Motivating factors and barriers towards exercise in severe mental illness: a systematic review and meta-analysis

Experiences of exercise services for individuals with severe mental illness: A qualitative approach

Regular exercise can be beneficial for people living with a severe mental illness. By better understanding the perspectives and challenges of adults with severe mental illness who are engaged in exercise, we can enhance the design and implementation of exercise programs to better support their mental health and recovery. Nineteen adults (aged 19-73 years) were recruited from transdiagnostic mental health services and local disability services in Western Australia. Patients had engaged in structured exercise services within last 6 months as part of the treatment and/or management of their mental illness. Thematic analysis was used to understand participants' experiences and health outcomes. Participants described themes relating to their exercise experience including establishment of human connection, routine and purpose, and emotional experiences in exercise. Exercise engagement was perceived to improve acute and sustained mental health effects, and behavioural replacement. Patients reported better symptom management, replacing harmful behaviours with positive ones, and reported gains in overall physical health and personal strength. Our findings demonstrate the importance of incorporating the voice of those with lived experience to better understand how exercise impacts their health, treatment, and recovery outcomes. This research has provided valuable insights for clinicians and researchers to develop sustainable client-centred interventions, that may improve health outcomes for this population.

From energy metabolism to mood regulation: The rise of lactate as a therapeutic target

BACKGROUND

Disruption of cerebral energy metabolism is increasingly recognized as a key factor in the pathophysiology of mood disorders. Lactate, beyond its role as a metabolic byproduct, is now understood to be a critical player in brain energy homeostasis and a modulator of neuronal function. Recent advances in understanding lactate shuttling between astrocytes and neurons have opened new avenues for exploring its multifaceted roles in mood regulation. Exercise, known to modulate brain lactate levels, further underscores the potential of lactate as a therapeutic target in mood disorders.

AIM OF REVIEW

This review delves into the alterations in cerebral lactate associated with mood disorders, emphasizing their implications for brain energy dynamics and signaling pathways. Additionally, we discuss the therapeutic potential of lactate in mood disorders, particularly through its capacity to remodel cerebral function. We conclude by assessing the promise of exercise-induced lactate production as a novel strategy for mood disorder treatment.

KEY SCIENTIFIC CONCEPTS OF THE REVIEW

Alterations in brain lactate may contribute to the pathogenesis of mood disorders. In several studies, lactate is not only a substrate for brain energy metabolism, but also a molecule that triggers signaling cascades. Specifically, lactate is involved in the regulation of neurogenesis, neuroplasticity, endothelial cell function, and microglia lysosomal acidification, therefore improving mood disorders. Meanwhile, exercise as a low-risk intervention strategy can improve mood disorders through lactate regulation. Thus, the evidence from this review supports that lactate could be a potential therapeutic target for mood disorder, contributing to a deeper understanding of mood disorder pathogenesis and intervention.

Clusters of healthy lifestyle behaviours are associated with symptoms of depression, anxiety, and psychological distress: A systematic review and meta-analysis of observational studies

Engagement in healthy and unhealthy lifestyle behaviours are related to a range of mental health outcomes. Most existing research has focussed on individual lifestyle behaviours, so it is not clear the extent to which clusters of healthy lifestyle behaviours relate to mental health outcomes. Therefore, this study aimed to systematically review and quantitatively synthesise research which have examined the association between clusters of lifestyle behaviours with symptoms of depression, anxiety, and psychological distress. A systematic search of five electronic databases were conducted to identify studies which used person-centred approaches (e.g., cluster analysis, latent class analysis) to identify subgroups of participants based on at least two unique lifestyle behaviours (i.e., physical activity/sedentary behaviours, diet, sleep, alcohol/tobacco/drug use) and examined differences in symptoms of depression, anxiety, or psychological distress between clusters. A correlated and hierarchical random effects meta-analysis was used to synthesise the results. A total of 81 studies reporting on nearly one-million individual participants were included in the review. Results demonstrated that participants who engaged in the healthiest clusters of lifestyle behaviours reported significantly fewer symptoms of depression (SMD = -0.41), anxiety (SMD = -0.43) and psychological distress (SMD = -0.34) compared to participants engaging in less healthy combinations of lifestyle behaviours, and a dose response relationship was observed across outcomes. These results demonstrate that there is a moderate-to-strong relationship between engaging in clusters of healthy lifestyle behaviours and mental health outcomes and demonstrate the importance of considering healthy lifestyle as a whole instead of as individual parts.

[Sports Programs for Mental Illness: How Mental Health Professionales Can Provide Effective Support]

Despite the positive effects of physical activity, people with mental illness often remain inactive. Exercise recommendations are inconsistent and challenging to follow.This study assessed exercise behavior and the need for programs during and after inpatient treatment to develop clinical recommendations.Patients from the psychiatric clinic at the University of Augsburg were recruited via flyer/QR-Code.A total of 47 patients participated in this survey. Over 70% exercise regularly, and over 70% are interested in peer-sports-groups with low-threshold conditions (e.g. no prior registration required). Strength training and moderate intensity training were favored over endurance sports.Our findings complement the World Health Organization's exercise recommendations. Strength training programs and accessible options may promote physical activity in this population.

We like to move it - patients with schizophrenia spectrum disorders are impaired in estimating their physical fitness levels and benefit from individualized exercise

BACKGROUND

People with schizophrenia spectrum disorders (SSD) engage less in physical activity than healthy individuals. The impact of subjectively assessed physical fitness levels on motivation for sports engagement and its relation to objective fitness parameters in SSD is unclear.

METHODS

25 patients with SSD (P-SSD) and 24 healthy controls (H-CON) participated in a randomized controlled study. Individual anaerobic thresholds (AT) were determined by an incremental exercise test and on separate days, aerobic exercise (cycling at 80% of workload at AT) and non-exercise control (sitting on an ergometer without cycling) sessions were performed. Demographic, clinical and objective physical fitness data (i.e., weekly physical activity, workload at AT, heart rate) were collected. Subjective physical fitness parameters were assessed before and after exercise and control sessions.

RESULTS

Weekly physical activity in P-SSD was lower than in H-CON (p < 0.05) attributed to reduced engagement in sport activities (p < 0.001). Workload and percentage of predicted maximal heart rate at AT were also reduced in P-SSD compared to H-CON (both p < 0.05). Although objective and subjective physical fitness parameters were related in H-CON (p < 0.01), this relationship was absent in P-SSD. However, during exercise sessions subjective physical fitness ratings increased to a stronger extent in P-SSD than H-CON (p < 0.05).

CONCLUSION

The missing relationship between subjective and objective physical fitness parameters in people with SSD may represent a barrier for stronger engagement in physical activity. Accordingly, supervised exercise interventions with individually adjusted workload intensity may support realistic subjective fitness estimations and enhance motivation for sports activity in individuals with SSD.

Treadmill exercise ameliorates hippocampal synaptic injury and recognition memory deficits by TREM2 in AD rat model

OBJECTIVE

The impairment of cognitive function has been associated with Alzheimer's disease (AD). Exercise exerts a positive modulatory effect on cognition by reducing synapse injury. However, limited in vivo evidence is available to validate the neuroprotective effect of TREM2 on synaptic function in this phenomenon. Here, we aim to explore whether physical exercise pretreatment alters Aβ-induced recognition memory impairment in structural synaptic plasticity within the hippocampus in AD rats. METHODS：: In study 1, fifty-two Sprague-Dawley (SD) rats were randomly divided into following four groups: control group (C group, n = 13), Alzheimer's disease group (AD group, n = 13), 4 weeks of physical exercise and Alzheimer's disease group (Exe+AD group, n = 13), 4 weeks of physical exercise and blank group (Exercise group, n = 13). Four weeks of treadmill exercise intervention was performed, and AD model were established by intra-cerebroventricular injection (ICV) injection of Aβ1-42 protein. After 3 weeks, we also conducted a novel object test to evaluate recognition memory in the behavior assessment. Golgi staining and transmission electron microscopy were used to evaluate the morphology and synaptic ultrastructure of neurons. Western blotting was used to measure the expression of hippocampal synaptic proteins. Extracellular neurotransmitters in the hippocampus were detected by microdialysis coupled with high-performance liquid chromatography. In study 2, 33 SD rats were randomly divided into three groups: 4 weeks of physical exercise and Alzheimer's disease group (Exe+AD group, n = 11), AAV-Control and physical exercise and Alzheimer's disease group (AAV-Control+Exe+AD group, n = 11), AAV-TREM2 and physical exercise and Alzheimer's disease group (AAV-TREM2 +Exe+AD group, n = 11). Stereotactic intracerebral injection in the bilateral hippocampus was performed to achieve microglial TREM2 down-expression by using adeno-associated virus (AAV) with CD68 promoter. After 4 weeks treadmill exercise and 3 weeks Aβ injection, all rats received behavior test and molecular experiment, which the same with experiment 2.

RESULTS

Novel recognition index in novel object recognition test significantly decreased, and western blot demonstrate that hippocampal TREM2 protein is significantly decreased (P < 0.001). But physical exercise reversed this phenomenon(P < 0.001). In addition, compared with Con group, the neuron from Exe+AD group exhibited a more complex branching pattern (P < 0.05). And impaired synaptic ultrastructure was observed in AD group. Hippocampal synaptic-related protein (SYX, SYP, GAP43, PSD95) and neurotransmitter (DA, Glu, GABA) was also significantly decreased (P < 0.01) in AD group. But the neuroprotection effect can be found in Exe+AD group, which are associated with the inhibition of synaptic injury by activate hippocampal TREM2 (P < 0.05). However, when blockade of hippocampal TREM2 reduced brain protective effect of exercise in AD rat model, including increased the damage of neuronal dendritic complexity, synaptic ultrastructure, and the decrease of hippocampal synapses-related protein, typical neurotransmitter.

CONCLUSION

Treadmill exercise facilitated recognition memory acquisition via TREM2-mediated structural synaptic plasticity of the hippocampus in an AD rat model.

DIAMONDS-a diabetes self-management intervention for people with severe mental illness: protocol for an individually randomised controlled multicentre trial

INTRODUCTION

Type 2 diabetes mellitus (T2DM) is two to three times more common in people with severe mental illness (SMI) than in the general population. Supporting self-management in diabetes is fundamental to improving clinical outcomes. The DIAMONDS trial aims to evaluate the clinical and cost effectiveness of a novel, codesigned, supported diabetes self-management programme for people with T2DM and SMI.

METHODS AND ANALYSIS

This multicentre, two-armed, parallel, individually randomised controlled trial will be conducted in National Health Service mental health trusts across England. We will recruit 380 participants (≥18 years old) with a diagnosis of SMI (schizophrenia, bipolar disorder, schizoaffective disorder, psychosis and severe depression) and T2DM. Eligible and consenting participants will be randomised to the DIAMONDS intervention or treatment as usual. The intervention group will receive one-to-one sessions with a trained DIAMONDS Coach for six months. These sessions will focus on goal setting, action planning and diabetes self-management education, supported by a paper-based workbook and an optional digital application. Individuals allocated to the control group will continue to receive usual care and may be offered National Institute for Health and Care Excellence-recommended generic diabetes self-management education programmes in line with usual practice. The primary outcome is the difference in glycated haemoglobin (HbA1c) between both groups at 12 months postrandomisation. The secondary outcomes include measures of physical and mental health, diabetes complications and physical activity. Economic and process evaluations will also be performed. Outcomes will be collected at baseline and at six and 12 month post-randomisation.

ETHICS AND DISSEMINATION

This study received ethics approval by the West of Scotland Research Ethics Committee 3 (22/WS/0117). Findings will be published in peer-reviewed, academic and professional journals. We will also be producing plain language summaries, infographics and audio summaries on the website, as well as attending conferences and dissemination events. A summary of the results will be distributed to all participants and other relevant stakeholders, and we will use social media channels, websites and knowledge exchange events to communicate our findings beyond academic audiences.

TRIAL REGISTRATION NUMBER

ISRCTN22275538.

The Impact of Metformin on Weight and Waist Circumference in Patients Treated With Clozapine: A One-Year Retrospective Cohort Study

BACKGROUND

Metformin shows potential in combating clozapine-induced weight gain (CIWG). However, current evidence for its use remains limited. Through an audit we determined the prevalence of metformin use among clozapine-treated patients and its impact on weight and waist circumference (WC).

METHODS

This retrospective cohort study examined electronic medical records of community-based clozapine patients under the care of metropolitan community mental health teams within the Central Adelaide Local Health Network (CALHN) from January 2014 to June 2023. We included patients treated with clozapine both with and without metformin, above 18 years of age, with complete physical monitoring data at baseline, 6, and 12 months.

RESULTS

There were 357 patients, who met study criteria. Metformin was prescribed to 23% of patients, of whom 78% had diabetes. At baseline, WC was > 101 cm in 71% of males and > 87 cm in 86% of females, placing them at increased risk of weight-related comorbidities, including cardiovascular disease, cancer, and death. After 1 year, males and females in the highest risk group for WC-related comorbidities increased to 76.3% and 95.4%, respectively. Co-prescription of metformin with clozapine was associated with unadjusted mean weight loss (-1.67 kg) and decrease in WC (-1.00 cm). Patients not using metformin gained weight (0.68 kg) and WC (2.49 cm). Using a linear mixed-effects models adjusting for repeated measurements, age, sex, and type 2 diabetes, over 12 months, patients treated with metformin were 3.08 kg lighter than those not taking metformin (95% confidence interval [CI]: 0.54-5.62, p = 0.018). Similar models suggested patients treated with metformin showed an average 2.83 cm decrease in WC compared with those not taking metformin (CI: 0.26-5.40, p = 0.03). There was no significant interaction between difference from baseline in weight or WC and metformin dose (p > 0.05).

DISCUSSION/CONCLUSION

The prevalence of metformin use for CIWG appears low in this cohort, where over 84% of patients were overweight or obese. Metformin use was associated with a significantly lower incidence of weight and WC gain over 12 months. Pharmacists are crucial for educating clinicians and patients about the benefits of metformin for reducing CIWG.

Physical Inactivity and Cardiovascular Health in Aging Populations: Epidemiological Evidence and Policy Implications from Riyadh, Saudi Arabia

BACKGROUND

Cardiovascular Diseases (CVDs) are the leading cause of morbidity and mortality globally, particularly among older adults. Physical inactivity, a modifiable risk factor, is strongly associated with the development and progression of CVD through its correlation with hypertension, diabetes, obesity, and hyperlipidemia. This study examines the association between physical inactivity and cardiovascular health among older adults in the Riyadh region, Saudi Arabia.

METHODS

A cross-sectional study was conducted on 168 participants aged 60 years and older attending a tertiary hospital in Riyadh. Data were collected using a structured questionnaire, the Physical Activity Scale for the Elderly (PASE), anthropometric measurements, and medical record reviews. Cardiovascular health indicators and risk factors were analyzed using descriptive statistics, chi-square tests, and multivariate logistic regression.

RESULTS

Participants with low physical activity levels had a higher prevalence of hypertension (78.2%), diabetes (64.4%), and obesity (51.3%) compared to those with high activity levels (41.8%, 28.7%, and 22.3%, respectively). Multivariate analysis showed that physical inactivity was significantly associated with an increased likelihood of CVD (adjusted OR: 1.98, p < 0.001), with hypertension and diabetes also being strong predictors.

CONCLUSIONS

Physical inactivity is strongly correlated with adverse cardiovascular outcomes in older adults. Interventions targeting increased physical activity are essential to reducing the CVD burden. Community-based programs and policy-driven initiatives tailored to the Riyadh region's specific environmental and cultural factors are crucial in promoting active lifestyles among aging populations.

Is there an association between psychological distress during early adulthood and later trajectories of physical activity during adulthood? Longitudinal data from two cohort studies

BACKGROUND

Our aim was to analyse the prospective association between psychological distress during early adulthood and physical activity trajectories between early and middle adulthood.

METHODS

We used data from the 1958 National Child Development Study (NCDS) (n=8994, 4388 women) and the 1970 British Cohort Study (BCS) (n=7014, 4388 women). Psychological distress was assessed using the Malaise inventory at 23 years in the 1958 NCDS and at 26 years at the 1970 BCS. Self-report leisure-time physical activity (LTPA) was assessed at 33 years, 42 years, 46 years, 50 years and 55 years in the 1958 NCDS as well as at 30 years, 34 years, 42 years and 46 years in the 1970 BCS. We created physical activity trajectories, using latent class growth analysis. Poisson regression analysis was used for association.

RESULTS

We identified three trajectories of physical activity during adulthood in both cohorts. Participants with psychological distress at 23 years were less likely to be in the persistently high trajectory (RRadjusted: 0.79; 95% CI 0.64 to 0.98) in the 1958 NCDS. In addition, participants with psychological distress at 26 years were less likely to be in the increased LTPA (0.73; 0.59 to 0.89) and persistently high (0.59; 0.50 to 0.69) trajectories, comparing with participants without psychological distress.

CONCLUSION

Elevated psychological distress during early adulthood is associated with a lower probability of adopting positive trajectories of LTPA during adulthood.

Mindfulness-based (non-contact) boxing therapy (MBBT) for depression and anxiety: A feasibility study

OBJECTIVES

Mindfulness-Based (non-contact) Boxing Therapy (MBBT) is a novel intervention designed to empower and promote self-agency through behavioral interventions, while reducing barriers to exercise for individuals with mental disorders. MBBT is an instructor-led, manualized, non-contact boxing group-exercise program (delivered in 90 min sessions, twice a week, over 10 weeks) that blends principles of mindfulness, meditation and group therapy. The current study tested the acceptability and feasibility of delivering MBBT to adults with major depressive disorder (MDD) or generalized anxiety disorder (GAD).

METHODS

Nine adult outpatients with MDD or GAD were recruited from a psychiatric outpatient clinic in Toronto, Canada in a 10-week feasibility trial of MBBT using a pre-post design. Feasibility was assessed through recruitment and retention rates, while acceptability was assessed through the CSQ-8, and self-questionnaires. Secondary clinical outcomes included the PHQ-9, GAD-7, K10, CGI, and MAAS. Trial registry: ISRCTN23023309.

RESULTS

Eight participants (5 female, 3 male) were included in the final analysis. Results indicated a high user retention (89%), attendance (84%), and satisfaction (98%). The study observed a statistically significant mean percent reduction in depression (54%), anxiety (51%) and distress (36%), alongside a mean percent increase in mindfulness (79%). Post intervention qualitative feedback from participants revealed themes of inclusivity and accessibility, cathartic release and control of emotions, improved self-esteem and confidence, self-agency, community, and trust in leadership.

CONCLUSIONS

Given the limitation of the study, MBBT appeared to be feasible and acceptable as an exercise/behavioural intervention. Further well-designed randomized clinical trials are warranted to confirm the clinical benefits of MBBT.

"One Size Doesn't Fit All": Design Considerations for an Exercise Program to Improve Physical Function in Older Veterans with Serious Mental Illness

Older adults with serious mental illness (SMI) (i.e., schizophrenia, schizoaffective disorder, bipolar disorder) have compromised physical function that adversely affects their quality of life. Exercise is an effective intervention to improve function in older persons; however, older people with SMI experience barriers to exercise engagement. This study sought to obtain feedback on an exercise program in development for older people with SMI that comprised home-based exercise delivery, individualized exercise prescription, and motivational health coaching calls. Individual interviews and focus groups were conducted with older Veterans with SMI (n = 3) and clinical staff serving this population (directors: n = 3; clinicians: n = 15, k = 3) to elicit feedback on the perceived feasibility and acceptability of the preliminary program and recommendations for modifications to the program. Rapid analysis was used to summarize transcripts of audio-recorded interviews and focus groups. Results indicated a strong perceived feasibility and acceptability of the preliminary intervention because of how the individualized exercise prescription component (i.e., exercise plan) would be personalized to the Veteran's preferences and abilities. Clinical staff participants expressed concerns about how the lack of real-time supervision would negatively affect exercise completion. Participants recommended tailoring the home-based exercise delivery and motivational health coaching calls components to each Veteran's unique context.

Is Engagement in Physical Activity Related to Its Perceived Mental Health Benefits Among People With Depression and Anxiety? A Population-Scale Survey Study

OBJECTIVE

To examine the prevalence of awareness of PA (physical activity) benefits among those with mental disorders and explore how this is related to actual PA levels in this population.

METHODS

We queried data from the Health Information National Trends Survey 2019. A sample of 1,139 adults with self-reported depression and anxiety (61% female; mean age of 52.5 years) was analyzed. Multivariable logistic regression was employed to investigate the association between awareness that PA benefits mental health and respondents' levels of PA.

RESULTS

Of the entire sample, a total of 904 individuals (80.9%) endorsed awareness that PA helps reduce symptoms of depression and anxiety. In multivariable analysis, awareness that PA improves mental health was significantly associated with greater odds of being less sedentary (OR 2.31; P = 0.025) and meeting national recommendations for weekly physical activity (OR 2.35; P = 0.046).

CONCLUSION

Overall, findings from this nationally representative survey data indicates that about 4 in 5 adults living with depression and anxiety in the United States endorsed awareness of the mental health benefits of PA. Furthermore, we found that the awareness of these benefits is related to PA engagement.

The long-lasting impact of high-intensity training via collaborative care in patients with schizophrenia: A 5-year follow-up study

Although exercise is medicine for outpatients with schizophrenia, it is unclear if one-year adherence-supported exercise leads to a "tipping point", at which the exercise becomes a routine manifested as life-long training in the patient group.

METHODS

Forty-eight outpatients (28 men/20 women: 35 ± 11 (mean ± SD) years) with schizophrenia (ICD-10: F20-29) were randomised to: 1) collaborative care group (TG), performing aerobic interval (AIT; 4 × 4-min treadmill walking/running at ∼90 % peak heart rate) and leg press maximal strength training (MST; 4 × 4 repetitions at ∼90 % maximal strength [1RM]) 2d·wk.-1 for 1-year, supported by transportation and training supervision; or 2) control group (CG). Peak oxygen uptake (V̇O2peak) and walking work efficiency were measured directly along with scaled 1RM/power, anthropometry, blood pressure, and blood samples at inclusion, 1-year, and 5-years post-intervention.

RESULTS

The TG increased V̇O2peak (11 %, p < .01), scaled 1RM (40 %, p < .001), and power (26 %, p < .001) compared to CG after 1-year. At follow-up, no intergroup differences in these factors were observed (all p > .05). Both groups improved walking work efficiency (TG: 11 %; CG: 18 %; both p < .05) after 1-year (no intergroup difference, p > .05), but not at follow-up (both p > .05). At follow-up, HDL (high-density lipoprotein)-cholesterol (-15 %, p < .01) and glucose (26 %, p < .01) decreased/increased(respectively) more in the TG than CG. No other intergroup differences were observed in anthropometry or blood samples.

CONCLUSION

1-year adherence-supported high-intensity training improves V̇O2peak, 1RM, and power in outpatients with schizophrenia. However, the improvements in these factors key to longevity are not maintained after 5 years. These findings highlight the importance of long-lasting cost-efficient adherence support, ultimately affecting the population's prognosis.

Propensity score matching analysis of the association between physical activity and multimorbidity in middle-aged and elderly Chinese

In the context of an aging population, older adults increasingly face the challenge of managing multiple chronic conditions simultaneously. This study utilized analytical methods such as propensity score matching (PSM) and multivariate logistic regression, to explore the relationship between physical activity and the number of chronic diseases as well as the risk of developing co-morbidities among middle-aged and elderly Chinese individuals using data from the 2020 China Health and Retirement Longitudinal Survey. The PSM results showed that physical activity decreased the number of chronic diseases in middle-aged and elderly people by 0.050 (p < 0.05). The multivariate logistic regression results the odds ratio (OR) for the risk of multimorbidity in the moderate and high intensity physical activity groups compared to the group with inadequate physical activity were 0.845 (95% CI 0.729-0.980) and 0.847 (95% CI 0.727-0.988), which means that moderate-intensity physical activity is strongly associated with a reduced risk of multimorbidity. Regular physical activity among middle-aged and older adults is associated with a reduction in the number of chronic diseases they suffer from.

Active bodies - active minds? A deep dive into the voluntary sports programs for individuals with psychiatric disorders in Switzerland: participants view

BACKGROUND

The positive influence of physical activities on a person's physical and mental health has been proven many times. These findings were implemented in the regular exercise therapy offered within psychiatric hospitals in Switzerland. However, after leaving a psychiatric hospital, there are insufficient opportunities for individuals with psychiatric disorders to engage in sports. Therefore, voluntary sports groups for this specific population have been offered in Switzerland by the disability sports systems since 2015. Still, the perspective of individuals with psychiatric disorders as well as perceived barriers and facilitators for participating in these groups have neither been assessed nor included in the design of sports programs.

METHODS

This study consists of 15 semi-structured interviews (N = 15) lasting up to one hour each with individuals with psychiatric disorders who participated in voluntary sports groups for this specific population in Switzerland. The results were analyzed employing Thematic Analysis using Nvivo.

RESULTS

Interviewees named offer-specific (disability-related), emotional (social exchange), and rational motives (health) for their participation in voluntary sports groups for individuals with psychiatric disorders. In addition, intrapersonal (psychological/physical deficits), sociocultural (stigmatization), and structural (unsuitable location) factors were mentioned as possible inhibitors in the context of participation in voluntary sports groups for individuals with psychiatric disorders. Furthermore, participants experienced predominantly positive outcomes from participation.

CONCLUSION

Individuals with psychiatric disorders benefit socially, physically, and psychologically from participating in voluntary sports groups for this specific population. However, participation is associated with barriers that need to be minimized in the future. Additionally, a large-scale survey is necessary to validate the results among the population.

Correlates and Barriers of Exercise, Stress, and Wellness in Medical Students

Medical students report higher stress and increased mental illness than peers of similar age. Burnout and depression among medical students and physicians have also been correlated with increased risk of medical errors and decreased importance of altruistic values, such as providing care to medically underserved populations. This study works to analyze the effects of exercise, nutrition, sleep, and other factors affecting wellness and performance of medical students, as well as identifying barriers to exercise and possible solutions. A survey was distributed to medical students in the Midwest to evaluate exercise habits, dietary intake, sleep, and other factors affecting wellness. An investigation of the correlation of variables and comparison of year in school for the variables was conducted. Satisfaction with social relationship and performance in school correlated with exercise, stress, and sleep variables. Several variables, including satisfaction with exercise, social life, and performance in school, showed significant differences based on year in school. No significant findings were noted between students from the various medical institutions at which the survey was distributed regarding satisfaction with exercise, academic performance, social life, personal relationships, hours spent in clerkship/class, hours spent studying, and stress. Students tended to have higher satisfaction with school and social relationships if they engaged in exercise more often, exercised with greater intensity, and slept better. Students identified barriers to exercise including cost, availability, and lack of time. Potential solutions include a workout facility in school buildings/hospitals, allocated wellness periods for exercise, and a more consistent schedule.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40670-024-02134-5.

Supporting movement and physical activity in people with psychosis: A qualitative exploration of the carer perspective

BACKGROUND

The need to increase exercise and decrease sedentary behaviour in people diagnosed with psychosis is well-recognised.

AIMS

We set out to explore caregivers' perspectives on what supports and prevents physical activity, and how to use carers' support most effectively.

METHOD

Fourteen caregivers of people diagnosed with psychosis were interviewed. Data were analysed using reflexive thematic analysis, in collaboration with caregivers.

RESULTS

Four themes were developed, the first flagging the importance of physical activity, then the others calling for action: (a) Physical inactivity matters: carers are keen to support efforts to increase physical activity in their family or friends because of the enormous impact physical inactivity has on patients, and consequently on carers themselves, such as social isolation and reduction in their own activity. (b) Tell us: without being well-informed about how to help, carers can feel like they are powerless to stop a 'slow suicide' or 'decline' in patients. (c) Listen to us: through knowing their family and friends well, carers are able to identify important changes in patients and identify successful motivators for them, but these insights can feel uninvited. (d) Ask us: being invited to support activity as a partner in a patients' care is desirable but having offers of help rejected can "demotivate the motivator."

CONCLUSIONS

Caregivers described strong motivation to help patients to be more physically active but can feel that their support is overlooked and under-used by services. Clinical recommendations for carer involvement in physical activity interventions are offered.

Supporting Older Adults' Mental Health Against Suspected Mental Health Problems: The Moderating Role of an Age-Friendly Neighborhood

This study examined how compensatory and enabling domains of an Age-Friendly City (AFC) moderate the relationship between suspected mental health problems and depressive and anxiety symptoms among older adults. Four thousand six hundred and twenty-five Hong Kong Chinese aged ≥60 years completed a telephone survey between April and July 2022, including PHQ-2 and GAD-2. AFC indices sourced from prior territory-wide study. Linear mixed models showed that enabling AFC domains, namely, social participation, respect and social inclusion, and civic participation and employment, alleviated the effects of suspected mental health problems on respondents' depressive and anxiety symptoms (b = -0.40 to -0.56). Three-way interaction models revealed that the protective effects of all compensatory and enabling AFCC domains (b = -1.23 to -6.18), except civic participation and employment, were stronger in old-old (70-79 years) and oldest-old (≥80 years) than young-old (60-69 years). AFCC-based interventions should focus on compensatory and enabling domains to support older adults' mental health.

People Living With Mental Illness Perceptions of Physical Health, Mental Health and Well-Being

Understanding the perspectives of regional people living with mental illness is crucial to adapting services, improving holistic care and meeting individual needs. This study explored people living with mental illness perceptions of physical health, mental health and well-being. A descriptive qualitative study design underpinned by empowerment theory was conducted. Qualitative data were collected verbally via semi-structured interviews, with demographic details provided verbally at the end of the interview. Thematic analysis was utilised to identify themes. The COREQ checklist was used for reporting. Fourteen participants admitted to regional mental health inpatient units aged between 25 and 84 years old were interviewed. Participants felt their overall well-being was good despite feeling their physical health or mental health was suboptimal, suggesting that their perceived well-being is influenced by factors beyond their physical and mental health. Most participants reported looking after their physical health, mental health and well-being and identified various behavioural lifestyle strategies they found helpful. Thematic analysis identified three themes: functioning well, feeling in control and meeting basic needs. Mental health services and clinicians play an important role in empowering people with mental illness to improve their physical health, mental health and well-being while admitted to inpatient services; however, it is acknowledged resources can be limited. Mental health services may consider referring people with mental illness to social prescribing programmes to meet their individualised needs on discharge.

(Cost-)effectiveness and implementation of a combined lifestyle intervention for outpatients with severe mental illness (GOAL!): a hybrid quasi-experimental study protocol

BACKGROUND

People with severe mental illness (SMI) face not only impaired mental health, but also a greater risk of physical comorbidities and a shorter life expectancy compared to the general population. A poor lifestyle plays a substantial role in this disparity. Combined Lifestyle Interventions targeting multiple lifestyle behaviors can improve mental and physical health, and quality of life. However, there is currently no appropriate structural support for people with SMI in outpatient care in the Netherlands. The Combined Lifestyle Intervention for Outpatients with SMI (GOAL!) is developed to address this gap. This study examines the (cost-)effectiveness and implementation of GOAL!.

METHODS

In a type 1 hybrid quasi-experimental study with a mixed-method matched design, GOAL! participants (N = 50) are compared to people receiving care as usual (N = 50). The GOAL! program includes group and individual sessions, given by allied health professionals, over a period of two years. The first year starts with a 3-month intensive course on physical activity and nutrition, followed by 9 months of aftercare covering various lifestyle topics tailored to the group's needs. There is close collaboration with local stakeholders to facilitate transfer to the community setting. The second year focuses on maintaining established activities in one's daily living environment. Our primary outcome will be the change in physical activity, comparing GOAL! participants to those receiving care as usual. Secondary outcomes are changes in other lifestyle behaviors, physical health, mental well-being, and healthcare and societal costs. Additionally, achieving lifestyle-related goals, adverse effects, and barriers and facilitators to implementation are examined. Measurements are obtained at start (T0), and after 3 (T1), 12 (T2) and 24 months (T3).

DISCUSSION

This study investigates the effects of GOAL! on lifestyle behaviors, health outcomes, implementation factors and cost-effectiveness after two years, aiming to offer valuable insights into the effectiveness and implementation outcomes of lifestyle interventions for outpatients with SMI.

TRIAL REGISTRATION

ClinicalTrials.gov (Identifier: NCT05600205). Prospectively registered on October 26, 2022.

Hyperbaric Oxygen Therapy Ameliorates Olanzapine-Induced Hypolocomotion in a Rat Model

Olanzapine (OLZ) is a commonly prescribed drug for the treatment of schizophrenia and related disorders. However, OLZ use is associated with several adverse effects, including decreased locomotor activity and increased body weight. While the majority of studies have directed their focus towards managing the metabolic side effects of OLZ, there has been limited attention given to the effects on locomotor activity. This study aimed to investigate the potential therapeutic effect of hyperbaric oxygen therapy (HBOT) in alleviating OLZ-induced locomotor impairment in female Sprague Dawley rats. Subjects were divided into four groups: control rats (CR), HBOT, OLZ, and HBOT + OLZ. In addition to behavioral effects, we also evaluated the total antioxidant capacity (TAC) of rats' brain tissue to demonstrate the maintenance of OLZ effectiveness in improving antioxidant status during the intervention using a rotarod device to measure locomotor activity and coordination. Results showed that HBOT effectively counteracted the hypolocomotion produced after OLZ administration. Moreover, HBOT did not result in a decrease in TAC in brain tissue, which is linked to OLZ treatment effectiveness. Therefore, our results suggest that HBOT may represent a promising non-pharmacological approach to improving locomotor and motor coordination impairments associated with OLZ treatment.

Gym and swim: a co-facilitated exercise program that improves community connection, confidence, and exercise habits in a community mental health service

High rates of cardiometabolic disease and poor physical health outcomes contribute to significant premature mortality in people living with severe mental illness (PLWSMI). Lifestyle interventions such as exercise are known to improve both physical and mental health outcomes, however the best way to deliver exercise programs for PLWSMI remains a challenge. This paper uses a pragmatic program evaluation of a co-delivered low-cost community-based exercise program implemented over a 6-month period. Of 46 referrals in the first half of 2023 to the SLHD Gym and Swim program, 13 gave consent to participate in standardised measures and qualitative interviews. Findings revealed an increase in average hours of sport/exercise, improvements in confidence to exercise independently and within group settings, as well as achievement of individualised goals. The success of the program was in part due to the co-facilitation between peer support workers and exercise physiologists, community connection and the established partnership between the public health service and the local government council. Results offer evidence to adopt and implement accessible and low-cost exercise opportunities in the community external to health services to address barriers of attendance for PLWSMI.

Engagement in a virtual group-based walking intervention for persons with schizophrenia: a qualitative study

BACKGROUND

Exercise is beneficial for persons with schizophrenia; however, high dropout rates limit the impact of interventions. Virtual exercise programs have the potential to improve engagement; however, few intervention studies of virtual programs have been conducted in this population.

METHODS

This study examined qualitative data from 15 adults with schizophrenia who participated in a pilot randomized controlled trial of Virtual PACE-Life, a live, video-delivered group walking intervention guided by self-determination theory. Interviews elicited feedback on the intervention, barriers and facilitators to engagement, recommendations for intervention refinement, and preferences for exercise programming modality. Rapid qualitative analysis was used to explore similarities and differences between completers (i.e., those that attended ≥ 50% of virtual walking sessions; n = 9) and non-completers (i.e., those that attended < 50% of virtual walking sessions; n = 6).

RESULTS

Both groups viewed Virtual PACE-Life positively but found the virtual exercise sessions challenging and inadequate for facilitating social interaction. Work obligations impacted completers' attendance whereas technological issues and forgetting impacted non-completers' attendance at virtual walking sessions. Completers preferred virtual exercise programs and non-completers preferred in-person exercise programs.

CONCLUSIONS

These findings suggest that future virtual group-based walking programs should prioritize enhancing the social aspect, offering scheduling choices, and regularly assessing the perceived difficulty of exercise sessions. These modifications not only have the potential to improve intervention engagement but they also may increase participant autonomy and relatedness, core components of self-determination theory.

Validation of the Comprehensive and Brief International Classification of Functioning, Disability and Health Core Sets for Schizophrenia from the Perspective of Individuals Diagnosed with the Disorder: A Worldwide Study Using Focus Groups

The comprehensive and brief International Classification of Functioning, Disability and Health (ICF) core sets for schizophrenia, based on the World Health Organization (WHO) framework, aim to describe the functioning of individuals with schizophrenia. The objective of this study was to identify the most common problems faced by these individuals and validate the ICF core sets. Eight focus groups were conducted, recorded, and transcribed verbatim. The linking process involved two independent coders identifying meaningful units and linking agreed-upon concepts to the ICF categories. Data saturation was defined as the point at which no new categories emerged from additional focus groups. The 37 participants in this study represented the WHO regions of Africa, South-East Asia, the Western Pacific, and Europe. The focus groups confirmed the relevance of all ICF core set categories, with an additional 21 second-level categories being proposed in at least six of the eight focus groups. In this study, the ICF core sets for schizophrenia were validated from the perspective of individuals. However, several second-level categories not currently included in the ICF core sets also emerged. To ensure that the ICF core sets are truly international in scope, the potential relevance of these categories should be investigated further.

A randomized controlled clinical trial of a Wim Hof Method intervention in women with high depressive symptoms

Objective

Stress is a driver of depression, and people with depression often struggle to cope with stress and anxiety. This study directly compares the mental health effects of a Wim Hof Method intervention to an active control condition (slow breathing) in women with high stress and high depressive symptoms.

Methods

We randomized 84 healthy midlife women with high stress and high depressive symptoms to either: 1) the hormetic stress condition based on the Wim Hof Method (WHM) involving a breathing technique designed to induce intermittent hypoxia and cold showers (n = 41) or 2) an active comparison condition involving slow-paced breathing and warm showers (n = 43). We provided participants with daily audio instructions (15 min) for three weeks during the COVID-19 pandemic (2020-2021). Our primary outcomes were depressive symptoms, anxiety symptoms, and perceived stress collected at pre-intervention, post-intervention, and 3 months later. We also assessed daily stress rumination and affect with daily diary during the intervention, and participants completed a laboratory stressor, the Trier Social Stress Test, before and after the intervention, and provided samples for salivary cortisol reactivity.

Results

Participants in the active control condition perceived the intervention to be more credible and expected greater mental wellbeing benefits compared to those in the Wim Hof Method condition. Differential attrition was observed with six participants (7 %) dropping out -- all from WHM condition. Among the participants who completed the intervention, both groups improved on mental health outcomes immediately after the intervention with a 24 % reduction in depressive symptoms, a 27 % reduction in anxiety symptoms, and 20 % reduction in perceived stress. Improvements were maintained at the 3-month follow-up with 46 % of the sample reporting mild or no depressive symptoms. Participants in the WHM condition had significant reductions in rumination after daily stressful events compared to those in the active control group. Both conditions had reduced daily negative affect across the intervention and lower peak cortisol reactivity to the lab stressor post-intervention.

Conclusions

Counter to the preregistered predictions, and despite participants' differing expectations, the interventions led to equivalent reductions in depressive symptoms, anxiety symptoms, and perceived stress, which were sustained at three months. They also produced comparable reductions in cortisol reactivity and daily negative affect. However, the WHM condition was associated with greater reduction in reported rumination after daily stressful events than the active control, a finding that needs replication with larger and more diverse samples.

Facilitators and barriers of long-term exercise adherence in healthcare workers formerly suffering from post-COVID-19 syndrome : A qualitative 1-year follow-up and quantitative pilot study of the COFIT trial

BACKGROUND

Early exercise intervention studies showed promising positive effects of physical exercising on post-COVID-19 symptoms; however, little is known about long-term training adherence and what influences it.

MATERIAL AND METHODS

Semi-structured interviews were conducted with 17 participants of the 8‑week original exercise intervention study. Facilitators and barriers were identified via thematic analysis and compared between those participants who continued their regular exercise behavior (continuous exercise group, CEG, n = 7) and those who stopped exercising (discontinuous exercise group, DEG, n = 10). Physical performance parameters and questionnaires regarding psychological health dimensions and work ability were assessed analogously to the original study.

RESULTS

Qualitative analysis showed that two of the top three facilitators, (improving physical and mental health, sport has high priority) were the same in both groups. The respective third of the top three facilitators was (re)build physical and cognitive performance in the CEG and training in the group in the DEG. The top three barriers (exhaustion, sport has little priority, procrastination) were not only the same in both groups but also in the same order.

CONCLUSION

The strongest post-COVID-19 associated facilitator for long-term exercise adherence is when the need for further reconditioning is felt. The strongest post-COVID-19 associated barrier is exhaustion. Availability of exercising in a group is a key factor in increasing long-term exercise adherence.

Risk factors, prevention and treatment of weight gain associated with the use of antidepressants and antipsychotics: a state-of-the-art clinical review

INTRODUCTION

People with severe mental illness have poor cardiometabolic health. Commonly used antidepressants and antipsychotics frequently lead to weight gain, which may further contribute to adverse cardiovascular outcomes.

AREAS COVERED

We searched MEDLINE up to April 2023 for umbrella reviews, (network-)meta-analyses, trials and cohort studies on risk factors, prevention and treatment strategies of weight gain associated with antidepressants/antipsychotics. We developed 10 clinical recommendations.

EXPERT OPINION

To prevent, manage, and treat antidepressant/antipsychotic-related weight gain, we recommend i) assessing risk factors for obesity before treatment, ii) monitoring metabolic health at baseline and regularly during follow-up, iii) offering lifestyle interventions including regular exercise and healthy diet based on patient preference to optimize motivation, iv) considering first-line psychotherapy for mild-moderate depression and anxiety disorders, v)choosing medications based on medications' and patient's weight gain risk, vi) choosing medications based on acute vs long-term treatment, vii) using effective, tolerated medications, viii) switching to less weight-inducing antipsychotics/antidepressants where possible, ix) using early weight gain as a predictor of further weight gain to inform the timing of intervention/switch options, and x) considering adding metformin or glucagon-like peptide-1 receptor agonists, or topiramate(second-line due to potential adverse cognitive effects) to antipsychotics, or aripiprazole to clozapine or olanzapine.

Exercise behaviours and motivation after a first psychotic episode: A digital intervention

AIM

Research has demonstrated that participation in aerobic exercise can have significant beneficial effects across both physical and mental health domains for individuals who are in the early phase of schizophrenia. Despite these notable benefits of exercise, deficits in motivation and a lack of methods to increase engagement are significant barriers for exercise participation, limiting these potentially positive effects. Fortunately, digital health tools have the potential to improve adherence to an exercise program. The present study examined the role of motivation for exercise and the effects of an automated digital text messaging program on participation in an aerobic exercise program.

METHODS

A total of 46 first-episode psychosis participants from an ongoing 12-month randomized clinical trial (Enhancing Cognitive Training through Exercise Following a First Schizophrenia Episode (CT&E-RCT)) were included in an analysis to examine the efficacy of motivational text messaging. Personalized motivational text message reminders were sent to participants with the aim of increasing engagement in the exercise program.

RESULTS

We found that participants with higher levels of intrinsic motivation to participate in a text messaging program and in an exercise intervention completed a higher proportion of individual, at-home exercise sessions. In a between groups analysis, participants who received motivational text messages, compared to those who did not, completed a higher proportion of at-home exercise sessions.

CONCLUSION

These results indicate the importance of considering a person's level of motivation for exercise and the potential utility of using individualized and interactive mobile text messaging reminders to increase engagement in aerobic exercise in the early phase of psychosis. We emphasize the need for understanding how individualized patient preferences and needs interplay between intrinsic motivation and digital health interventions for young adults.

Speak for yourself: usability and acceptability of audio diaries to explore physical activity, sedentary and sleep behaviours of those living with severe mental illness

BACKGROUND

People living with severe mental illness (SMI) face significant health inequalities, including reduced quality of life and life expectancy. Evidence has shown that people living with SMI are highly sedentary, face challenges when seeking to engage in physical activity (PA), and experience sleep difficulties. Motivation, mood and energy have been identified as critical determinants of these behaviours. PA and sleep are traditionally measured in isolation using quantitative approaches, limiting our understanding of the contexts and interactive ways in which these occur, especially for this population. Here, we adopted a flexible and holistic approach, using audio diaries to explore the usability and acceptability of capturing movement behaviours in people living with SMI.

METHODS

This study employed a qualitative design. Data were collected with 10 participants self-identifying as living with SMI, who completed 7-days of audio diaries, pre and post diary use interviews. Reflexive thematic analysis was used to analyse participants' movement behaviours and their experiences of using the audio diaries.

RESULTS

Audio diaries were perceived as acceptable to participants and their use for data capture was feasible, with participants experiencing their use as a flexible and empowering method of data capture. Within the exploratory data generated we identified four themes relating to participants' movement behaviours: finding themselves in a "vicious circle" with physical and mental issues impacting movement behaviours; a daily internal fight and dialogue concerning fear of feeling guilty and wasting time; a determination to "not let fatigue win" by pushing through the day; and the mixed effects of understanding the importance of movement behaviours yet finding it challenging to engage.

CONCLUSION

Audio diaries offered an easy to use and relatively inclusive means of exploring movement behaviours for people living with SMI, especially their context and interrelated nature. Our findings reinforced the well-established link between mental and physical health, and their influence on 24 h movement behaviours, identifying population-specific challenges derived from medication side effects, rigid engagement opportunities, and illness symptoms. Given this, co-production involving individuals with lived experience is crucial for developing tailored recommendations and support to promote sleep and movement among those living with SMI. We emphasized the need for holistic measurement approaches and opportunities that consider the interconnected impact of disrupted sleep and movement.

The effects of mindful exercise on cognition in patients with schizophrenia: A systematic review and meta-analysis of randomized controlled trials

Cognitive impairment is a core symptom of schizophrenia. This study investigated the effects of mindful exercise on the cognitive performance of individuals with schizophrenia. A systematic review and meta-analysis were performed from inception to March 2023. The quality of included studies was evaluated using the Physiotherapy Evidence Database (PEDro) scale. A random effects model was used to generate the pooled effect size. Ten randomized controlled trials met the inclusion criteria with fair-to-good methodological quality. The results showed that Mindful exercise significantly improved global cognition in patients with schizophrenia (g = 0.25, p = .002). There was a significant difference in mindful exercise compared with the passive control group (g = 0.34, p = .002), whereas no significant difference was found between the mindful exercise and exercise intervention group (g = 0.09, p = .371). These findings indicate that mindful exercise could be promising for improving cognition in patients with schizophrenia.

Physical activity in adult users of inpatient mental health services: A scoping review

People with severe mental illness engage in considerably less physical activity than those without. They also experience premature mortality of around 10-25 years. A large proportion of these premature deaths are attributed to modifiable behaviours, including physical activity. The inpatient environment provides an opportunity to support people to become more physically active; however, there is limited evidence on which interventions are most successful and what contextual factors affect their delivery. A scoping review was conducted to help understand the extent and type of evidence in this area and identify research gaps. We included studies of physical activity correlates and interventions in adult inpatient mental health services published in peer-reviewed journals. Reviews, meta-analyses, and papers focusing on eating disorder populations were excluded. We searched the MEDLINE, CINAHL, PsycINFO, ASSIA and Web of Science databases for relevant studies published in English. We extracted data on study design, participant characteristics, intervention and control conditions, key findings, and research recommendations. We used a descriptive analytical approach and results are presented in tables and figures. Of 27,286 unique records screened, 210 reports from 182 studies were included. Sixty-one studies reported on correlates of physical activity, and 139 studies reported on physical activity interventions. Most intervention studies used a single-group, pre-post design (40%) and included fewer than 100 participants (86%). Ninety percent of interventions delivered physical activity directly to participants, and 50% included group-based sessions. The duration, type, frequency and intensity of sessions varied. Mental health was the most commonly reported outcome (64%), whereas physical activity was rarely an outcome (13%). Overall, there is a modest but growing body of research on physical activity in adult users of inpatient mental health services. More high-quality trials are needed to advance the field, and future research should target neglected intervention types, outcomes, populations and settings.

Validation and Measurement Invariance of the Tendency to Avoid Physical Activity and Sport Scale (TAPAS) Among Thai Young Adults

Examining ways of reducing physical inactivity has been at the forefront of public health research. Moreover, valid and reliable scales are needed to objectively assess physical activity (PA) avoidance. Previous research has shown that experiencing weight stigma and physical appearance-related concerns are associated with physical inactivity. However, there is currently no Thai instrument that assesses physical inactivity in relation to weight stigma. Therefore, the present study examined the psychometric properties of the Thai version of the Tendency to Avoid Physical Activity and Sport Scale (TAPAS). Thai university students (N = 612) recruited via convenience sampling completed an online survey using SurveyMonkey between September 2022 and January 2023. Confirmatory factor analysis (CFA), multigroup CFA, and Pearson correlations (between TAPAS scores, age, body mass index, and time spent exercising) were used to analyze the data. The CFA showed robust psychometric properties for the Thai version of TAPAS regarding its unidimensional structure. The TAPAS was measurement invariant across sex, weight status, and daily hours of exercise. However, no significant Pearson correlations were found. In general, the results showed that the TAPAS is a good scale for assessing PA avoidance among Thai young adults across different sexes, weight status, and daily hours of exercise.

The influence of exercise intensity on comorbid anxious behavior in psychiatric conditions

Many experts have extensively studied the potential of exercise as a treatment option for psychiatric conditions, including depression and autism spectrum disorder (ASD). Despite their core symptoms, these conditions exhibits comparable component traits, an anxiety. In this study, we explored the effect of exercise on behavioral abnormalities in psychiatric conditions, focusing on its intensity and emotional resilience. Shank3B knockout (KOSED) mice displaying self-injurious repetitive behavior and C57BL/6J mice, susceptible to stress as ASD and depression model, respectively, were subjected to moderate-intensity exercise (ME) for 2 weeks. ME mitigated the core symptoms (excessive grooming traits and behavioral despair) but did not exert a significant anxiolytic effect. Notably, exercise intensity has emerged as a critical determinant of its efficacy, as evidenced by a lower ventilation threshold and anxiolytic effect mediated by low-intensity exercise. The findings substantiate the notion that exercise is promising as a disease-modifying treatment, but intensity matters for emotional resilience.

What stops us and what motivates us? A scoping review and bibliometric analysis of barriers and facilitators to physical activity

INTRODUCTION

Physical inactivity is a major global health concern, contributing to the rising non-communicable disease burden. Elucidating barriers and facilitators influencing participation is critical to promoting activity. This study aimed to synthesize the literature and analyze the extent of research on determinants of physical activity engagement.

METHODS

Scoping review methodology guided the synthesis of 272 publications on factors influencing physical activity. Bibliometric analysis examined publication trends, productivity, influential studies, content themes, and collaboration networks.

RESULTS

Since 2010, the United States has led a significant increase in research output. Highly cited articles identified physiological limitations and psychosocial determinants as key barriers and facilitators. Extensive focus was seen in clinical medicine and exercise science journals. Analysis revealed predominant attention to psychosocial factors, physiological responses, and applications in respiratory disease. Gaps remain regarding policy and environmental factors.

CONCLUSION

This review showed major advances in elucidating determinants while revealing the remaining needs to curb the pandemic of inactivity globally. Expanding international collaboration, contemporary theoretical models, and tailored mixed-methods approaches could promote progress through greater global participation. Addressing knowledge gaps across populations and disciplines should be a priority.

Feasibility and Acceptability of a Physical Activity Group Program Using telerehabilitation during the COVID-19 Pandemic in Multiple early Intervention for Psychosis Services

BACKGROUND

Although physical activity (PA) is beneficial to young people with early psychosis (YEP) to improve physical health and psychiatric symptoms, few YEP initiate and maintain PA. The sports group interventions offered in early psychosis services had to be suspended due to the COVID-19 pandemic. Telehealth has shown promising results in different fields of health services including for patients with mental health disorders.

METHODS

Descriptive retrospective study aiming to determine the feasibility and acceptability of a telekinesiology intervention among YEP and to describe its multicenter implementation. The PA sessions were delivered to YEP by a kinesiologist and peer support workers. Feasibility was measured by the number of programs approached which referred participants, and the proportion of referred YEP who participated to at least one PA session. Acceptability was measured by the proportion of participants who attended more than one PA session, the number of sessions attended per participant and by surveys on patient satisfaction.

RESULTS

Of the 35 clinics approached, 150 YEP (of 214 referred) from 13 clinics participated to at least one of the 204 telekinesiology sessions (offered 2-3 times/week from May 2020 to May 2022) The mean number per participant was 5.5 sessions. 106 YEP engaged in more than one session (mean of 7.3 sessions per persistent participant). The mean number of participants per session was 4 (1-12). 99 % of the survey respondents were very satisfied/or satisfied with the sessions.

CONCLUSION

Telekinesiology appears to be an acceptable and feasible option to be implemented simultaneously in multiple early intervention services.

Psychological distress and health behaviours in people living with and beyond cancer: a cross-sectional study

This study aimed to examine whether psychological distress was cross-sectionally associated with meeting World Cancer Research Fund (WCRF) recommendations in people living with and beyond cancer. Participants were adults living with and beyond breast, prostate and colorectal cancer, participating in the baseline wave of the Advancing Survivorship after Cancer Outcomes Trial (ASCOT). Anxiety/depression was assessed using the EQ-5D-5L and dichotomised into any/no problems. WCRF recommendations were assessed via pedometers, 24-h dietary recalls, self-reported alcohol intake (AUDIT-C), and self-reported smoking status. Participants were categorised as meeting WCRF recommendations using the following cut-offs: average daily steps (≥ 10,000/day), average weekly aerobic steps (≥ 15,000/day), fruit and vegetables (≥ 400 g/day), fibre (≥ 30 g/day), red meat (< 500 g/week), processed meat (0 g/day), high calorie food (fat ≤ 33% of total daily energy intake and free sugar ≤ 5% of total daily energy intake), alcohol (≤ 14 units/week) and smoking (non-smoking). A composite health behaviour risk index (CHBRI) was calculated by summing the number of WCRF recommendations met (range: 0-9). Among 1348 participants (mean age = 64 years (SD = 11.4)), 41.5% reported anxiety/depression problems. The mean CHBRI score was 4.4 (SD = 1.4). Anxiety/depression problems were associated with lower odds of meeting WCRF recommendations for average daily steps (odds ratio (OR) = 0.73; 95% CI 0.55, 0.97), but not for any other health behaviour. Psychological distress is associated with lower adherence to WCRF recommendations for physical activity in people living with and beyond cancer. Physical activity may be a mechanism linking psychological distress and poorer outcomes among people living with and beyond cancer, and this should be explored in longitudinal studies.

From movement to motivation: a proposed framework to understand the antidepressant effect of exercise

Depression is the leading cause of disability worldwide, exerting a profound negative impact on quality of life in those who experience it. Depression is associated with disruptions to several closely related neural and cognitive processes, including dopamine transmission, fronto-striatal brain activity and connectivity, reward processing and motivation. Physical activity, especially aerobic exercise, reduces depressive symptoms, but the mechanisms driving its antidepressant effects are poorly understood. Here we propose a novel hypothesis for understanding the antidepressant effects of exercise, centred on motivation, across different levels of explanation. There is robust evidence that aerobic exercise decreases systemic inflammation. Inflammation is known to reduce dopamine transmission, which in turn is strongly implicated in effort-based decision making for reward. Drawing on a broad range of research in humans and animals, we propose that by reducing inflammation and boosting dopamine transmission, with consequent effects on effort-based decision making for reward, exercise initially specifically improves 'interest-activity' symptoms of depression-namely anhedonia, fatigue and subjective cognitive impairment - by increasing propensity to exert effort. Extending this framework to the topic of cognitive control, we explain how cognitive impairment in depression may also be conceptualised through an effort-based decision-making framework, which may help to explain the impact of exercise on cognitive impairment. Understanding the mechanisms underlying the antidepressant effects of exercise could inform the development of novel intervention strategies, in particular personalised interventions and boost social prescribing.

Designing and implementing a physical exercise intervention for people with first episode psychosis using experience-based co-design: A pilot study from Chennai, India

BACKGROUND

Physical exercise can improve outcomes for people with first-episode psychosis (FEP). Co-designing physical exercise interventions with end users has the potential to enhance their acceptability, feasibility, and long-term viability. This study's objective was to use experience-based co-design (EBCD) methodology to develop a physical exercise intervention for FEP, and pilot test it.

METHODS

The study was conducted at the Schizophrenia Research Foundation's FEP program in Chennai, India. Participants(N=36) were individuals with FEP and their caregivers, mental health professionals (MHPs, and physical training experts. EBCD methodology included one-to-one interviews, focus group discussions, joint conferences, and co-design workshops. Two instructional videos were developed. Twelve FEP patients engaged in physical exercise with help of the videos over three months. They were followed up through weekly phone calls and in-person interviews to capture data on regularity, frequency, location of exercise, and comfort levels.

RESULTS

Several touch points emerged from the interviews, focus groups, and joint meetings including lack of motivation, knowledge about physical exercise; differing perspectives about physical exercise; limited resource, and time constraints. Two instructional videos demonstrating activities for participants incorporated strategies that addressed these touch points. Pilot data indicated that participants engaged with the physical exercise intervention over 3 months.

CONCLUSION

This was the first study to use co-design methodology to design a physical exercise intervention for first-episode psychosis. The intervention may have therefore been responsive to stakeholder needs and preferences. Results of this study highlight the potential of co-design in designing and adapting interventions. There is need for rigorous testing with larger samples.

Influence of Lifestyle Factors on Metabolic Syndrome in Psychiatric Patients Attending a Community Mental Health Setting: A Cross-sectional Study

Background

Metabolic syndrome (MetS) is a concern in psychiatric patients. We aimed to study the influence of the modifiable lifestyle factors on MetS in adult psychiatric patients along with associated clinical factors and quality of life.

Methods

Factors such as diet (Healthy Eating Index), exercise, substance use, cardiovascular risk (QRISK), illness severity (Clinical Global Impression), medications, adverse events (Systematic Monitoring of Adverse Events Related to Treatments), and quality of life (Recovering Quality of Life Scale) were assessed along with clinical components for MetS in 323 psychiatric patients receiving routine care and monitoring in a Community Mental Health Team.

Results

MetS was present in 50.5% (95% CI: 45.0-55.9). It was significantly associated with higher age, duration of mental illness, body mass index (BMI), QTc, QRISK, and antipsychotic drugs. In logistic regression, age, QTc, QRISK, and BMI remained significantly linked to MetS. Patients with or without MetS were comparable in their lifestyle factors such as diet, exercise, and substance use, along with the family history of metabolic disorders, age at onset of mental illness, duration of antipsychotic medication, side effects, psychiatric diagnoses, and quality of life. However, many patients with or without MetS had poorer diet and physical inactivity, indicating scope for interventions.

Conclusions

Around half of the psychiatric patients had MetS, and modifiable lifestyle factors did not differentiate individuals with or without MetS. The need for further research on the prevention and management of MetS in psychiatric patients is highlighted.

Parental physical activity, parental mental health, children's physical activity, and children's mental health

Introduction

The benefits of physical activity for mental health and well-being and the associations between parental mental health and children's mental health have been well established. These important issues tend to be examined separately however, and there is limited research on the associations between parent and child physical activity and mental health when all considered together. While family focused practice is recommended to provide support for parents who have mental health problems and their families and includes various components (such as psychoeducation, support for mental health and parenting), promoting physical activity for parents and children is not usually a core component of these interventions.

Methods

The Northern Ireland Youth Wellbeing Survey aimed to provide estimates of the prevalence of mental health problems among children and young people. The survey also included questions about parental physical activity, parental mental health, and children's physical activity (for those aged 11-19 years). The main aim of the analysis reported in this article was to explore possible bivariate associations between parent and child physical activity and mental health and also explore these associations when all considered together. Participants were included in the analysis where there were completed interviews for the young person and one of their parents, and both young person and parent provided responses in relation to questions on weekly physical activity (n = 882).

Results

The findings highlight the positive associations between parental physical activity and parental mental health, and between children's physical activity and children's mental health. They also explore some of the more complex interactions between these four variables, which suggest that gender may also be an important consideration. There were significant associations between father's physical activity and son's mental health, and son's physical activity and father's mental health.

Discussions

These findings suggest that including support for parental physical activity and children's physical activity should be a routine component of family focused mental health interventions. It is important to acknowledge that there may be additional barriers to engaging in physical activity for families where a parent is experiencing mental health problems, and these should also be explored and addressed.

Evaluating the nutrition and body mass index clinical link pathway in mental health and learning disability services: A mixed-methods study

This research involved an evaluation of the Nutrition and Body Mass Index Clinical Link Pathway (NBMI CLiP) implemented in practice across Severe Mental Illness and/or learning disabilities ward in Tees, Esk and Wear Valleys NHS Foundation Trust (TEWV), to understand how the NBMI CLiP is used, inpatient staff feedback on the CLiP for supporting service users to manage their weight, and whether using the NBMI CLiP impacted on staffs' own weight management. To account for the uneven distribution of the secondary data, descriptive statistics such as medians and the inter-quartile range were conducted to assess anychanges in recording of Body Mass Index, nutrition screening (SANSI) and intervention planss. Staff survey data investigated barriers and facilitators to using the NBMI CLiP in practice and the impact on their own weight management. Secondary data analysis found most wards improved recording of BMI, SANSI and Intervention Planning. Forensic Learning Disabilities, Adult Learning Disabilities, mixed gender wards and North Yorkshire and York Operational Directorate indicated the greatest improvement. Survey results (n = 55) found three times as many participants (n = 12, 75%) found the NBMI CLiP easy or very easy to use; most fully understood it (n = 13, 81.20%) and were confident or very confident to carry out a SANSI Screen (n = 14, 87.50%) or a recovery focused intervention plan (n = 9, 56.20%). Open-text responses, analysed using content analysis, indicated a need for further training of staff on the NBMI CLiP. It is recommended that to support weight management across these wards, that a nudge or choice architecture approach to weight management is adopted, supported by training delivered by a dietitian.

The impact of providing care for physical health in severe mental illness on informal carers: a qualitative study

BACKGROUND

People with severe mental illness (SMI) such as schizophrenia and bipolar disorder are at a substantially higher risk of premature death in that they die between 10 and 20 years earlier than the general population. Cardiovascular disease (CVD) and diabetes are the main potentially avoidable contributors to early death. Research that explores the experiences of people with SMI highlights their struggles in engaging with health professionals and accessing effective and timely interventions for physical health conditions. A consequence of such struggles to navigate and access physical healthcare results in many people with SMI relying heavily on support provided by informal carers (e.g., family members, close friends). Despite this, the experiences of informal carers, and the roles they undertake in relation to supporting the physical health and psychotropic medication use of people with SMI, remains under-researched.

AIMS

To explore the impacts of providing care for physical health in severe mental illness on informal carers.

METHOD

Thematic analysis of semi-structured interviews with eight informal carers of people with SMI in United Kingdom (UK) national health services.

RESULTS

Informal carers played an active part in the management of the patient's conditions and shared their illness experience. Involvement of informal carers was both emotional and practical and informal carers' own lives were affected in ways that were sometimes deeply profound. Informal carers were involved in both 'looking after' the patient from the perspective of doing practical tasks such as collecting dispensed medication from a community pharmacy (caring for) and managing feelings and emotions (caring about).

CONCLUSIONS

Providing care for the physical health of someone with SMI can be understood as having two dimensions - 'caring for' and 'caring about'. The findings suggest a bidirectional relationship between these two dimensions, and both have a cost for the informal carer. With appropriate support informal carers could be more actively involved at all stages of care without increasing their burden. This should be with an awareness that carers may minimise the information they share about their own needs and impacts of their role to spare the person they care and themselves any distress.

Factors that influence participation in physical activity for people with bipolar disorder: a synthesis of qualitative evidence

BACKGROUND

Mental health problems contribute significantly to the overall disease burden worldwide and are major causes of disability, suicide, and ischaemic heart disease. People with bipolar disorder report lower levels of physical activity than the general population, and are at greater risk of chronic health conditions including cardiovascular disease and obesity. These contribute to poor health outcomes. Physical activity has the potential to improve quality of life and physical and mental well-being.

OBJECTIVES

To identify the factors that influence participation in physical activity for people diagnosed with bipolar disorder from the perspectives of service users, carers, service providers, and practitioners to help inform the design and implementation of interventions that promote physical activity.

SEARCH METHODS

We searched MEDLINE, PsycINFO, and eight other databases to March 2021. We also contacted experts in the field, searched the grey literature, and carried out reference checking and citation searching to identify additional studies. There were no language restrictions.

SELECTION CRITERIA

We included qualitative studies and mixed-methods studies with an identifiable qualitative component. We included studies that focused on the experiences and attitudes of service users, carers, service providers, and healthcare professionals towards physical activity for bipolar disorder.

DATA COLLECTION AND ANALYSIS

We extracted data using a data extraction form designed for this review. We assessed methodological limitations using a list of predefined questions. We used the "best fit" framework synthesis based on a revised version of the Health Belief Model to analyse and present the evidence. We assessed methodological limitations using the CASP Qualitative Checklist. We used the GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research) guidance to assess our confidence in each finding. We examined each finding to identify factors to inform the practice of health and care professionals and the design and development of physical activity interventions for people with bipolar disorder.

MAIN RESULTS

We included 12 studies involving a total of 592 participants (422 participants who contributed qualitative data to an online survey, 170 participants in qualitative research studies). Most studies explored the views and experiences of physical activity of people with experience of bipolar disorder. A number of studies also reported on personal experiences of physical activity components of lifestyle interventions. One study included views from family carers and clinicians. The majority of studies were from high-income countries, with only one study conducted in a middle-income country. Most participants were described as stable and had been living with a diagnosis of bipolar disorder for a number of years. We downgraded our confidence in several of the findings from high confidence to moderate or low confidence, as some findings were based on only small amounts of data, and the findings were based on studies from only a few countries, questioning the relevance of these findings to other settings. We also had very few perspectives of family members, other carers, or health professionals supporting people with bipolar disorder. The studies did not include any findings from service providers about their perspectives on supporting this aspect of care. There were a number of factors that limited people's ability to undertake physical activity. Shame and stigma about one's physical appearance and mental health diagnosis were discussed. Some people felt their sporting skills/competencies had been lost when they left school. Those who had been able to maintain exercise through the transition into adulthood appeared to be more likely to include physical activity in their regular routine. Physical health limits and comorbid health conditions limited activity. This included bipolar medication, being overweight, smoking, alcohol use, poor diet and sleep, and these barriers were linked to negative coping skills. Practical problems included affordability, accessibility, transport links, and the weather. Workplace or health schemes that offered discounts were viewed positively. The lack of opportunity for exercise within inpatient mental health settings was a problem. Facilitating factors included being psychologically stable and ready to adopt new lifestyle behaviours. There were positive benefits of being active outdoors and connecting with nature. Achieving balance, rhythm, and routine helped to support mood management. Fitting physical activity into a regular routine despite fluctuating mood or motivation appeared to be beneficial if practised at the right intensity and pace. Over- or under-exercising could be counterproductive and accelerate depressive or manic moods. Physical activity also helped to provide a structure to people's daily routines and could lead to other positive lifestyle benefits. Monitoring physical or other activities could be an effective way to identify potential triggers or early warning signs. Technology was helpful for some. People who had researched bipolar disorder and had developed a better understanding of the condition showed greater confidence in managing their care or providing care to others. Social support from friends/family or health professionals was an enabling factor, as was finding the right type of exercise, which for many people was walking. Other benefits included making social connections, weight loss, improved quality of life, and better mood regulation. Few people had been told of the benefits of physical activity. Better education and training of health professionals could support a more holistic approach to physical and mental well-being. Involving mental health professionals in the multidisciplinary delivery of physical activity interventions could be beneficial and improve care. Clear guidelines could help people to initiate and incorporate lifestyle changes.

AUTHORS' CONCLUSIONS

There is very little research focusing on factors that influence participation in physical activity in bipolar disorder. The studies we identified suggest that men and women with bipolar disorder face a range of obstacles and challenges to being active. The evidence also suggests that there are effective ways to promote managed physical activity. The research highlighted the important role that health and care settings, and professionals, can play in assessing individuals' physical health needs and how healthy lifestyles may be promoted. Based on these findings, we have provided a summary of key elements to consider for developing physical activity interventions for bipolar disorder.

Effectiveness of lifestyle intervention on prevention/management of antipsychotic-induced weight gain among persons with severe mental illness: A systematic review and meta-analysis

Individualized lifestyle interventions using motivational interviewing (MI) approach are recommended for persons with severe mental illness (SMI) for effective weight management. The aim of this meta-analysis was to assess the effectiveness of various lifestyle interventions that addressed obesity among persons with SMI. Twelve RCTs were assessed by individual reviewers using revised cochrane risk-of-bias tool (RoB 2). The standardized mean difference (SMD) was calculated with a 95% CI. The age of participants was between 18 and 70 years. Waist circumference showed an SMD of -0.09 (-0.22, 0.03), weight -0.03 (-0.10, 0.15) and BMI -0.07 (-0.07, 0.22). The findings in this meta-analysis revealed that though lifestyle interventions were statistically insignificant in reducing antipsychotic induced weight gain among persons with SMI, they show changes in intervention group. Psychosocial management along with lifestyle interventions, and MI are effective in the management of antipsychotic induced weight gain.

Self-determined motivational health coaching ('SAMI') during outpatient treatment to promote physical activity of people with serious mental illness: a pilot controlled trial

BACKGROUND

Brief motivational coaching, integrated into health care; seems promising to address physical inactivity of people with serious mental illness (SMI).

AIMS

To test the impact of a self-determined health coaching approach (the "SAMI" intervention) during outpatient mental health treatment on moderate-to-vigorous physical activity (MVPA) of people with SMI.

METHODS

Adults (mean age = 41.9, SD = 10.9) with an ICD-10 diagnosis of mental illness were semi-randomized to the SAMI-intervention group (IG) or control group (CG). The IG received 30 minutes of health coaching based on the self-determination theory (SDT). MVPA and sedentary time (ST) were measured with the International Physical Activity Questionnaire - short form (IPAQ-SF) and symptoms of mental illness with the Brief Symptom Inventory (BSI-18), each at baseline and follow-up (3-4 months). Differences in primary (MVPA) and secondary (ST, BSI-18) outcomes were evaluated using negative binomial regressions and general linear models.

RESULTS

In the IG (n = 30), MVPA increased from 278 (interquartile range [IQR] = 175-551) to 435 (IQR = 161-675) min/week compared to a decrease from 250 (IQR = 180-518) to 155 (IQR = 0-383) min/week in the CG (n = 26; adjusted relative difference at follow-up: Incidence Rate Ratio [IRR] = 2.14, 95% CI: 1.17-3.93, p = 0.014). There were no statistically significant differences in ST and BSI-18.

CONCLUSIONS

Brief self-determined health coaching during outpatient treatment could increase post-treatment MVPA in people with SMI, potentially up to a clinically relevant level. However, great uncertainty (for all outcomes) weakens the assessment of clinical relevance.

Implementing exercise recommendations into clinical practice-new findings from mental health professionals' and patients' perspectives in a university psychiatric setting

Introduction

To date, concrete recommendations for physical activity in psychiatric treatments are limited. Thus, we evaluated knowledge, barriers and beliefs associated with exercise prescription of mental health professionals (MHP) to people with mental illnesses. We aimed to identify patients' barriers to exercise participation and to work out options addressing these barriers.

Methods

In our cross-sectional and questionnaire-based investigation, we recruited medical, nursing and therapeutic staff and patients of a psychiatric clinic by email and personal contact. Questionnaires contained the German versions of The Exercise in Mental Illness Questionnaire (EMIQ-G) and the International Physical Activity Questionnaires (IPAQ).

Results

We included 100 MHP and 100 patients. MHP had significantly more knowledge regarding positive effects of exercise on general health than patients. Exercise was prescribed mostly (48.4%) or always (37.9%) by MHP. The data showed missing education in exercise prescriptions and different recommendation behavior. Male patients seemed to experience exercise more often as a positive distraction and had lower physical health barriers than females.

Discussion

Physical activity needs to be more integrated in psychiatric treatments. Some strategies as educating MHP and patients regarding potential benefits of exercise via psychoeducative brochures and adapting recommendations to individual symptoms could improve exercise behavior in psychiatric patients.

Nurses' and patients' perceptions of physical health screening for patients with schizophrenia spectrum disorders: a qualitative study

BACKGROUND

Despite worldwide concern about the poor physical health of patients with schizophrenia spectrum disorders (SSD), physical health screening rates are low. This study reports nurses' and patients' experiences of physical health screening among people with SSD using the Finnish Health Improvement Profile (HIP-F) and their ideas for implementation improvements.

METHODS

A qualitative exploratory study design with five group interviews with nurses (n = 15) and individual interviews with patients with SSD (n = 8) who had experience using the HIP-F in psychiatric outpatient clinics. Inductive content analysis was conducted.

RESULTS

Two main categories were identified. First, the characteristics of the HIP-F were divided into the subcategories of comprehensive nature, facilitating engagement, interpretation and rating of some items and duration of screening. Second, suggestions for the implementation of physical health screening consisted of two subcategories: improvements in screening and ideas for practice. Physical health screening was felt to increase the discussion and awareness of physical health and supported health promotion. The HIP-F was found to be a structured, comprehensive screening tool that included several items that were not otherwise assessed in clinical practice. The HIP-F was also considered to facilitate engagement by promoting collaboration in an interactive way. Despite this, most of the nurses found the HIP-F to be arduous and too time consuming, while patients found the HIP-F easy to use. Nurses found some items unclear and infeasible, while patients found all items feasible. Based on the nurses' experiences, screening should be clear and easy to interpret, and condensation and revision of the HIP-F tool were suggested. The patients did not think that any improvements to the HIP-F were needed for implementation in clinical settings.

CONCLUSIONS

Patients with schizophrenia spectrum disorders are willing to participate in physical health screening. Physical health screening should be clear, easy to use and relatively quick. With this detailed knowledge of perceptions of screening, further research is needed to understand what factors affect the fidelity of implementing physical health screening in clinical mental health practice and to gain an overall understanding on how to improve such implementation.

Physical activity and sedentary behavior levels among individuals with mental illness: A cross-sectional study from 23 countries

People with mental illness tend to present low levels of physical activity and high levels of sedentary behavior. The study aims to compare these levels in mental illness patients, exploring the role of socioeconomic development and treatment setting. This cross-sectional study used accelerometers and the Simple Physical Activity Questionnaire (SIMPAQ) to assess physical activity and sedentary behavior in mental illness individuals living in 23 countries. Two-way ANOVAs were used to evaluate the interaction between socioeconomic development and the treatment settings on physical activity and sedentary behavior. A total of 884 (men = 55.3%) participants, mean age of 39.3 (SD = 12.8), were evaluated. A significant interaction between socioeconomic development and treatment settings was found in sedentary behavior (F = 5.525; p = 0.019; η2p = 0.009; small effect size). Main effects were observed on socioeconomic development (F = 43.004; p < 0.001; η2p = 0.066; medium effect size) and treatment setting (F = 23.001; p < 0.001; η2p = 0.036; small effect size) for sedentary behavior and physical activity: socioeconomic development (F = 20.888; p < 0.001; η2p = 0.033; small effect size) and treatment setting (F = 30.358; p < 0.001; η2p = 0.047; small effect size), showing that HIC patients were more active, while MIC patients were more sedentary. Moreover, despite of inpatients had presented higher levels of physical activity than outpatients, they also spent more time sitting. Socioeconomic development plays an important role in sedentary behavior in patients with mental disorders, warning the need to develop new strategies to reduce these levels in this population.

The use of physical exercise in forensic psychiatric care in Sweden: a nationwide survey

BACKGROUND

Exercise protects against somatic comorbidities and positively affects cognitive function and psychiatric symptoms in patients with severe mental illness. In forensic psychiatry, exercise is a novel concept. Staff at inpatient care facilities may be important resources for successful intervention. Little is known about staff's knowledge, attitudes and behaviors regarding exercise in forensic psychiatric care.

AIMS

To translate, culturally adapt and test the feasibility of the Exercise in Mental Health Questionnaire-Health Professionals Version (EMIQ-HP) in the Swedish context, and to use this EMIQ-HP-Swedish version to describe staff's knowledge, attitudes and behaviors regarding exercise.

METHOD

The EMIQ-HP was translated, culturally adapted, pilot-tested and thereafter used in a cross-sectional nationwide survey.

RESULTS

Ten of 25 clinics and 239 health professionals (50.1%) participated. Two parts of the EMIQ-HP-Swedish version showed problems. Most participants considered exercise to be a low-risk treatment (92.4%) that is beneficial (99.2%). Training in exercise prescription was reported by 16.3%. Half of participants (52.7%) prescribed exercise and 50.0% of those undertook formal assessments prior to prescribing.

CONCLUSIONS

Creation of the EMIQ-HP-Swedish version was successful, despite some clarity problems. Exercise appears to be prescribed informally by non-experts in Swedish forensic psychiatric care and does not address treatment goals.