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Seymour J, Pratt G, Patterson S, Korman N, Rebar A, Tillston S, Chapman J. Changes in self-determined motivation for exercise in people with mental illness participating in a community-based exercise service in Australia. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e1611-e1624. [PMID: 34614232 DOI: 10.1111/hsc.13588] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 07/11/2021] [Accepted: 09/20/2021] [Indexed: 06/13/2023]
Abstract
Exercise has diverse benefits for physical and mental health in people with mental illness; however, it is unclear how to effectively promote exercise motivation in this group. The aim of this study is to evaluate the effectiveness of interventions utilising exercise instruction or behavioural counselling with people with mental illness to improve self-determined motivation for exercise, and physical and mental health. Participants were adults (aged 18+ years) receiving mental health services. Participants could choose from two 8-week programs comprising weekly group-based sessions delivered by an exercise physiologist: (a) exercise instruction in a gym (GYM) or (b) behavioural counselling (MOT). Self-determined motivation was measured using the Behaviour Regulations for Exercise Questionnaire (BREQ3). Physical health indicators included waist circumference, blood pressure, leg strength (sit-to-stand test), physical capacity (six-minute walk test) and self-reported exercise. Mental health was assessed using the Kessler-6 scale of psychological distress. Most of the 95 participants chose exercise instruction (GYM = 60; MOT = 35). At baseline, participants who chose MOT had higher external motivation, body mass index, waist circumference and psychological distress, and a higher proportion had multiple physical comorbidities than those who chose GYM. More self-determined motivation was associated with meeting physical activity guidelines. Post-intervention, GYM participants had significant improvements in self-determined motivation, psychological distress and sit-to-stand test; MOT participants had significant improvements in integrated regulation, self-reported exercise and physical functioning. In conclusion, exercise instruction can improve self-determined motivation; however, more intensive behavioural counselling support may be needed to improve self-determined motivation. Counselling programs can increase exercise behaviour and may appeal more to people with poorer health and more external motivation. Findings have high ecological validity and applicability to real-world implementation of exercise interventions. To accommodate people with diverse conditions and motivations, motivational counselling should be combined with practical exercise support, and participants afforded the autonomy to decide their level of involvement.
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Affiliation(s)
- Jessica Seymour
- Queensland Police-Citizens Youth Welfare Association, Brisbane, Queensland, Australia
| | - Greg Pratt
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Sue Patterson
- Metro North Hospital and Health Service, Mental Health, Brisbane, Queensland, Australia
- School of Applied Psychology, Griffith University, Mt Gravatt, Queensland, Australia
| | - Nicole Korman
- Addiction and Mental Health, Metro South Hospital and Health Service, Brisbane, Queensland, Australia
- School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Amanda Rebar
- Motivation of Health Behaviours Lab, College of Psychology, Rockhampton, Queensland, Australia
| | - Stephen Tillston
- Queensland Police-Citizens Youth Welfare Association, Brisbane, Queensland, Australia
| | - Justin Chapman
- Queensland Police-Citizens Youth Welfare Association, Brisbane, Queensland, Australia
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
- Addiction and Mental Health, Metro South Hospital and Health Service, Brisbane, Queensland, Australia
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Queensland, Australia
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Wytsma-Fisher K, Ester M, Mustata S, Cowan T, Culos-Reed SN. Results From a Physical Activity Intervention Feasibility Study With Kidney Inpatients. Can J Kidney Health Dis 2022; 9:20543581221079958. [PMID: 35237444 PMCID: PMC8883299 DOI: 10.1177/20543581221079958] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 12/29/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Individuals with end-stage kidney disease requiring dialysis are often physically inactive, resulting in reduced physical functioning, increased frailty, and reduced quality of life. Furthermore, extended hospital stays and frequent readmissions are common, exacerbating health care costs. Physical activity may improve physical functioning, disability, and frailty but is not part of standard care of patients requiring dialysis. Research is required to determine the feasibility of implementing physical function assessments and physical activity programs in kidney inpatients requiring dialysis. Objective: To assess the feasibility and preliminary efficacy of an early-physical activity intervention (Move More study) in the care of kidney inpatients requiring dialysis. It was hypothesized that the intervention would be feasible with regards to administration and participation, meeting a priori feasibility criteria, and that kidney inpatients would benefit from participating. Design: Pilot study. Setting: Patient Unit 37, Foothills Medical Center, Calgary, AB, Canada. Patients: Kidney in-patients receiving dialysis. Measurements: Feasibility data were collected for recruitment, participation, assessment completion, physical activity completion, and adverse events. Participant and healthcare practitioner (HCP) satisfaction with the intervention was assessed using a questionnaire. Frailty and physical function were assessed by the kinesiologist at baseline and postintervention prior to hospital discharge. Methods: The study was a single-arm pilot intervention examining feasibility and preliminary efficacy. Kidney inpatients requiring dialysis were recruited to an individualized in-hospital physical activity intervention for the duration of their hospital stay. The intervention was led by a kinesiologist and supported by the clinical care team, including physiotherapists and nurse clinicians. Individualized exercise programs were created for patients to perform daily during their stay. These programs focused on strength, mobility, balance, and general movement and were tailored to each patient’s needs. Results: Thirty-six percent of eligible patients (n = 23/64) consented to participate in the Move More study, of whom 78% (n = 18/23) completed the intervention. The a priori level for consent to participate in the intervention was set at 60%. In addition, the a priori level for completion of assessments pre and postintervention was 50%. Ninety-five percent (n = 22/23) of preintervention assessments were completed compared to 65% of postintervention assessments. All participants who completed the survey (100%, n = 14/14) and most of the staff (77%, n = 24/31) reported being satisfied or very satisfied with the program. There were no adverse events related to the intervention. On average, Move More patients demonstrated improvements in frailty status and specific subsets of quality of life. Limitations: Firstly, as a feasibility study, the research was not powered to address the effectiveness of the intervention and lacked a comparison group to definitively link observed changes to the intervention itself. The voluntary nature of recruitment may have been biased toward ESKD inpatients with above-average motivation and baseline function. Furthermore, the small sample size from a single site limits the generalizability of findings. An additional limitation was the fact that postassessments were missed on a large number of patients, due to them being discharged prior to research staff knowing and being able to complete the assessments. Finally, studying the length of stay across the institution, as opposed to just the individual ward, would provide insight into hospitalization impact for these patients. Conclusions: The administration of and participation in a physical activity intervention for kidney inpatients requiring dialysis was initially not feasible primarily due to low recruitment and adherence challenges. The study was modified by including a research team member on the unit to increase recruitment efforts and support exercise adherence. The intervention impact includes potentially benefits on frailty and quality of life.
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Bredin SSD, Kaufman KL, Chow MI, Lang DJ, Wu N, Kim DD, Warburton DER. Effects of Aerobic, Resistance, and Combined Exercise Training on Psychiatric Symptom Severity and Related Health Measures in Adults Living With Schizophrenia: A Systematic Review and Meta-Analysis. Front Cardiovasc Med 2022; 8:753117. [PMID: 35211516 PMCID: PMC8860832 DOI: 10.3389/fcvm.2021.753117] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 12/20/2021] [Indexed: 11/13/2022] Open
Abstract
Previous research has demonstrated the efficacy, effectiveness, and safety of exercise training in persons living with schizophrenia. However, the optimal exercise training program remains unclear. The aim of this paper was to conduct a systematic review and meta-analysis of the effects of aerobic, resistance, and combined aerobic and resistance training on health-related physical fitness and positive and negative symptoms in persons living with schizophrenia. Six electronic databases were searched systematically from their inception to December 2020 [MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, SPORTDiscus, and Cumulative Index to Nursing and Allied Health Literature (CINAHL)] to identify literature examining the effects of exercise training on psychiatric symptoms and health-related physical fitness indicators in persons living with schizophrenia. A total of 22 studies (n = 913) were included in this review, and 12 studies (n = 554) included within the meta-analysis reported the effects of exercise training (aerobic, resistance, and combined aerobic and resistance) in persons living with schizophrenia. Aerobic training had a significant decrease on Positive and Negative Syndrome Scale (PANSS) negative scores (ES −2.28, 95% CI −3.57 to −1.00; p = 0.0005) and PANSS general scores (ES −2.51, 95% CI −3.47 to −1.55; p < 0.00001). Resistance training did not lead to significant effects on PANSS total scores. Combined aerobic and resistance training did not lead to significant changes in body mass index, PANSS positive scores, or PANSS total scores. However, grouping together the results from all exercise training modalities (including aerobic training, resistance training, and combined aerobic and resistance training) revealed significant effects on body mass index (ES 1.86, 95% CI 0.84 to 2.88; p = 0.0003), maximal/peak oxygen consumption (ES 2.54, 95% CI 1.47 to 3.62; p = < 0.00001), body weight (ES 6.58, 95% CI 2.94 to 10.22; p = 0.0004), PANSS negative scores (ES −1.90, 95% CI −2.70 to −1.10; p < 0.00001), and Scale for the Assessment of Negative Symptoms (SANS) total (ES −14.90, 95% CI −22.07 to −7.74; p < 0.0001). Collectively, these findings support the importance of exercise participation (aerobic and resistance training) in persons living with schizophrenia.
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Affiliation(s)
- Shannon S. D. Bredin
- Physical Activity Promotion and Chronic Disease Prevention Unit, University of British Columbia, Vancouver, BC, Canada
- Laboratory for Knowledge Mobilization, University of British Columbia, Vancouver, BC, Canada
| | - Kai L. Kaufman
- Physical Activity Promotion and Chronic Disease Prevention Unit, University of British Columbia, Vancouver, BC, Canada
- Cardiovascular Physiology and Rehabilitation Laboratory, University of British Columbia, Vancouver, BC, Canada
| | - Maddison I. Chow
- Physical Activity Promotion and Chronic Disease Prevention Unit, University of British Columbia, Vancouver, BC, Canada
- Cardiovascular Physiology and Rehabilitation Laboratory, University of British Columbia, Vancouver, BC, Canada
| | - Donna J. Lang
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Nana Wu
- Physical Activity Promotion and Chronic Disease Prevention Unit, University of British Columbia, Vancouver, BC, Canada
- Cardiovascular Physiology and Rehabilitation Laboratory, University of British Columbia, Vancouver, BC, Canada
| | - David D. Kim
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, BC, Canada
| | - Darren E. R. Warburton
- Physical Activity Promotion and Chronic Disease Prevention Unit, University of British Columbia, Vancouver, BC, Canada
- Cardiovascular Physiology and Rehabilitation Laboratory, University of British Columbia, Vancouver, BC, Canada
- *Correspondence: Darren E. R. Warburton
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The short and long-term effects of aerobic, strength, or mixed exercise programs on schizophrenia symptomatology. Sci Rep 2021; 11:24300. [PMID: 34934115 PMCID: PMC8692409 DOI: 10.1038/s41598-021-03761-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 12/06/2021] [Indexed: 11/08/2022] Open
Abstract
The purpose of this study was to compare the effects of three different physical exercise programs on the symptomatology, body composition, physical activity, physical fitness, and quality of life of individuals with schizophrenia. A total of 432 patients were assessed for eligibility and 86 were randomized into the aerobic (n = 28), strength (n = 29) or mixed (n = 29) groups. Positive, negative, and general symptoms of psychosis, body mass index (BMI), physical activity (IPAQ-SF), physical fitness (6-min walk test [6MWT] and hand-grip strength [HGS]), and quality of life (WHOQUOL-BREF) were assessed at baseline, post-intervention (16 weeks), and at 10-months. Our results at 16 weeks showed significant improvements in all three groups in the negative, general, and total symptoms with moderate to large effect sizes (P < 0.01, ηp2 > 0.11), no change in the BMI, 6MWT or IPAQ-SF, and a significant improvement in the HGS test in the strength and mixed groups (P ≤ 0.05, ηp2 > 0.08). Nonetheless, all the improvements had disappeared at 10 months. We concluded that 3 weekly sessions of a moderate to vigorous progressive exercise program for 16 weeks improved the symptomatology of individuals with schizophrenia in all three groups, with no differences between them. However, the effects had declined to baseline levels by the 10-month follow-up, suggesting that exercise interventions should be maintained over time.
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Çelik İnce S, Partlak Günüşen N. Effect of a nurse-led intervention program on the physical health and quality of life of individuals with severe mental illness. Perspect Psychiatr Care 2021; 57:1751-1764. [PMID: 33616211 DOI: 10.1111/ppc.12745] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 01/29/2021] [Accepted: 02/01/2021] [Indexed: 11/28/2022] Open
Abstract
PURPOSE The aim of this study was to investigate the effect of nurse-led intervention programs on patients' physical health, physical activities, healthy lifestyle behaviors, and quality of life. DESIGN AND METHODS The research was conducted with a quasi-experimental design. The sample consisted of 33 individuals with severe mental illness. Data were collected with the Healthy Lifestyle Behavior Scale II, the Short Form-36 Quality-of-Life Instrument, and pedometers. FINDINGS The individuals in the intervention group showed a statistically significant decrease in waist circumference and increases in the physical activity and nutrition dimensions of healthy lifestyle behaviors and the physical function of quality of life. No statistically significant changes were detected in anthropometric measurements, healthy lifestyle behaviors, or quality-of-life subscales in the control group. PRACTICE IMPLICATIONS Mental health nursing and psychiatric nurses should plan and implement interventions to encourage healthy eating and physical activity for patients.
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Affiliation(s)
- Sevecen Çelik İnce
- Psychiatric Nursing Department, Faculty of Health Science, Zonguldak Bülent Ecevit University, Zonguldak, Turkey.,Psychiatric Nursing Department, Health Sciences Institute, Dokuz Eylul University, Izmir, Turkey
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Whybird G, Nott Z, Savage E, Korman N, Suetani S, Hielscher E, Vilic G, Tillston S, Patterson S, Chapman J. Promoting quality of life and recovery in adults with mental health issues using exercise and nutrition intervention. INTERNATIONAL JOURNAL OF MENTAL HEALTH 2020. [DOI: 10.1080/00207411.2020.1854023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
| | - Zoie Nott
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland
- The University of Queensland, School of Psychology, Brisbane, Queensland
| | - Emma Savage
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland
- The University of Queensland, School of Psychology, Brisbane, Queensland
| | - Nicole Korman
- Metro South Addictions and Mental Health Service, Metro South Health, Brisbane, Queensland
- The University of Queensland, School of Medicine, Brisbane, Queensland
| | - Shuichi Suetani
- Metro South Addictions and Mental Health Service, Metro South Health, Brisbane, Queensland
- The University of Queensland, School of Medicine, Brisbane, Queensland
| | - Emily Hielscher
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland
- The University of Queensland, School of Medicine, Brisbane, Queensland
| | - Gabrielle Vilic
- Metro South Addictions and Mental Health Service, Metro South Health, Brisbane, Queensland
| | - Stephen Tillston
- Queensland Police-Citizens Youth Welfare Association, Brisbane, Queensland
| | - Sue Patterson
- Metro North Mental Health Service, Metro North Health, Brisbane, Queensland
| | - Justin Chapman
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland
- Metro South Addictions and Mental Health Service, Metro South Health, Brisbane, Queensland
- Queensland Police-Citizens Youth Welfare Association, Brisbane, Queensland
- The University of Queensland, School of Human Movement and Nutrition Sciences, Brisbane, Queensland
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7
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Pillny M, Schlier B, Lincoln TM. "I just don't look forward to anything". How anticipatory pleasure and negative beliefs contribute to goal-directed activity in patients with negative symptoms of psychosis. Schizophr Res 2020; 222:429-436. [PMID: 32389616 DOI: 10.1016/j.schres.2020.03.059] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 02/16/2020] [Accepted: 03/27/2020] [Indexed: 01/18/2023]
Abstract
Anticipatory pleasure refers to a state of positive affect in anticipation of future events that has been found to motivate goal-directed behavior. Previous research has indicated that patients with negative symptoms of psychosis show reduced goal-directed behavior because 'demotivating beliefs' impede anticipatory pleasure. This study aims to link demotivating beliefs and anticipatory pleasure to patients' motivation in everyday life. Using the Experience Sampling Method, we examined the motivational process of goal-directed activity in the daily lives of 35 patients with negative symptoms and 36 healthy controls. We tested whether the mechanism underlying goal-directed behavior differs between patients and healthy controls and whether demotivating beliefs interfere with goal-directed behavior by impeding anticipatory pleasure. Multilevel analyses revealed that anticipatory pleasure mediated the association between goal-intentions and goal-directed activity in both groups (indirect effects: 24-30%). In the patient group, however, the association between social goal-intentions and anticipatory pleasure was weaker (b = -0.09, SE = 0.05, p ≤ .01, [-0.17;-0.04]) than in the controls, but this was not found for goal-intentions related self-care or recreational activites. Also, demotivating beliefs were more pronounced in the patient sample. (F(1,70) = 72.11, p ≤ .001) and moderated the effect of goal-intentions on anticipatory pleasure for social activities in the whole sample (b = -0.12, SE = 0.05, p ≤ .01, [-0.20;-0.08]). Our results support the assumption that a set of demotivating beliefs prevents patients with negative symptoms from looking forward to social activities and thus provide a possible psychological explanation for the social withdrawal of patients with negative symptoms.
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Affiliation(s)
- Matthias Pillny
- Clinical Psychology and Psychotherapy, Institute of Psychology, Faculty of Psychology and Human Movement, Universität Hamburg, Hamburg, Germany..
| | - Björn Schlier
- Clinical Psychology and Psychotherapy, Institute of Psychology, Faculty of Psychology and Human Movement, Universität Hamburg, Hamburg, Germany
| | - Tania M Lincoln
- Clinical Psychology and Psychotherapy, Institute of Psychology, Faculty of Psychology and Human Movement, Universität Hamburg, Hamburg, Germany
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Suetani S, Chapman J, Korman N, Chapman C, Dodd C, Dark F, Parker S, Siskind D. A comparison study of three physical activity measurement tools examining acceptability in people with psychosis. Australas Psychiatry 2020; 28:175-179. [PMID: 31637964 DOI: 10.1177/1039856219881957] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To compare the acceptability of three distinct physical activity measurement tools in people with psychosis: an objective measurement tool, a self-report measure, and an exercise capacity test. METHODS We measured the completion rate for each measurement tool. Participants rated the ease/difficulty of each measure using a 7-point Likert scale. Participants were also asked to rank the three tools in order of the ease of use. RESULTS Sixty-six per cent (46/69) of participants completed all three assessment tools, and 60.9% (42/69) completed the acceptability questionnaire. The majority of the participants found it easy to complete all three measurement tools. The majority (52.8%) of the participants ranked the objective measurement tool as the easiest to use. CONCLUSION All three measures were acceptable to people with psychosis, but objective measurement tools may be easier to use.
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Affiliation(s)
- Shuichi Suetani
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Brisbane, QLD.,Queensland Brain Institute, The University of Queensland, Brisbane, QLD.,Metro South Addiction and Mental Health Service, Brisbane, QLD, Australia
| | - Justin Chapman
- Metro South Addiction and Mental Health Service, Brisbane, QLD.,QIMR Berghofer Medical Research Institute, Brisbane, QLD.,Queensland Police-Citizens Youth Welfare Association, Brisbane, QLD, Australia
| | - Nicole Korman
- Metro South Addiction and Mental Health Service, Brisbane, QLD.,School of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Carly Chapman
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Cassandra Dodd
- Metro South Addiction and Mental Health Service, Brisbane, QLD, Australia
| | - Frances Dark
- Metro South Addiction and Mental Health Service, Brisbane, QLD, Australia
| | - Stephen Parker
- Metro South Addiction and Mental Health Service, Brisbane, QLD.,School of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Dan Siskind
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Brisbane, QLD.,Metro South Addiction and Mental Health Service, Brisbane, QLD.,School of Medicine, University of Queensland, Brisbane, QLD, Australia
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Korman N, Fox H, Skinner T, Dodd C, Suetani S, Chapman J, Parker S, Dark F, Collins C, Rosenbaum S, Siskind D. Feasibility and Acceptability of a Student-Led Lifestyle (Diet and Exercise) Intervention Within a Residential Rehabilitation Setting for People With Severe Mental Illness, GO HEART (Group Occupation, Health, Exercise And Rehabilitation Treatment). Front Psychiatry 2020; 11:319. [PMID: 32411024 PMCID: PMC7198865 DOI: 10.3389/fpsyt.2020.00319] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 03/31/2020] [Indexed: 12/20/2022] Open
Abstract
PURPOSE People with severe mental illness (SMI) experience poor physical health and premature mortality, contributed significantly by modifiable lifestyle risk factors such as poor nutrition, low cardiorespiratory fitness, and physical inactivity. Lifestyle interventions can reduce cardiometabolic risk and confer a range of other positive mental and physical health benefits. We assessed the feasibility, acceptability, safety, and preliminary effectiveness of a lifestyle (combined dietary and exercise) intervention lead by senior exercise and dietetics students in a residential mental health rehabilitation setting. DESIGN Single arm, prospective study evaluating outcomes pre and post a 10-week dietary and exercise intervention. METHOD People with SMI from three residential rehabilitation units participated in a mixed aerobic and resistance training exercise intervention three times per week that was combined with a dietary intervention (six individual and group sessions). Primary outcome considerations were feasibility (recruitment, retention, and participation rates), acceptability, and adverse events. Secondary outcomes were preliminary effectiveness; (functional exercise capacity, volume of exercise, and metabolic markers), psychiatric symptoms, quality of life, and attitudes to exercise. RESULTS Forty-two participants were recruited (92% primary diagnosis of schizophrenia). Intervention feasibility was supported by high levels of recruitment (68%), retention (77%), and participation (70% exercise, 65% diet sessions); and the absence of serious adverse events. Significant improvements in functional exercise capacity, volume of exercise, general psychiatric symptoms, and negative psychotic symptoms occurred. Anthropometric and metabolic blood markers did not change. While the intervention was acceptable to participants, motivation for and perceived value of exercise reduced over 10 weeks. CONCLUSIONS A brief pragmatic student-led lifestyle intervention integrated into usual mental health care was feasible, acceptable, safe, and scalable across two additional mental health residential rehabilitation sites, and resulted in physical and mental health improvements. Increased frequency of dietary sessions and length of dietary intervention may improve metabolic outcomes in the future. People with SMI living in residential rehabilitation units should have access to lifestyle programs to address modifiable lifestyle risk factors. While this brief intervention was feasible and acceptable, this study highlights some of the challenges associated with maintaining motivation for healthy lifestyles for people with SMI. Longer term investigation of real-world lifestyle interventions is warranted, together with additional interventions that may support people with SMI to sustain motivation to address lifestyle factors. CLINICAL TRIAL REGISTRATION The trial was registered with the Australian New Zealand Clinical Trials Registry (ANZCTR), Unique Identifier: ACTRN 12618000478213, http://www.anzctr.org.au Universal trial number (UTN)-U1111-1211-4009.
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Affiliation(s)
- Nicole Korman
- Addiction and Mental Health Services, Metro South Health Services, Brisbane, QLD, Australia.,School of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Harley Fox
- School of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Tina Skinner
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, QLD, Australia
| | - Cassandra Dodd
- Addiction and Mental Health Services, Metro South Health Services, Brisbane, QLD, Australia
| | - Shuichi Suetani
- Addiction and Mental Health Services, Metro South Health Services, Brisbane, QLD, Australia
| | - Justin Chapman
- Addiction and Mental Health Services, Metro South Health Services, Brisbane, QLD, Australia.,Queensland Institute of Medical Research, Mental Health and Complex Disorders, Brisbane, QLD, Australia
| | - Stephen Parker
- Addiction and Mental Health Services, Metro South Health Services, Brisbane, QLD, Australia.,School of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Frances Dark
- Addiction and Mental Health Services, Metro South Health Services, Brisbane, QLD, Australia.,School of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Cheryl Collins
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, QLD, Australia
| | - Simon Rosenbaum
- School of Psychiatry, Faculty of Medicine, UNSW, Sydney, NSW, Australia
| | - Dan Siskind
- Addiction and Mental Health Services, Metro South Health Services, Brisbane, QLD, Australia.,School of Medicine, University of Queensland, Brisbane, QLD, Australia
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Parker S, Siskind D, Hermens DF, Dark F, McKeon G, Korman N, Arnautovska U, Harris M, Whiteford H. A Comprehensive Cohort Description and Statistical Grouping of Community-Based Residential Rehabilitation Service Users in Australia. Front Psychiatry 2019; 10:798. [PMID: 31780965 PMCID: PMC6857698 DOI: 10.3389/fpsyt.2019.00798] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 10/07/2019] [Indexed: 01/10/2023] Open
Abstract
Background: Community Care Units (CCUs) are a model of community-based residential rehabilitation support available in Australia that assists people affected by severe and persistent mental illness to enhance their independent living skills and community involvement. These services have been subject to limited evaluation, and available descriptions of consumer cohorts lack relevance to the understanding of their rehabilitation needs. Method: A clinical assessment battery covering a broad range of relevant domains was completed with consumers commencing at three CCUs in Queensland, Australia, between December 2014 and December 2017 (N = 145). The cohort was described based on demographic, diagnostic, treatment-related variables, and the assessment battery. The comparability of included sites was assessed. This contemporary cohort was also compared to the pooled cohort of Australian community-based residential rehabilitation services emerging from a previous systematic review. Additionally, cluster analysis (CA) was completed in two stages based on the clinician-rated assessments: hierarchical CA (Wards method) to identify the optimal number of clusters, followed by K-means clustering. Results: Dominant features of the cohort were male sex and the primary diagnoses of schizophrenia spectrum disorders. The average consumer age was 31.4 years. Most consumers were referred from the community, had been living with family, and were not subject to involuntary treatment orders. No site-based differences were observed on demographic, diagnostic and treatment-related variables. However, some site-based variation in levels of symptoms and functional impairment emerged. Overall, the cohort was comparable with the Transitional Residential Rehabilitation (TRR) cohort defined in a previous systematic review. Through CA, a three-cluster solution emerged: Cluster 1 (15%) was characterised by higher levels of substance use comorbidity; Cluster 2 (39%) was characterised by higher levels of disability and symptoms; and Cluster 3 (46%) was distinguished by lower levels of general psychiatric symptoms. Conclusions: The cohort was generally comparable to the TRR cohort. Site-based variability in the characteristics of admitted consumers was minimal. The CA solution suggested that three different sub-groups of consumers are admitted to CCUs, which have implications for adapting the approach to rehabilitation. Recommendations include ensuring early availability of interventions to address co-morbidities and pacing rehabilitation expectations to consumers stage of recovery.
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Affiliation(s)
- Stephen Parker
- Rehabilitation Academic Clinical Unit, Metro South Addiction and Mental Health Services (MSAMHS), Brisbane, QLD, Australia.,School of Public Health, University of Queensland, Herston, QLD, Australia
| | - Dan Siskind
- Rehabilitation Academic Clinical Unit, Metro South Addiction and Mental Health Services (MSAMHS), Brisbane, QLD, Australia.,School of Public Health, University of Queensland, Herston, QLD, Australia
| | - Daniel F Hermens
- Sunshine Coast Mind and Neuroscience-Thompson Institute, University of the Sunshine Coast, Birtinya, QLD, Australia
| | - Frances Dark
- Rehabilitation Academic Clinical Unit, Metro South Addiction and Mental Health Services (MSAMHS), Brisbane, QLD, Australia.,School of Public Health, University of Queensland, Herston, QLD, Australia
| | - Gemma McKeon
- Psychosis Academic Clinical Unit, Metro South Addiction and Mental Health Services (MSAMHS), Brisbane, QLD, Australia
| | - Nicole Korman
- Rehabilitation Academic Clinical Unit, Metro South Addiction and Mental Health Services (MSAMHS), Brisbane, QLD, Australia
| | - Urska Arnautovska
- PA Foundation, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Meredith Harris
- School of Public Health, University of Queensland, Herston, QLD, Australia
| | - Harvey Whiteford
- School of Public Health, University of Queensland, Herston, QLD, Australia
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