Therapeutic impact of exercise on psychiatric diseases: guidelines for exercise testing and prescription

Beyond Pharmacology: A Narrative Review of Alternative Therapies for Anxiety Disorders

BACKGROUND

Anxiety disorders significantly reduce patients' quality of life. Current pharmacological treatments, primarily benzodiazepines and antidepressants, are associated with numerous side effects. Consequently, there is a continual search for alternative methods to traditional therapies that are less burdensome for patients and broaden their therapeutic options. Our objective was to determine the role of selected alternative methods in the treatment of anxiety disorders.

METHODS

In this review, we examined recent evidence on alternative treatments for anxiety disorders, including physical activity, mindfulness, virtual reality (VR) technology, biofeedback, herbal remedies, transcranial magnetic stimulation (TMS), cryotherapy, hyperbaric therapy, vagus nerve stimulation (VNS), 3,4-methylenedioxymethamphetamine (MDMA), electroconvulsive therapy (ECT), and eye movement desensitization and reprocessing (EMDR) therapy. For this purpose we reviewed PubMed and after initial search, we excluded works unrelated to our aim, non-orginal data and animal studies. We conducted second search to cover all minor methods.

RESULTS

We included 116 studies, which data is presented in Tables. We have investigated which methods can support treatment and which can be used as a stand-alone treatment. We assessed the risks to benefits of using alternative treatments.

CONCLUSION

Alternative treatments significantly expand the options available to patients and clinicians, with many serving as adjuncts to traditional therapies. Among the methods presented, mindfulness has the most significant therapeutic potential.

Play Badminton Forever: A Systematic Review of Health Benefits

Regular physical activity (PA) engagement has multiple benefits for individual general health at all ages and life stages. The present work focuses on badminton, which is one of the most popular sports worldwide. The aim was to conduct a systematic review focused on examining and analysing this sport and the benefits it brings to the health of those who engage in it. Examination was conducted from the viewpoint of overall health and provides an overview of the current state-of-the-art as presented in published scientific literature. PRISMA 2020 guidelines were adhered to. An exhaustive search was conducted of four electronic databases or search engines: Web of Science, Scopus, MEDLINE and Google Scholar. The search terms used were "badminton AND health" and "badminton AND benefits". In total, 27 studies were eligible for inclusion in the systematic review. After analysing the results, it was concluded that badminton engagement may lead to an improvement in all areas, the most studied being those related to physical health, in particular the improvement of cardiac and pulmonary functions and the development of basic physical capacities.

A Comparative Study on the Influence of Undersampling and Oversampling Techniques for the Classification of Physical Activities Using an Imbalanced Accelerometer Dataset

Accelerometer data collected from wearable devices have recently been used to monitor physical activities (PAs) in daily life. While the intensity of PAs can be distinguished with a cut-off approach, it is important to discriminate different behaviors with similar accelerometry patterns to estimate energy expenditure. We aim to overcome the data imbalance problem that negatively affects machine learning-based PA classification by extracting well-defined features and applying undersampling and oversampling methods. We extracted various temporal, spectral, and nonlinear features from wrist-, hip-, and ankle-worn accelerometer data. Then, the influences of undersampilng and oversampling were compared using various ML and DL approaches. Among various ML and DL models, ensemble methods including random forest (RF) and adaptive boosting (AdaBoost) exhibited great performance in differentiating sedentary behavior (driving) and three walking types (walking on level ground, ascending stairs, and descending stairs) even in a cross-subject paradigm. The undersampling approach, which has a low computational cost, exhibited classification results unbiased to the majority class. In addition, we found that RF could automatically select relevant features for PA classification depending on the sensor location by examining the importance of each node in multiple decision trees (DTs). This study proposes that ensemble learning using well-defined feature sets combined with the undersampling approach is robust for imbalanced datasets in PA classification. This approach will be useful for PA classification in the free-living situation, where data imbalance problems between classes are common.

Reliability and validity of physical fitness tests in people with mental disorders: A systematic review and meta-analysis

BACKGROUND

Several tests are available to assess the different components of physical fitness, including cardiorespiratory fitness, muscular strength, and flexibility. However, the reliability and validity of physical fitness tests in people with mental disorders has not been meta-analyzed.

AIMS

To examine the reliability, concurrent, and convergent validity of physical fitness tests in people with mental disorders.

METHODS

Studies evaluating the reliability, concurrent, and convergent validity of physical fitness tests in people with mental disorders were searched from major databases until January 20, 2020. Random-effects meta-analyses were performed pooling (1) reliability: test-retest correlations at two-time points, (2) convergent validity between submaximal tests and maximal protocols, or (3) concurrent validity between two submaximal tests. Associations are presented using r values and 95% confidence intervals. Methodological quality was assessed using the Quality Appraisal of Reliability Studies and the Critical Appraisal Tool.

RESULTS

A total of 11 studies (N = 504; 34% females) were included. Reliability of the fitness tests, produced r values ranging from moderate (balance test-EUROFIT; [r = 0.75 (0.60-0.85); p = 0.0001]) to very strong (explosive leg power EUROFIT; [r = 0.96 (0.93-0.97); p = 0.0001]). Convergent validity between the 6-min walk test (6MWT) and submaximal cardiorespiratory tests was moderate (0.57 [0.26-0.77]; p = 0.0001). Concurrent validity between the 2-min walk test and 6MWT (r = 0.86 [0.39-0.97]; p = 0.0004) was strong.

CONCLUSION

The present study demonstrates that physical fitness tests are reliable and valid in people with mental disorders.

Critical Reflections on Technology to Support Physical Activity among Older Adults

Contemporary policy on ageing overwhelmingly focuses on active ageing and achieving a sustainable increase in disability-free years, leading to an agenda that promotes interventions that often focus on deficits of older persons with little consideration of their perspectives on physical activity. As the integration of technology to support physical activity routines becomes more common, this trend also becomes relevant to the Human-Computer Interaction (HCI) research community.

In this article, we present findings from a structured search of technical systems addressing physical activity among older adults that were published at the most cited HCI venues. Drawing from Thematic Analysis, we explore how the model of active ageing informs existing research, and how it is operationalized in technology design. We find that the deficit-focused perspective on ageing is reflected in many technology solutions published at the most visible HCI venues, and discuss shortcomings and strengths of present research to help guide discourse and future work in HCI.

Models of First Responder Coping: Police Officers as a Unique Population

The term "first responders" refers to a range of professional occupations, including police officers, fire fighters, search and rescue personnel, ambulance personnel, and military personnel. Research by the present authors has developed empirical models of first responder coping, identifying 2 coping pathways with differential outcomes: approach and avoidance coping. The present investigation considers police officers as a unique group and measures the extent to which police officers differ from other first responders in coping behaviours following trauma, based upon a nationally representative survey of 917 Swedish police officers. Although the model of coping behaviours following trauma and the effects on well-being displayed several similarities between police officers and other first responders, there was compelling evidence to suggest that there are professionally bound aspects of psychological coping, resilience, and well-being that merit further exploration. Among police officers, for example, avoidant coping was related to worse well-being, and police officers reported greater consequence to well-being related to substance use than other first responders. The unique aspects of police officer coping in comparison with other first responder groups are explored.

Is the Cardiovascular Response Equivalent Between a Supervised Center-Based Setting and a Self-care Home-Based Setting When Rating of Perceived Exertion Is Used to Guide Aerobic Exercise Intensity During a Cardiac Rehabilitation Program?

OBJECTIVES

The aim of this study was to investigate if exercise intensity guided by rating of perceived exertion (RPE) results in an equivalent cardiovascular response when applied in either a center-based or a home-based setting.

DESIGN

Data from patients with heart disease (post-valve surgery and atrial fibrillation post-radiofrequency ablation) participating in exercise-based rehabilitation were included. Patients performed a 12-week program in either a center- or a home-based setting. Using RPE, patients recorded their exercise intensity 3 times during an aerobic training phase. Exercise intensity was objectively measured using heart rate (HR) monitors.

RESULTS

A total of 2622 RPE values with corresponding HR data were available. There was no difference in the level of association (interaction P = 0.51) between HR and RPE seen in the center-based setting (mean of 6.1 beats/min per 1.0 difference in RPE; 95% confidence interval, 4.8-7.5 beats/min) compared with the home-based setting (mean of 5.3 beats/min per 1.0 difference in RPE; 95% confidence interval, 4.0-6.5 beats/min). The level of patient familiarization, exercise intensity, and patient characteristics did not affect the level of association between RPE and HR.

CONCLUSIONS

Independent of exercise setting, RPE appears to be equally effective in guiding exercise intensity of patients participating in cardiac rehabilitation.

A Model of First-responder Coping: An Approach/Avoidance Bifurcation

The work of first responders is fraught with numerous stressors, ranging from potentially traumatic critical incidents to institutional strains. The severity and pervasiveness of these difficulties prompt a necessary consideration of the coping methods employed by first responders. The present study developed an empirical model of first-responder coping strategies, based upon a nationally representative survey sample of 6240 first responders. Participants were drawn from Swedish first responders in the following occupations: coast guard, customs control, military, emergency medical services, fire department and police services. In the final model, exposure to stress related to well-being through several indirect paths that in sum accounted for the original direct relationship between these constructs. These several indirect paths were classified theoretically as either approach or avoidance coping behaviours or subsequent health outcomes. In general, approach coping behaviours were related to better well-being; and avoidance was related to a decrease in the outcome. The size of the present sample, as well as the diverse nature of the included first responders, suggests that the resulting model may offer a unique insight into potentially adaptive pathways for first-responder coping. Copyright © 2016 John Wiley & Sons, Ltd.

Cross-sectional association of exercise, strengthening activities, and cardiorespiratory fitness on generalized anxiety, panic and depressive symptoms

OBJECTIVE

Limited research has evaluated the individual and combined associations of physical activity (PA), cardiorespiratory fitness (CRF) and muscle strengthening activities (MSA) on generalized anxiety, panic and depressive symptoms. We evaluated this topic in a representative sample of young (20-39 years) adults, with considerations by sex.

METHODS

Data from the 1999-2004 National Health and Nutrition Examination Survey (N = 2088) were used. Generalized anxiety, panic and depressive symptoms were assessed via self-report as well as using the Generalized Anxiety Disorder, Panic Disorder, and Depressive Disorders modules of the automated version of the World Health Organization Composite International Diagnostic Interview (CIDI-Auto 2.1). PA and MSA were assessed via validated self-report questionnaires and CRF was determined via a submaximal treadmill-based test. An index variable was created summing the number (range = 0-3) of these parameters for each participant. For example, those meeting PA guidelines, MSA guidelines and having moderate-to-high CRF were classified as having an index score of 3.

RESULTS

MSA was not independently associated with generalized anxiety, panic and depressive symptoms, but those with higher levels of PA and CRF had a reduced odds of these symptoms (ranging from 40 to 46% reduced odds). Compared to those with an index score of 0, those with an index score of 1, 2, and 3, respectively, had a 39%, 54% and 71% reduced odds of having generalized anxiety, panic and depressive symptoms. Results were consistent across both sexes.

CONCLUSION

PA and CRF, but not MSA, were independently associated with generalized anxiety, panic and depressive symptoms. There was evidence of an additive association between PA, CRF, and MSA on these symptoms.

A Walking Program for Outpatients in Psychiatric Rehabilitation: Pilot Study

The purposes of this quasi-experimental pilot study were to determine adherence to a 12-week group-based moderate-intensity walking program for sedentary adult outpatients with serious and persistent mental illness and to examine change from baseline to after the walking program in health status (mental and physical health, mood, and psychosocial functioning) and exercise motivation (exercise outcomes expectancies, exercise decisional balance). The 15 volunteers in this study were aged 21 to 65 years and enrolled in psychosocial rehabilitation; they participated in a 12-week walking program meeting three times per week for 1 hr, supplemented with four health information workshops delivered at the beginning of the study. Participants received individual exercise prescriptions determined by preprogram fitness testing and used heart rate monitors during walking sessions. Thirteen participants (87%) completed the study and attended 76% of the walking sessions. Overall, they walked at lower intensity than prescribed, with pulses within target heart rate ranges 35% of the time during Weeks 1 through 4, 26% of the time during Weeks 5 through 8, and 22% of the time during Weeks 9 through 12. However, mood improved (Profile of Mood States, t = -2.51, two-tailed, df = 12, p = .02), as did psychosocial functioning (Multnomah Community Ability Scale, two-tailed, df = 12, t = 2.49, p = .02). The findings indicate a walking group may be feasible for rehabilitation programs. In addition to the known cardiovascular risk-reduction benefits of regular walking, walking may improve mood and psychosocial functioning in adults with serious and persistent mental illness.

Physical activity in patients with anorexia nervosa

Anorexia nervosa (AN) is often associated with physical hyperactivity. Recent studies have established links between anorexia and hyperactivity, suggesting the existence of commonalities in neural pathways. How physical activity should be managed during the clinical care of patients with anorexia remains controversial. This review first focuses on the implication of hyperactivity in the pathophysiology of AN. Hyperactivity during refeeding of patients with AN has been associated with increased energy needs to achieve weight gain, poorer clinical outcome, longer hospitalization, and increased psychiatric comorbidity. This typically leads to the prescription of bed rest. However, current knowledge suggests that preserving some kind of physical activity during refeeding of patients with AN should be safe and beneficial for the restoration of body composition, the preservation of bone mineral density, and the management of mood and anxiety. In the absence of standardized guidelines, it is suggested here that physical activity during refeeding of patients with AN should be personalized according to the physical and mental status of each patient. More research is needed to assess whether programmed physical activity may be a beneficial part of the treatment of AN.

Development of a Conceptual Model for Smoking Cessation: Physical Activity, Neurocognition, and Executive Functioning

PURPOSE

Considerable research has shown adverse neurobiological effects of chronic alcohol use, including long-term and potentially permanent changes in the structure and function of the brain; however, much less is known about the neurobiological consequences of chronic smoking, as it has largely been ignored until recently. In this article, we present a conceptual model proposing the effects of smoking on neurocognition and the role that physical activity may play in this relationship as well as its role in smoking cessation.

METHODS

Pertinent published peer-reviewed articles deposited in PubMed delineating the pathways in the proposed model were reviewed.

RESULTS

The proposed model, which is supported by emerging research, demonstrates a bidirectional relationship between smoking and executive functioning. In support of our conceptual model, physical activity may moderate this relationship and indirectly influence smoking behavior through physical activity-induced changes in executive functioning.

CONCLUSIONS

Our model may have implications for aiding smoking cessation efforts through the promotion of physical activity as a mechanism for preventing smoking-induced deficits in neurocognition and executive function.

Clinical exercise interventions in alcohol use disorders: a systematic review

The therapeutic impact of exercise interventions in psychiatric diseases such as depression, anxiety and schizophrenia has already been proven through several reviews whereas substance use disorders such as alcohol use disorders (AUD) have so far less frequently been a matter of investigation. Although several publications have summarized studies focusing on physical activities in substance use disorders, no systematic review exists summarizing the evidence of exercise interventions in AUD. A total of 14 studies using the Medline Database, CCMed, Cochrane Library and PsychINFO were identified and met the inclusion criteria. In order to evaluate the evidence, we used the evaluation system of the Oxford Centre for Evidence-Based Medicine (2011). Due to methodological flaws the overall evidence of the studies is rated level "3" but primarily findings confirm that exercise interventions as a complementary treatment component in AUD are feasible and safe. No adverse events were reported. This systematic review indicates that exercise may have beneficial effects on certain domains of physical functioning including VO2max, basal heart rate, physical activity level and strength. Inconsistent effects with a slight trend towards a positive effect on anxiety, mood management, craving, and drinking behavior have been shown and need to be verified. Results must be interpreted cautiously due to the numerous methodological flaws and the heterogeneity of the interventions and measures. However, according to preclinical studies several mechanisms of action are conceivable, especially as to alcohol-related outcomes and additionally seem to be promising. RCTs with high methodological quality are urgently needed in future research to establish evidence-based exercise recommendations for the treatment of AUD.

A educação física no âmbito do tratamento em saúde mental: um esforço coletivo e integrado

Este artigo analisa a Educação Física no processo de tratamento de doenças mentais, identificando as contribuições dessa prática profissional às terapias em saúde mental. Discute-se nesse estudo o papel da Educação Física enquanto atividade terapeutica auxiliar na diminuição da sintomatologia dessas doenças em função da aplicação de atividades físicas identificada em diversos estudos. Concluiu-se que a integração da Educação Física como ciência auxiliar à Psiquiatria tem se constituído um esforço interdisciplinar nos tratamentos de pacientes em sofrimento mental.

A Pilot Physical Activity Initiative to Improve Mental Health Status amongst Iranian Institutionalized Older People

BACKGROUND

Sufficient level of physical activity may promote overall and mental health of old people. This study was carried out to investigate the practi-cability of a physical activity promotion initiative amongst institutionalized older people in Tabriz, Iran.

METHODS

Purposive sampling method was used in this semi-experimental study to recruit 31 older people living in a selected residential care in Tabriz. Moderate-intensity aerobic and mus-cle-strengthening activity was planned for those who had not severe baseline cognitive impairment or were not too frail to undertake the survey. The General Health Questionnaire (GHQ-28) was used to measure mental health status be-fore and after intervention through a face-to-face interview. Descriptive statistics, Wilkcoxon rank-sum, Mann-Whitney U and Chi-Square tests were employed to analyses the data.

RESULTS

The applied intervention was significantly improved status of physical health, anxiety and insomnia, social dysfunction and severe depression.

CONCLUSION

Incorporation of physical activity promotion programs into routines of older people residential care homes in Iran is feasible but may need training of physical activity specialists to work with older people based on their physical endurance and limitations.

A pilot trial of a videogame-based exercise program for methadone maintained patients

Few studies have examined exercise as a substance use disorder treatment. This pilot study investigated the feasibility and acceptability of an exercise intervention comprising the Wii Fit Plus™ and of a time-and-attention sedentary control comprising Wii™ videogames. We also explored their impact on physical activity levels, substance use, and psychological wellness. Twenty-nine methadone-maintained patients enrolled in an 8-week trial were randomly assigned to either Active Game Play (Wii Fit Plus™ videogames involving physical exertion) or Sedentary Game Play (Wii™ videogames played while sitting). Participants had high satisfaction and study completion rates. Active Game Play participants reported greater physical activity outside the intervention than Sedentary Game Play participants despite no such differences at baseline. Substance use decreased and stress and optimism improved in both conditions. Active Game Play is a feasible and acceptable exercise intervention, and Sedentary Game Play is a promising time-and-attention control. Further investigations of these interventions are warranted.

Mental health and social participation skills of wheelchair basketball players: a controlled study

The aim of this study was to assess differences in psychological well-being, symptomatic psychological disorders and social participation, between competitive wheelchair basketball participants and those non-participants. Forty-six wheelchair participants, 24 Basketball players (aged 35.60 ± 7.56) and 22 non-players (aged 36.20 ± 6.23), completed three validated self-report questionnaires: Participation Scale (PS), Psychological Well-Being Scale [PWBS] and Symptom Checklist 90 R [SCL-90-R]. ANOVA showed significant overall differences between the two groups. The social restriction score, evaluated by PS, was significantly higher in the non-basketball participants (p=0.00001) than the basketball participants. The PWB Scale showed significant differences in all 6 dimensions: positive relations with others, environmental mastery, personal growth, purpose in life and self-acceptance (p<0.01), and autonomy (p<0.05), with better scores in the basketball participants. The SCL-90-R scores were significantly lower for the basketball group in the following 6 symptomatic dimensions: depression, phobic anxiety, and sleep disorder (p<0.01), somatization, interpersonal sensitivity and psychoticism (with p<0.05). It was concluded that competitive wheelchair basketball participants showed better psychological well-being and social skills than those non-participants.

Comparing physical exercise in groups to group cognitive behaviour therapy for the treatment of panic disorder in a randomized controlled trial

BACKGROUND

Previous studies have suggested that physical exercise can reduce symptoms for subjects suffering from panic disorder (PD). The efficacy of this intervention has so far not been compared to an established psychotherapy, such as cognitive behaviour therapy (CBT). Assessment of controlled long-term effects and the clinical significance of the treatment are also lacking.

AIM

To compare physical exercise to CBT as treatment for PD, and assess controlled long-term and clinically significant effects.

METHOD

PD-patients were randomized to either three weekly sessions of physical exercise (n = 17), or one weekly session of CBT (n = 19). Both treatments ran for 12 weeks, were manualized and administered in groups. Patients were assessed twice before the start of treatment, at post-treatment and at 6 and 12 months thereafter. Primary outcome-measures consisted of the Mobility Inventory (MI), the Agoraphobia Cognitions Questionnaire (ACQ) and the Body Sensations Questionnaire (BSQ).

RESULTS

A two-way repeated measures MANOVA of these measures demonstrated a significant effect of time, F(16, 544) = 7.28, p < .01, as well as a significant interaction effect, F(16, 544) = 1.71, p < .05, in favour of CBT. This finding was supported by the assessment of clinically significant changes of avoidant behaviour and of treatment-seeking one year later.

CONCLUSION

Group CBT is more effective than group physical exercise as treatment of panic disorder, both immediately following treatment and at follow-up assessments.

Psychological well-being and social participation assessment in visually impaired subjects playing Torball: a controlled study

The aim of this study was to evaluate the differences in psychological well-being, symptomatic psychological disorders and social participation, between blind Torball players and non-players. Thirty blind male participants were recruited, 17 Torball players (aged 36.27±3.46) and 13 non-players (aged 34.80±2.53), and evaluated for social participation level, psychological well-being and symptomatic psychological disorders, using three validated self-report questionnaires: Participation Scale (PS), Psychological Well-Being Scale (PWBS) and Symptom Checklist 90 R (SCL-90-R) respectively. ANOVA showed significant overall differences between the two groups. The social restriction score in the non-player group was significantly higher (p<0.01) than the player group. The Torball player group showed significant better scores than non-player group in 5 of the 6 dimensions of the PWB Scale (p<0.01) and in 8 of the 10 dimensions of the SCL-90-R (7 dimensions p<0.01; 1 dimension p<0.05) and in the three global scores of the SCL-90-R (p<0.01). The results of this study showed a relationship between psychological well-being and social skills of visually impaired people and their Torball practice.

Soccer practice as an add-on treatment in the management of individuals with a diagnosis of schizophrenia

Physical activity is an important aspect of good health for everyone; it is even more important for psychiatric patients who usually live an unhealthy lifestyle. In recent years, there has been growing focus on the use of soccer as a vehicle to improve the health of subjects with severe mental illness. The aim of this study was to investigate the effects of soccer practice on the self-reported health quality of life (SRHQL) and sports performance (SP) in psychotic subjects. Eighteen male patients with diagnosis of schizophrenia were randomized into either a trained (TG) or a control group (CG). The TG was trained for 12 weeks using two soccer training sessions per week. The CG did not perform any regular sports activity during the experimental period. Anthropometric measurements, SRHQL, personal time records in a 30 meter sprint test and slalom test running with a ball were evaluated before and after the experimental period. SRHQL was assessed using Short Form-12 questionnaire measuring physical and mental component summary scores. After the training period, the TG showed a relevant decrease by 4.6% in bodyweight (BW) and body mass index compared to baseline. Conversely, the CG showed an increased BW and body mass index by 1.8% from baseline to posttest. Moreover, after 12 weeks we found that control patients increased their BW significantly when compared to trained patients (Δ = 5.4%; P < 0.05). After the training period, comparing the baseline TG's Short Form-12-scores to posttest results, we found an improvement of 10.5% and 10.8% in physical component summary and mental component summary, respectively. In addition, performances on the 30 meter sprint test and slalom test running with a ball in the TG improved significantly (P < 0.01) from baseline to posttest when compared to CG. Soccer practice appears able to improve psychophysical health in individuals with diagnosis of schizophrenia. Indeed, our study demonstrated that programmed soccer physical activity could reduce antipsychotic medication-related weight gain and improve SRHQL and sports performance in psychotic subjects.

Exercise in multiple sclerosis -- an integral component of disease management

Multiple sclerosis (MS) is the most common chronic inflammatory disorder of the central nervous system (CNS) in young adults. The disease causes a wide range of symptoms depending on the localization and characteristics of the CNS pathology. In addition to drug-based immunomodulatory treatment, both drug-based and non-drug approaches are established as complementary strategies to alleviate existing symptoms and to prevent secondary diseases. In particular, physical therapy like exercise and physiotherapy can be customized to the individual patient's needs and has the potential to improve the individual outcome. However, high quality systematic data on physical therapy in MS are rare. This article summarizes the current knowledge on the influence of physical activity and exercise on disease-related symptoms and physical restrictions in MS patients. Other treatment strategies such as drug treatments or cognitive training were deliberately excluded for the purposes of this article.

Exercise augmentation compared to usual care for post traumatic stress disorder: a randomised controlled trial (the REAP study: Randomised Exercise Augmentation for PTSD)

BACKGROUND

The physical wellbeing of people with mental health conditions can often be overlooked in order to treat the primary mental health condition as a priority. Exercise however, can potentially improve both the primary psychiatric condition as well as physical measures that indicate risk of other conditions such as diabetes mellitus and cardiovascular disease. Evidence supports the role of exercise as an important component of treatment for depression and anxiety, yet no randomised controlled trials (RCT's) have been conducted to evaluate the use of exercise in the treatment of people with post traumatic stress disorder (PTSD). This RCT will investigate the effects of structured, progressive exercise on PTSD symptoms, functional ability, body composition, physical activity levels, sleep patterns and medication usage.

METHODS AND DESIGN

Eighty participants with a Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) diagnosis of PTSD will be recruited. Participants will have no contraindications to exercise and will be cognitively able to provide consent to participate in the study. The primary outcome measures will be PTSD symptoms, measured through the PTSD Checklist Civilian (PCL-C) scale. Secondary outcome measures will assess depression and anxiety, mobility and strength, body composition, physical activity levels, sleep patterns and medication usage. All outcomes will be assessed by a health or exercise professional masked to group allocation at baseline and 12 weeks after randomisation. The intervention will be a 12 week individualised program, primarily involving resistance exercises with the use of exercise bands. A walking component will also be incorporated. Participants will complete one supervised session per week, and will be asked to perform at least two other non-supervised exercise sessions per week. Both intervention and control groups will receive all usual non-exercise interventions including psychotherapy, pharmaceutical interventions and group therapy.

DISCUSSION

This study will determine the effect of an individualised and progressive exercise intervention on PTSD symptoms, depression and anxiety, mobility and strength, body composition, physical activity levels, sleep patterns and medication usage among people with a DSM-IV diagnosis of PTSD.

TRIAL REGISTRATION

ACTRN12610000579099.

Trends of elevated PTSD risk in firefighters exposed to the World Trade Center disaster: 2001-2005

OBJECTIVES

We identified trends in the prevalence of elevated posttraumatic stress disorder (PTSD) risk as determined by the Fire Department of the City of New York (FDNY)-modified PTSD Checklist in World Trade Center (WTC)-exposed firefighters. We also examined trends in relation to WTC exposure, social support, change in recreational activities, and functional health.

METHODS

We analyzed 16,826 questionnaires from 10,074 firefighters in yearly intervals, from September 12, 2001, to September 11, 2005.

RESULTS

The prevalence of elevated PTSD risk increased over time, from 9.8% in year 1 to 10.6% in year 4 (p < 0.0001). Earliest arrival at the WTC site (odds ratio [OR] = 6.0; 95% confidence interval [CI] 4.4, 8.3), prolonged work at the site (OR = 2.0; 95% CI 1.8, 2.3), providing supervision without previous supervisory experience (OR = 4.1; 95% CI 2.8, 6.1), and retirement due to a WTC-related disability (OR=1.3; 95% CI 1.1, 1.5) were associated with ever having elevated PTSD risk. Difficulty functioning at home was strongly associated with elevated PTSD risk (ORs ranged from 17.0 [95% CI 14.5, 20.0] in year 1 to 26.7 [95% CI 20.3, 35.2] in year 3), as was difficulty functioning at work (ORs ranged from 12.1 [95% CI 10.2, 14.2] in year 1 to 23.0 [95% CI 14.6, 36.3] in year 2).

CONCLUSIONS

Elevated PTSD risk was associated with exposure to the WTC site as well as functional impairment, and remained largely unabated during the first four years of the study. Screening for elevated PTSD risk may be useful in identifying those who could benefit from interventions during long-term follow-up, as well as in the immediate aftermath of disasters.

Dissociation of performance parameters at the IAT requires specific exercise recommendations for depressed patients

Aerobic exercise training is considered an adequate complementary treatment strategy for major depressive disorder (MDD). However, there is a need for comparative methodological investigations to determine the appropriate exercise intensity for these patients. The study compared submaximal exercise intensity determination with those derived from maximal parameters such as percentages of heart rate reserve (HRR), maximal heart rate (HR(max)) and peak oxygen uptake (VO(2peak)) of patients and controls. An exhaustive incremental bicycle exercise test was completed by 15 female MDD patients and matched controls. The individual anaerobic lactate threshold (IAT) as a gold standard to determine individual aerobic exercise intensity was assessed according to Stegmann and coworkers. Exercise intensities at 70 and 85% of HR(max), 70 and 85% of HRR and 50 to 80% of VO(2peak) were compared to the IAT. Patients suffering from MDD switched earlier to anaerobic metabolism than matched healthy controls. But interestingly, the level of self-rated perceived exertion, concentration of lactate, respiratory exchange ratio and heart rate at the IAT level revealed no significant difference between both groups. Due to a growing number of clinical aerobic exercise treatments in depressive disorders exercise intensities >70% of (a) HR(max), (b) HRR, (c) VO(2peak) should be amended by the IAT and Borg scale measurements to avoid over challenging as well as increased anaerobic metabolism.

Physical activity in treatment units for eating disorders: clinical practice and attitudes

OBJECTIVE

Physical activity (PA) in eating disorders (ED) may be harmful, but in a therapeutic setting also beneficial. The purpose of this survey was to examine these contradictory aspects of PA in ED specialist treatment settings. We examined whether 1) PA is assessed by the unit, 2) the units have guidelines for managing excessive PA, 3) the units have staff with higher education and special competence in PA and exercise science, 4) how units regard PA in ED, 5) whether regular PA is integrated in the treatment programs, and 6) how the units rate the role of PA in the treatment of ED compared with other mental disorders.

METHODS

Of the 49 units located in Scandinavia and the United Kingdom, 41 (84%) responded to a questionnaire.

RESULTS

In 28 units (68%) PA was assessed regularly. Excessive PA was considered a harmful symptom in ED, and most units reported guidelines to manage excessive PA. Thirty-two units included PA in their treatment programmes. Clinicians found PA most relevant in the treatment of obesity and, except for binge eating, less for ED.

CONCLUSION

PA was more commonly integrated in treatment compared to previous studies. Future research should address how to manage excessive PA, and the potential beneficial role of PA in the treatment of ED.

Predicting transitory mood from physical activity level among people with severe mental illness in two cultures

BACKGROUND

Previous studies have indicated that physical activity (PA) is positively related to health-related quality of life and well-being among people with severe mental illness (SMI). Physical activity is broadly defined in this research as any skeletal muscle movement resulting in energy expenditure, including common daily activities such as housework and gardening, as well as walking for transportation and formal exercise. Although the physical health benefits of PA are well documented, evidence suggests that PA provides psychological benefits as well.

AIMS

The purpose of this study was to identify if PA level was associated with transitory mood in the everyday lives of people with SMI across two cultures.

METHODS

Subjects were drawn through mental health centres in Serbia (n = 12) and the USA (n = 11). Data were collected using both experience sampling methodology and accelerometry. Data were analyzed using hierarchical linear modelling.

RESULTS

Subjects demonstrated low levels of PA, which did not differ significantly between groups. Hierarchical analysis indicated that PA remained significantly positively associated with mood after accounting for individual variation, and this was consistent across groups.

CONCLUSIONS

This study reinforces previous findings that people with SMI demonstrate low PA levels generally. It also supports the consideration of physical activity interventions as a regular part of psychiatric rehabilitation. It appears that increased PA may have the potential to affect both physical health and mood among people with SMI.

Evaluation of physical activity habits in patients with posttraumatic stress disorder

OBJECTIVE

In this study, we present data from a survey that aimed to assess the physical activity habits of adult Brazilian patients with Posttraumatic Stress Disorder.

METHOD

Fifty male and female patients with Posttraumatic Stress Disorder participated in this study. The mean age at onset was 37+/-12 years, and the mean time between diagnosis and follow-up was 3.6+/-4.2 years.

RESULTS

Substantial changes in physical activity habits were observed following the onset of PTSD. While more than half of the patients participated in physical activities prior to Posttraumatic Stress Disorder onset, there was a significant reduction in their participation afterwards. The justifications for stopping physical activities or sport participation were lack of time and lack of motivation.

DISCUSSION

Several studies have shown that physical exercise decreases reverts symptoms of psychiatric disorders such as depression, anxiety and social isolation. We could therefore hypothesize that patients with Posttraumatic Stress Disorder who exercise should experience the same benefits.

CONCLUSION

Our findings demonstrated that patients with Posttraumatic Stress Disorder have low levels of participation in sports or physical activities.

Perspectives of mental health professionals and patients on self-injury in psychiatry: a literature review

Professionals in psychiatry often encounter patients who injure themselves. To explore the perspectives of mental health professionals and patients on self-injurious behavior and treatment, the authors carried out a literature review. The reviewers found little documented data that elucidated or discussed any shared understanding about self-injurious behavior between patients and professionals or between professionals themselves. Many of the problems experienced in relation to self-injury may be due to this lack of a common view. There were few evidence-based strategies for managing self-injury that received any attention in the literature. Future studies should focus on the development and testing of preventative interventions, putting particular emphasis on effective communication between professionals and patients.

Gender, mental health service use and objectively measured physical activity: Data from the National Health and Nutrition Examination Survey (NHANES 2003-2004)

OBJECTIVE: To examine the relationship between physical activity levels measured objectively by accelerometry and the use of mental health services (MHS) in a representative sample of males and females. METHOD: NHANES 2003-2004 is a cross-sectional study of the civilian, non-institutionalized US adult population. Participants reported whether or not they had seen a mental health professional during the past 12 months. Three measures of daily physical activity (light minutes, moderate-vigorous minutes, and total activity counts) and sedentary minutes were determined by accelerometry. The relationship between physical activity and use of MHS was modeled with and without adjustments for potential socioeconomic and health confounders. RESULTS: Of the 1846 males and 1963 females included in this analysis, 7 and 8% reported seeing mental health professionals during the past 12 months, respectively. Men who used MHS were significantly less active than men who did not use MHS (227,700 versus 276,900 total activity counts, respectively, p < 0.05). Men who did not use MHS engaged in 38 min (95% CI 16.3, 59.0) more of light or moderate-vigorous physical activity per day than men who used MHS. Physical activity levels of women, regardless of MHS use, were significantly lower than men who did not use MHS. Differences in total physical activity between women who did and did not use MHS were small (1.3, 95% CI - 14.0, 11.4). CONCLUSION: Men and women who used MHS were relatively sedentary. Additional research is warranted to determine if increasing physical activity levels results in improved mental health in individuals who use MHS.

O exercício físico no tratamento da depressão em idosos: revisão sistemática

OBJETIVOS: Revisar a literatura quanto (I) ao possível efeito protetor do exercício físico sobre a incidência de depressão e (II) à eficácia do exercício físico como intervenção no tratamento da depressão. MÉTODO: Revisão sistemática de artigos em inglês e português nas bases ISI, PubMed, SciELO e LILACS de janeiro de 1993 a maio de 2006, utilizando conjuntamente os termos "depressão", "idosos" e "exercício". Artigos que avaliaram o efeito do exercício em idosos com doenças clínicas ou que utilizaram escalas para depressão somente para um diagnóstico inicial foram excluídos. RESULTADOS: Do total de 155 artigos, 22 atenderam aos critérios de inclusão, e oito foram acrescentados com busca manual. Os artigos de corte transversal (n = 8) utilizaram somente questionários de auto-avaliação para medir os níveis de atividade física. Os artigos longitudinais (n = 22) utilizaram também pedômetro digital, consumo direto de oxigênio e o exercício físico como intervenção metodológica. Os estudos que atenderam ao objetivo I apontaram para uma relação inversamente proporcional entre atividade física e alterações nos níveis de depressão. Os trabalhos que utilizaram o exercício como intervenção terapêutica na depressão encontraram resultados divergentes e apontaram para a interferência de fatores fisiológicos e psicológicos nessa relação. CONCLUSÃO: O papel do exercício e da atividade física no tratamento da depressão direciona-se para duas vertentes: a depressão promove redução da prática de atividades físicas; a atividade física pode ser um coadjuvante na prevenção e no tratamento da depressão no idoso.

Body Composition and Cardiorespiratory Fitness among Refugee Somali Women Living in New Zealand

The purpose of this study was to compare the body composition and cardiorespiratory fitness levels of a sample of refugee Somali women living in New Zealand with normative data. Refugee Somali women were invited to participate in sessions to assess physical fitness and body measurements. Height, bodyweight and waist and hip circumference were measured. The Rockport Fitness Walk Test was used to estimate the women's cardiorespiratory fitness levels. Thirty-one women between 12 and 66 years old participated in this study. There was a significantly greater proportion (71.4%) of participants with a BMI in the overweight or obese range (>or=25 kg/m2) compared to normative New Zealand women's data (49.3%; p = 0.015). The proportion of Somali women (42%) with a waist-to-hip ratio in excess of 0.8 was higher than that of New Zealand women (35.6%), but not statistically so. All women over 30 years of age (n = 12) had an estimated VO2max below the 50th percentile with eight participants below the 10th percentile. The extent of overweight and obesity and low fitness levels, particularly among the older Somali women in this study, suggests that Somali women are at increased risk of developing lifestyle related diseases.

Medical co-morbidity risk factors and barriers to care for people with schizophrenia

The management of risk is a fundamental component of the work of mental health nurses and is most commonly associated with aggressive, violent and suicidal behaviours exhibited by those suffering from mental illness. However, people with severe mental illness are increasingly at risk of experiencing a number of related and complex health problems that include obesity, diabetes and cardiovascular disease. This group also has much higher rates of morbidity and mortality than that of the general population resulting in high social, economic and individual costs. Some of the barriers to receiving prompt and appropriate physical health care include lack of recognition by health professionals and the difficulties faced by consumers of mental health services in negotiating the health care system. Establishment of comprehensive (addressing both physical and mental health issues) programmes of care can address this need and offer additional opportunities for closer and more collaborative nurse-patient relationships. This paper explores risk factors for medical co-morbidity for people living with schizophrenia and suggests strategies that can facilitate better health outcomes.

Cigarette smoking and overweight/obesity among individuals with serious mental illnesses: a preventive perspective

BACKGROUND

Cigarette smoking and lifestyle factors underlying overweight/obesity (such as unhealthy diet and physical inactivity) appear to play a major role in the excess medical morbidity and mortality among persons with serious mental illnesses. The literature on the prevalence, etiology, prevention, and treatment of these two risk factors, in the context of serious mental illnesses, are reviewed following a preventive approach.

METHODS

The review relied upon searches of the MEDLINE database, from 1996 through April 2006, restricted to the English language. Original research, review articles, and clinical guidelines relevant to the topics of cigarette smoking, unhealthy diet, physical inactivity, and overweight/obesity among individuals with serious mental illnesses were identified.

RESULTS

Compared to those without a mental illness, individuals with a current mental illness are more than twice as likely to smoke cigarettes and more than 50% more likely to be overweight/obese, presumably the product of unhealthy diet and physical inactivity. Various biological, iatrogenic, and social factors place psychiatric patients at risk for these and other adverse health behaviors. Studies suggest that many of the same preventive approaches developed for general medical populations are likely to be effective in persons with serious mental disorders, though specialized approaches also are needed. Domains of prevention include primary prevention (population-based strategies to reduce the incidence of these adverse health behaviors), secondary prevention (early detection and treatment), and tertiary prevention (pharmacological and psychosocial treatments to reduce the burden of illness among those with the behaviors in question). However, mental health clinicians commonly lack the training or expertise to provide these services.

CONCLUSIONS

The high prevalence, adverse effects, and efficaciousness of treatments for smoking and obesity in persons with serious mental illnesses suggest the importance of addressing these problems in this population. Both further research and dissemination efforts are needed to ensure that patients with serious mental illnesses receive the appropriate preventive and clinical services for these two adverse health conditions.

Comparison of changes in physical self-concept, global self-esteem, depression and anxiety following two different psychomotor therapy programs in nonpsychotic psychiatric inpatients

BACKGROUND

The first objective of this study was to compare the changes in physical self-concept, global self-esteem, depression and anxiety after participation in one of two 16-week psychomotor therapy programs for nonpsychotic psychiatric inpatients. The second objective was to study the relationship between changes in these variables.

METHODS

One hundred and ninety-nine inpatients were randomly assigned to either a personalized psychomotor fitness program, consisting of aerobic exercise and weight training, or a general program of psychomotor therapy, consisting of different forms of physical exercises and relaxation training. Physical self-concept was evaluated using the Dutch version of the Physical Self-Perception Profile at baseline, after 8 weeks, and after completion of the 16-week interventions. At the same time points, additional variables of global self-esteem, depression and anxiety were assessed by means of the Rosenberg Self-Esteem Inventory, the Beck Depression Inventory and the Trait Anxiety Inventory, respectively.

RESULTS

After 16 weeks, both groups showed significant improvements in all outcome measures (p values ranged from 0.01 to < 0.0001), with no between-group differences. In both groups, the improvement in physical self-concept was correlated with increased global self-esteem and decreased depression and anxiety levels (p < 0.01).

CONCLUSIONS

The results suggest that both psychomotor therapy programs are equally effective in enhancing physical self-concept. The relationship between improvements in physical self-concept and enhancements in global self-esteem, depression and anxiety supports the potential role of the physical self-concept in the recovery process of depressed and anxious psychiatric inpatients.

Exercise and Its Effects on the Central Nervous System

Exercise can have profound effects on numerous biologic systems within the human body, including the central nervous system (CNS). The inherent complexity of the CNS, and the methodologic difficulties in evaluating its in vivo neurochemistry in humans, provide challenges to investigators studying the impact of exercise on the CNS. As a result, our knowledge in this area of exercise science remains relatively limited. However, advances in research technology are allowing investigators to gain valuable insight into the neurobiologic mechanisms that contribute to the bidirectional communication that occurs between the periphery and the CNS during exercise. This article examines how exercise-induced alterations in the CNS contribute to central fatigue and the overtraining syndrome, and how exercise can influence psychologic wellbeing and cognitive function.

A study of a structured exercise program with members of an ICCD Certified Clubhouse: program design, benefits, and implications for feasibility

Individuals with serious mental illness (SMI) have significantly greater risk of comorbid health problems and premature death, and there is need for interventions that can improve physical fitness and overall health. Accordingly, a study was conducted which evaluated the effectiveness of a structured physical exercise program that was developed as part of a wellness project in an ICCD Certified Clubhouse. Seventeen clubhouse members completed a 16-week program with evidence of significant improvement in aerobic capacity and perceived mental health as well as positive trends in perceived improvements in physical and social functioning. Qualitative data indicated satisfaction with the program by all participants, especially the value of group support, while also highlighting the need for greater attention to nutrition as part of a future program. Moreover, the study found that a structured exercise program can be successfully provided to members of an ICCD Certified Clubhouse.

The effects of short- vs. long-bout exercise on mood, VO2max, and percent body fat

BACKGROUND

To compare the ACSM-CDC physical activity accumulation recommendation to the traditional recommendation, for impact on mood and physiological markers of fitness.

METHODS

Randomized controlled trial with sedentary male (n = 21) and female (n = 19) subjects assigned to walk either long bouts (LB; 30 min/day), short bouts (SB; 3 x 10 min/day), or a nonexercise control (CTL) group for 8 weeks. Pre- and post-measures were collected for V02max and percent body fat. Pre-, mid-, and post-measures were collected for the Profile of Mood States (POMS).

RESULTS

VO2max increased in the SB group (+7.2%) and LB (+6.7%; P < or = 0.05). Percent body fat decreased in the LB group (-6.7%; P < or = 0.05). Total mood disturbance (TMD) decreased in the LB and SB groups (P < or = 0.05); only the LB group showed reductions compared to the CTL group (P < or = 0.05). Tension-anxiety and vigor-activity were altered in the LB group compared to the other two groups (P < or = 0.05). Reductions in percent body fat correlated with TMD (r = 0.38; P < or = 0.05) and Tension-anxiety reduction (r = 0.40; P < or = 0.05).

CONCLUSIONS

LB and SB walking produced similar and significant improvements in VO2max LB walking was more effective at reducing percent body fat, tension-anxiety and total mood disturbance, and increasing vigor compared to the control group.

Evaluation of cardio-respiratory fitness and perceived exertion for patients with depressive and anxiety disorders: a study on reliability

PURPOSE

The implementation of a physical reconditioning programme for patients with depressive and/or anxiety disorders requires a thorough evaluation of the physical fitness and the perceived exertion during exercise. This implies the use of reliable and clinically useful instruments. The present study examined the reliability of the Franz ergocycle test, as measure for cardio-respiratory fitness, and the Borg Category Ratio 10 Scale, as measure for subject-perceived exertion.

METHOD

Sixty-eight hospitalized patients performed test and re-test of the Franz ergocycle test and the Borg CR 10 Scale with a between interval of 1 week.

RESULTS

The Physical Work Capacity 130 and the Physical Work Capacity 150, determined by the Franz ergocycle test, had a proper to good test-re-test reliability (r ranged from 0.74 to 0.90). The Borg Category Ratio 10 Scale had a moderate reliability (r ranged from 0.42 to 0.82).

CONCLUSIONS

The Franz ergocycle test seems to be a reasonable reliable instrument for measuring physical work capacity of these patients. Possible explanations for the simply moderate reliability of the Borg Category Ratio 10 Scale could be the low level of physical activity prior to hospitalization, and the depressive and anxiety symptoms that might influence the perceived exertion.

Physical activity programs for refugee Somali women: working out in a new country

Islamic refugee women from non-westernized countries face a number of challenges in adapting to their new country, especially when that new country is westernized and is not Islamic. Refugees are primarily women and children, so it is important that women be in their best health because they usually bear the responsibility of caring for each other and children, often in very difficult situations. Maintaining or obtaining good levels of physical activity contributes to good health: mentally, physically and socially. At the request of women in the local Somali community, a number of initiatives were taken to increase their opportunities for physical activity. Through interviews, observations and conversations we explored barriers to fitness and exercise, the social, physical, and cultural effects of physical activity, and solutions to facilitate Somali women's access to fitness and exercise opportunities. Physical activity interventions included exercise classes in a community center used by the Somali community, trial memberships at a local women-only fitness center, and walking and sports groups. We discuss the procedural issues relating to setting-up these physical activity opportunities, the results of interviews with 37 of the women about their health and perceptions and issues relating to the physical activity options, and our recommendations for setting up similar classes with other Somali or Islamic communities.

Increase in Serum S100B Protein Level After a Swimming Race

Physical activity has been shown to be a beneficial stimulus to the central and peripheral nervous systems. The S100B is a cytokine physiologically produced and released predominantly by astrocytes on the central nervous system (CNS). In order to study the possible influence of a nonimpact exercise on S100B serum levels, we measured this protein serum level after a 7,600-meter swimming race. We observed an increase in S100B levels in athletes post-race compared with their baseline values, pointing to a potential acute influence of physical exercise on serum S100B levels not related with CNS injury. We discuss this result and emphasize the possible central and peripheral origins of S100B serum levels. Key words: exercise, serotonin, astrocytes