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Andersen MF, Roed K, Sørensen V, Riis A, Rafn BS, Ebdrup BH, Midtgaard J. Required elements for an educational programme for lay exercise instructors in charge of community-based exercise targeting young adults with schizophrenia spectrum disorders - A stakeholder focus group study. BMC Psychiatry 2024; 24:228. [PMID: 38532355 PMCID: PMC10967036 DOI: 10.1186/s12888-024-05648-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 02/28/2024] [Indexed: 03/28/2024] Open
Abstract
BACKGROUND Exercise plays a crucial role in addressing the increased cardiometabolic morbidity and premature mortality in people with schizophrenia spectrum disorders. When delivered in community-based settings, exercise may also reduce loneliness, while promoting overall physical activity behaviours. Skilled instructors are essential to deliver effective community-based exercise; however, knowledge about their roles and required training is lacking. We aim to explore various stakeholders' perspectives regarding lay exercise instructors' roles, and the required elements in an educational programme supporting the delivery of community-based exercise for young adults with SSD. METHODS We used semi-structured homogeneous focus groups with representatives from different stakeholder groups (i.e., including representatives of clinical staff within mental health, physiotherapists, exercise instructors, young adults with schizophrenia spectrum disorders, and relatives of individuals with schizophrenia spectrum disorders) targeted or affected by a community-based exercise intervention. Data were analysed using qualitative content analysis. RESULTS We conducted six focus groups comprising a total of 30 individuals representing five different stakeholder groups The analysis identified three categories: (i) awareness and understanding of mental illness, i.e., providing basic knowledge to dispel common myths and stigma regarding mental illness (ii) protecting youth identity, i.e., supporting the feeling of being more than just a patient, and (iii) promoting exercise as a shared activity, i.e., a communal pursuit, fostering personal growth among participants, their peers and the instructors. CONCLUSIONS An educational programme for lay exercise instructors delivering community-based exercise targeting young adults with SSD should empower the instructors to assume the role of guardians of an inclusive exercise culture. Educational elements identified were adapted and integrated into an educational programme implemented and evaluated as a part of the Vega trial. Our results may be transferable to the education of lay workers in mental health care where the aim is to facilitate sustainable, recreational, community-based activities.
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Affiliation(s)
- Martin Færch Andersen
- Centre for Applied Research in Mental Health Care (CARMEN), Mental Health Centre Glostrup, University of Copenhagen, Copenhagen, Denmark.
- Department of Physiotherapy, University College of Northern Denmark, Aalborg, Denmark.
| | - Kickan Roed
- Centre for Applied Research in Mental Health Care (CARMEN), Mental Health Centre Glostrup, University of Copenhagen, Copenhagen, Denmark
| | - Victor Sørensen
- Centre for Applied Research in Mental Health Care (CARMEN), Mental Health Centre Glostrup, University of Copenhagen, Copenhagen, Denmark
| | - Allan Riis
- Department of Physiotherapy, University College of Northern Denmark, Aalborg, Denmark
- Center for General Practice, Aalborg University, Aalborg, Denmark
| | - Bolette Skjødt Rafn
- Centre for Applied Research in Mental Health Care (CARMEN), Mental Health Centre Glostrup, University of Copenhagen, Copenhagen, Denmark
- Late Effects Research Center (CASTLE), Department of Oncology, Danish Cancer Society National Cancer Survivorship, Copenhagen University Hospital- Rigshospitalet, Copenhagen, Denmark
| | - Bjørn Hylsebeck Ebdrup
- Center for Neuropsychiatric Schizophrenia Research (CNSR), Mental Health Centre Glostrup, University of Copenhagen, Glostrup, Denmark
- Faculty of Health and Medical Science, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Julie Midtgaard
- Centre for Applied Research in Mental Health Care (CARMEN), Mental Health Centre Glostrup, University of Copenhagen, Copenhagen, Denmark
- Faculty of Health and Medical Science, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Pfledderer CD, Ranjit N, Pérez A, Malkani RI, Ferreira De Moraes AC, Hunt ET, Smith CL, Hoelscher DM. Using the Nutrition Facts Label to Make Food Choices Is Associated with Healthier Eating among 8th and 11th-Grade Students: An Analysis of Statewide Representative Data from the 2019-2020 Texas School Physical Activity and Nutrition Survey. Nutrients 2024; 16:311. [PMID: 38276549 PMCID: PMC10819117 DOI: 10.3390/nu16020311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 01/12/2024] [Accepted: 01/17/2024] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Nutrition labels are a tool to inform and encourage the public to make healthier food choices, but little information is available about use in multi-ethnic adolescent populations in the U.S. The purpose of this study was to examine associations between the level of nutrition label usage and healthy/unhealthy eating behaviors among a statewide representative sample of 8th and 11th-grade students in Texas. METHODS We analyzed cross-sectional associations between the Nutrition Facts label use and eating behaviors from a statewide sample of 8th and 11th-grade students in Texas, (n = 4730, weighted n = 710,731, mean age = 14.7 ± 1.6 years; 49% female, 51% Hispanic), who completed the 2019-2020 Texas School Physical Activity and Nutrition (TX SPAN) survey. Students self-reported their level of nutrition label usage to make food choices (5-point Likert scale from "Never" to "Always") and previous day consumption of 26 food items (13 healthy, 13 unhealthy). The 26 food items were used to calculate a Healthy Eating Index (HEI) score (0-100), a Healthy Foods Index (HFI) score (0-100), and an Unhealthy Foods Index (UFI) score (0-100). Weighted linear regression models were employed to examine the associations between self-reported use of nutrition labels to make food choices and HEI, HFI, and UFI scores. Marginal predicted means of HEI, HFI, and UFI scores were calculated post hoc from linear regression models. The odds of consuming specific individual food items for nutrition label usage were also calculated from weighted logistic regression models. All linear and logistic regression models were adjusted for grade, sex, Body Mass Index (BMI), race/ethnicity, economic disadvantage, and percentage of English language learners by school. RESULTS A total of 11.0% of students reported always/almost always using nutrition labels to make food choices, 27.9% reported sometimes using them, while 61.0% indicated they never/almost never used nutrition labels to make food choices. The average HEI score among students in the sample was 47.7 ± 5.9. Nutrition Facts label usage was significantly and positively associated with HEI (b = 5.79, 95%CI: 4.45, 7.12) and HFI (b = 7.28, 95%CI:4.48, 10.07), and significantly and negatively associated with UFI (b = -4.30, 95%CI: -6.25, -2.34). A dose-response relationship was observed between nutrition label usage and HEI, HFI, and UFI scores, such that the strength of these associations increased with each one-point increase in nutrition label usage. Students who reported using nutrition labels always/almost always to make food choices had significantly higher odds of consuming healthy foods including baked meat, nuts, brown bread, vegetables, whole fruit, and yogurt (ORrange = 1.31-3.07), and significantly lower odds of consuming unhealthy foods including chips, cake, candy, and soda (ORrange = 0.48-0.68) compared to students who reported never/almost never using the Nutrition Facts label. CONCLUSIONS Using the Nutrition Facts labels to make food choices is beneficially associated with healthy and unhealthy eating among 8th and 11th-grade students, although the proportion of students using nutrition labels to make their food choices was low. Public health efforts should be made to improve nutrition literacy and encourage nutrition label use among secondary students in the United States.
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Affiliation(s)
- Christopher D. Pfledderer
- Department of Health Promotion and Behavioral Sciences, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health in Austin, Austin, TX 78701, USA; (N.R.); (E.T.H.); (D.M.H.)
- Michael & Susan Dell Center for Healthy Living, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health in Austin, Austin, TX 78701, USA; (A.P.); (R.I.M.); (C.L.S.)
| | - Nalini Ranjit
- Department of Health Promotion and Behavioral Sciences, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health in Austin, Austin, TX 78701, USA; (N.R.); (E.T.H.); (D.M.H.)
- Michael & Susan Dell Center for Healthy Living, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health in Austin, Austin, TX 78701, USA; (A.P.); (R.I.M.); (C.L.S.)
| | - Adriana Pérez
- Michael & Susan Dell Center for Healthy Living, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health in Austin, Austin, TX 78701, USA; (A.P.); (R.I.M.); (C.L.S.)
- Department of Biostatistics and Data Science, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health in Austin, Austin, TX 78701, USA
| | - Raja I. Malkani
- Michael & Susan Dell Center for Healthy Living, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health in Austin, Austin, TX 78701, USA; (A.P.); (R.I.M.); (C.L.S.)
| | - Augusto César Ferreira De Moraes
- Department of Epidemiology, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health in Austin, Austin, TX 78701, USA;
| | - Ethan T. Hunt
- Department of Health Promotion and Behavioral Sciences, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health in Austin, Austin, TX 78701, USA; (N.R.); (E.T.H.); (D.M.H.)
- Michael & Susan Dell Center for Healthy Living, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health in Austin, Austin, TX 78701, USA; (A.P.); (R.I.M.); (C.L.S.)
| | - Carolyn L. Smith
- Michael & Susan Dell Center for Healthy Living, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health in Austin, Austin, TX 78701, USA; (A.P.); (R.I.M.); (C.L.S.)
| | - Deanna M. Hoelscher
- Department of Health Promotion and Behavioral Sciences, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health in Austin, Austin, TX 78701, USA; (N.R.); (E.T.H.); (D.M.H.)
- Michael & Susan Dell Center for Healthy Living, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health in Austin, Austin, TX 78701, USA; (A.P.); (R.I.M.); (C.L.S.)
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Andersen MF, Roed K, Riis A, Rafn BS, Ebdrup BH, Midtgaard J. Perspectives of professional experts in relation to the development of community-based exercise for young adults with schizophrenia: a qualitative study. BMJ Open Sport Exerc Med 2023; 9:e001658. [PMID: 37780132 PMCID: PMC10533806 DOI: 10.1136/bmjsem-2023-001658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2023] [Indexed: 10/03/2023] Open
Abstract
Physical activity is a key modifiable factor in protecting physical and mental health in people with severe mental illness including schizophrenia. Therefore, early promotion of physical activity is recommended and programmes supporting long-term maintenance of physically active behaviour are warranted. This study aimed to explore the perspectives of professional experts in relation to the development of a sustainable community-based exercise programme tailored to young adults with schizophrenia and intended to promote change and adoption of physical activity. We conducted 9 semistructured interviews with 11 clinical and professional experts. Qualitative content analysis, as described by Graneheim and Lundman, was applied to analyse data. We identified four categories: (1) living a physical active life with schizophrenia, (2) exercise as promotor of personal recovery, (3) prescribing safe and relevant exercise and (4) instructors' qualifications and formation. When developing sustainable community-based exercise programmes tailored to young adults with schizophrenia, developers should ensure instructors' qualifications and provide an exercise protocol. In addition, developers should consider providing an inclusive and recovery-oriented exercise environment.
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Affiliation(s)
- Martin Færch Andersen
- Centre for Applied Research in Mental Health Care, Psychiatric Center Glostrup, Glostrup, Denmark
- Department of Physiotherapy, University College of Northern Denmark, Aalborg, Denmark
| | - Kickan Roed
- Centre for Applied Research in Mental Health Care, Psychiatric Center Glostrup, Glostrup, Denmark
| | - Allan Riis
- Department of Physiotherapy, University College of Northern Denmark, Aalborg, Denmark
- Center for General Practice, Aalborg University, Aalborg, Denmark
| | - Bolette Skjødt Rafn
- Centre for Applied Research in Mental Health Care, Psychiatric Center Glostrup, Glostrup, Denmark
- Department of Oncology, Rigshospitalet Department of Oncology, Copenhagen, Denmark
| | - Bjørn Hylsebeck Ebdrup
- Center for Neuropsychiatric Schizophrenia Research, Psychiatric Center Glostrup, Glostrup, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Julie Midtgaard
- Centre for Applied Research in Mental Health Care, Psychiatric Center Glostrup, Glostrup, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Rafn BS, Andersen MF, Sørensen V, Bjerre ED, Baandrup L, Vernal DL, Mors O, Knop FK, Wolf RT, Tolver A, Firth J, Nøhr N, Skou ST, Ebdrup BH, Midtgaard J. Value of gym-based group exercise versus usual care for young adults receiving antipsychotic medication: study protocol for the multicenter randomized controlled Vega trial. BMC Psychiatry 2023; 23:634. [PMID: 37648977 PMCID: PMC10466717 DOI: 10.1186/s12888-023-05086-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 08/07/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND Exercise is recommended to protect physical health among people with severe mental illness and holds the potential to facilitate long-term recovery. An inclusive exercise community provides an opportunity for life skill training and social connectedness and may reduce the experience of loneliness and internalized stigmatization which together may improve personal recovery. Using a pragmatic randomized design, we aim to examine the effectiveness of a gym-based exercise intervention tailored to young adults in antipsychotic treatment (i.e., Vega Exercise Community) compared to usual care. It is hypothesized that the Vega Exercise Community will be superior to usual care for personal recovery at four months. METHODS The trial will be conducted at four sites in Denmark from which 400 participants, aged 18 to 35 years, who are in current treatment with antipsychotic medications for the management of schizophrenia spectrum or affective disorders, will be recruited. Participants will be randomized (2:1) to Vega Exercise Community or usual care. Vega Exercise Community includes three weekly group-based exercise sessions hosted in commercial functional training centers delivered by certified Vega instructors. After four months, participants in Vega Exercise Community will be randomized (1:1) to minimal versus extended support with regards to sustained physical activity. Data will be collected at baseline, four, six and 12 months. The primary outcome is personal recovery assessed by Questionnaire about the Process of Recovery at four months. Behavioral symptoms, health-related quality of life, metabolic health, and program costs will be evaluated to further determine the effectiveness and cost-effectiveness of the Vega Exercise Community. Finally, the quality of life and physical and mental health of the participants' primary relative will be evaluated. DISCUSSION The results of this trial may have important implications for health, sustained physical activity, and recovery for individuals in treatment with antipsychotics. Given the pragmatic design, positive results may readily be implemented by mental health care professionals to promote exercise as an integrated part of treatment of severe mental illness. TRIAL REGISTRATION Clinical Trials.gov (NCT05461885, initial registration June 29th, 2022). WHO Universal Trial Number (UTN): U1111-1271-9928.
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Affiliation(s)
- Bolette Skjødt Rafn
- Center for Applied Research in Mental Health Care (CARMEN), Mental Health Center Glostrup, University of Copenhagen, Glostrup, Denmark.
- Danish Cancer Society National Cancer Survivorship and Late Effects Research Center (CASTLE), Department of Oncology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
| | - Martin Færch Andersen
- Center for Applied Research in Mental Health Care (CARMEN), Mental Health Center Glostrup, University of Copenhagen, Glostrup, Denmark
- Department of Physiotherapy, University College of Northern Denmark, Aalborg, Denmark
| | - Victor Sørensen
- Center for Applied Research in Mental Health Care (CARMEN), Mental Health Center Glostrup, University of Copenhagen, Glostrup, Denmark
- Center for Neuropsychiatric Schizophrenia Research (CNSR), Mental Health Centre Glostrup, University of Copenhagen, Copenhagen, Denmark
| | - Eik Dybboe Bjerre
- Center for Applied Research in Mental Health Care (CARMEN), Mental Health Center Glostrup, University of Copenhagen, Glostrup, Denmark
| | - Lone Baandrup
- Center for Neuropsychiatric Schizophrenia Research (CNSR), Mental Health Centre Glostrup, University of Copenhagen, Copenhagen, Denmark
- Mental Health Centre Copenhagen, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Ditte Lammers Vernal
- Psychiatry, Aalborg University Hospital North, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Ole Mors
- Psychosis Research Unit, Aarhus University Hospital, Aarhus, Denmark
| | - Filip Krag Knop
- Faculty of Health and Medical Sciences, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Center for Clinical Metabolic Research, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
- Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Rasmus Trap Wolf
- Center for Applied Research in Mental Health Care (CARMEN), Mental Health Center Glostrup, University of Copenhagen, Glostrup, Denmark
| | - Anders Tolver
- Data Science Lab, Department of Mathematical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Joseph Firth
- Division of Psychology and Mental Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Nikolaj Nøhr
- Center for Applied Research in Mental Health Care (CARMEN), Mental Health Center Glostrup, University of Copenhagen, Glostrup, Denmark
- , Arca, Denmark
| | - Søren T Skou
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Region Zealand, Denmark
| | - Bjørn H Ebdrup
- Center for Neuropsychiatric Schizophrenia Research (CNSR), Mental Health Centre Glostrup, University of Copenhagen, Copenhagen, Denmark
- Mental Health Centre Copenhagen, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Julie Midtgaard
- Center for Applied Research in Mental Health Care (CARMEN), Mental Health Center Glostrup, University of Copenhagen, Glostrup, Denmark.
- Faculty of Health and Medical Sciences, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
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Kearns Murphy C, Kemps L, McDonough C, McDonough S. Operation recovery: a feasibility study of an 8 week exercise and lifestyle programme within an Irish first episode psychosis service. IRISH JOURNAL OF OCCUPATIONAL THERAPY 2022. [DOI: 10.1108/ijot-03-2022-0014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Purpose
Early interventions focusing on exercise and lifestyle are important for individuals with a diagnosis of psychosis due to increased risk of poor physical health and reduced life expectancy. This study aims to test the feasibility of a multicomponent lifestyle intervention for individuals with first episode psychosis (FEP).
Design/methodology/approach
Individuals attending an Irish FEP service were invited to engage in an eight-week programme including individual and group exercise sessions, group educational sessions and one dietician consultation. Physical activity, physical health, mental health, cognition and personal goals measures were completed pre- and post-intervention and analysed using descriptive statistics. Feasibility data was collected via a non-standardised participant questionnaire and informal data on completion of measures and engagement with the programme.
Findings
Ten participants with a diagnosis of FEP completed the intervention. Participants were satisfied with the intervention and adherence rates were high for weekly individual gym sessions but lower for group exercise and education sessions. Mean time spent engaging in physical activity increased and sedentary behaviours decreased. Participants indicated increased readiness for change with 90% moving to the action or maintenance stages of change. Participants attained 74% of their personal goals. There were no changes in average body mass index, cognition or mental health. Data relating to blood pressure, blood tests and steps was missing or incomplete.
Originality/value
This study indicates an eight-week exercise and lifestyle programme is feasible and acceptable in a clinical setting. Recommendations relating to satisfaction, clinical markers and resource requirements are made for future studies.
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Falkai P, Schmitt A, Rosenbeiger CP, Maurus I, Hattenkofer L, Hasan A, Malchow B, Heim-Ohmayer P, Halle M, Heitkamp M. Aerobic exercise in severe mental illness: requirements from the perspective of sports medicine. Eur Arch Psychiatry Clin Neurosci 2022; 272:643-677. [PMID: 34873635 PMCID: PMC9095557 DOI: 10.1007/s00406-021-01360-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 11/24/2021] [Indexed: 12/21/2022]
Abstract
Major depression, bipolar disorder, and schizophrenia are severe mental illnesses. Despite receiving psychopharmacological and psychosocial treatments, about half of patients develop a chronic course with residual cognitive and negative symptoms and have a high risk for cardiovascular disease and reduced life expectancy. Therefore, add-on innovative treatment approaches are needed to improve outcome. Aerobic exercise interventions have been shown to improve global functioning, cognition, and negative and depressive symptoms in these patients. The basic mechanism of these exercise-related changes has been reported to be improved brain plasticity, e.g., increased volume of disease-related brain regions such as the hippocampus. The optimal type, duration, and frequency of exercise have not yet been determined and need to be addressed in supervised physical exercise studies. Because of the low physical activity levels, lack of drive related to negative and depressive symptoms, and high prevalence of cardiovascular comorbidities in patients with severe mental illness, besides aiming to improve symptoms of mental illness, exercise interventions should also aim to increase cardiorespiratory fitness, which they should comprehensively assess by direct measurements of maximal oxygen uptake. Based on the recommendations for developing cardiorespiratory fitness by the American College of Sports Medicine, 150 min moderate-intensity training per week or vigorous-intensity exercise training for 75 min per week are appropriate. Most studies have had relatively short intervention periods, so future studies should focus on long-term adherence to exercise by implementing motivational strategies supported by telemedicine and by identifying and targeting typical barriers to exercise in this patient population.
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Affiliation(s)
- Peter Falkai
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstrasse 7, 80336 Munich, Germany
| | - 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 São Paulo, São Paulo, Brazil
| | - Christian P. Rosenbeiger
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstrasse 7, 80336 Munich, Germany
| | - Isabel Maurus
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstrasse 7, 80336, Munich, Germany.
| | - Lisa Hattenkofer
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstrasse 7, 80336 Munich, Germany
| | - Alkomiet Hasan
- Department of Psychiatry and Psychosomatics of the University Augsburg, Medical Faculty, Bezirkskrankenhaus Augsburg, University of Augsburg, Augsburg, Germany
| | - Berend Malchow
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Von-Siebold-Str. 5, 37075 Göttingen, Germany
| | - Pascale Heim-Ohmayer
- Department of Prevention and Sports Medicine, Medical Faculty, Technical University of Munich, University Hospital ‘Klinikum Rechts der Isar’, Munich, Germany
| | - Martin Halle
- Department of Prevention and Sports Medicine, Medical Faculty, Technical University of Munich, University Hospital ‘Klinikum Rechts der Isar’, Munich, Germany ,DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Melanie Heitkamp
- Department of Prevention and Sports Medicine, Medical Faculty, Technical University of Munich, University Hospital ‘Klinikum Rechts der Isar’, Munich, Germany
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Midtgaard J, Schnor H, Bjerre ED, Jespersen T, Jelsøe N, Frølund N, Seier S, Rønbøg JW, Nordsborg NB, Ebdrup BH. Exercise training complementary to specialised early intervention in patients with first-episode psychosis: a feasibility randomised trial. Pilot Feasibility Stud 2021; 7:162. [PMID: 34412705 PMCID: PMC8375206 DOI: 10.1186/s40814-021-00900-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 08/10/2021] [Indexed: 11/19/2022] Open
Abstract
Background The aim of this study was to examine feasibility of trial processes and group-based, structured exercise training in patients with first-episode psychosis. Methods Twenty-five patients with first-episode psychosis took part in a two-arm randomised feasibility trial. They were individually randomised (1:1) via a computer-generated randomisation sequence and allocated to either an exercise intervention group (INT) or a control group (CON). Patients allocated to INT completed a physical exercise training programme at moderate-to-vigorous intensity, 1 h three times weekly for 8 weeks. CON patients were encouraged to continue their usual level of activity and were offered the training programme after 8 weeks. Primary outcomes included screening rate, recruitment rate, retention rate, attendance and adverse events. Secondary outcomes included heart rate response during training, cardiovascular health (VO2max, resting heart rate, blood pressure), body composition (muscle mass, fat percentage), muscle strength (sit-to-stand, grip strength, jump height) and balance. Results Recruitment lasted 6 weeks and 86 out of 324 patients (27%) were screened, 71 of whom (83%) were deemed eligible. Twenty-five (35%) accepted inclusion (mean age 25.5; mean body mass index 25.1) and were subsequently randomised (INT = 13, CON = 12). Retention of patients was 76% and 52% at the 8-week and 16-week follow-up, respectively. Attendance was 43% (min. 9%, max. 96%). No significant changes were observed between groups in secondary physiological outcome measures. Conclusions Feasibility was challenged by limited recruitment and retention rates, suggesting that modifications are required if a large-scale randomised controlled trial is to be conducted. Recommendations for modifications are presented and discussed. Trial registration Clinicaltrials.gov, NCT03409393. Retrospectively registered. Supplementary Information The online version contains supplementary material available at 10.1186/s40814-021-00900-5.
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Affiliation(s)
- Julie Midtgaard
- Mental Health Centre Glostrup, University of Copenhagen, Nordstjernevej 41, DK-2600, Glostrup, Denmark. .,Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, DK-2200, Copenhagen N, Denmark. .,The University Hospitals Centre for Health Research, Copenhagen University Hospital - Rigshospitalet, Department 9701, Blegdamsvej 9, DK-2100, Copenhagen Ø, Denmark.
| | - Helle Schnor
- Mental Health Centre Glostrup, University of Copenhagen, Nordstjernevej 41, DK-2600, Glostrup, Denmark.,University College Copenhagen, Tagensvej 86, DK-2200, Copenhagen N, Denmark
| | - Eik D Bjerre
- The University Hospitals Centre for Health Research, Copenhagen University Hospital - Rigshospitalet, Department 9701, Blegdamsvej 9, DK-2100, Copenhagen Ø, Denmark
| | - Tobias Jespersen
- Mental Health Centre Glostrup, University of Copenhagen, Nordstjernevej 41, DK-2600, Glostrup, Denmark
| | - Nina Jelsøe
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Nørre Alle 51, DK-2200, Copenhagen N, Denmark
| | - Nanna Frølund
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Nørre Alle 51, DK-2200, Copenhagen N, Denmark
| | - Søren Seier
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Nørre Alle 51, DK-2200, Copenhagen N, Denmark
| | - Jacob W Rønbøg
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Nørre Alle 51, DK-2200, Copenhagen N, Denmark
| | - Nikolai B Nordsborg
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Nørre Alle 51, DK-2200, Copenhagen N, Denmark
| | - Bjørn H Ebdrup
- Mental Health Centre Glostrup, University of Copenhagen, Nordstjernevej 41, DK-2600, Glostrup, Denmark.,Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, DK-2200, Copenhagen N, Denmark.,Center for Neuropsychiatric Schizophrenia Research (CNSR) and Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS), Mental Health Centre Glostrup, University of Copenhagen, Nordstjernevej 41, DK-2600, Glostrup, Denmark
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Smith J, Griffiths LA, Band M, Hird-Smith R, Williams B, Bold J, Bradley E, Dilworth R, Horne D. Early Intervention in Psychosis: Effectiveness and Implementation of a Combined Exercise and Health Behavior Intervention Within Routine Care. Front Endocrinol (Lausanne) 2020; 11:577691. [PMID: 33193094 PMCID: PMC7649318 DOI: 10.3389/fendo.2020.577691] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 09/30/2020] [Indexed: 12/20/2022] Open
Abstract
Aim Young people with psychosis have higher rates of obesity, premature cardiovascular disease, and death compared to non-psychotic peers in the general population due to changes in metabolic regulation linked to antipsychotic medication and adverse health risk behaviors. The aim of this paper is to outline the development, implementation, and evaluation of a combined 12-week exercise and health behavior intervention delivered as part of an Early Intervention in Psychosis (EIP) routine service, within the UK. Methods Participants (n = 27) completed a 12-week combined intervention program, engaging in weekly, 90-min sessions comprising a healthy behavior education session (45 min), followed by a facilitated exercise session (45 min). Anthropometric data from participants (n = 26) were collected at baseline, 12 weeks, and 12 months post-intervention. Health behaviors and clinical measurements were assessed at baseline and 12 months. Results Mean baseline data suggests participants were at an increased health risk on entry to the program, with elevated values in mean body mass index (BMI; 70% overweight/obese), waist circumference, resting heart rate, and triglycerides. Fifty percent reported smoking daily, 64% ate < 5 fruits/vegetables per day, and 52% of participants were prescribed highly obesogenic antipsychotic medications (i.e., Olanzapine). At 12 weeks and 12 months, no changes were observed in mean BMI, waist circumference or any other clinical variable (p > 0.05). At 12 months, participants reported a positive impact on health behaviors including improved diet, increased physical activity levels, and cessation of substance use (n = 2), alcohol use (n = 2), and smoking (n = 4). Focus groups captured participant experiences, engagement with and satisfaction with the program, including challenges/barriers to program adherence. Conclusions The 12-week exercise and health behaviors program supported participants to attenuate their physical health risk which was sustained at 12-month follow-up. Self-reported positive health behavior changes are likely to have contributed to the prevention of excessive weight gain in this high-risk period. The evaluation was designed to have validity for a "real world EIP setting" and reflect the complexity of delivery to this participant group. Evaluation findings influenced subsequent commissioning of the physical health intervention as an ongoing element of routine EIP care within the participant site.
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Affiliation(s)
- Jo Smith
- School of Allied Health and Community, University of Worcester, Worcester, United Kingdom
| | - Lisa A. Griffiths
- Department of Nutrition, Food and Exercise Science, Florida State University, Tallahassee, FL, United States
| | - Marie Band
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Rachael Hird-Smith
- School of Allied Health and Community, University of Worcester, Worcester, United Kingdom
| | - Briony Williams
- School of Allied Health and Community, University of Worcester, Worcester, United Kingdom
| | - Justine Bold
- School of Allied Health and Community, University of Worcester, Worcester, United Kingdom
- Centre for Medical Education, Medical School, Cardiff University, Cardiff, United Kingdom
| | - Eleanor Bradley
- School of Allied Health and Community, University of Worcester, Worcester, United Kingdom
| | - Richard Dilworth
- School of Allied Health and Community, University of Worcester, Worcester, United Kingdom
| | - Dominic Horne
- School of Allied Health and Community, University of Worcester, Worcester, United Kingdom
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Physical health interventions for patients who have experienced a first episode of psychosis: a narrative review. Ir J Psychol Med 2020; 38:62-75. [DOI: 10.1017/ipm.2020.92] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Objectives:Service users with severe psychiatric illnesses, such as schizophrenia, major depressive disorder and bipolar disorder, are more likely to suffer from ill health. There is evidence that lifestyle interventions, for example, exercise, dietary advice and smoking cessation programmes for service users with severe mental illness can be of health benefit. This review was carried out to identify the literature pertaining to physical health interventions for service users who have experienced a first-episode psychosis (FEP), to examine the nature of the interventions which were carried out and to assess these interventions in terms of feasibility and efficacy.Methods:A narrative review was conducted in August 2019 by searching ‘Pubmed’ and ‘Embase’ electronic databases. Studies investigating the effect a physical health intervention had on service users who had experienced a FEP were included in the review.Results:Fifteen studies met inclusion criteria: 12 quantitative studies and 3 qualitative. Exercise, dietary advice, smoking cessation and motivational coaching were some of the physical health interventions utilised in the identified studies. Positive effects were seen in terms of physical health markers wherever they were investigated, particularly when the intervention was delivered early. The impact on psychiatric symptoms and longer-term impacts on health were less frequently assessed.Conclusions:Physical health interventions have a positive impact on service users who have experienced a FEP. More research is warranted in this area in Ireland. These studies should include controls, have longer follow-up periods and should assess the impact on psychiatric health.
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