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Vijayalakshmi U, Padmavati R, Raghavan V, Chandrasekaran S, Mohan G, Durairaj J, Currie G, Lilford R, Furtado V, Madan J, Birchwood M, Meyer C, Sood M, Chadda R, Mohan M, Shah J, John S, Iyer SN, Thara R, Singh S. Designing and implementing a physical exercise intervention for people with first episode psychosis using experience-based co-design: A pilot study from Chennai, India. Asian J Psychiatr 2024; 97:104072. [PMID: 38815437 DOI: 10.1016/j.ajp.2024.104072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 05/09/2024] [Accepted: 05/11/2024] [Indexed: 06/01/2024]
Abstract
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.
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Affiliation(s)
- U Vijayalakshmi
- Schizophrenia Research Foundation, R/7A, North Main Road, Anna Nagar West Extension, Chennai, India
| | - R Padmavati
- Schizophrenia Research Foundation, R/7A, North Main Road, Anna Nagar West Extension, Chennai, India.
| | - Vijaya Raghavan
- Schizophrenia Research Foundation, R/7A, North Main Road, Anna Nagar West Extension, Chennai, India
| | - Sangeetha Chandrasekaran
- Schizophrenia Research Foundation, R/7A, North Main Road, Anna Nagar West Extension, Chennai, India
| | - Greeshma Mohan
- Schizophrenia Research Foundation, R/7A, North Main Road, Anna Nagar West Extension, Chennai, India
| | - Jothilakshmi Durairaj
- Schizophrenia Research Foundation, R/7A, North Main Road, Anna Nagar West Extension, Chennai, India
| | - Graeme Currie
- Warwick Business School, University of Warwick, Coventry, UK
| | - Richard Lilford
- Institution of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Vivek Furtado
- Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
| | - Jason Madan
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Maximilian Birchwood
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Caroline Meyer
- WMG and Warwick Medical School, University of Warwick, Coventry, UK
| | - Mamta Sood
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Chadda
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Mohapradeep Mohan
- Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
| | - Jai Shah
- Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute; Montreal, Canada; Department of Psychiatry, McGill University, Montreal, Canada
| | - Sujit John
- Schizophrenia Research Foundation, R/7A, North Main Road, Anna Nagar West Extension, Chennai, India
| | - Srividya N Iyer
- Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute; Montreal, Canada; Department of Psychiatry, McGill University, Montreal, Canada
| | - R Thara
- Schizophrenia Research Foundation, R/7A, North Main Road, Anna Nagar West Extension, Chennai, India
| | - Swaran Singh
- Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK; Conventry and Warwickshire Partnership Trust, Coventry, UK
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Marais BS. South African mental healthcare providers' views about exercise for people with mental illness. S Afr J Psychiatr 2024; 30:2227. [PMID: 38726326 PMCID: PMC11079334 DOI: 10.4102/sajpsychiatry.v30i0.2227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 03/18/2024] [Indexed: 05/12/2024] Open
Abstract
Background People living with mental illness (PWMI) have significantly reduced life expectancy compared to the general population, yet mental healthcare providers (MHCPs) do not regularly prescribe exercise, despite its proven health benefits. Aim This study aimed to evaluate South African MHCPs' views regarding exercise for PWMI. Setting A cross-sectional descriptive study conducted across five public sector specialised psychiatric units in Gauteng. Methods Mental healthcare providers were surveyed using the Exercise in Mental Illness Questionnaire - Health Professionals Version. Results Most participants were nurses (49.1%) and doctors (26.2%) and reported no prior formal training in exercise prescription (79.4%). The vast majority (up to 89.7%) agreed regarding the physical benefits of exercise, particularly cardiometabolic benefits. The most common barriers, as perceived by MHCPs, to exercise participation for PWMI were: stigma (56.5%) and medication side effects (56.5%). The majority (76.2%) reported prescribing exercise for PWMI at least 'occasionally'. The method most frequently used was personal discussion (77.3%) and aerobic exercise was most frequently recommended (81.0%). Specific instructions regarding physical activity recommendations however were often not provided. Regarding MHCPs personal exercise habits, only a third (34%) met physical activity guidelines. Most MHCPs (92.1%) indicated an interest in further training regarding exercise for PWMI. Conclusion Mental healthcare providers were supportive of exercise for PWMI. Strategies to address the stigma around mental illness and medication side-effects, to improve training regarding exercise prescription, as well as the exercise habits of MHCPs themselves, and collaboration with exercise professionals and organisations are recommended. Contribution This study provides insight into the views of South African MHCPs regarding exercise for PWMI.
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Affiliation(s)
- Belinda S Marais
- Department of Psychiatry, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Martinez-Calderon J, Villar-Alises O, García-Muñoz C, Pineda-Escobar S, Matias-Soto J. Exercise or mind-body exercises for psychiatry symptoms and quality of life in schizophrenia spectrum and other psychotic disorders: an overview of systematic reviews with meta-analysis. Disabil Rehabil 2024:1-17. [PMID: 38436073 DOI: 10.1080/09638288.2024.2321318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 02/14/2024] [Indexed: 03/05/2024]
Abstract
PURPOSE This overview of systematic reviews with meta-analysis aimed to summarize the effects of exercise, regular physical activity, and mind-body exercises on negative symptoms, depression symptoms, and quality of life in schizophrenia spectrum and other psychotic disorders. MATERIAL AND METHODS The CINAHL, Embase, PubMed, SPORTDiscus, and the Cochrane Library databases were searched up to November 10, 2023. AMSTAR 2 was used and the overlap between reviews was calculated. RESULTS Eighteen reviews were included. No reviews meta-analyzed regular physical activity. Aerobic exercise may be more effective than yoga, treatment-as-usual, or multiple controls for reducing negative symptoms. Tai chi may be more effective than multiple controls for decreasing negative symptoms. Aerobic exercise or multimodal exercise programs may be more effective than multiple controls for reducing depression symptoms. Yoga may be more effective than waitlist for decreasing depression symptoms. Aerobic exercise may be more effective than multiple controls for improving quality of life. Yoga may be more effective than treatment-as-usual for improving quality of life. The rest of the meta-analyses found no differences between groups or combined different types of interventions in their meta-analyses. CONCLUSIONS Despite these results, important methodological concerns were detected that precluded us from making sound clinical recommendations. PROTOCOL REGISTRATION https://doi.org/10.17605/OSF.IO/7V5QZ.
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Affiliation(s)
- Javier Martinez-Calderon
- Instituto de Biomedicina de Sevilla, IBiS, Departamento de Fisioterapia, Universidad de Sevilla, Sevilla, Spain
- CTS 1110: Understanding Movement and Self in health from Science (UMSS) Research Group, Andalusia, Spain
| | - Olga Villar-Alises
- CTS 1110: Understanding Movement and Self in health from Science (UMSS) Research Group, Andalusia, Spain
- Department of Physiotherapy, Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, Seville, Spain
| | - Cristina García-Muñoz
- CTS 1110: Understanding Movement and Self in health from Science (UMSS) Research Group, Andalusia, Spain
- Departamento de Ciencias de la Salud y Biomédicas, Universidad Loyola de Andalucía, Sevilla, Spain
| | - Saul Pineda-Escobar
- CTS 1110: Understanding Movement and Self in health from Science (UMSS) Research Group, Andalusia, Spain
- Department of Physiotherapy, Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, Seville, Spain
| | - Javier Matias-Soto
- CTS 1110: Understanding Movement and Self in health from Science (UMSS) Research Group, Andalusia, Spain
- Faculty of Health Sciences, Department of Physical Therapy, Universidad de Malaga, Malaga, Spain
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Schmitt A, Maurus I, Falkai P. Treatment of negative symptoms in schizophrenia: a challenge for clinical research. Eur Arch Psychiatry Clin Neurosci 2023; 273:525-526. [PMID: 36977788 PMCID: PMC10085889 DOI: 10.1007/s00406-023-01595-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Affiliation(s)
- Andrea Schmitt
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstrasse 7, 80336, Munich, Germany.
- Laboratory of Neuroscience (LIM27), Institute of Psychiatry, University of Sao Paulo, São Paulo, Brazil.
| | - Isabel Maurus
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstrasse 7, 80336, Munich, Germany
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstrasse 7, 80336, Munich, Germany
- Max Planck Institute of Psychiatry, Munich, Germany
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Kim M, Lee Y, Kang H. Effects of Exercise on Positive Symptoms, Negative Symptoms, and Depression in Patients with Schizophrenia: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3719. [PMID: 36834415 PMCID: PMC9967614 DOI: 10.3390/ijerph20043719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 02/16/2023] [Accepted: 02/17/2023] [Indexed: 06/18/2023]
Abstract
This study was performed to evaluate the effects of exercise on positive and negative symptoms and depression in patients with schizophrenia through a systematic review and meta-analysis focusing on randomized controlled trials (RCTs). PubMed, Embase, CINAHL, MEDLINE, Cochrane Library, PsycINFO, and Web of Science were searched from their inception to 31 October 2022. We also conducted a manual search using Google Scholar. This meta-analysis was conducted according to the PRISMA guidelines. The methodological quality of the studies was assessed using the Cochrane risk-of-bias tool for randomized trials. To identify the cause of heterogeneity, subgroup analysis, meta-ANOVA, and meta-regression analyses were performed as moderator analyses. Fifteen studies were included. The meta-analysis (random-effects model) for overall exercise showed a medium significant effect (standardized mean difference [SMD] = -0.51, 95% confidence interval [CI]: -0.72 to -0.31) on negative symptoms, a small significant effect (SMD = -0.24, 95% CI: -0.43 to -0.04) on positive symptoms, and a nonsignificant effect (SMD = -0.87, 95% CI: -1.84 to 0.10) on depression. Our findings demonstrate that exercise can relieve the negative and positive symptoms of schizophrenia. However, the quality of some included studies was low, limiting our results for clear recommendations.
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Affiliation(s)
| | | | - Hyunju Kang
- College of Nursing, Kangwon National University, Chuncheon-si 24341, Republic of Korea
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