Attending to Timely Contingencies: Promoting Physical Activity Uptake Among Adults with Serious Mental Illness with an Exercise-For-Mood vs. an Exercise-For-Fitness Prescription

Lessons and Untapped Potential of Smartphone-Based Physical Activity Interventions for Mental Health: Narrative Review

BACKGROUND

Physical activity has well-known and broad health benefits, including antidepressive and anxiolytic effects. However, only approximately half of Americans meet even the minimum exercise recommendations. Individuals with anxiety, depression, or related conditions are even less likely to do so. With the advent of mobile sensors and phones, experts have quickly noted the utility of technology for the enhanced measurement of and intervention for physical activity. In addition to being more accessible than in-person approaches, technology-driven interventions may uniquely engage key mechanisms of behavior change such as self-awareness.

OBJECTIVE

This study aims to provide a narrative overview and specific recommendations for future research on smartphone-based physical activity interventions for psychological disorders or concerns.

METHODS

In this paper, we summarized early efforts to adapt and test smartphone-based or smartphone-supported physical activity interventions for mental health. The included articles described or reported smartphone-delivered or smartphone-supported interventions intended to increase physical activity or reduce sedentary behavior and included an emotional disorder, concern, or symptom as an outcome measure. We attempted to extract details regarding the intervention designs, trial designs, study populations, outcome measures, and inclusion of adaptations specifically for mental health. In taking a narrative lens, we drew attention to the type of work that has been done and used these exemplars to discuss key directions to build on.

RESULTS

To date, most studies have examined mental health outcomes as secondary or exploratory variables largely in the context of managing medical concerns (eg, cancer and diabetes). Few trials have recruited psychiatric populations or explicitly aimed to target psychiatric concerns. Consequently, although there are encouraging signals that smartphone-based physical activity interventions could be feasible, acceptable, and efficacious for individuals with mental illnesses, this remains an underexplored area.

CONCLUSIONS

Promising avenues for tailoring validated smartphone-based interventions include adding psychoeducation (eg, the relationship between depression, physical activity, and inactivity), offering psychosocial treatment in parallel (eg, cognitive restructuring), and adding personalized coaching. To conclude, we offer specific recommendations for future research, treatment development, and implementation in this area, which remains open and promising for flexible, highly scalable support.

Predictors of Long-Term Exercise Engagement in Patients With Obsessive-Compulsive Disorder: The Role of Physical Activity Enjoyment

Most U.S. adults, even more so those with psychiatric conditions like obsessive-compulsive disorder (OCD), do not engage in the recommended amount of physical activity (PA), despite the wide array of physical and mental health benefits associated with exercise. Therefore, it is essential to identify mechanistic factors that drive long-term exercise engagement so they can be targeted. Using the science of behavior change (SOBC) framework, this study examined potential predictors of long-term exercise engagement as a first step towards identifying modifiable mechanisms, in individuals with OCD, such as PA enjoyment, positive or negative affect, and behavioral activation. Fifty-six low-active patients (mean age = 38.8 ± 13.0, 64% female) with a primary diagnosis of OCD were randomized to either aerobic exercise (AE; n = 28) or health education (HE; n = 28), and completed measures of exercise engagement, PA enjoyment, behavioral activation, and positive and negative affect at baseline, postintervention, and 3-, 6-, and 12-month follow-up. Significant predictors of long-term exercise engagement up to 6-months postintervention were baseline PA (Estimate = 0.29, 95%CI [0.09, 0.49], p = .005) and higher baseline PA enjoyment (Estimate = 1.09, 95%CI [0.30, 1.89], p = .008). Change in PA enjoyment from baseline to postintervention was greater in AE vs. HE, t(44) = -2.06, p = .046, d = -0.61, but endpoint PA enjoyment did not predict follow-up exercise engagement above and beyond baseline PA enjoyment. Other hypothesized potential mechanisms (baseline affect or behavioral activation) did not significantly predict exercise engagement. Results suggest that PA enjoyment may be an important modifiable target mechanism for intervention, even prior to a formal exercise intervention. Next steps aligned with the SOBC framework are discussed, including examining intervention strategies to target PA enjoyment, particularly among individuals with OCD or other psychiatric conditions, who may benefit most from long-term exercise engagement's effects on physical and mental health.

A narrative review of exercise and obsessive-compulsive disorder

OBJECTIVE

Individuals with obsessive-compulsive disorder (OCD) suffer significant distress due to their condition; however, there can be multiple barriers to treatment. Even following OCD-tailored treatment, symptoms often remain. Exercise may be an effective and available approach to managing OCD, and yet, there are no specifically dedicated reviews, limiting integration into clinical practice. This study aimed to provide an overview of the literature on exercise and OCD.

METHOD

Four databases, the Cochrane Central Register of Controlled Trials, MEDLINE, PsycINFO, and EMBASE, were systematically searched. 1534 records were screened and the reference lists of eligible articles were examined. For this review, 11 extracted studies were narratively explored.

RESULTS

Two observational and nine interventional studies were included, of which one article focused on youth and ten studies focused on adults. Physical activity likely reduces the risk of metabolic syndrome or general health conditions. Several pre-post studies demonstrated exercise's benefits for OCD symptoms, while the only randomized controlled trial showed negative findings for its efficacy in reducing obsessions and compulsions.

CONCLUSIONS

The evidence for aerobic exercise's long-term benefits for the symptoms of OCD is mixed, but remains promising. Potential mechanisms of exercise's effects and future directions for research are explored.

Physical activity in a pandemic: A new treatment target for psychological therapy

The COVID-19 pandemic and its management are placing significant new strains on people's well-being, particularly those with pre-existing mental health conditions. Physical activity has been shown to improve mental as well as physical health. Increasing activity levels should be prioritized as a treatment target, especially when the barriers to exercise are greater than ever. Promoting physical activity has not traditionally been the remit of psychologists. Yet psychological theory and therapeutic techniques can be readily applied to address physical inactivity. We present theoretical perspectives and therapy techniques relating to (1) beliefs about physical activity, (2) motivation to be physically active, and (3) the sense of reward achieved through being physically active. We outline strategies to initiate and maintain physical activity during the COVID-19 pandemic, thereby benefitting mental and physical health. COVID-19 is demanding rapid and substantial change across the whole health care system. Psychological therapists can respond creatively by addressing physical activity, a treatable clinical target which delivers both mental and physical health benefits. PRACTITIONER POINTS: Physical activity is essential for our mental and physical health. Yet COVID-19 presents novel barriers to physical activity. Psychological theory and techniques to address beliefs, motivation, and reward can be applied to increase physical activity during COVID-19. Physical activity is an important clinical target to sustain and improve mental health, especially in the current pandemic.

COVID-19 quarantine: Two-way interaction between physical activity and mental health

Recent studies have revealed that physical activity significantly reduces the risk of coronavirus disease 2019 (COVID-19) infection by strengthening the immune system. Also, regular physical activity can reduce the risks of developing physical and mental health problems such as diabetes, hypertension, coronary heart disease, stress, anxiety, depression, etc. However, the two-way interaction between physical activity and psychological symptoms has not been well addressed yet. This paper is intended to examine various dimensions of this interaction and its effects on mental health at the time of COVID-19 quarantine.

Combined intervention approaches for initiating and maintaining physical activity in depressed individuals: design and rationale of the Project MOVE randomized clinical trial

INTRODUCTION

Regular engagement in physical activity decreases risks for many chronic conditions, and may also improve depression symptoms. However, rates of physical activity and adherence to exercise interventions remain low among depressed individuals relative to non-depressed individuals.

METHODS

This is a study protocol for Project MOVE. This study is a theoretically-driven, 3-arm randomized controlled trial for increasing physical activity with depressed adults. Each successive arm includes an added component that may serve to increase and maintain physical activity. The arms are: 1) Brief advice (BA) to exercise alone (minimal treatment control condition); 2) BA + supervised and home-based exercise (SHE) + health education (HE; serves as contact control for CBEX); and 3) BA + SHE +cognitive-behavioral sessions focused on increasing and maintaining exercise (CBEX). The target sample size is 240. Assessments are conducted at baseline, Month 1.5, end of intervention (month 3), and at 6 and 9 months. The primary outcome is minutes of moderate-to-vigorous physical activity, assessed via an accelerometer. Secondary outcomes include cardiorespiratory fitness, body composition, and depression, and maintenance of moderate-vigorous physical activity through 6 and 9 month follow-ups. Mediators and moderators derived from behavior change theories, including the Health Behavior Model, Self-Determination Theory, and Social Ecological Theory, will be examined.

CONCLUSION

Project MOVE is designed to test primarily whether both a structured exercise program (SHE) and a cognitive-behavioral group (CBEX) increase physical activity in depressed adults during both a 3-month intervention period, and during the 6-months that follow.

Physical fitness and levels of physical activity in people with severe mental illness: a cross-sectional study

Background

Physical fitness is a crucial variable in people with severe mental illness as these people could be more independent and improve their job opportunities. The present study compared the physical fitness of physically active and inactive people with severe mental illness.

Methods

Physical fitness was evaluated in sixty-two people with severe mental illness using 11 physical tests that include strength, flexibility, balance and aerobic condition. Significant differences were found between both groups in muscle strength (handgrip test) and balance (single leg balance test and functional reach) with better performance in the group of physically active people.

Results

The results of the present study suggest that physical fitness (strength and balance) is higher in people with severe mental illness who practise regular physical activity that those who are inactive people.

Conclusions

Physical active people may have a reduced risk of falls and fractures due to their higher levels of physical fitness.