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Table 2 Research team identifies the problem and its causes

From: Co-production of “nature walks for wellbeing” public health intervention for people with severe mental illness: use of theory and practical know-how

Around one in four people in the UK experience a mental illness each year [13]. Mental health is generally better on average in rural areas compared to urban areas but in sparsely populated remote and rural areas, mental health is worse than national averages [23, 24]. People with severe mental illness die 15 to 20 years earlier than the general population [25]. In rural areas, this health inequality may be masked by overall and average levels of wellbeing in rural areas [26,27,28,29]. It is argued that increased mortality risk is due to the higher risk of obesity, hyperglycaemia and metabolic syndrome and subsequent development of cardiovascular disease [30]. A dual emphasis on mental and physical health is therefore essential for people with mental illness [13, 31,32,33,34] . Two potential modifiable pathways through which people’s mental illness impacts physical health and thereby mortality risk are the high levels of sedentary behaviour and low levels of exercise [35,36,37]. Given that people with mental illness are more sedentary and less active than the general population [35,36,37] and face illness-related barriers to being active [38, 39], this group needs support to become and remain more active.