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Sauer F, Schmitz-Buhl M, Gouzoulis-Mayfrank E. [Effects of a Motivational Intervention on the Effectiveness and Sustainability of Sports and Exercise Therapy in Inpatient Psychiatric Care]. Psychother Psychosom Med Psychol 2024; 74:323-330. [PMID: 38710216 DOI: 10.1055/a-2298-8510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
OBJECTIVE Reinforcement and sustainability of sports and exercise therapy in inpatient depression treatment. METHODS Randomized controlled study with 3 measurement times: t0 admission to the study, t1 after four weeks, t2 two months after discharge. 96 inpatients with depressive disorders (ICD-10 F32, F33) were randomly assigned to an intervention group (IG) or a control group (KG). In addition to sports and exercise therapy (KG), the IG received an educational and motivational session on the importance of sports and exercise, as well as a motivational final discussion. RESULTS Endurance performance and physical fitness improved more significantly in the IG than in the CG over the 3 measurement times. The motivational final discussion was rated as more helpful. DISCUSSION The intervention was well accepted by the patients and partially increased the effects of sports and exercise therapy. Not only psychological aspects of depression treatment were influenced, but also measurable physical effects. CONCLUSION The practical and time-efficient motivational intervention in inpatient psychiatric care can complement sports and exercise therapy for depressive patients.
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Affiliation(s)
- Frank Sauer
- LVR-Klinik Köln, Akademisches Lehrkrankenhaus der Universität zu Köln, Köln, Germany
| | - Mario Schmitz-Buhl
- LVR-Klinik Köln, Akademisches Lehrkrankenhaus der Universität zu Köln, Köln, Germany
| | - Euphrosyne Gouzoulis-Mayfrank
- LVR-Klinik Köln, Akademisches Lehrkrankenhaus der Universität zu Köln, Köln, Germany
- Fachliche Direktorin Forschung, LVR-Institut für Forschung und Bildung, Köln, Germany
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Wolf S, Seiffer B, Zeibig JM, Frei AK, Studnitz T, Welkerling J, Meinzinger E, Bauer LL, Baur J, Rosenstiel S, Fiedler DV, Helmhold F, Ray A, Herzog E, Takano K, Nakagawa T, Günak MM, Kropp S, Peters S, Flagmeier AL, Zwanzleitner L, Sundmacher L, Ramos-Murguialday A, Hautzinger M, Sudeck G, Ehring T. A transdiagnostic group exercise intervention for mental health outpatients in Germany (ImPuls): results of a pragmatic, multisite, block-randomised, phase 3 controlled trial. Lancet Psychiatry 2024; 11:417-430. [PMID: 38670127 DOI: 10.1016/s2215-0366(24)00069-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 02/23/2024] [Accepted: 02/29/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND Globally, mental health conditions pose a substantial burden of disease. Despite the availability of evidence-based pharmacological and psychological treatments, the symptoms of a substantial subgroup of patients do not respond to these interventions, and only a minority of patients have access to them. This study aimed to assess the efficacy of ImPuls, a 6-month transdiagnostic group exercise intervention, plus treatment-as-usual, compared with treatment-as-usual alone in outpatients with various mental disorders. METHODS In this pragmatic, two-arm, multisite, randomised controlled trial in Germany, ten outpatient rehabilitative and medical care facilities were involved as study sites. Participants were outpatients diagnosed according to ICD-10 with one or more of the following disorders based on structured clinical interviews: moderate or severe depression, primary insomnia, post-traumatic stress disorder (PTSD), panic disorder, or agoraphobia. Participants were required to be aged between 18 years and 65 years, insured by the health insurers Allgemeine Ortskrankenkasse Baden-Württemberg or Techniker Krankenkasse, fluent in German, and without medical contraindications for exercise. Blocks of six participants were randomly allocated to ImPuls plus treatment-as-usual or treatment-as-usual alone (allocation ratio: 1:1), stratified by study site. The randomisation sequence was generated by an external data manager. The team responsible for data collection and management was masked to the randomisation sequence. The ImPuls intervention comprised evidence-based outdoor exercises lasting 30 min, and aimed at achieving at least moderate intensity. It also incorporated behavioural change techniques targeting motivational and volitional determinants of exercise behaviour. Treatment-as-usual was representative of typical outpatient health care in Germany, allowing patients access to any standard treatments. The primary outcome was global symptom severity at 6 months after randomisation, measured using self-report on the Brief Symptom Inventory (BSI-18) and analysed in the intention-to-treat sample. No individuals with lived experience of mental illness were involved in conducting the study or writing the final publication. Safety was assessed in all participants. The trial was registered with the German Clinical Trials Register (DRKS00024152) with a completion date of June 30, 2024. FINDINGS 600 patients provided informed consent, were recruited to the study, and underwent a diagnostic interview between Jan 1, 2021, and May 31, 2022. Following this, 199 were excluded on the basis of inclusion and exclusion criteria and one withdrew consent during the baseline assessment. Of the 400 eligible participants, 284 (71%) self-identified as female, 106 (27%) self-identified as male, and nine (2%) self-identified as other. The mean age was 42·20 years (SD 13·23; range 19-65). Ethnicity data were not assessed. 287 (72%) participants met the criteria for moderate or severe depression, 81 (20%) for primary insomnia, 37 (9%) for agoraphobia, 46 (12%) for panic disorder, and 72 (18%) for PTSD. 199 participants were allocated to the intervention group of ImPuls plus treatment-as-usual and 201 to the control group of treatment-as-usual alone. 38 (19%) participants did not receive the minimum ImPuls intervention dose. ImPuls plus treatment-as-usual demonstrated superior efficacy to treatment-as-usual alone in reducing global symptom severity, with an adjusted difference on BSI-18 of 4·11 (95% CI 1·74-6·48; d=0·35 [95% CI 0·14-0·56]; p=0·0007) at 6 months. There were no significant differences in the total number of adverse events or serious adverse events between the two groups. There was one serious adverse event (male, torn ligament) related to the intervention. INTERPRETATION ImPuls is an efficacious transdiagnostic adjunctive treatment in outpatient mental health care. Our findings suggest that exercise therapy should be implemented in outpatient mental health care as an adjunctive transdiagnostic treatment for mental disorders such as depression, insomnia, panic disorder, agoraphobia, and PTSD. Transdiagnostic group exercise interventions might ameliorate the existing disparity in care provision between the many individuals in need of evidence-based treatment and the few who are receiving it. FUNDING The German Innovation Fund of the Federal Joint Committee of Germany.
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Affiliation(s)
- Sebastian Wolf
- Faculty of Economics and Social Sciences, Institute of Sports Science, Department of Education & Health Research, University of Tübingen, Tübingen, Germany.
| | - Britta Seiffer
- Faculty of Economics and Social Sciences, Institute of Sports Science, Department of Education & Health Research, University of Tübingen, Tübingen, Germany
| | - Johanna-Marie Zeibig
- Faculty of Economics and Social Sciences, Institute of Sports Science, Department of Education & Health Research, University of Tübingen, Tübingen, Germany
| | - Anna Katharina Frei
- Faculty of Economics and Social Sciences, Institute of Sports Science, Department of Education & Health Research, University of Tübingen, Tübingen, Germany
| | - Thomas Studnitz
- Faculty of Economics and Social Sciences, Institute of Sports Science, Department of Education & Health Research, University of Tübingen, Tübingen, Germany
| | - Jana Welkerling
- Faculty of Economics and Social Sciences, Institute of Sports Science, Department of Education & Health Research, University of Tübingen, Tübingen, Germany
| | - Edith Meinzinger
- Faculty of Economics and Social Sciences, Institute of Sports Science, Department of Education & Health Research, University of Tübingen, Tübingen, Germany
| | - Leonie Louisa Bauer
- Faculty of Economics and Social Sciences, Institute of Sports Science, Department of Education & Health Research, University of Tübingen, Tübingen, Germany
| | - Julia Baur
- Faculty of Science, Psychological Institute, Department of Clinical Psychology and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Stephanie Rosenstiel
- Faculty of Economics and Social Sciences, Institute of Sports Science, Department of Education & Health Research, University of Tübingen, Tübingen, Germany
| | - David Victor Fiedler
- Faculty of Economics and Social Sciences, Institute of Sports Science, Department of Education & Health Research, University of Tübingen, Tübingen, Germany
| | - Florian Helmhold
- Medical Faculty, Institute of Medical Psychology and Behavioural Neurobiology, University of Tübingen, Tübingen, Germany; International Max Planck Research School for Cognitive and Systems Neuroscience, Tübingen, Germany
| | - Andreas Ray
- Medical Faculty, Institute of Medical Psychology and Behavioural Neurobiology, University of Tübingen, Tübingen, Germany
| | - Eva Herzog
- Department of Psychology, Division of Clinical Psychology and Psychological Treatment, LMU Munich, Munich, Germany
| | - Keisuke Takano
- Department of Psychology, Division of Clinical Psychology and Psychological Treatment, LMU Munich, Munich, Germany; Human Informatics and Interaction Research Institute, National Institute of Advanced Industrial Science and Technology, Tsukuba, Japan
| | - Tristan Nakagawa
- Department of Psychology, Division of Clinical Psychology and Psychological Treatment, LMU Munich, Munich, Germany
| | - Mia Maria Günak
- Department of Psychology, Division of Clinical Psychology and Psychological Treatment, LMU Munich, Munich, Germany
| | - Saskia Kropp
- Chair of Health Economics, Technical University Munich, Munich, Germany
| | - Stefan Peters
- German Association for Health-Enhancing Physical Activity and Exercise Therapy, Hürth-Efferen, Germany; Department of Human Sciences, Institute of Sport Science, Bundeswehr University Munich, Munich, Germany
| | | | | | - Leonie Sundmacher
- Chair of Health Economics, Technical University Munich, Munich, Germany
| | - Ander Ramos-Murguialday
- Medical Faculty, Institute of Medical Psychology and Behavioural Neurobiology, University of Tübingen, Tübingen, Germany; Department of Neurology & Stroke, University of Tübingen, Tübingen, Germany; Tecnalia, Basque Research and Technology Alliance, San Sebastián, Spain; Athenea Neuroclinics, San Sebastián, Spain
| | - Martin Hautzinger
- Faculty of Science, Psychological Institute, Department of Clinical Psychology and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Gorden Sudeck
- Faculty of Economics and Social Sciences, Institute of Sports Science, Department of Education & Health Research, University of Tübingen, Tübingen, Germany
| | - Thomas Ehring
- Department of Psychology, Division of Clinical Psychology and Psychological Treatment, LMU Munich, Munich, Germany; German Center for Mental Health, Munich, Germany
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Kreppke JN, Cody R, Beck J, Brand S, Donath L, Eckert A, Faude O, Hatzinger M, Imboden C, Lang UE, Ludyga S, Mans S, Mikoteit T, Oswald A, Schweinfurth-Keck N, Holsboer-Trachsler E, Zahner L, Gerber M. Long-term outcomes of physical activity counseling in in-patients with major depressive disorder: results from the PACINPAT randomized controlled trial. Transl Psychiatry 2024; 14:160. [PMID: 38521772 PMCID: PMC10960795 DOI: 10.1038/s41398-024-02885-0] [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: 08/09/2023] [Revised: 03/14/2024] [Accepted: 03/18/2024] [Indexed: 03/25/2024] Open
Abstract
Major depressive disorder (MDD) is an increasingly common psychiatric illness associated with a high risk of insufficient physical activity, which in turn is associated with negative mental and physical health outcomes. Theory-based, individually tailored, in-person and remote physical activity counseling has the potential to increase physical activity levels in various populations. Given this, the present study investigated the effect of such a physical activity intervention on the physical activity behavior of in-patients with MDD. This was a multi-center, two-arm randomized controlled trial including initially insufficiently physically active adult in-patients with MDD from four study sites in Switzerland. The sample consisted of 220 participants (Mage = 41 ± 12.6 years, 52% women), 113 of whom were randomized to the intervention group and 107 to the control group. The main outcome, moderate-to-vigorous physical activity (MVPA), was assessed at three time points via hip-worn accelerometer. According to accelerometer measures, there was no significant difference in minutes spent in MVPA over a 12-month intervention period when comparing the intervention with the control group (β = -1.02, 95% CI = -10.68 to 8.64). Higher baseline physical activity significantly predicted physical activity at post and follow-up. This study showed that it is feasible to deliver an individually tailored, theory-based physical activity counseling intervention to in-patients with MDD, however yielding no significant effects on accelerometer-based MVPA levels. Further efforts are warranted to identify efficacious approaches.Trial registration: ISRCTN, ISRCTN10469580, registered on 3rd September 2018, https://www.isrctn.com/ISRCTN10469580 .
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Affiliation(s)
- Jan-Niklas Kreppke
- Department for Sport, Exercise and Health, University of Basel, Basel, Switzerland.
| | - Robyn Cody
- Department for Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | | | - Serge Brand
- Department for Sport, Exercise and Health, University of Basel, Basel, Switzerland
- Adult Psychiatric Clinics (UPKE), University of Basel, Basel, Switzerland
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, 6719851115, Iran
- Substance Use Prevention Research Center and Sleep Disorder Research Center, Kermanshah, University of Medical Sciences (KUMS), Kermanshah, 6715847141, Iran
- School of Medicine, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Lars Donath
- German Sport University Cologne, Department of Intervention Research in Exercise Training, Cologne, Germany
| | - Anne Eckert
- Adult Psychiatric Clinics (UPKE), University of Basel, Basel, Switzerland
| | - Oliver Faude
- Department for Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Martin Hatzinger
- Psychiatric Services, Solothurn, and Medical Faculty, University of Basel, Basel, Switzerland
| | - Christian Imboden
- Private Clinic Wyss, Muenchenbuchsee, Switzerland
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Undine E Lang
- Adult Psychiatric Clinics (UPKE), University of Basel, Basel, Switzerland
| | - Sebastian Ludyga
- Department for Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Sarah Mans
- Private Clinic Wyss, Muenchenbuchsee, Switzerland
| | - Thorsten Mikoteit
- Psychiatric Services, Solothurn, and Medical Faculty, University of Basel, Basel, Switzerland
| | - Anja Oswald
- Psychiatric Clinic Sonnenhalde, Riehen, Switzerland
| | | | | | - Lukas Zahner
- Department for Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Markus Gerber
- Department for Sport, Exercise and Health, University of Basel, Basel, Switzerland
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Li R, Wang W, Guo J, Liu W, Huang X, Qiao Y, Jia S, Tian L, Zhou J, Wang G. Efficacy and acceptability of supervised group exercise for mild to moderate major depressive disorder: A feasibility study. J Affect Disord 2023; 329:96-104. [PMID: 36841307 DOI: 10.1016/j.jad.2023.02.090] [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: 06/09/2022] [Revised: 02/11/2023] [Accepted: 02/19/2023] [Indexed: 02/26/2023]
Abstract
BACKGROUND Exercise can efficiently reduce the symptoms of major depression disorder (MDD). This study aims to examine the efficacy and acceptability of supervised group exercise intervention among patients in an acute phase of mild to moderate MDD. METHODS We enrolled patients in the psychiatric clinic of Beijing Anding Hospital affiliated to Capital Medical University in a prospective, single-arm objective performance criteria (OPC) trial. A total of 40 adults aged 18-50 who had a diagnosis of an episode of depression and the 17-item Hamilton Rating Scale for Depression (HRSD-17) score of 7-20 were recruited. Supervised exercise group intervention was applied on participants with a new episode of mild to moderate depression 3 times a week for 8 weeks without any other treatment. Every exercise session should meet the standard of moderate intensity, defined as approximately equal to 50 %-80 % of the maximal heart rate for 150 min every week. The primary end point was the clinical response at week 8, defined as a 50 % reduction in the baseline HRSD-17 score. Meanwhile, the secondary end points included the acceptability of the supervised group exercise intervention for both patients and investigators, remission rate (defined as an HRSD-17 score of 7 or less), the change of Patient Health Questionnaire (PHQ-9) and the Quality of Life, Enjoyment and Satisfaction Questionnaire-Short Form (Q-LES-Q-SF). RESULTS Among the 46 screened patients, 40 were enrolled. Of them, 4 people dropped out, while 36 received all the planned sessions of the supervised group exercise therapy and completed the week-8 assessment. At week 8, the response rate was 89 % (95 % confidence interval [CI] 74 % to 97 %) and the remission rate was 83 % (95%CI 67 % to 94 %). The overall acceptance of the supervised group exercise based on the VAS score (range 0-10) was 9.19 ± 1.27 for patients and 9.67 ± 0.62 for investigators. The least-squares mean (±SE) change from baseline at week 8 was-9.99 in the PHQ-9 score and 25.15 in the Q-LES-Q-SF score. No serious adverse events were reported during this trial. The percentage of any adverse event was 5 %. CONCLUSION Supervised group exercise intervention is effective in patients with acute mild to moderate MDD and has good acceptance rate among both patients and investigators.
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Affiliation(s)
- Ruinan Li
- National Clinical Research Center for Mental Disorders, Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing 100088, China
| | - Weiwei Wang
- National Clinical Research Center for Mental Disorders, Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing 100088, China; Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China
| | - Jianjun Guo
- Capital University of Physical Education And Sports, Beijing 100192, China
| | - Wenyang Liu
- National Clinical Research Center for Mental Disorders, Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing 100088, China
| | - Xiaohan Huang
- National Clinical Research Center for Mental Disorders, Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing 100088, China
| | - Yu Qiao
- National Clinical Research Center for Mental Disorders, Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing 100088, China
| | - Shengtao Jia
- National Clinical Research Center for Mental Disorders, Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing 100088, China
| | - Lu Tian
- National Clinical Research Center for Mental Disorders, Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing 100088, China
| | - Jingjing Zhou
- National Clinical Research Center for Mental Disorders, Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing 100088, China.
| | - Gang Wang
- National Clinical Research Center for Mental Disorders, Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing 100088, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing 100069, China.
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Fiedler DV, Rosenstiel S, Zeibig JM, Seiffer B, Welkerling J, Frei AK, Studnitz T, Baur J, Helmhold F, Ray A, Herzog E, Takano K, Nakagawa T, Kropp S, Franke S, Peters S, Flagmeier AL, Zwanzleitner L, Sundmacher L, Ramos-Murguialday A, Hautzinger M, Ehring T, Sudeck G, Wolf S. Concept and study protocol of the process evaluation of a pragmatic randomized controlled trial to promote physical activity in outpatients with heterogeneous mental disorders-the ImPuls study. Trials 2023; 24:330. [PMID: 37189210 PMCID: PMC10186678 DOI: 10.1186/s13063-023-07331-y] [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: 05/27/2022] [Accepted: 04/28/2023] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND Evidence suggests that patients suffering from different mental disorders benefit from exercise programs combined with behavior change techniques. Based on this evidence, we have developed an exercise program (ImPuls) specifically designed to provide an additional treatment option in the outpatient mental health care system. The implementation of such complex programs into the outpatient context requires research that goes beyond the evaluation of effectiveness, and includes process evaluation. So far, process evaluation related to exercise interventions has rarely been conducted. As part of a current pragmatic randomized controlled trial evaluating ImPuls treatment effects, we are therefore carrying out comprehensive process evaluation according to the Medical Research Council (MRC) framework. The central aim of our process evaluation is to support the findings of the ongoing randomized controlled trial. METHODS The process evaluation follows a mixed-methods approach. We collect quantitative data via online-questionnaires from patients, exercise therapists, referring healthcare professionals and managers of outpatient rehabilitative and medical care facilities before, during, and after the intervention. In addition, documentation data as well as data from the ImPuls smartphone application are collected. Quantitative data is complemented by qualitative interviews with exercise therapists as well as a focus-group interview with managers. Treatment fidelity will be assessed through the rating of video-recorded sessions. Quantitative data analysis includes descriptive as well as mediation and moderation analyses. Qualitative data will be analyzed via qualitative content analysis. DISCUSSION The results of our process evaluation will complement the evaluation of effectiveness and cost-effectiveness and will, for example, provide important information about mechanisms of impact, structural prerequisites, or provider qualification that may support the decision-making process of health policy stakeholders. It might contribute to paving the way for exercise programs like ImPuls to be made successively available for patients with heterogeneous mental disorders in the German outpatient mental health care system. TRIAL REGISTRATION The parent clinical study was registered in the German Clinical Trials Register (ID: DRKS00024152, registered 05/02/2021, https://drks.de/search/en/trial/DRKS00024152 ).
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Affiliation(s)
- David Victor Fiedler
- Faculty of Economics and Social Sciences, Institute of Sports Science, Department of Education & Health Research, University of Tübingen, Tübingen, Germany.
| | - Stephanie Rosenstiel
- Faculty of Economics and Social Sciences, Institute of Sports Science, Department of Education & Health Research, University of Tübingen, Tübingen, Germany
| | - Johanna-Marie Zeibig
- Faculty of Economics and Social Sciences, Institute of Sports Science, Department of Education & Health Research, University of Tübingen, Tübingen, Germany
- Faculty of Science, Psychological Institute, Department of Clinical Psychology and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Britta Seiffer
- Faculty of Economics and Social Sciences, Institute of Sports Science, Department of Education & Health Research, University of Tübingen, Tübingen, Germany
- Faculty of Science, Psychological Institute, Department of Clinical Psychology and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Jana Welkerling
- Faculty of Economics and Social Sciences, Institute of Sports Science, Department of Education & Health Research, University of Tübingen, Tübingen, Germany
- Faculty of Science, Psychological Institute, Department of Clinical Psychology and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Anna Katharina Frei
- Faculty of Economics and Social Sciences, Institute of Sports Science, Department of Education & Health Research, University of Tübingen, Tübingen, Germany
- Faculty of Science, Psychological Institute, Department of Clinical Psychology and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Thomas Studnitz
- Faculty of Economics and Social Sciences, Institute of Sports Science, Department of Education & Health Research, University of Tübingen, Tübingen, Germany
- Faculty of Science, Psychological Institute, Department of Clinical Psychology and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Julia Baur
- Faculty of Economics and Social Sciences, Institute of Sports Science, Department of Education & Health Research, University of Tübingen, Tübingen, Germany
- Faculty of Science, Psychological Institute, Department of Clinical Psychology and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Florian Helmhold
- Medical Faculty, Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, Germany
| | - Andreas Ray
- Medical Faculty, Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, Germany
| | - Eva Herzog
- Department of Psychology, Clinical Psychology and Psychotherapy, LMU Munich, Munich, Germany
| | - Keisuke Takano
- Department of Psychology, Clinical Psychology and Psychotherapy, LMU Munich, Munich, Germany
| | - Tristan Nakagawa
- Department of Psychology, Clinical Psychology and Psychotherapy, LMU Munich, Munich, Germany
| | - Saskia Kropp
- Chair of Health Economics, Technical University Munich (TUM), Munich, Germany
| | - Sebastian Franke
- Chair of Health Economics, Technical University Munich (TUM), Munich, Germany
| | - Stefan Peters
- German Association for health-related Fitness and Exercise Therapy (German: DVGS), Hürth-Efferen, Germany
| | | | | | - Leonie Sundmacher
- Chair of Health Economics, Technical University Munich (TUM), Munich, Germany
| | - Ander Ramos-Murguialday
- Medical Faculty, Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, Germany
| | - Martin Hautzinger
- Faculty of Science, Psychological Institute, Department of Clinical Psychology and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Thomas Ehring
- Department of Psychology, Clinical Psychology and Psychotherapy, LMU Munich, Munich, Germany
| | - Gorden Sudeck
- Faculty of Economics and Social Sciences, Institute of Sports Science, Department of Education & Health Research, University of Tübingen, Tübingen, Germany
| | - Sebastian Wolf
- Faculty of Economics and Social Sciences, Institute of Sports Science, Department of Education & Health Research, University of Tübingen, Tübingen, Germany
- Faculty of Science, Psychological Institute, Department of Clinical Psychology and Psychotherapy, University of Tübingen, Tübingen, Germany
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Zeibig JM, Seiffer B, Frei AK, Takano K, Sudeck G, Rösel I, Hautzinger M, Wolf S. Long-term efficacy of exercise across diagnostically heterogenous mental disorders and the mediating role of affect regulation skills. PSYCHOLOGY OF SPORT AND EXERCISE 2023; 64:102340. [PMID: 37665821 DOI: 10.1016/j.psychsport.2022.102340] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 10/14/2022] [Accepted: 11/17/2022] [Indexed: 09/06/2023]
Abstract
BACKGROUND Exercise interventions are efficacious in reducing disorder-specific symptoms in various mental disorders. However, little is known about long-term transdiagnostic efficacy of exercise across heterogenous mental disorders and the potential mechanisms underlying treatment effects. METHODS Physically inactive outpatients, with depressive disorders, anxiety disorders, insomnia or attention deficit hyperactivity disorder were randomized to a standardized 12-week exercise intervention, combining moderate exercise with behavior change techniques (BCTs) (n = 38), or a passive control group (n = 36). Primary outcome was global symptom severity (Symptom Checklist-90, SCL-90-R) and secondary outcomes were self-reported exercise (Physical Activity, Exercise, and Sport Questionnaire), exercise-specific affect regulation (Physical Activity-related Health Competence Questionnaire) and depression (SCL-90-R) assessed at baseline (T1), post-treatment (T2) and one year after post-treatment (T3). Intention-to-treat analyses were conducted using linear mixed models and structural equations modeling. RESULTS From T1 to T3, the intervention group significantly improved on global symptom severity (d = -0.43, p = .031), depression among a depressed subsample (d = -0.62, p = .014), exercise (d = 0.45, p = .011) and exercise-specific affect regulation (d = 0.44, p = .028) relative to the control group. The intervention group was more likely to reveal clinically significant changes from T1 to T3 (p = .033). Increases in exercise-specific affect regulation mediated intervention effects on global symptom severity (ß = -0.28, p = .037) and clinically significant changes (ß = -0.24, p = .042). CONCLUSIONS The exercise intervention showed long-term efficacy among a diagnostically heterogeneous outpatient sample and led to long-lasting exercise behavior change. Long-term increases in exercise-specific affect regulation within exercise interventions seem to be essential for long-lasting symptom reduction.
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Affiliation(s)
- Johanna-Marie Zeibig
- Faculty of Economics and Social Sciences, Institute of Sports Science, Department of Education & Health Research, University of Tuebingen, 72074, Tuebingen, Germany.
| | - Britta Seiffer
- Faculty of Economics and Social Sciences, Institute of Sports Science, Department of Education & Health Research, University of Tuebingen, 72074, Tuebingen, Germany
| | - Anna Katharina Frei
- Faculty of Economics and Social Sciences, Institute of Sports Science, Department of Education & Health Research, University of Tuebingen, 72074, Tuebingen, Germany
| | - Keisuke Takano
- Human Informatics and Interaction Research Institute (HIIRI), National Institute of Advanced Industrial Science and Technology (AIST), 1-1-1 Umezono, Tsukuba, Ibaraki, 305-8560, Japan
| | - Gorden Sudeck
- Faculty of Economics and Social Sciences, Institute of Sports Science, Department of Education & Health Research, University of Tuebingen, 72074, Tuebingen, Germany
| | - Inka Rösel
- Faculty of Medicine, Institute for Clinical Epidemiology and Applied Biostatistics, University of Tuebingen, 72074, Tuebingen, Germany
| | - Martin Hautzinger
- Faculty of Science, Psychological Institute, Department of Clinical Psychology and Psychotherapy, University of Tuebingen, 72074, Tuebingen, Germany
| | - Sebastian Wolf
- Faculty of Economics and Social Sciences, Institute of Sports Science, Department of Education & Health Research, University of Tuebingen, 72074, Tuebingen, Germany
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Zhao Y, Niu H, Liu S. Effects of aerobics training on anxiety, depression and sleep quality in perimenopausal women. Front Psychiatry 2022; 13:1025682. [PMID: 36506429 PMCID: PMC9730414 DOI: 10.3389/fpsyt.2022.1025682] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 11/07/2022] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To investigate the effect of aerobics training on anxiety, depression and sleep disturbance in perimenopausal women. MATERIALS AND METHODS A total of 289 perimenopausal women with anxiety, depression or sleep disorder in Lishi district of Luliang city were treated with aerobics training. Self-rating anxiety scale, self-rating depression scale and Pittsburgh sleep scale were used to investigate the anxiety, depression and sleep status of perimenopausal women before and after intervention. RESULTS After aerobics training, the scores of self-rating anxiety scale, self-rating depression scale and Pittsburgh sleep questionnaire were 48.26 ± 6.47, 50.27 ± 6.54 and 10.64 ± 4.38, respectively. The levels of anxiety, depression and sleep disorder in 289 subjects were significantly lower than those before intervention (t = 3.865, 4.541, 5.596, P < 0.01). The remission rate of symptoms was significantly different in subjects with different frequency of spontaneous practice (P < 0.01), and the higher the number of spontaneous practice, the higher the remission rate of anxiety, depression and sleep disorders in subjects (P < 0.01). CONCLUSION aerobics training can effectively improve the anxiety and depression of perimenopausal women, improve sleep quality, the more frequency of practice, the more obvious the effect. It can be used as an intervention to improve the mental health level of perimenopausal women in terms of anxiety, depression and sleep quality in clinical promotion.
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Affiliation(s)
- Yan Zhao
- Department of Physical Education, Lyuliang University, Lvliang, China
| | - Hualiang Niu
- Department of Physical Education, Lyuliang University, Lvliang, China
| | - Shengjie Liu
- Department of Physical Education, Changzhi University, Changzhi, China
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8
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Liu Z, Zhang Y, Sun L, Wang J, Xia L, Yang Y, Sun F, Li W, Yao X, Yang R, Liu H. Physical activity levels associated with insomnia and depressive symptoms in middle-aged and elderly patients with chronic schizophrenia. Front Psychiatry 2022; 13:1045398. [PMID: 36683978 PMCID: PMC9852857 DOI: 10.3389/fpsyt.2022.1045398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 12/16/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Previous evidence suggested that physical activity had beneficial effects on psychopathological symptoms, insomnia, or depressive symptoms in people with schizophrenia. This study investigated the association between physical activity levels and insomnia and depressive symptoms in middle-aged and elderly hospitalized patients with chronic schizophrenia (CS). METHODS 179 participants were enrolled. We used the 30-item Positive and Negative Syndrome Scale (PANSS-30) to assess the psychopathological symptoms. We used the Insomnia Severity Index scale (ISI) and 17-item Hamilton Depression Scale (HAMD-17) to evaluate insomnia and depressive symptoms. Daily physical activity time less than 30 min, within 30-60 min, and more than 60 min were defined as physical inactivity, moderate physical activity, and vigorous physical activity, respectively. The Chi-square test, analysis of variance (ANOVA), and Mann-Whitney U-test were applied for categorical, continuous, and non-normal distribution variables, respectively. The Pearson or Spearman's correlation analyses were utilized to examine the association between physical activity levels, ISI total scores, HAMD total scores, and socio-demographic and clinical variables. Finally, socio-demographic variables with a P-value < 0.05 in the comparison between insomnia/depressive group and non-insomnia/depressive group were considered for inclusion in binary logistic regression analysis to determine the relationship between physical activity levels and insomnia or depressive symptoms. RESULTS The ISI total scores (r = -0.247, P = 0.001) and HAMD total scores (r = -0.312, P < 0.001) were negatively correlated with physical activity levels. Logistic regression analysis revealed that older age, higher depressive factor scores, and lower physical activity level were influential factors of insomnia symptoms in CS patients (P < 0.05). In addition, vigorous physical activity (compared with physical inactivity) and higher negative and depressive factor scores were independently associated with depressive symptoms in CS patients (P < 0.05). CONCLUSION Physical activity levels were influential factors in comorbid insomnia and depressive symptoms in CS patients. Given the benefits of physical activity, it should be strengthened as a routine adjunct to clinical treatment or psychiatric care so as to improve the physical and mental health of patients with psychiatric symptoms.
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Affiliation(s)
- Zhiwei Liu
- Department of Psychiatry, The Third People's Hospital of Fuyang, Fuyang, China
| | - Yulong Zhang
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, China.,Anhui Psychiatric Center, Anhui Medical University, Hefei, China
| | - Liang Sun
- Department of Psychiatry, The Third People's Hospital of Fuyang, Fuyang, China
| | - Juan Wang
- Department of Psychiatry, Chengdu Fourth People's Hospital, Chengdu, China
| | - Lei Xia
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, China.,Anhui Psychiatric Center, Anhui Medical University, Hefei, China
| | - Yating Yang
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, China.,Anhui Psychiatric Center, Anhui Medical University, Hefei, China
| | - Feng Sun
- Department of Psychiatry, The Third People's Hospital of Fuyang, Fuyang, China
| | - Wenzheng Li
- Department of Psychiatry, Hefei Fourth People's Hospital, Hefei, China
| | - Xianhu Yao
- Department of Psychiatry, Ma'anshan Fourth People's Hospital, Ma'anshan, China
| | - Rongchun Yang
- Department of Psychiatry, The Third People's Hospital of Fuyang, Fuyang, China
| | - Huanzhong Liu
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, China.,Anhui Psychiatric Center, Anhui Medical University, Hefei, China
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Wolf S, Seiffer B, Zeibig JM, Welkerling J, Bauer LL, Frei AK, Studnitz T, Rosenstiel S, Fiedler DV, Helmhold F, Ray A, Herzog E, Takano K, Nakagawa T, Kropp S, Franke S, Peters S, El-Kurd N, Zwanzleitner L, Sundmacher L, Ramos-Murguialday A, Hautzinger M, Sudeck G, Ehring T. Efficacy and cost-effectiveness of a Transdiagnostic group-based exercise intervention: study protocol for a pragmatic multi-site randomized controlled trial. BMC Psychiatry 2021; 21:540. [PMID: 34717567 PMCID: PMC8556805 DOI: 10.1186/s12888-021-03541-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 09/22/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Mental disorders are prevalent and cause considerable burden of disease. Exercise has been shown to be efficacious to treat major depressive disorders, insomnia, panic disorder with and without agoraphobia and post traumatic stress disorder (PTSD). METHODS This pragmatic, two arm, multi-site randomised controlled trial will evaluate the efficacy and cost-effectiveness of the manualized, group-based six-months exercise intervention "ImPuls", among physically inactive patients with major depressive disorders, insomnia, panic disorder, agoraphobia and PTSD within a naturalistic outpatient context in Germany. A minimum of 375 eligible outpatients from 10 different study sites will be block-randomized to either ImPuls in addition to treatment as usual (TAU) or TAU only. ImPuls will be conducted by trained exercise therapists and delivered in groups of six patients. The program will combine (a) moderate to vigorous aerobic exercise carried out two-three times a week for at least 30 min with (b) behavior change techniques for sustained exercise behavior change. All outcomes will be assessed pre-treatment, post-treatment (six months after randomization) and at follow-up (12 months after randomization). Primary outcome will be self-reported global symptom severity assessed with the Brief Symptom Inventory (BSI-18). Secondary outcomes will be accelerometry-based moderate to vigorous physical activity, self-reported exercise, disorder-specific symptoms, quality-adjusted life years (QALY) and healthcare costs. Intention-to-treat analyses will be conducted using mixed models. Cost-effectiveness and cost-utility analysis will be conducted using incremental cost-effectiveness and cost-utility ratios. DISCUSSION Despite its promising therapeutic effects, exercise programs are currently not provided within the outpatient mental health care system in Germany. This trial will inform service providers and policy makers about the efficacy and cost-effectiveness of the group-based exercise intervention ImPuls within a naturalistic outpatient health care setting. Group-based exercise interventions might provide an option to close the treatment gap within outpatient mental health care settings. TRIAL REGISTRATION The study was registered in the German Clinical Trials Register (ID: DRKS00024152 , 05/02/2021).
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Affiliation(s)
- Sebastian Wolf
- Faculty of Economics and Social Sciences, Department of Education & Health Research, Institute of Sports Science, University of Tuebingen, Tuebingen, Germany.
- Faculty of Science, Department of Clinical Psychology and Psychotherapy, Psychological Institute, University of Tuebingen, Tuebingen, Germany.
| | - Britta Seiffer
- Faculty of Economics and Social Sciences, Department of Education & Health Research, Institute of Sports Science, University of Tuebingen, Tuebingen, Germany
- Faculty of Science, Department of Clinical Psychology and Psychotherapy, Psychological Institute, University of Tuebingen, Tuebingen, Germany
| | - Johanna-Marie Zeibig
- Faculty of Economics and Social Sciences, Department of Education & Health Research, Institute of Sports Science, University of Tuebingen, Tuebingen, Germany
- Faculty of Science, Department of Clinical Psychology and Psychotherapy, Psychological Institute, University of Tuebingen, Tuebingen, Germany
| | - Jana Welkerling
- Faculty of Economics and Social Sciences, Department of Education & Health Research, Institute of Sports Science, University of Tuebingen, Tuebingen, Germany
- Faculty of Science, Department of Clinical Psychology and Psychotherapy, Psychological Institute, University of Tuebingen, Tuebingen, Germany
| | - Leonie Louisa Bauer
- Faculty of Economics and Social Sciences, Department of Education & Health Research, Institute of Sports Science, University of Tuebingen, Tuebingen, Germany
- Faculty of Science, Department of Clinical Psychology and Psychotherapy, Psychological Institute, University of Tuebingen, Tuebingen, Germany
| | - Anna Katharina Frei
- Faculty of Economics and Social Sciences, Department of Education & Health Research, Institute of Sports Science, University of Tuebingen, Tuebingen, Germany
- Faculty of Science, Department of Clinical Psychology and Psychotherapy, Psychological Institute, University of Tuebingen, Tuebingen, Germany
| | - Thomas Studnitz
- Faculty of Economics and Social Sciences, Department of Education & Health Research, Institute of Sports Science, University of Tuebingen, Tuebingen, Germany
- Faculty of Science, Department of Clinical Psychology and Psychotherapy, Psychological Institute, University of Tuebingen, Tuebingen, Germany
| | - Stephanie Rosenstiel
- Faculty of Economics and Social Sciences, Department of Education & Health Research, Institute of Sports Science, University of Tuebingen, Tuebingen, Germany
| | - David Victor Fiedler
- Faculty of Economics and Social Sciences, Department of Education & Health Research, Institute of Sports Science, University of Tuebingen, Tuebingen, Germany
| | - Florian Helmhold
- Medical Faculty, Institute of Medical Psychology and Behavioral Neurobiology, University of Tuebingen, Tuebingen, Germany
| | - Andreas Ray
- Medical Faculty, Institute of Medical Psychology and Behavioral Neurobiology, University of Tuebingen, Tuebingen, Germany
| | - Eva Herzog
- Department of Psychology, Clinical Psychology and Psychotherapy, LMU Munich, Munich, Germany
| | - Keisuke Takano
- Department of Psychology, Clinical Psychology and Psychotherapy, LMU Munich, Munich, Germany
| | - Tristan Nakagawa
- Department of Psychology, Clinical Psychology and Psychotherapy, LMU Munich, Munich, Germany
| | - Saskia Kropp
- Chair of Health Economics, Technical University Munich (TUM), Munich, Germany
| | - Sebastian Franke
- Chair of Health Economics, Technical University Munich (TUM), Munich, Germany
| | - Stefan Peters
- German Association for health-related Fitness and Exercise Therapy (German: DVGS), Hürth-Efferen, Germany
| | | | | | - Leonie Sundmacher
- Chair of Health Economics, Technical University Munich (TUM), Munich, Germany
| | - Ander Ramos-Murguialday
- Medical Faculty, Institute of Medical Psychology and Behavioral Neurobiology, University of Tuebingen, Tuebingen, Germany
| | - Martin Hautzinger
- Faculty of Science, Department of Clinical Psychology and Psychotherapy, Psychological Institute, University of Tuebingen, Tuebingen, Germany
| | - Gorden Sudeck
- Faculty of Economics and Social Sciences, Department of Education & Health Research, Institute of Sports Science, University of Tuebingen, Tuebingen, Germany
| | - Thomas Ehring
- Department of Psychology, Clinical Psychology and Psychotherapy, LMU Munich, Munich, Germany
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10
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Xie Y, Wu Z, Sun L, Zhou L, Wang G, Xiao L, Wang H. The Effects and Mechanisms of Exercise on the Treatment of Depression. Front Psychiatry 2021; 12:705559. [PMID: 34803752 PMCID: PMC8602192 DOI: 10.3389/fpsyt.2021.705559] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 10/05/2021] [Indexed: 12/12/2022] Open
Abstract
Background: It is necessary to seek alternative therapies for depression, because side effects of medications lead to poor adherence and some patients do not achieve a clinical treatment effect. Recently the role of exercise as a low-cost and easy-to-use treatment for depression has gained attention with a number of studies showing that exercise is effective at reducing depressive symptoms and improving body functions such as cardiorespiratory system and cognitive function. Because of the heterogeneity of exercise therapy programs, there is no standardized and unified program. Few studies have summarized the specific properties of exercise programs (type, intensity, duration, and frequency) and clinical prescriptions for exercise are not mentioned in most articles. Aims: This study aimed to investigate the feasibility and efficacy of exercise therapy for patients with depression, in order to appraise the evidence and outline accepted guidelines to direct individualized treatment plans for patients with depression based on their individual situations. Methods: A systematic review of English language literature including papers published from 2010 to present in PubMed was performed. Given the feasibility of prescribing exercise therapy for patients with depression, nearly 3 years of clinical studies on the treatments of depressive symptoms with exercise were first reviewed, comparing the exercise programs utilized. Conclusions: Exercise has therapeutic effects on depression in all age groups (mostly 18-65 years old), as a single therapy, an adjuvant therapy, or a combination therapy, and the benefits of exercise therapy are comparable to traditional treatments for depression. Moderate intensity exercise is enough to reduce depressive symptoms, but higher-dose exercise is better for overall functioning. Exercise therapy has become more widely used because of its benefits to the cardiovascular system, emotional state, and systemic functions. Recommendations: Aerobic exercise/mind-body exercise (3-5 sessions per week with moderate intensity lasting for 4-16 weeks) is recommended. Individualized protocols in the form of group exercise with supervision are effective at increasing adherence to treatment.
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Affiliation(s)
- Yumeng Xie
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
| | - Zuotian Wu
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
| | - Limin Sun
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
| | - Lin Zhou
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
| | - Gaohua Wang
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
| | - Ling Xiao
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
| | - Huiling Wang
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
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