Table 4 Overview of analysis resulting in required educational elements derived from three categories and nine subcategories with corresponding illustrative quotes

a) Basic knowledge in core symptoms of SSD with particular focus on negative symptoms.

b) Understanding the impact of antipsychotic medication side effects on the body.

c) Analysis of cases demonstrating how symptoms and medical side effects can influence behaviour.

d) Reflection on internalized stigma among individuals with SSD.

Awareness and understanding of mental illness

Knowledge kills prejudice

It would be nice to know something about the illness [SSD] before you start as an instructor… it would be nice to confirm or deny some common myths and assumptions regarding schizophrenia. (Exercise instructor)

Lack of meaning

It makes me think about the shame… the feeling of: “Why is this so awkward? Why am I making it awkward? Why can’t I figure out how to be in company with other people?” I have thought a lot about that. (Young adult with SSD)

Extra compassion

The process in getting better is long and thus it may be beneficial to focus on the small things, like “I see you look happier today” or “you could do 20 [repetition of an exercise] and now you can easily do 30”. So, you look at what is small, good, or on the way. (Clinical staff at mental health outpatient clinic)

a) Reflections on the concept of mental health versus mental illness.

b) Practice of respectful and inquisitive communication.

c) Knowledge about social inclusion and personal recovery.

d) Understanding the concept of proximal zone of development.

Protecting youth identity

Person before the diagnosis

Two people with the same diagnosis can have totally different symptoms and functional level… they are so much more than just a diagnosis. (Clinical staff at mental health outpatient clinic)

Stepping out of the patient role

So, she [a young adult with SSD] can take a selfie for her friends and tag it with “going to the gym, smiley” helping her maintain an identity similar to her friends. (Relative of an individual with SSD)

Good and bad days

Once, I heard on the radio that you can climb a hill in different ways. You can run, you can walk, and you can crawl…but we all need to get up there. (Young adult with SSD)

a) Guidelines and procedures for contacting appropriate parties if needed.

b) Strategies for combining group facilitation with selective participation.

c) reflection on non-fitness related goals in community-based exercise.

Promoting exercise as shared activity

Safe space

Trust that others [health professionals] have the responsibility to address this, not themselves [instructors]. They are just one part of the journey for the young person to feel better. No further demands should be imposed on the instructors besides doing the best they can and knowing that they are doing something good. (Relative of an individual with SSD)

Making exercise meaningful

Having a playful part at the beginning [of an exercise class] really loosened up the atmosphere…playing around positively affected the dynamic… and ending the class well…having a good experience to go home with. (Exercise instructor)

Alone and together

They can give each other so much. Somebody may contribute with more motivation. Sometimes, you may come up with your own goals, but you may also be inspired by others, and suddenly, you have a common goal. (Physiotherapists working in mental healthcare)