Exercise therapy and mental health in clinical populations: is exercise therapy a worthwhile intervention?

Mental health, physical health, and health-related behaviors of U.S. Army Special Forces

Objectives

To prospectively examine the health and health-related behaviors of Army Special Forces personnel in comparison with two distinct, but functionally similar Army groups.

Methods

Special Forces, Ranger Qualified, and General Purposes Forces enrolled in the Millennium Cohort Study were identified using data from the Defense Manpower Data Center. Using prospective survey data (2001–2014), we estimated the association of Army specialization with mental health, social support, physical health, and health-related behaviors with multivariable regression models.

Results

Among the 5,392 eligible participants (84.4% General Purposes Forces, 10.0% Special Forces, 5.6% Ranger Qualified), Special Forces personnel reported the lowest prevalence of mental disorders, physical health problems, and unhealthy behaviors. In the multivariable models, Special Forces personnel were less likely to report mental health problems, multiple somatic symptoms, and unhealthy behaviors compared with General Purpose Forces infantrymen (odds ratios [OR]: 0.20–0.54, p-values < .01). Overall, Special Forces personnel were similar in terms of mental and physical health compared with Ranger Qualified infantrymen, but were less likely to sleep < 5 hours/night (OR: 0.60, 95% confidence intervals: 0.40, 0.92) and have 5 or more multiple somatic symptoms (OR: 0.69, 95% CI: 0.49, 0.98). Both Special Forces personnel and Ranger Qualified infantrymen engaged in more healthy behaviors compared with General Purpose Forces infantrymen (OR: 2.57–6.22, p-values<0.05). Engagement in more healthy behaviors reduced the odds of subsequent adverse health outcomes, regardless of specialization.

Conclusions

Army Special Forces personnel were found to be mentally and physically healthier than General Purpose Forces infantrymen, which may in part be due to their tendency to engage in healthy behaviors. Findings indicate that engagement in a greater number of healthy behaviors may reduce odds for subsequent adverse outcomes.

The buffer effect of physical activity: Why does parental marital satisfaction affect adolescents' problematic Internet use

•

Marital satisfaction negatively predicted adolescents' problematic internet use (PIU).

•

Depression mediated the relationship between marital satisfaction and PIU.

•

The mediating effect was significant for individuals with low physical activity.

•

The mediating effect was not significant for individuals with high physical activity.

Introduction

To explore the moderating effect of physical activity and the mediating effect of depression on the relationship between marital satisfaction and adolescents’ problematic internet use (PIU).

Methods

This study adopted a sample of 288 adolescents and their parents, and measured adolescents’ depression, PIU, physical activity, and parents’ marital satisfaction.

Results

These results showed that parental marital satisfaction negatively predicted adolescents' PIU. Adolescents’ depression played a mediating role between parental marital satisfaction and adolescents’ PIU. Further mediated moderation effect analysis showed that the interaction between marital satisfaction and adolescents' physical activity affected the PIU through adolescents’ depression. Specifically, for individuals with lower physical activity, the marital satisfaction affected the PIU through adolescents' depression. However, for the group with higher physical activity, physical activity weakened the effects of marital satisfaction on adolescents' depression, and the mediating effect of depression did not reach a significant level.

Conclusion

These results are of theoretical and practical significance in understanding and intervening to address adolescents' PIU.

Cytokine responses across submaximal exercise intensities in women with major depressive disorder

Background

Major depressive disorder (MDD) is associated with chronic inflammation. Exercise training can treat depression in adults with MDD, potentially through reducing inflammatory activity. This improvement may occur through adaptations to repeated acute inflammatory responses. Cytokine responses to acute steady-state exercise of varying intensities were determined in women with different levels of depression.

Methods

This analysis included 19 women with MDD who each participated in four sessions consisting of 30 ​min of quiet rest, light, moderate, or hard intensity exercise. Blood samples were collected pre- and within 10 ​min post-session. Changes in the levels of IL-6, IL-8, IL-10, and TNF were evaluated in each session.

Results

Serum concentrations of IL-6, IL-8 and TNF were all significantly elevated following vigorous exercise (i.e., hard) compared to the quiet rest session. No changes in cytokine levels occurred after light and moderate exercise. Depression severity did not appear to influence the acute inflammatory response to exercise.

Limitations

The sample size was small, all female, and from a secondary data analysis, which limits the generalizability of the findings.

Conclusions

Repeat, acute increases in inflammatory activity following hard exercise sessions may prompt adaptations and lead to reductions in chronic inflammation over time. This dose-response study identified an exercise intensity threshold to induce acute inflammatory responses in women with MDD.

The impact of disability type and visibility on self-concept and body image: Implications for mental health nursing

WHAT IS KNOWN ON THE SUBJECT?: Physical appearance, as in the case of individuals with physical disabilities who use a cane, walker or wheelchair, also influence others' reactions and as a result, may lead to one's negative or positive feelings and thoughts. A disability that is not observable by others, as in the case of individuals with psychiatric disabilities (mental illnesses), may also have a negative impact on one's feelings and thoughts, due to stigma associated with psychiatric disabilities. To date, research has mainly focused on the way persons with a noticeable type of disability think about themselves. It is also important to evaluate the impact of disability type on ones' feelings and thoughts, and compare persons with visible and invisible disabilities. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: We asked 119 adults (over the age of 18 years) with different types of disabilities to complete a set of questionnaires and found that those who had a disability that was not observable by others (a psychiatric disability) felt more negative about themselves and their body than those who had a disability that was observable by others (a physical disability). The study extends the current knowledge on the impact of disability type and its visibility on the way persons with disabilities think about themselves. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The findings suggest that healthcare services should be modified to address the psychological needs of people with different types of disability. Mental health nurses should identify practices in the community that will improve the feelings and thoughts of consumers with disabilities, and especially those who cope with a psychiatric disability. Abstract Introduction Individuals with disabilities often face stigma and discrimination, which may negatively affect their self-concept. To date, research has mainly focused on the psychological implications of living with a noticeable physical disability. Less attention has been given to individuals with invisible psychiatric disabilities as a stigmatized subgroup in the disability community. Aim To evaluate the impact of disability type and its visibility on the self-concept and body image. Method A cross-sectional quantitative study design was implemented to compare the self-concept and body image of individuals with visible physical disabilities and individuals with invisible psychiatric disabilities (n = 119). Pearson correlations, ANOVA and multiple linear regression models were performed. Results Individuals with invisible psychiatric disabilities reported lower levels of self-concept and body image compared to individuals with visible physical disabilities. Gender, family status and the severity level of the disability were found to be associated with self-concept and body image. Discussion The study extends the current knowledge by showing that disability visibility might play a protective role for persons with physical disabilities compared to persons with psychiatric disabilities. Implications for Practice Mental health nurses should apply practices to enhance the self-concept and body image of consumers with invisible psychiatric disabilities.

Cognitive Interpretation Bias: The Effect of a Single Session Moderate Exercise Protocol on Anxiety and Depression

Research conducted within the cognitive bias modification (CBM) paradigm has revealed that cognitive biases such as negative cognitive interpretation biases contribute to mental health disorders such as anxiety (Beard, 2011). It has been shown that exercise reduces anxiety (Ensari et al., 2015). Exercise has also been found to reduce negative cognitive attention biases (Tian and Smith, 2011), however, no research to date has investigated the effect of exercise on cognitive interpretation bias. The key aims of the current project is to investigate whether moderate exercise reduces self-reported symptoms of depression and stress. Additionally, to establish which intensity of exercise is required to achieve anxiety reduction and reduce an individual's negative cognitive interpretation biases. Study 1 recruited a healthy sample of adult participants who were randomly assigned to one of two conditions: a walking exercise protocol or a control condition (n = 2 × 12). Participants completed anxiety and cognitive interpretation bias measures before and after the walking exercise or control condition. Those in the walking exercise condition presented less symptoms of trait anxiety on a measure of state and trait anxiety inventory (STAI), compared to controls relative to baseline measures following the intervention. Study 2 recruited frequent exercisers who were assigned to an exercise or control group (n = 2 × 24). Participants completed anxiety, depression, psychological stress, and cognitive interpretation bias measures before and after the exercise or control condition. Following the intervention, negative interpretation biases decreased in the exercise group and stayed stable in the control group. The exercise group also had significantly decreased anxiety, depression, and stress measures after the exercise condition, while controls did not. The research concludes that CBM holds promise for the management of mood disorders and exercise is an effective accompaniment to psychotherapy.

Improving the physical health of long-stay psychiatric in-patients

Research evidence has shown that morbidity and mortality rates are higher in psychiatric patients than in the general population. This article describes factors that affect the physical health of psychiatric patients living in institutions and the steps that can be taken to review, monitor and improve their physical health. The physical health care of long-stay patients should reach the same standards as those expected in the general population.

Exercise as antidepressant treatment: Time for the transition from trials to clinic?

The publisher regrets that this article has been temporarily removed. A replacement will appear as soon as possible in which the reason for the removal of the article will be specified, or the article will be reinstated. The full Elsevier Policy on Article Withdrawal can be found at http://www.elsevier.com/locate/withdrawalpolicy.

Bidirectional longitudinal relationship between leisure-time physical activity and psychotropic medication usage: A register linked follow-up study

This study aimed to examine the bidirectional relationship between psychotropic medication use and changes in leisure-time physical activity (LTPA) among a population cohort study. Phase 1 data were collected by mail surveys in 2000-2002 among 40-60-year-old employees of the City of Helsinki, Finland, and phase 2 follow up survey was conducted in 2007. Based on self-report, the respondents were classified as inactive and active (≥14.75 MET-hours/week) at the phases 1 and 2. Hazard ratios (HR) were calculated for subsequent (2007-10) psychotropic medication purchasing according to changes in physical activity (phases 1-2). Odds ratios (OR) for physical inactivity at phase 2 were calculated according to the amount of psychotropic medication between phases 1-2. Overall, 5361 respondents were included (mean age 50 years, 80% women). Compared with the persistently active, the persistently inactive, those decreasing and adopting LTPA had an increased risk for psychotropic medication. Only the persistently inactive remained at increased risk for psychotropic medication use, following the adjustment for prior psychotropic medication use. Compared with those having no medication, the risk for physical inactivity increased as the psychotropic medication increased. Our data suggest that physical activity has an important role in maintaining wellbeing and reducing psychotropic medication usage.

Preliminary Effectiveness and Sustainability of Group Aerobic Exercise Program in Patients with Schizophrenia

The objective of this study was to examine the feasibility and sustained effect of a group aerobic exercise program in patients with schizophrenia. Twenty-four schizophrenic patients participated in a group-based individually tailored 90-minute outdoor cycling session per week for 3 months with intervention to enhance motivation. Physical health was evaluated by anthropometric measures, cardiorespiratory (CR) fitness, and blood tests. Mental health was assessed on self-esteem, interpersonal relationship, quality of life, and global function. Attrition rate for the exercise program was 8.3%. Exercise program significantly increased participant's self-esteem, positive relationship, global function, and quality of life. CR fitness significantly improved after 3 months. At the 9-month follow-up, 6 months after program completion, only in interpersonal relationship change the improved effects were maintained. These findings support the feasibility of group aerobic exercise program with high level of adherence and its long-term benefits in positive relationship change.

Evaluation of a combined cognitive-behavioural and exercise intervention to manage fear of falling among elderly residents in nursing homes

OBJECTIVES

Although the fear of falling is common among elderly residents in long-term care facilities, interventions developed for fear of falling management is very rare. Of these limited interventions, most were exercise interventions with only limited testing. The cognitive-behavioural intervention can decrease the fear of falling; however no intervention of the kind was developed and assessed to decrease fear of falling among the elderly in long-term care facilities. The purpose of this study was to examine the effectiveness of cognitive-behavioural strategies either with or without exercise in reducing fear of falling among elderly residents in nursing homes.

METHOD

A prospective randomized control trial was conducted in six nursing homes in northern Taiwan. Seventy-five elderly participants were randomly assigned to one of the three groups: the comparison group, the cognitive-behavioural strategies with or without exercise group. The fear of falling, falls, depressive inclination, mobility, and muscle strength of extremities were collected at the two-month and five-month follow-up sessions, in which the progress of the patients were assessed.

RESULTS

The mixed model analysis revealed that elderly adults in the combination experimental group had significant improvements compared with the other two groups on fear of falling, depressive inclination, mobility, and muscle strength at five months. The incidences of falls, post intervention, in both experimental groups were significantly lower than those in the comparison group.

CONCLUSIONS

The results suggest that the combination intervention helped elderly residents manage their fear of falling and falls, decrease their depressive inclination, and enhance their mobility and muscle strength.

Act-Belong-Commit: Lifestyle Medicine for Keeping Mentally Healthy

Lifestyle medicine has generally focused on behaviors related to improving physical health and preventing physical illnesses, with little attention to behaviors related to mental health. This reflects the far greater concern in health systems around the globe for physical health over mental health. The Act-Belong-Commit campaign is the first major attempt to provide a lifestyle framework for promoting mental health that can be applied at a population level, within specific settings, and in the clinic. This article describes the campaign and offers clinicians a guide to implementing the campaign in their practice.

Exercise Augmentation of Exposure Therapy for PTSD: Rationale and Pilot Efficacy Data

Brain-derived neurotrophic factor (BDNF) is associated with synaptic plasticity, which is crucial for long-term learning and memory. Some studies suggest that people suffering from anxiety disorders show reduced BDNF relative to healthy controls. Lower BDNF is associated with impaired learning, cognitive deficits, and poor exposure-based treatment outcomes. A series of studies with rats showed that exercise elevates BDNF and enhances fear extinction. However, this strategy has not been tested in humans. In this pilot study, we randomized participants (N = 9, 8 females, M(Age) = 34) with posttraumatic stress disorder (PTSD) to (a) prolonged exposure alone (PE) or (b) prolonged exposure+exercise (PE+E). Participants randomized to the PE+E condition completed a 30-minute bout of moderate-intensity treadmill exercise (70% of age-predicted HR(max)) prior to each PE session. Consistent with prediction, the PE+E group showed a greater improvement in PTSD symptoms (d = 2.65) and elevated BDNF (d = 1.08) relative to the PE only condition. This pilot study provides initial support for further investigation into exercise augmented exposure therapy.

Exploring the role of physical activity for people diagnosed with serious mental illness in Ireland

The aim of the study was to elicit the views and opinions of people diagnosed with serious mental illness in relation to physical activity. Ten people who were attending a community mental health centre participated in semi-structured interviews. The main results showed that participants found physical activity beneficial in terms of psychological and social well-being and perceived clear gains in relation to recovery and quality of life. Physical activity should be routinely included in plans of care and mental health policy guidelines globally should contain physical activity as a key component. Mental health policy guidelines globally should contain physical activity as a key component. The aim of the current study was to explore the subjective experiences of people diagnosed with serious mental illness (SMI) in relation to physical activity. The study was conducted using a qualitative exploratory descriptive approach. The participants (n = 10), who were outpatients attending a day centre, were interviewed to elicit their views and opinions about physical activity. The data were thematically analysed using a recognized framework. The main themes that emerged included physical activity as a meaningful activity, physical activity as a mental activity, quality of life and recovery, and perceived challenges to physical activity. The unique perspectives of service users provides fresh insights on the topic and the findings support the justification for the inclusion of physical activity in plans of care and to be contained in global mental health policy directives.

Clinical exercise interventions in alcohol use disorders: a systematic review

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

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

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

The impact of exercise projects to promote mental wellbeing

BACKGROUND

There is a well-established link between physical activity and psychological wellbeing, but less evidence on whether it can increase comfort in disclosure of mental health problems and help to reduce the perceived stigma of mental illness.

AIMS

To investigate whether exercise projects, funded by the time to change anti-stigma programme to reduce mental health-related stigma and discrimination in England, can improve (1) wellbeing, (2) participation in physical activity, (3) readiness to disclose mental health problems or (4) perceived reduction in levels of stigma and discrimination.

METHODS

Participants of exercise projects run in routine community settings by local Mind and Rethink Mental Illness associations completed the Warwick-Edinburgh Mental Well-being Scale (WEMWBS) and questions addressing the other three outcomes at baseline and three month follow-up (N = 2663 baseline; N = 531 three month follow-up).

RESULTS

There was significant improvement at three months on the WEMWBS (t(386) = -7.64, p = <0.001, r = 0.36); readiness to disclose (χ(2)(1) = 10.86, p = 0.001) and participation in physical activity outside of the project (χ(2)(1) = 12.01, p = 0.001).

CONCLUSIONS

Community-based exercise projects have the potential to produce multifaceted positive outcomes for people with mental health problems; however, more methodologically robust studies are needed to adequately determine the effects of exercise.

Mood Disorders among Older Adults Participating in Individual and Group Active Environments: "Me" versus "Us," or Both?

Involvement in physical activity is associated with improved mental health including better social skills, coping mechanisms, and lower rates of depression. However, evidence on whether group or individual active environments better facilitate these benefits remains inconsistent. This cross-sectional cohort study examined the mental health reports of older adults (aged 50+) in relation to participation in group or individual active environments. Logistic multivariate regression analyses were conducted on the Canadian Community Health Survey (cycle 4.1, 2007-2008, n = 44, 057). Results illustrated that those active in both group and individual environments were 59% less likely to have a mood disorder than those who were not participating in either (P < 0.001). Also, those active in both environments were 31% less likely to have a mood disorder than those active in an individual environment (P < 0.001). Participating in only group or only individual environments had a similar effect compared to individuals not active in any environments for reducing rates of reported mood disorders (22% and 28%, resp.). However, the findings related to only group environments were not significant. These findings reveal that participating in both group and individual physical activities may have important implications for maintaining older adults' mental health status.

Placing physical activity in mental health care: a leadership role for mental health nurses

The wide-ranging benefits of physical activity for consumers with mental illness are acknowledged within the mental health nursing field; however, this is not commonly translated to practice. The primary aim of this paper is to argue that mental health nurses are well positioned to, and should, provide leadership in promoting physical activity to improve the quality of care for people with mental illness. Topics addressed in this paper include the relationship between physical activity and both physical and mental health, the views and experiences of consumers with physical activity, the efficacy of physical activity interventions, the attitudes of nurses to physical activity as a component of care, barriers to a physical activity focus in care for mental illness, and the role of mental health nurses in promoting physical activity. There is a clear and important relationship between physical activity and mental health. Mental health nurses are well positioned to encourage and assist consumers to engage in physical activity, although they might lack the educational preparation to perform this role effectively.

Effect of aging on the perceptions of physical and mental health in an Australian population

The aim of this study was to examine the impact of age on the perceptions of mental and physical health in an Australian population. A cross-sectional study of the Queensland population was conducted via telephone interviews (n = 1165). The Short Form-12 Health Survey was used to measure the population's perceived physical and mental health and additional demographic information was collected. Groups with participants who were aged 18-24, 25-34, 35-44, 45-54, 55-64, and > 65 years were compared. The results suggested that the participants' perceptions of mental health gradually increased with age, as the 55-64 and > 65 years old age groups scored significantly higher than did the younger age groups. Conversely, the older participants scored significantly lower than the younger participants on the physical health scale. Further research is warranted to consider the factors that might influence the perceptions of mental health across the life span.

The Role of Exercise in Treating Postpartum Depression: A Review of the Literature

There is now evidence to support the antidepressant effects of exercise in general and in clinical populations. This article reviews the evidence regarding the potential role of exercise, particularly pram walking, as an adjunctive treatment for postpartum depression. Database searches revealed two small randomised controlled trials conducted in Australia which support exercise as a useful treatment for women with postpartum depression. In addition, uncontrolled studies and observational evidence suggest that postpartum women, some of whom were depressed, report benefit from participation in exercise programmes. There are plausible mechanisms by which exercise could have such an effect. Limited evidence supports a relationship between participation in exercise and reduction in postpartum depression. Given the reluctance by some women to use antidepressant medication postpartum and the limited availability of psychological therapies, exercise as a therapeutic possibility deserves further exploration. Further research using well-designed randomised controlled trial methodologies are warranted.

The health benefits of urban green spaces: a review of the evidence

BACKGROUND

Urban development projects can be costly and have health impacts. An evidence-based approach to urban planning is therefore essential. However, the evidence for physical and non-physical health benefits of urban green space is unclear.

METHODS

A literature search of academic and grey literature was conducted for studies and reviews of the health effects of green space. Articles found were appraised for their relevance, critically reviewed and graded accordingly. Their findings were then thematically categorized.

RESULTS

There is weak evidence for the links between physical, mental health and well-being, and urban green space. Environmental factors such as the quality and accessibility of green space affects its use for physical activity. User determinants, such as age, gender, ethnicity and the perception of safety, are also important. However, many studies were limited by poor study design, failure to exclude confounding, bias or reverse causality and weak statistical associations.

CONCLUSION

Most studies reported findings that generally supported the view that green space have a beneficial health effect. Establishing a causal relationship is difficult, as the relationship is complex. Simplistic urban interventions may therefore fail to address the underlying determinants of urban health that are not remediable by landscape redesign.

The Association Between Extra-Curricular Sport Participation and Social Anxiety Symptoms in Children

Social anxiety is a common psychological complaint that can have a significant and long-term negative impact on a child’s social and cognitive development. In the current study, the relationship between sport participation and social anxiety symptoms was investigated. Swiss primary school children (N=201), parents, and teachers provided information about the children’s social anxiety symptoms, classroom behavior, and sport involvement. Gender differences were observed on social anxiety scores, where girls tended to report higher social anxiety symptoms, as well as on sport activity, where boys engaged in more sport involvement. MANCOVAs with gender as covariant showed no differences in social anxiety symptoms between children involved in an extracurricular sport and those not engaged in sport participation. Nevertheless, children engaged in team sports displayed fewer physical social anxiety symptoms than children involved in individual sports.

The place and promotion of well-being in mental health services: a qualitative investigation

The study investigated the place and promotion of well-being from the perspectives of services users and mental health professionals. * Data from focus groups and interviews were analysed and found that well-being promotion was available, for example weight management groups in mental health services. However, they also found that there were some contradictions between the groups of people interviewed about what was available and what to promote in the future. * The study concludes suggesting partnerships with local communities to further develop well-being services, such as opportunities for physical activity, for people with mental health problems. Abstract This study explored service users' and mental health professionals' understandings, experiences and opinions of well-being and its promotion within mental health services. A qualitative case study methodology included nine participants (five adult service users, three mental health professionals, one senior manager) who were purposively sampled from a Mental Health Trust in England. Service users participated in a focus group, while individual semi-structured interviews were held with the mental health professionals and senior manager. Interpretative phenomenological analysis of the data revealed five main themes including well-being as a holistic concept; well-being promotion; the place, promotion and position of well-being; role of mental health services in well-being promotion; and areas for further improvement. Findings revealed evidence of well-being promotion; however, there were contradictions regarding what was known between the groups of participants and what could be provided in the future. Implications for practice include the need to establish more effective partnership working between mental health services and local communities, especially in light of financial constraints within health services at large. This could assist the increased provision of therapeutic services for well-being promotion.

How effective are physical activity interventions for alleviating depressive symptoms in older people? A systematic review

BACKGROUND

The benefits of physical exercise in reducing clinically defined depression in the general population have been established, although a review of the evidence for older adults is needed.

OBJECTIVES

To assess the efficacy of physical exercise for the treatment of depressive symptoms in older adults (>60 years).

DATA SOURCES

We searched: MEDLINE (1966-May 2008); EMBASE (1980-May 2008); Cumulative Index to Nursing & Allied Health Literature (CINAHL; 1982-May 2008); PsycINFO (1966-May 2008), The Cochrane Library (Issue 2, 2008), and National Research Register (NRR; Issue 2, 2008).

REVIEW METHODS

Randomized controlled trials and quasi-experimental studies of physical exercise interventions for depression were included where 80% or more of participants were >60 years. Abstracts were assessed to determine whether they met specified inclusion criteria. Primary analysis focused on the prevalence of diagnosable depressive disorder following intervention. Secondary outcome was depression or mood scores on standardized scales.

RESULTS

Eleven randomized controlled trials with a total of 641 participants were included in the review. Short-term positive outcome for depression or depressive symptoms was found in nine studies, although the mode, intensity and duration of intervention varied across studies. Medium- to long-term effects of intervention were less clear.

CONCLUSION

Physical exercise programmes obtain clinically relevant outcomes in the treatment of depressive symptoms in depressed older people. Exercise, though not appropriate for all in this population, may improve mood in this group. Further research is needed to establish medium- to long-term effects and cost-effectiveness.

Schizophrenia and physical health problems

OBJECTIVE

To estimate the prevalence of physical health problems in patients with schizophrenia, and to appraise the impact on mortality rates and quality of life (QoL) in such patients.

METHOD

A selective review of clinical articles relating to physical health such as cardiovascular disease, metabolic syndrome and QoL. In addition, current guidelines and recommendations for the monitoring of physical health in schizophrenia were reviewed.

RESULTS

Cardiovascular events contribute most strongly to the excess mortality observed in schizophrenia. Other factors that contribute significantly include obesity, metabolic aberrations, smoking, alcohol, lack of exercise and poor diet - all of which might be targets for health promoting activities.

CONCLUSION

Physical health problems in patients with schizophrenia are common, and contribute to the excess mortality rate, as well as decreasing QoL. Many adverse physical factors are malleable in such patients, and physical benefit may be gained by following practical guidelines for their monitoring and improvement.

The effects of physical exercises to mental state and quality of life in patients with schizophrenia

The purpose of this study was to examine the effects of 10 weeks of physical exercises programme on mental states and quality of life (QOL) of individuals with schizophrenia. The study involved 30 inpatients or outpatients with schizophrenia who were assigned randomly into aerobic exercise (n = 15) group and control (n = 15) group, participated to the study voluntarily. There were no personal differences such as age, gender, disorder duration, medication use between the both groups. An aerobic exercise programme was applied to the subject group, the periods of 10 weeks as 3 days in a week. Data were collected by using the Brief Symptom Inventory, the Scale for the Assessment of Positive Symptoms, the Scale for the Assessment of Negative Symptoms and to the both group before and after the exercise programme. After the 10-week aerobic exercise programmes the subjects in the exercise programme showed significantly decreases in the Scale for the Assessment of Positive Symptoms, the Scale for the Assessment of Negative Symptoms and the Brief Symptom Inventory points and their World Health Organization Quality of Life Scale-Turkish Version points were increased than controls. These results suggest that mild to moderate aerobic exercise is an effective programme for decreasing psychiatric symptoms and for increasing QOL in patients with schizophrenia.

The effect of exercise on psychological & physical health outcomes: preliminary results from a Norwegian forensic hospital

People with mental illness are more likely to experience physical health problems and die prematurely than are comparable populations. This study evaluated whether exercise, when offered as part of routine treatment, affects the psychological and physical health of patients in a high-secure forensic unit in Norway. Thirteen patients completed a structured exercise program lasting 8 to 12 weeks. After completion of the program, resting heart rate and systolic blood pressure after treadmill testing were significantly improved. In addition, patients' subjective feelings of well-being and safety improved significantly. This study shows that structured exercise is possible to perform with noticeable improvements and low attrition among patients with complex conditions. Implications for future studies and practice are discussed.

Let's get physical

There is growing recognition and understanding of the inextricable interrelationship between physical and mental health. In mental health care, the physical health of consumers is now acknowledged as a serious problem requiring urgent action. This issue is undoubtedly related to negative symptoms and the lifestyle of people with mental illness. Much of the burden is also clearly linked with the detrimental side effects of psychotropic medications and deficits in the knowledge, skill, and confidence of mental health clinicians in relation to physical health matters. This paper highlights the problem of physical health in mental health care and presents recommendations to address this issue. The benefits of exercise on mental health in particular are explored. The authors argue that mental health nurses must play an active role in health promotion, primary prevention, and the early detection and management of physical health problems in all areas of clinical practice.

Uptake and participation in physical activity referral schemes in the UK: an investigation of patients referred with mental health problems

The study compared outcomes of uptake, attendance, and completion between two patient groups (mental health, n = 134 and physical health, n = 2767) in a physical activity referral scheme in the UK during 2000 to 2003. Despite similar rates for the physical health and mental health groups for initial progression (94% vs. 90%), referral uptake (60% vs. 69%; p < 0.001) and programme completion (22% vs. 34%; p < 0.001) were significantly lower in the mental health referrals. In conclusion, physical activity referral schemes appear to be less well suited to the needs of the mental health patient. Further research is recommended.

'I know it is only exercise, but to me it is something that keeps me going': a qualitative approach to understanding mental health service users' experiences of sports therapy

The relationship between exercise and mental health is well documented and has led to the inclusion of exercise into the treatment of people with mental health problems. A qualitative (grounded theory) methodology, using focus groups, investigated the experiences of people with mental health problems, who had successfully participated in exercise as part of their treatment. The aim of this study was to investigate the experiences of service users who had successfully participated in sports therapy as part of their treatment. One of the researchers is also a service user who has participated in sports therapy and these experiences provided an insight into the research, especially in the design of the interview schedule, data collection (empathy with participants), and in the interpretation of the data. The dual role of service user and researcher is commended in contemporary mental health research and as such makes this study unique. A conceptual model is presented that explains the participants' subjective experiences, opinions, and perceptions of the role exercise has in their treatment, and their perceived outcomes from participation. The findings support sports therapy as an acceptable and beneficial adjunct to usual treatment for some people with mental health problems within the community, but that problems exist regarding knowledge and understanding of the theory underpinning its use.

Biopsychosocial effects of qigong as a mindful exercise for people with anxiety disorders: a speculative review

In view of the inadequacies of mainstream treatments for anxiety disorders, we suggest that qigong, an ancient oriental mindful exercise, may be a useful adjunctive treatment. We base this on a biopsychosocial model for health. Evidence suggests that the benefits of exercise on personal well-being can be explained using six theories: cognitive behaviour; distraction; social interaction; cardiovascular fitness; amine; and endorphin theories. To date, not much has been done to employ these theories to analyze the benefits of mindful exercises. We try here to reorganize these theories into psychosocial and physiologic perspectives and integrate them with the "mind regulation," "body regulation," and "breath regulation" components of qigong. We propose, because of its potential therapeutic effects, that qigong can be considered as an alternative therapy to help meet the increasing demand of nonpharmacologic modalities in achieving biopsychosocial health for those suffering from anxiety in the general population.

Exercise interventions as an adjunct therapy for psychosis: a critical review

PURPOSE

To review the existing evidence examining effectiveness of exercise as an adjunct therapy for psychosis.

METHOD

A search of databases including Pub Med, Psych Info, Cochrane Library, Cinahl, Sports Discus and Web of Knowledge was conducted to identify studies investigating the psychological changes following exercise interventions in people with psychosis. Literature was subjected to a critical review to determine the effectiveness of exercise as a therapy for psychosis.

RESULTS

A total of ten studies met the inclusion criteria: four quantitative, two qualitative and four using a mixed method design. Exercise interventions were supervised and generally lasted between 10 and 12 weeks. Study samples were small, even in the quantitative studies, meaning that statistical analysis was not always possible. Study design and outcome measures varied across all studies. Generally the research findings demonstrated a positive trend towards improved mental health for those participants utilising exercise.

CONCLUSION

The findings suggest the presence of a positive effect of exercise on mental health in people with psychosis, yet there is a need for greater consistency within the research to determine the size of effects and the most successful type of intervention. As exercise is increasingly used in the mental health service, more research is needed to provide a more comprehensive evidence-based practice.

Walking back to health: a qualitative investigation into service users' experiences of a walking project

The relationship between physical activity and mental health is well documented and has led to the inclusion of physical activity into the treatment of people with mental health problems within heath care. However, little research has been conducted on the outcomes these programmes have for the people who participate in them. This study investigated the perceived health outcomes of people with mental health problems who had successfully participated in a walking project. The research is a descriptive qualitative study that used individual interviews and the constant comparative method of analysis. Findings conclude that physical activity programmes have a significant part to play in the quality of life of people with mental health problems and have the potential to be an integral part of their health care.

Psychological effects of a low-grade abnormal cervical smear test result: anxiety and associated factors

Receipt of an abnormal cervical smear result often generates fear and confusion and can have a negative impact on a woman's well-being. Most previous studies have focussed on high-grade abnormal smears. This study describes the psychological and psychosocial effects, on women, of having received a low-grade abnormal smear result. Over 3500 women recruited to TOMBOLA (Trial Of Management of Borderline and Other Low-grade Abnormal smears) participated in this study. Anxiety was assessed using the Hospital Anxiety and Depression Scale (HADS) at recruitment. Socio-demographic and lifestyle factors, locus of control and factors associated with the psychosocial impact of the abnormal smear result were also assessed. Women reported anxiety levels consistent with those found in previous studies of women with high-grade smear results. Women at highest risk of anxiety were younger, had children, were current smokers, or had the highest levels of physical activity. Interventions that focus particularly on women's understanding of smear results and pre-cancer, and/or directly address their fears about cancer, treatment and fertility might provide the greatest opportunity to reduce the adverse psychosocial impact of receiving a low-grade abnormal cervical smear result.