs. These include extending the duration of phases, enhancing the content of the intervention toolbox, and integrating the expert-by-experience and coach roles more effectively. These changes aim to strengthen engagement, reduce drop-out risk, and facilitate long-term behaviour change. Implications This feasibility study suggests that a sports-based intervention may support both individual recovery and broader social outcomes. While the focus was on personal change, the overarching aim of this study was to promote social (re)integration into the community. Social integration is a key factor in recovery from psychosis, and community-based strategies currently offered (such as peer support and structured activities) are known to expand social networks [ 10 ], but often fall short in enabling meaningful participation in the community. The current study focused on a personalised sports approach, which is unique in providing a normalising, stigma-reducing, and socially engaging context [ 26 , 28 ]]. In line with these findings, future implementation should allow for greater flexibility in intensity and pacing to accommodate individual differences in vulnerability, motivation, and life circumstances. Strengths and limitations The study design provided valuable insights into the experiences of the participants, allowing for real-time adaptability of intervention, study design and detailed data collection. This approach enabled us to tailor the intervention to individual needs, addressing obstacles as they arose and refining the protocol for the larger trial. A key strength was the use of ESM, which minimized memory biases by collecting real-time and contextual data. This adaptability not only personalized the intervention but also facilitated a thorough evaluation of the outcome measures and helped to test hypotheses of the larger intervention early. While this study provided valuable insights, it is important to acknowledge the limitations inherent in single-case research, particularly with regard to generalizability. With only three participants working on personal goals, the findings may not be generalizable to a broader population. Additionally, the participants in our study were found to have already taken some steps towards more physical activity, and there experiences may not reflect the challenges faced by other individuals in the period after a first psychosis. For the future larger study, we will emphasize the potential benefits of the intervention also for participants that are in earlier stages of recovery and/or that are not yet already engaged in sports during the recruitment process. Conclusion This feasibility study demonstrated that a sports-based intervention for individuals with psychosis is promising in terms of acceptability, applicability, and potential individual benefits. Although recruitment proved challenging, participants who enrolled were highly satisfied with the intervention, completed the full program, and reported meaningful improvements in routine, self-confidence, and social interaction. The selected outcome measures were largely feasible, with some necessary adjustments made. These findings led to improvements in both the intervention and study design, supporting the next step toward a larger single-case multiple baseline study. Declarations Funding This feasibility study is part of a larger research project (ISRCTN14328965, August 2022). funded by the Netherlands Organization for Scientific Research (NWO) within the research programme on Societal (re)integration of adolescents and adults with autism and psychosis [Maatschappelijke (re-)integratie van adolescenten en volwassenen met autisme en psychose’], Grant Number Auth.19.014, May 2020. Disclosure of interest The authors have no competing interests to declare that are relevant to the content of this article. Ethics approval This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Medical Ethical Board of the University Medical Center Groningen (NL79574.042.2, June 2022). Consent Informed consent was obtained from all individual participants included in the study. Data availability statement The data that support the findings of this study are available on request from the corresponding author. 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1","display":"","copyAsset":false,"role":"figure","size":35474,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eOverview design and procedure\u003c/em\u003e\u003csup\u003e\u003cem\u003e1\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e1\u003c/sup\u003e ESM, Experience Sampling Methodology.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7992569/v1/f9ef92c63de9186bbd67130d.png"},{"id":95314225,"identity":"404670bb-6586-4a72-a1da-0a2388cdc54b","added_by":"auto","created_at":"2025-11-06 15:52:36","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":261295,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eVisual representation of different outcomes over baseline and intervention for participant 1,2 and 3*\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e* Note: The x-axis represents time points over 9 periods, and the y-axis shows average scores for the respective parameter. Blue dots indicate mean scores per separate measurement, and black lines represent median scores per period. The baseline period is delineated by a vertical black line, and phases 1, 2, and 3 are separated by gray dashed vertical lines. For complete table with all results see Supplement 2.\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003e\u003csup\u003eNote that participant 1 has a larger number of measurements than participant 2 and 3, due to a technical error in phase 3. For participants 3 there is only one data point in phase 3, preventing accurate PEM score calculations comparing baseline and phase 3; PEM scores presented are calculated over baseline and phase 2.\u003c/sup\u003e\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7992569/v1/8b27a2d2fe37f27beb7e00aa.png"},{"id":100356586,"identity":"9add9845-597e-4a30-b433-df67001622fc","added_by":"auto","created_at":"2026-01-16 07:15:52","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1582929,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7992569/v1/776464e8-de4e-4e43-b8a1-1656128fbecd.pdf"},{"id":95313647,"identity":"b1adaa39-c930-4385-b714-350191f61aa7","added_by":"auto","created_at":"2025-11-06 15:51:48","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":51064,"visible":true,"origin":"","legend":"","description":"","filename":"MullerFeasibilitypsychomotorsportsinterventionsupplementarymaterial.docx","url":"https://assets-eu.researchsquare.com/files/rs-7992569/v1/238096c4d3d952657d32634b.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Do not stop me now: A feasibility study for a personalized, phased psychomotor sports intervention to promote social integration in people with early psychosis.","fulltext":[{"header":"Introduction","content":"\u003cp\u003eA first psychotic episode is often associated with significant personal and societal consequences [\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Already in the early phases of a psychotic disorder, social integration becomes challenging [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Social integration is a multidimensional concept that can be defined as the participation of an individual in the key dimensions of the society in which he or she lives [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Individuals with early psychosis often need to (temporarily) stop working, studying and/or engaging in leisurely activities. As a result, many of them report low social support, a lack of contact with peers and loneliness after a psychotic episode [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Overall, the evidence demonstrates that social participation becomes increasingly difficult after a psychotic episode. In contrast, a higher frequency of social interactions [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e] and a larger size of the social network [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e] increase chances of recovery, emphasizing the need to provide support towards better social (re)integration for this group.\u003c/p\u003e\u003cp\u003eStandard therapy to treat symptoms of psychosis is antipsychotic medication in combination with cognitive behavioral therapy (CBT) [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Although this has been shown to be effective in treating especially the positive symptoms of psychosis [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] little to no effect on social outcomes was found [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Evidence shows that providing support to individuals with psychosis in social activities in the community is effective in increasing their social networks, through initiatives such as befriending, employment and education or peer support [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. However, only some of these promising efforts are currently included in standard treatments and there is an overall need to focus on providing initiatives integrated into the community [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. As such, research examining new interventions are needed.\u003c/p\u003e\u003cp\u003eIn these new interventions attention should be paid to the factors that play a role in the diminished social integration in early psychosis. First, the presence of negative symptoms, especially a lack of initiative, makes it challenging to actively engage in social situations [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Self-stigma, or the anticipation of discrimination because of one\u0026rsquo;s mental illness, can significantly lower the motivation to engage in social interactions and to participate in the community [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Research confirms the association between lower social functioning and increased self-stigma in participants with a psychotic disorder [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Low self-esteem has also been suggested to contribute to a lack of social participation and role functioning in individuals with severe mental illness [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Moreover, increased sedentary behaviour makes social (re)integration more difficult, as it impairs restricts the ability to seek out and engage in activities within one\u0026rsquo;s own social network and in the community [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Also, a negative body image, as a consequence of weight gain through medication and sedentary life style can contributes to withdrawal from social relationships and activities [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eBased on the findings, we developed a sports based intervention \u0026ldquo;Don\u0026rsquo;t Stop me Now\u0026rdquo; to increase social integration in early psychosis by targeting the factors negative symptoms [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e], self-stigma [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e], low self-esteem [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] sedentary behaviour [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] and a negative body image [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. The aim of the current study is to examine the feasibility of, this personalized, phased sports intervention for individuals with early psychosis, targeted to improve social integration through sports. The intervention comprises three phases; an individual and a group phase with Psychomotor Therapy (PMT) offered in a mental health context and a phase with a sports coach in the community. PMT is an experience-oriented therapy that utilizes movement and physical activity to address psychological and psychiatric complaints [\u003cspan additionalcitationids=\"CR22 CR23 CR24 CR25\" citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. By integrating PMT with community sports, our intervention purposes to harness the unique benefits of sport-based approaches, which are non-stigmatizing and can positively affect both physical and mental health, while also facilitating improvements in social functioning [\u003cspan additionalcitationids=\"CR27 CR28\" citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e].\u003c/p\u003e\n\u003ch3\u003eObjective\u003c/h3\u003e\n\u003cp\u003eThe current study examines the feasibility of the intervention in preparation for a larger multiple baseline single-case design study. The aim is three-fold: to assess 1) appropriateness of the recruitment strategy (clinician and patient willingness, adherence rate), 2) feasibility of measuring intervention effects using the chosen outcome measures, and 3) applicability of the intervention for the target group.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis feasibility study is part of a larger research project (ISRCTN14328965, August 2022).\u003c/p\u003e\n\u003ch3\u003eDesign\u003c/h3\u003e\n\u003cp\u003eData were collected using a multiple baseline single-case design [30], with each participant serving as their own control. Participants started with randomly varied baseline periods (12\u0026ndash;21 days) and commenced simultaneously at phase 1. Figure\u0026nbsp;1 outlines design and procedure.\u003c/p\u003e\n\u003ch3\u003eParticipants \u0026amp; Procedure\u003c/h3\u003e\n\u003cp\u003eParticipants were recruited at a specialized early intervention psychosis team. Eligible participants were informed by their clinician. After an informative contact by phone, participants were provided with written information and an informed consent form. They were given two weeks to consider participation. It was our goal to recruit five participants supplementary to their treatment.\u003c/p\u003e\n\u003cp\u003eInclusion criteria consisted of:\u003c/p\u003e\n\u003cp\u003ea) 18\u0026ndash;35 years,\u003c/p\u003e\n\u003cp\u003eb) a diagnosis of a first psychotic disorder no more than five years ago,\u003c/p\u003e\n\u003cp\u003ec) the desire to be (more) physically active\u003c/p\u003e\n\u003cp\u003ed) subjective experiences of reduced (social) participation,\u003c/p\u003e\n\u003cp\u003ee) not currently practicing sports with others in the community,\u003c/p\u003e\n\u003cp\u003ef) read and speak Dutch fluently,\u003c/p\u003e\n\u003cp\u003eg) capable of following the research procedures,\u003c/p\u003e\n\u003cp\u003eh) willing and able to provide informed consent.\u003c/p\u003e\n\u003cp\u003eThe exclusion criteria were:\u003c/p\u003e\n\u003cp\u003ea) significant hearing or visual problems,\u003c/p\u003e\n\u003cp\u003eb) no internet connection at home or on mobile phone,\u003c/p\u003e\n\u003cp\u003ec) physical conditions (e.g., handicaps, illnesses or pregnancy), that make sports unwise or impossible.\u003c/p\u003e\n\u003ch3\u003eIntervention\u003c/h3\u003e\n\u003cp\u003eBefore developing the intervention, a qualitative study was conducted to assess the needs and barriers to sports participation for the target population (\u003cem\u003ein prep).\u003c/em\u003e The intervention's current design is based on the interview outcomes.\u003c/p\u003e\n\u003cp\u003eIn phase 1, participants focus on identifying personal goals and regaining trust in their physical abilities through weekly individual PMT sessions. With the therapist's assistance, they select goals that remain central throughout the intervention, along with exercises from a specially developed Toolbox (see Table\u0026nbsp;1; (see Supplementary Information (SI) Table\u0026nbsp;1 for the different modules with PMT exercises aligning with the modifiable factors underlying social integration) Toolbox available on request). During phase 2, participants transition to group-based PMT with the other study participants. While continuing to work on personal goals, the focus here lies on fostering social connections, practicing social behavior in a safe environment and deciding on what sport to try. In phase 3, participants work outside the mental health setting with a community sports coach, who provides tailored support, making steps towards independent sports activities in the community.\u003c/p\u003e\n\u003cdiv\u003eDescription of the three phases of the sport-intervention.\n\u003ctable border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv\u003eTable 1\u003c/div\u003e\n\u003c/caption\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003ePhase 1\u003c/p\u003e\n\u003cp\u003eIndividual psychomotor therapy\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003ePhase 2\u003c/p\u003e\n\u003cp\u003eGroups sports therapy\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003ePhase 3\u003c/p\u003e\n\u003cp\u003eCommunity sport coach\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd\u003e\n\u003cp\u003eGeneral objectives\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003eGoal setting and regaining trust in one\u0026rsquo;s own physical capabilities\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003eSocial connectedness\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003eSocial (re)integration\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"3\"\u003e\n\u003cp\u003eGeneral goals\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003eWorking on wishes and goals and getting used to physical activity\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003eMaking and maintaining social contact\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003eMaintaining an active lifestyle\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd\u003e\n\u003cp\u003eGetting acquainted with sports activities by making use of a \u0026lsquo;toolbox\u0026rsquo;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003eEstablishing a social connection within the group and discussing shared difficulties (such as self-stigma)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003eJoining a sports association in the community\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd\u003e\n\u003cp\u003eFormulate work goals for phase 2 and 3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003eContinue to practice with the work goals in a group setting\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003eReducing self-stigma and increase of self-esteem\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd\u003e\n\u003cp\u003eDuration phase\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e6 weeks\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e6 weeks\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e6 to 8 weeks\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd\u003e\n\u003cp\u003eDuration session\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e45 minutes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e75 minutes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e60 minutes on average (depending on the type of sport)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd\u003e\n\u003cp\u003eFrequency\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003eMinimum of 4 and a maximum of 6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003eMinimum of 4 and a maximum of 6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003eMinimum of 6 and a maximum of 8\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd\u003e\n\u003cp\u003eLocation\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003ePsychomotor center in the Mental health institution\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003ePsychomotor center in the Mental health institution\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003eVarious locations in the region where the participant lives.\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cdiv\u003e\n\u003ch2\u003eMeasures\u003c/h2\u003e\n\u003cdiv\u003e\n\u003ch2\u003eExperience sampling method (ESM)\u003c/h2\u003e\n\u003cp\u003eESM was used to monitor participants real-world experiences [31] three times daily (morning, afternoon, and evening) at scheduled intervals for five consecutive days at the beginning and end of each phase. The ESM questions were selected on the basis of validated questionnaires (e.g. PANSS [32]; ISMI [33]), the ESM database (https://esmitemrepositoryinfo.com/), and previous ESM studies (e.g. Mirorr study [34], Trails Trans-id study [35], and was reviewed by an expert-by-experience pool, leading to the final version. The ESM questions covered daily variations of the factors proposed to underlie social integration, namely negative symptoms, self-stigma, self-esteem, sedentary behaviour and negative body image, in addition to social integration itself. Participants also had the option to select two personal items matching their personal goals.\u003c/p\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003ch3\u003eInterviews\u003c/h3\u003e\n\u003cp\u003eDuring the baseline and after the intervention two semi structured interviews were administered. The Positive and Negative Syndrome Scale (PANSS [23]) was used, a 30-item rating scale based on a semi-structured interview aimed at assessing symptom severity with adequate psychometric quality (test\u0026ndash;retest reliability 0.77\u0026ndash;0.89; internal consistency overall: \u0026alpha;\u0026thinsp;=\u0026thinsp;.79, SD\u0026thinsp;=\u0026thinsp;13.6 [23]). Next, the Brief Negative Symptom Scale (BNSS [36\u0026ndash;37]) was completed, a 13-item instrument that assesses negative symptoms across six domains: anhedonia, asociality, avolition, blunted affect, alogia, and lack of normal suffering (\u0026alpha;\u0026thinsp;=\u0026thinsp;.79, SD\u0026thinsp;=\u0026thinsp;12.49).\u003c/p\u003e\n\u003cp\u003eA qualitative baseline interview assessed participants' expectations of the intervention and reasons for participation, while a post-intervention interview evaluated overall experiences (e.g. goals attained, and opinions on the intervention design). To quantify satisfaction, participants rated the intervention on a client \u0026lsquo;satisfaction\u0026rsquo; thermometer. The intervention protocol was considered feasible if the average satisfaction score was at least 5 out of 10 [38]. At the end of phase 2, a joint evaluation was held with all participants, researchers, and the psychomotor therapist, reviewing the intervention's strengths and areas for improvement. Interview were audiotaped with the consent of participants and transcribed verbatim.\u003c/p\u003e\n\u003cdiv\u003e\n\u003ch2\u003eQuestionnaires\u003c/h2\u003e\n\u003cp\u003eParticipants also completed online questionnaires prior to the baseline and post-intervention interviews.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSocial Integration.\u003c/strong\u003e The Assessment of Life Habits (LIFE-H [39] evaluates how individuals accomplish daily living activities and social roles using 69 questions covering domains such as fitness, housing, interpersonal relationships, community life, and employment (Overall \u0026alpha;\u0026thinsp;=\u0026thinsp;.78, Dutch LIFE H 3.0 [40]).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSocial Functioning.\u003c/strong\u003e The Groningen Social Behaviour Questionnaire (GVSG) assesses the degree of social functioning [41] with 45 items that evaluate social relations, work, school, household, and leisure activities. (\u0026alpha;\u0026thinsp;=\u0026thinsp;.83 [42]).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSocial Network.\u003c/strong\u003e The Social Network Questionnaire (SNQ [43]) consists of 15 items divided into four domains: quality and frequency of social contacts, practical social support, emotional support, and the presence and quality of an intimate supportive relationship (overall reliability moderate to good [44]).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSocial Exclusion.\u003c/strong\u003e Social exclusion was assessed with one item based on Lincoln et al. [45], asking, \u0026ldquo;I feel excluded, rejected, like an outsider.\u0026rdquo; (1 \u0026lsquo;not applicable\u0026rsquo; to 11 \u0026lsquo;fully applicable\u0026rsquo;).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSelf-Stigma.\u003c/strong\u003e The Internalized Stigma of Mental Illness (ISMI) assesses self-stigma among individuals with psychiatric disorders [46] using 29 items across four subscales with higher scores indicating more self-stigma: alienation (A), stereotype endorsement (SE), discrimination experience (DE), social withdrawal (SW), and one subscale with higher scores indicating more stigma resistance (SR). Overall reliability is moderate to good (\u0026alpha;\u0026thinsp;=\u0026thinsp;.90; A: SD\u0026thinsp;=\u0026thinsp;.70; SE: SD\u0026thinsp;=\u0026thinsp;0.53; DE: SD\u0026thinsp;=\u0026thinsp;.61; SW: SD\u0026thinsp;=\u0026thinsp;0.66).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSelf-Esteem.\u003c/strong\u003e The Rosenberg Self-Esteem Scale (RSES) consists of 10 items assessing global self-esteem, defined as an individual's overall evaluation of their worth [47] (\u0026alpha;\u0026thinsp;=\u0026thinsp;.87; SD\u0026thinsp;=\u0026thinsp;4.48 [48]).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eBody Image.\u003c/strong\u003e The Dutch version of the Dresden Body Image Questionnaire [49] ((DBIQ-NL; \u0026alpha;\u0026thinsp;=\u0026thinsp;.88) consists of 35 items across five subscales: body acceptance (BA), sexual fulfillment (SF), physical contact (PC), vitality (V), and self-aggrandizement (SA). The validity of the Dutch version in a non-clinical population is very good (BA: ICC .80, SD\u0026thinsp;=\u0026thinsp;1.22, SF: ICC. 79, SD\u0026thinsp;=\u0026thinsp;1.34, PC: ICC.64, SD\u0026thinsp;=\u0026thinsp;1.23, V: ICC .82, SD\u0026thinsp;=\u0026thinsp;1.04, SA: ICC .78, SD\u0026thinsp;=\u0026thinsp;1.05 [50]).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePhysical Activity/Sedentary Behavior.\u003c/strong\u003e The International Physical Activity Questionnaire (IPAQ [51\u0026ndash;52]) assesses physical activity through 31 questions divided into five subscales: job-related physical activities, transportation, housework and family care, leisure-time activities, and time spent sitting (\u0026alpha;\u0026thinsp;=\u0026thinsp;.91). Participants reported the duration of each activity over the past week.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv\u003e\n\u003ch2\u003eActiGraph GT9X\u0026thinsp;+\u0026thinsp;accelerometers\u003c/h2\u003e\n\u003cp\u003eActiGraph GT9X\u0026thinsp;+\u0026thinsp;accelerometers were used to provide an objective assessment of sedentary behavior and physical activity. They were worn on the wrist of the non-dominant hand for five days at the beginning of each phase.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical analyses\u003c/strong\u003e\u003c/p\u003e\n\u003cem\u003e1) Appropriateness of the recruitment strategy\u003c/em\u003e\u003cbr /\u003e\n\u003cp\u003eClinician and patient willingness, and adherence rate, was examined descriptively by providing the total of potential participants that were approached, how many were interested in partaking in the study and how many completed the intervention. Drop-out (n, %) was determined for the included participants.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e2) Feasibility of measuring intervention effects using the chosen outcome measures\u003c/em\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv\u003e\n\u003ch2\u003eESM\u003c/h2\u003e\n\u003cp\u003eThe continuous rating scale questions were analyzed per parameter using R [53]. Responses to negatively framed questions were reversed. For outcomes with multiple questions, symptoms, social integration, self-esteem, and sedentary behavior, responses were averaged. All responses were plotted in separate graphs to visually examine trends across the baseline and intervention phases [30, 54]. Additionally, dichotomous questions (e.g., \"Have you been in contact with anyone?\") were presented descriptively.\u003c/p\u003e\n\u003cp\u003eThe data were then analyzed using the Percentage of Data Points Exceeding the Median (PEM [55]), an effect measure that mitigates the impact of outliers and floor and ceiling effects [56]. PEM is the percentage of data points in the last phase (3) that fall above or below the median of baseline data, reflecting change and stability after the intervention. A PEM between .70 and .89 is considered to reflect moderate effectiveness, higher than .90 effective and possibly clinically relevant [55, 57]. As a third step, the Tau-U method was calculated (singlecaseresearch.org/calculators/tau-u), combining nonoverlap between adjacent phases with the intervention phase trend while controlling for baseline trends [56].\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv\u003e\n\u003ch2\u003eQuestionnaires and semi structured interviews\u003c/h2\u003e\n\u003cp\u003eData from the questionnaires, assessed before baseline and post-intervention, were compared using Reliable Change Index (RCI) measures. RCI \u0026lsquo;s were calculated in excel by dividing the difference between baseline and post-intervention scores by the standard error of the difference, based on published standard deviation (SD) and test-retest reliability (ICC) or internal consistency \u0026alpha;\u0026rsquo;s [58\u0026ndash;59]. The RCI could not be computed for the GVSG 45 Total Score, the SNV Total Score and the 1 item for social exclusion 1-item since information on ICC or \u0026alpha; and SD is lacking.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv\u003e\n\u003ch2\u003eActiGraph GT9X\u0026thinsp;+\u0026thinsp;accelerometers\u003c/h2\u003e\n\u003cp\u003eAnalyses of ActiGraph data were done in excel. In line with previous research [60\u0026ndash;61] the following outcomes were described: time per day spent in sedentary behavior (SB: Total SB periods with \u0026lt;\u0026thinsp;150 counts/min, SBzero: 0 counts/min, SB: 1-150 counts/min), light-intensity physical activity (LPA: 151\u0026ndash;3207 counts/min), and moderate to vigorous physical activity (MVPA: \u0026ge;3208 counts/min) with changes operationalized as percentage differences between baseline and final assessment. The number of hours of rest within a 24-hour cycle was excluded from calculations and analyses focused on valid measurements with more than six hours of wear time per day for at least three days. The number of steps were registered.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e3) Applicability of the intervention for the target group\u003c/em\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv\u003e\n\u003ch2\u003eQualitative interviews\u003c/h2\u003e\n\u003cp\u003eThe qualitative data were descriptively analyzed by two of the authors (MKM, SS) individually, to evaluate participants' perceptions of the intervention and to identify emerging themes. After individual analysis, the final key themes were identified and agreed upon.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e\n \u003cp\u003e1) Appropriateness of the recruitment strategy\u003c/p\u003e\n \u003cp\u003eOver a period of five months, 20 eligible participants were approached of whom three (15%) agreed to participate in the study. Reasons for declining participation were: the perceived burden of participation (in addition to treatment), physical injuries, a preference for individual sports or already doing sports, working or studying. During the recruitment process two adjustments were made based on feedback from the mental health team: the maximum age restriction was expanded to 65 years and \u0026ldquo;no history of psychotic episodes before the current, according to the DSM-5 criteria\u0026rdquo; was adjusted to \u0026ldquo;within five years after the first diagnosis\u0026rdquo;.\u003c/p\u003e\n \u003cp\u003eThe three participants, one man and two women all below the age of 35, completed all three phases of the intervention (100%). \u003cem\u003eParticipant 1\u003c/em\u003e was a young adult receiving outpatient care following an earlier episode of psychosis. This person was already physically active on an individual level but expressed a desire to engage in more regular, group-based sports activities. \u003cem\u003eParticipant 2\u003c/em\u003e was a young adult living in supported housing and receiving a combination of pharmacological treatment and structured daytime activities. Initially, the main goal was to become more physically active, as most time was spent in sedentary activities such as gaming. Over time, the focus shifted toward participating in physical activity with others. \u003cem\u003eParticipant 3\u003c/em\u003e was a young adult living independently while taking part in a reintegration program alongside outpatient care. This participant hoped the intervention would help in engaging with more social forms of physical activity, but felt unable to initiate this independently. Concerns around body image played a role in this hesitation to initiate such activities independently.\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e2) Feasibility of measuring intervention effects using the chosen outcome\u003c/em\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e\n \u003ch2\u003eESM analyses\u003c/h2\u003e\n \u003cp\u003eCompletion rates for the ESM varied between participants: 43%, 81% and 31% for respectively participant 1, 2, and 3. Participant 1 had a restart in phase 3 due to a technical issue, resulting in a low completion rate. Participant 3 experienced several life events in phase 3, making it difficult to complete the ESM assessments in the last phase.\u003c/p\u003e\n \u003cp\u003eFigure 2 demonstrates the visual analysis and the PEM scores on all outcomes for each participant. For all complete PEM and TAU calculation see SI Table\u0026nbsp;2.\u003c/p\u003e\n \u003cp\u003eParticipant 1\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eVisual and descriptive analyses (PEM):\u0026nbsp;\u003c/em\u003e\u003c/strong\u003eFor participant 1 figure 2 demonstrates a visual decrease in negative symptoms 1, self-stigma and sedentary behavior, and an increase in the personal goal. No visual changes are observed for social inclusion or self-esteem. The PEM scores demonstrate a moderate positive effect on sedentary behavior.\u003cbr\u003eThe categorical variables demonstrated that participant 1 engaged in 12 activities (0% sports-related) at baseline, increasing to 13 activities (7.7% sports-related) at post-treatment. At baseline 13 social contacts were reported (0% sports-related), increasing to 14 social contacts (14.3% sports-related) at post-treatment.\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eInferential (TAU) analyses:\u003c/em\u003e\u003c/strong\u003e Negative symptoms decreased significantly from baseline to the end of the intervention (\u003cem\u003ep\u003c/em\u003e\u0026lt;0.05). No significant changes were demonstrated in the TAU-U analyses for the other factors (self-stigma, , social inclusion, self-esteem or personal goal).\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eParticipant 2\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eVisual and descriptive analyses (PEM):\u0026nbsp;\u003c/em\u003e\u003c/strong\u003eFigure 3 demonstrates a visual increase in negative symptoms, self-stigma and sedentary behavior. No changes are observed for social inclusion and self-esteem. The PEM scores indicate a strong positive effect on symptoms, (self)stigma and self esteem.\u003c/p\u003e\n \u003cp\u003eCategorical variables demonstrate that participant 2 engaged in 10 activities (20% sports-related) at baseline, decreasing to 8 activities (25% sports-related) at post-treatment. At baseline 8 social contacts (12.5% sports-related) were reported, which increased to 16 social contacts (18.8% sports-related) at post-treatment.\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eInferential (TAU) analyses:\u003c/em\u003e\u003c/strong\u003e Social inclusion significantly decreased from baseline to post-treatment (\u003cem\u003ep\u003c/em\u003e\u0026lt; 0.05) and self-esteem significantly increased from baseline to post-treatment (\u003cem\u003ep\u003c/em\u003e\u0026lt;0.05). No significant changes were demonstrated in the TAU-U analyses for the other factors (negative symptoms or self-stigma).\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eParticipant 3\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eVisual and descriptive analyses (PEM):\u0026nbsp;\u003c/em\u003e\u003c/strong\u003eFigure 4 demonstrates a visual increase in social inclusion. No visual changes are observed for negative symptoms, self-stigma, sedentary behavior and self-esteem. Due to missing data in phase 3, PEM scores and changes in categorical data are now presented are based on comparison between baseline and phase 2 and show moderate effects on symptoms and self esteem, a strong effect on social inclusion and no effect on (self)stigma and personal goals.\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eInferential (TAU) analyses:\u003c/em\u003e\u003c/strong\u003e Social inclusion significantly increased from baseline to post-treatment (\u003cem\u003ep\u0026lt;\u003c/em\u003e0.01, Supplement 2) and the personal goal significantly decreased from baseline to post-treatment (\u003cem\u003ep\u0026lt;\u003c/em\u003e0.01, Supplement 2). No significant changes were demonstrated in the TAU-U analyses for the other factors (negative symptoms, self-stigma, or self-esteem).\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eActiGraph GT9X+ accelerometers:\u0026nbsp;\u003c/em\u003e\u003c/strong\u003eThe data are summarized in Table 2. For Participant 1, findings indicate improvements in LPA and daily step counts, with a reduction in SB from baseline to phase 2. Data from phase 1 and 3, and the study end, were unavailable due to a technical error for this participant. Participant 2 showed improvements in LPA and daily step counts, along with a slight decrease in SB. Participant 3 showed no notable changes during the study.\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eTable 2\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eActiGraph GT9X+ accelerometers, measures of physical activity and sedentary behavior (minutes per day)\u003c/em\u003e\u003c/p\u003e\n \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"99%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e\u003cem\u003eParticipant 1\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003eBaseline\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003ePhase 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003ePhase 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003ePhase 3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003eEnd of study\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e% Dif.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eModerate to Vigorous Physical Activity (MVPA)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e~\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e2\u003csup\u003e3\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e~\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;~\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e#\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eLight Physical Activity (LPA)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e337\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e~\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e420\u003csup\u003e3\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e~\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp; ~\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e#\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eSedentary Behavior (SB)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e232\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e~\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e190\u003csup\u003e3\u003c/sup\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e~\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp; ~\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e#\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eZero Activity Sedentary Behavior (SB zero)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e198\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e~\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e124\u003csup\u003e3\u003c/sup\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e~\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;~\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e#\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eTotal Sedentary Behavior (Total SB)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e430\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e~\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e314\u003csup\u003e3\u003c/sup\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e~\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;~\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e#\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eSteps\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e14417\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e~\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e19098\u003csup\u003e3\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e~\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;~\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e#\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eHours of Rest within a 24-Hour Cycle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e10:06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e~\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e09:13\u003csup\u003e4\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e~\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;~\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e#\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e\u003cem\u003eParticipant 2\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003eBaseline\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003ePhase 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003ePhase 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003ePhase 3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003eEnd of study\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e% Dif.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eModerate to Vigorous Physical Activity (MVPA)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eLight Physical Activity (LPA)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e183\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e271\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e174\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e251\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e301\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e64.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eSedentary Behavior (SB)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e431\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e424\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e450\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e602\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e458\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e6.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eZero Activity Sedentary Behavior (SB zero)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e350\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e125\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e189\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e148\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e-77.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eTotal Sedentary Behavior (Total SB)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e781\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e549\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e639\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e749\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e535\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e-31.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eSteps\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e10599\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e13973\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e10495\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e14790\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e15066\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e42.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eHours of Rest within a 24-Hour Cycle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e09:49\u003csup\u003e\u0026Dagger;\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e08:43\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e09:02\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e06:51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e08:13\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e-16.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e\u003cem\u003eParticipant 3\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003eBaseline\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003ePhase 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003ePhase 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003ePhase 3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003eEnd of study\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e% Dif.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eModerate to Vigorous Physical Activity (MVPA)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eLight Physical Activity (LPA)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e248\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e216\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e169\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e223\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e196\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e-20.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eSedentary Behavior (SB)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e444\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e416\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e475\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e537\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e377\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e-15.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eZero Activity Sedentary Behavior (SB zero)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e238\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e191\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e239\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e242\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e351\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e47.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eTotal Sedentary Behavior (Total SB)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e682\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e607\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e714\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e779\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e728\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e6.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eSteps\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e127389\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e11926\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e9809\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e13008\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e10146\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e-92.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eHours of Rest within a 24-Hour Cycle\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e08:29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e08:48\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e07:27\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e08:42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e08:55\u003csup\u003e3\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e5.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003csup\u003eNote: % Dif. = percentage differences between the baseline and end of study. # Calculations were not possible due to missing data.\u0026nbsp;\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003e\u003csup\u003e1 Calculated over 3 days instead of 5 due to the non-wearing of the activity monitor. 2. Calculated over 4 nights instead of 5 because the measurement started on the day itself instead of at 00:00. 3. Calculated over 4 days instead of 5 due to the non-wearing of the activity monitor. 4. Calculated over 3 nights, as the measurement only started on the day itself instead of at 00:00, and the activity monitor was not worn on the last day. ~The criteria were unmet: wear time was less than six hours per day, making the measurement invalid.\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eQuestionnaires\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eClinical background scores, along with descriptive statistics and RCI\u0026rsquo;s, are presented in Table 3. For Participant 1, RCI\u0026rsquo;s for the DBIQ SF PC and SA subscales indicate a negative change in body experience and the same holds true for the total RSES RCI. The ISMI Stigma Resistance RCI indicated a significant positive change. For Participant 2, both RCI for total RSES score and ISMI Stigma Resistance indicate negative change. For Participant 3, RCI\u0026rsquo;s of the RSES scores and the ISMI Stigma Resistance indicated positive change but for the subscales of Alienation, Discrimination Experience, and Social Withdrawal an increase was found. The significant RCI\u0026rsquo;s for the DBIQ subscale of Sexual Fulfilment and Self-aggrandizement indicate an increase, thus positive change in body experience.\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3.\u0026nbsp;\u003c/strong\u003e\u003cem\u003eOutcomes baseline and post intervention and Relevant Change Indices (n=3)\u003c/em\u003e\u003c/p\u003e\n\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e\n \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"92%\" class=\"fr-table-selection-hover\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003eParticipant 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003eParticipant 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003eParticipant 3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003eBaseline\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003ePost\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003eDif.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003eRCI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003eBaseline\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\n \u003cp\u003ePost\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003eDif.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003eRCI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003eBaseline\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003ePost\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003eDiff.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003eRCI\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cem\u003eSymptoms\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePANSS Total score\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e-3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e-0.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\n \u003cp\u003e52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e-1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e-0.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e0.57\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003ePositive subscale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e-1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e-0.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e0.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e-2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e-0.36\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003eNegative subscale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e0.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e0.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e0.44\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003eCognitive subscale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e-3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e-0.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e-6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e-0.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e0.44\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBNSS Total Score\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e0.74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cem\u003eSocial (re-) integration\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGVSG 45 Total Score\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e17.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e-0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e~\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\n \u003cp\u003e11.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e-5.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e~\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e16.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e1.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e~\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSNV Total Score\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e3.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e2.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e-0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e~\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e3.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\n \u003cp\u003e2.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e-0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e~\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e2.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e~\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSocial exclusion 1-item\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e~\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e-7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e~\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e~\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cem\u003e(Self)-stigma\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eISMI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 4px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 6px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003eAlienation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e2.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e2.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 6px;\"\u003e\n \u003cp\u003e0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e-0.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e2.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\n \u003cp\u003e2.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 5px;\"\u003e\n \u003cp\u003e0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e-0.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e2.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 5px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e-3.19*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003eStereotype Endorsement\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e2.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e2.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 6px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e1.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\n \u003cp\u003e1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 5px;\"\u003e\n \u003cp\u003e-0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e0.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 5px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003eDiscrimination Experience\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e2.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e2.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 6px;\"\u003e\n \u003cp\u003e0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e-0.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\n \u003cp\u003e1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 5px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e2.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 5px;\"\u003e\n \u003cp\u003e1.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e-5.87*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003eSocial Withdrawal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e2.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e2.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 6px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e1.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\n \u003cp\u003e1.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 5px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e1.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e2.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 5px;\"\u003e\n \u003cp\u003e0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e-3.05*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003eStigma Resistance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e2.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e2.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 6px;\"\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e-1.75**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e2.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\n \u003cp\u003e1.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 5px;\"\u003e\n \u003cp\u003e-0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e2.63*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e1.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e2.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 5px;\"\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e-1.75*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cem\u003eSelf-esteem\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRSES Total Score\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e-3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e1.31**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e-12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e5.25*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e-5.25*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cem\u003eBody image\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDBIQ\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003eBody Acceptance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e4.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e4.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 6px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e2.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\n \u003cp\u003e3.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 5px;\"\u003e\n \u003cp\u003e0.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e-1.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e4.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e4.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 5px;\"\u003e\n \u003cp\u003e0.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e-0.70\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003eVitality\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e4.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e4.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 6px;\"\u003e\n \u003cp\u003e-0.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e0.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e2.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\n \u003cp\u003e3.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 5px;\"\u003e\n \u003cp\u003e0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e-0.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e3.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e2.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 5px;\"\u003e\n \u003cp\u003e-0.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e0.24\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003eSexual Fulfilment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e3.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e2.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 6px;\"\u003e\n \u003cp\u003e-1.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e2.28*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e4.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\n \u003cp\u003e3.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 5px;\"\u003e\n \u003cp\u003e-0.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e0.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e3.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e2.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 5px;\"\u003e\n \u003cp\u003e-1.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e2.03*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003ePhysical Contact\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e4.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e2.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 6px;\"\u003e\n \u003cp\u003e-1.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e2.75*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e3.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\n \u003cp\u003e4.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 5px;\"\u003e\n \u003cp\u003e0.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e-1.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e3.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e4.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 5px;\"\u003e\n \u003cp\u003e0.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e-0.55\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003eSelf-aggrandizement\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e3.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp\u003e1.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 6px;\"\u003e\n \u003cp\u003e-1.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e3.17*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e2.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4px;\"\u003e\n \u003cp\u003e2.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 5px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e2.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e1.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 5px;\"\u003e\n \u003cp\u003e-0.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e1.71**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"13\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003csup\u003eNote: Baseline = baseline measurement, post = after the intervention measurement, Dif. = difference in scores; Positive difference scores indicate a decrease in symptoms post-intervention, while negative scores indicate an increase, RCI = Reliable Change Index.\u0026nbsp;\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003e\u003csup\u003eFor abbreviations, see the \u0026quot;Measures\u0026quot; section under \u0026quot;Online Questionnaires\u0026quot; in the Methods.\u0026nbsp;\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003e\u003csup\u003e* RCI \u0026gt; 1.96 or \u0026lt; -1.96 indicates significance at p = 0.05 (95% CI), ** RCI \u0026gt; 1.64 or \u0026lt; -1.64 indicates significance at p = 0.10 (90% CI). ~RCI could not be calculated due to missing data on alpha scores and test-retest reliability.\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cem\u003e2) Applicability of the intervention for the target group\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAll participants completed the intervention. They reported to be highly satisfied with the intervention, demonstrated by an average score of 8,3 on the client thermometer at the end of the intervention. They indicated that the intervention provided them with the opportunity to become physically active through sports, to rebuild self-confidence, to maintain a routine and to experience meaningful social interaction. All participants engaged in some kind of physical activity by the end of the study (yoga, boxing or regular walking). Experienced difficulties consisted of confrontation with past vulnerabilities and the use of medication (yielding side-effects such as nausea and abdominal pain).\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;The recommendations made in the group discussion and interviews resulted in several changes to the intervention. Changes consisted of an increase in the length of phases (phase 1: 6 to 8 weeks, phase 3: 8 to 10 weeks) and individual session length (45 minutes to 60 minutes). The psychomotor therapy toolbox was expanded with additional themes, such as self-stigma and individual recovery. The role of the expert-by-experience was greatly appreciated and therefore became more pronounced in the intervention protocol. In line with comments of participants, the coach will be introduced earlier on in phase 2 (partaking in the last 2 sessions) as to ensure a smoother transition to phase 3.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Based on feedback from the participants we removed the LIFE-H questionnaire from the protocol, since they felt the questions were not applicable. Also, based on the difficulty to calculate relevant change, the GVSG will have to be replaced. Finally, participants suggested to make ESM assessments more flexible to complete, with a minimum completion requirement of once a day, and an increase in response time from one to two hours.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study assessed the feasibility of a personalized phased sports intervention in preparation for a larger multiple baseline single-case design study. The objectives were to assess the recruitment strategy, the feasibility of outcome instruments in measuring intervention effects and the applicability of the intervention for individuals with early psychosis. As a preparatory step, this study aimed to offer insights to improve the execution of future research.\u003c/p\u003e\u003cp\u003e\u003cb\u003eEvaluation of Recruitment Strategy\u003c/b\u003e\u003c/p\u003e\u003cp\u003eRecruitment proved to be more challenging than anticipated, even with adjustments made. Participants however appreciated the small group size. In the larger study we decided to form groups with three to five participants. Recruitment efforts will be intensified and flyers and posters will be improved with the help of an expert-by-experience who will also have a more extensive role in providing information to teams and potential participants.\u003c/p\u003e\u003cp\u003e\u003cb\u003eSuitability of outcome measures\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe feasibility of the chosen outcome measures showed mixed results. While all participants completed the full intervention and provided data on multiple measures, ESM completion rates varied widely, with technical issues and personal life events impacting data collection. Conform suggestions of participants, flexible adaptations to the ESM protocol, such as longer response windows and lower frequency requirements, have therefore been proposed [\u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eDespite variability in ESM data quality, both visual and statistical analyses revealed meaningful individual-level changes. For example, participant 1 showed significant improvements in negative symptoms and increased activity levels, while participant 2 experienced a significant increase in self-esteem. For participant 3 data indicated an improvement on social inclusion. Actigraph accelerometer data largely confirmed these trends, with participants 1 and 2 showing increases in light physical activity and daily step counts. Data from the larger questionnaires reveal that participants had different experiences where both body image and stigma are concerned. One participant reported reduced stigma and a more positive body image, while another (possibly due to the confrontation of exercising with individuals outside of mental health care) experienced increased stigma and a more negative body image. Two of the three participants reported a greater resistance to stigma.\u003c/p\u003e\u003cp\u003eThe diversity in outcomes and response patterns further underlines the importance of a personalized, idiographic approach. We also learned that some outcome measures were not well received (LIFE-H) or usable (GVSG), prompting replacement with better instruments in the next study phase.\u003c/p\u003e\u003cp\u003e\u003cb\u003eEvaluation of Intervention Protocol\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe intervention was positively evaluated by all participants, who qualitatively reported increased self-confidence, physical activity, and meaningful social contacts. All three were engaged in some sort of sport activity outside of mental health care services after completing the intervention. This suggests that the intervention is acceptable and potentially valuable for the target group. At the same time, participants noted emotional challenges and physical side effects, which highlight the need for close monitoring and flexible adaptation of content and pacing. Protocol adjustments were made to better align with participant preferences and needs. These include extending the duration of phases, enhancing the content of the intervention toolbox, and integrating the expert-by-experience and coach roles more effectively. These changes aim to strengthen engagement, reduce drop-out risk, and facilitate long-term behaviour change.\u003c/p\u003e\u003cp\u003e\u003cb\u003eImplications\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThis feasibility study suggests that a sports-based intervention may support both individual recovery and broader social outcomes. While the focus was on personal change, the overarching aim of this study was to promote social (re)integration into the community. Social integration is a key factor in recovery from psychosis, and community-based strategies currently offered (such as peer support and structured activities) are known to expand social networks [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], but often fall short in enabling meaningful participation in the community. The current study focused on a personalised sports approach, which is unique in providing a normalising, stigma-reducing, and socially engaging context [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]]. In line with these findings, future implementation should allow for greater flexibility in intensity and pacing to accommodate individual differences in vulnerability, motivation, and life circumstances.\u003c/p\u003e\u003cp\u003e\u003cb\u003eStrengths and limitations\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe study design provided valuable insights into the experiences of the participants, allowing for real-time adaptability of intervention, study design and detailed data collection. This approach enabled us to tailor the intervention to individual needs, addressing obstacles as they arose and refining the protocol for the larger trial. A key strength was the use of ESM, which minimized memory biases by collecting real-time and contextual data. This adaptability not only personalized the intervention but also facilitated a thorough evaluation of the outcome measures and helped to test hypotheses of the larger intervention early.\u003c/p\u003e\u003cp\u003eWhile this study provided valuable insights, it is important to acknowledge the limitations inherent in single-case research, particularly with regard to generalizability. With only three participants working on personal goals, the findings may not be generalizable to a broader population. Additionally, the participants in our study were found to have already taken some steps towards more physical activity, and there experiences may not reflect the challenges faced by other individuals in the period after a first psychosis. For the future larger study, we will emphasize the potential benefits of the intervention also for participants that are in earlier stages of recovery and/or that are not yet already engaged in sports during the recruitment process.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis feasibility study demonstrated that a sports-based intervention for individuals with psychosis is promising in terms of acceptability, applicability, and potential individual benefits. Although recruitment proved challenging, participants who enrolled were highly satisfied with the intervention, completed the full program, and reported meaningful improvements in routine, self-confidence, and social interaction. The selected outcome measures were largely feasible, with some necessary adjustments made. These findings led to improvements in both the intervention and study design, supporting the next step toward a larger single-case multiple baseline study.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis feasibility study is part of a larger research project (ISRCTN14328965, August 2022). \u0026nbsp; funded by the Netherlands Organization for Scientific Research (NWO) within the research programme on Societal (re)integration of adolescents and adults with autism and psychosis [Maatschappelijke (re-)integratie van adolescenten en volwassenen met autisme en psychose’], Grant Number Auth.19.014, May 2020.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDisclosure of interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors have no competing interests to declare that are relevant to the content of this article.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Medical Ethical Board of the University Medical Center Groningen (NL79574.042.2, June 2022).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInformed consent was obtained from all individual participants included in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to their containing information that could compromise the privacy of research participants.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBjornestad A, Hegelstad WTV, R\u0026oslash;ssberg JI (2017a) Social functioning and social networks in early psychosis. 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Eur Psychiatry 66:e34. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1192/j.eurpsy.2023.2438\u003c/span\u003e\u003cspan address=\"10.1192/j.eurpsy.2023.2438\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"personalized sports intervention, psychomotor therapy, social (re)integration, psychosis","lastPublishedDoi":"10.21203/rs.3.rs-7992569/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7992569/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003ePurpose:\u003c/h2\u003e\u003cp\u003eThis study examines the feasibility of a personalised and phased psychomotor sports intervention in preparation for a larger multiple-baseline single-case design study aimed at enhancing social integration in adults with early psychosis. The aim is to evaluate the recruitment strategy, the suitability of selected outcome measures, and the applicability of the intervention for the target population.\u003c/p\u003e\u003ch2\u003eMethods:\u003c/h2\u003e\u003cp\u003e Three participants engaged in a 20-week intervention designed to promote social (re-) integration through sports participation, with three phases 1) individual psychomotor therapy, (2) group psychomotor therapy, both offered within a mental health care setting and (3) community-based sports participation. Next to (qualitative) interviews, a multiple-baseline design was used, incorporating the Experience Sampling Method (ESM), ActiGraph GT9X\u0026thinsp;+\u0026thinsp;accelerometers, and questionnaires.\u003c/p\u003e\u003ch2\u003eResults:\u003c/h2\u003e\u003cp\u003eRecruitment proved challenging, with only three participants included out of twenty potentially suitable candidates. The selected outcome measures were largely feasible, with some adjustments made, particularly in the ESM procedure. The intervention was evaluated positively in terms of acceptability, applicability, and potential individual benefits, with several recommendations made regarding its duration and the roles of the peer support worker and the coach. All participants engaged in some kind of physical activity by the end of the study (yoga, boxing or regular walking).\u003c/p\u003e\u003ch2\u003eConclusion:\u003c/h2\u003e\u003cp\u003eWith broader inclusion criteria and flexibility in the data gathering procedure to tailor individual needs, this feasibility study supports the potential of a personalised, phased sports intervention to enhance social integration in early psychosis and informs methodological refinements for a future, larger single-case multiple-baseline study.\u003c/p\u003e","manuscriptTitle":"Do not stop me now: A feasibility study for a personalized, phased psychomotor sports intervention to promote social integration in people with early psychosis.","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-06 09:58:54","doi":"10.21203/rs.3.rs-7992569/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f2115d33-707c-4128-a484-821db460dc93","owner":[],"postedDate":"November 6th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-01-08T17:39:22+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-06 09:58:54","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7992569","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7992569","identity":"rs-7992569","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}