A Network Model of Health-Related Changes after a Lifestyle-Enhancing Treatment in Patients with Severe Mental Illness: the MULTI Study VI

Background/Objective

The effects of lifestyle interventions on physical and mental health in people with severe mental illness (SMI) are promising, but its underlying mechanisms remain unsolved. This study aims to examine changes in health-related outcomes after a lifestyle intervention, distinguishing between direct and indirect effects.

Method

We applied network intervention analysis on data from the 18-month cohort Multidisciplinary Lifestyle enhancing Treatment for Inpatients with SMI (MULTI) study in 106 subjects (62% male, mean age=54.7 (SD=10.8)) that evaluated changes in actigraphy-measured physical activity, metabolic health, psychopathology, psychosocial functioning, quality of life and medication use after MULTI (n=65) compared to treatment as usual (n=41).

Results

MULTI is directly connected to decreased negative symptoms and psychotropic medication dosage, and improved physical activity and psychosocial functioning, suggesting a unique and direct association between MULTI and the different outcome domains. Secondly, we identified associations between outcomes within the same domain (e.g., metabolic health) and between the domains (e.g., metabolic health and social functioning), suggesting potential indirect effects of MULTI.

Conclusions

This novel network approach shows that MULTI has direct and indirect associations with various health-related outcomes. These insights contribute to the development of effective treatment strategies in people with severe mental illness.

The association between mental healthcare professionals' personal characteristics and their clinical lifestyle practices: a national cross-sectional study in The Netherlands

BACKGROUND

Lifestyle interventions are important to improve the mental and physical health outcomes of people with mental illness. However, referring patients to lifestyle interventions is still not a common practice for mental healthcare professionals (MHCPs) and their own lifestyle habits may impact this. The aim of this study was to investigate MHCPs' personal lifestyle habits, their lifestyle history and referral practices, and if these are associated with their lifestyle habits, gender, and profession.

METHODS

In this cross-sectional study, an online questionnaire was distributed across relevant MHCP's in The Netherlands. Ordinal regression analyses on lifestyle habits, gender, profession, and lifestyle history and referral practices were conducted.

RESULTS

A total of the 1,607 included MHCPs, 87.6% finds that lifestyle should be part of every psychiatric treatment, but depending on which lifestyle factor, 55.1-84.0% take a lifestyle history, 29.7-41.1% refer to interventions, and less than half (44.2%) of smoking patients are advised to quit. MHCPs who find their lifestyle important, who are physically more active, females, and MHCPs with a nursing background take more lifestyle histories and refer more often. Compared to current smokers, MHCPs who never or formerly smoked have higher odds (2.64 and 3.40, respectively, p < 0.001) to advice patients to quit smoking.

CONCLUSIONS

This study indicates that MHCPs' personal lifestyle habits, gender, and profession affect their clinical lifestyle practices, and thereby the translation of compelling evidence on lifestyle psychiatry to improved healthcare for patients.

Screening and prevalence of cardiometabolic risk factors in patients with severe mental illness: A multicenter cross-sectional cohort study in the Netherlands

BACKGROUND

Due to increased cardiometabolic risks and premature mortality in people with severe mental illness (SMI), monitoring cardiometabolic health is considered essential. We aimed to analyse screening rates and prevalences of cardiometabolic risks in routine mental healthcare and its associations with patient and disease characteristics.

METHODS

We collected screening data in SMI from three mental healthcare institutions in the Netherlands, using most complete data on the five main metabolic syndrome (MetS) criteria (waist circumference, blood pressure, HDL-cholesterol, triglycerides, fasting blood glucose) within a 30-day timeframe in 2019/2020. We determined screened patients' cardiometabolic risks and analysed associations with patient and disease characteristics using multiple logistic regression.

RESULTS

In 5037 patients, screening rates ranged from 28.8% (waist circumference) to 76.4% (fasting blood glucose) within 2019-2020, and 7.6% had a complete measurement of all five MetS criteria. Older patients, men and patients with psychotic disorders had higher odds of being screened. Without regarding medication use, risk prevalences ranged from 29.6% (fasting blood glucose) to 56.8% (blood pressure), and 48.6% had MetS. Gender and age were particularly associated with odds for individual risk factors. Cardiometabolic risk was present regardless of illness severity and did generally not differ substantially between diagnoses, in-/outpatients and institutions.

CONCLUSIONS

Despite increased urgency and guideline development for cardiometabolic health in SMI last decades, screening rates are still low, and the MetS prevalence across screened patients is almost twice that of the general population. More intensive implementation strategies are needed to translate policies into action to improve cardiometabolic health in SMI.

The short and long-term effects of a lifestyle intervention in children with mental illnesses: a randomized controlled trial (Movementss study)

BACKGROUND

A lifestyle including poor diet, physical inactivity, excessive gaming and inadequate sleep hygiene is frequently seen among Dutch children. These lifestyle behaviors can cause long-term health problems later in life. Unhealthy lifestyle and poor physical health are even more prevalent among children with mental illness (MI) such as autism, attention-deficit/hyperactivity disorder, depression, and anxiety. However, research on lifestyle interventions among children with MI is lacking. As a result, there are currently no guidelines, or treatment programs where children with MI and poor lifestyle can receive effective support. To address these issues and to provide insight into the effectiveness of lifestyle interventions in children with MI and their families, the Movementss study was designed. This paper describes the rationale, study design, and methods of an ongoing randomized controlled trial (RCT) comparing the short-term (12 weeks) and long-term (1 year) effects of a lifestyle intervention with care as usual (CAU) in children with MI and an unhealthy lifestyle.

METHODS

A total of 80 children (6-12 years) with MI according to DSM-V and an unhealthy lifestyle are randomized to the lifestyle intervention group or CAU at a specialized child and adolescent mental hospital. The primary outcome measure is quality of life measured with the KIDSCREEN. Secondary outcomes include emotional and behavior symptoms, lifestyle parameters regarding diet, physical activity, sleep, and screen time, cognitive assessment (intelligence and executive functions), physical measurements (e.g., BMI), parenting styles, and family functioning, prior beliefs, adherence, satisfaction, and cost-effectiveness. Assessments will take place at the start of the study (T0), after 12 weeks (T1), six months (T2), and 12 months of baseline (T3) to measure long-term effects.

DISCUSSION

This RCT will likely contribute to the currently lacking knowledge on lifestyle interventions in children with MI.

TRIAL REGISTRATION

trialsearch.who.int/ NL9822. Registered at November 2nd, 2021.

Combining actigraphy and experience sampling to assess physical activity and sleep in patients with psychosis: A feasibility study

BACKGROUND

Sleep disorders and reduced physical activity are common in patients with psychosis and can be related to health-related outcomes such as symptomatology and functioning. Mobile health technologies and wearable sensor methods enable continuous and simultaneous monitoring of physical activity, sleep, and symptoms in one's day-to-day environment. Only a few studies have applied simultaneous assessment of these parameters. Therefore, we aimed to examine the feasibility of the simultaneous monitoring of physical activity, sleep, and symptoms and functioning in psychosis.

METHODS

Thirty three outpatients diagnosed with a schizophrenia or other psychotic disorder used an actigraphy watch and experience sampling method (ESM) smartphone app for 7 consecutive days to monitor physical activity, sleep, symptoms, and functioning. Participants wore the actigraphy watch during day and night and completed multiple short questionnaires (eight daily, one morning, and one evening) on their phone. Hereafter they completed evaluation questionnaires.

RESULTS

Of the 33 patients (25 male), 32 (97.0%) used the ESM and actigraphy during the instructed timeframe. ESM response was good: 64.0% for the daily, 90.6% for morning, and 82.6% for evening questionnaire(s). Participants were positive about the use of actigraphy and ESM.

CONCLUSION

The combination of wrist-worn actigraphy and smartphone-based ESM is feasible and acceptable in outpatients with psychosis. These novel methods can help both clinical practice and future research to gain more valid insight into physical activity and sleep as biobehavioral markers linked to psychopathological symptoms and functioning in psychosis. This can be used to investigate relationships between these outcomes and thereby improve individualized treatment and prediction.

Evaluating the implementation of a multidisciplinary lifestyle intervention for people with severe mental illness in sheltered housing: effectiveness-implementation hybrid randomised controlled trial

BACKGROUND

Lifestyle interventions can improve health-related outcomes for people with severe mental illness (SMI), but few studies evaluate this potential in everyday settings. After a successful approach in routine inpatient mental healthcare (MULTI), we sought to replicate this multidisciplinary lifestyle-enhancing support in people with SMI living in sheltered housing (MULTI_sh).

AIMS

To evaluate the effectiveness and implementation of MULTI_sh (trial registration: NCT03157557).

METHOD

In an effectiveness-implementation hybrid cluster-randomised controlled trial, six municipalities with sheltered housing facilities in The Netherlands were randomly assigned to MULTI_sh (n = 3) or treatment as usual (TAU, n = 3). After 12 months, we evaluated effects on metabolic health, sedentary behaviour/physical activity (ActiGraph GT3X+), quality of life (EuroQol 5D, WHOQoL-Bref) and psychopathology (Brief Psychiatric Rating Scale Expanded Version) using multiple regression, adjusting for baseline values and municipalities (intention to treat and per protocol). In addition, implementation fidelity and barriers/facilitators were evaluated (Measurement Instrument for Determinants of Innovation).

RESULTS

Of 177 eligible patients, 74 (42%) could be included in the analyses. Health outcomes did not substantially improve with MULTI_sh (n = 45) compared with TAU (n = 29). MULTI_sh was not implemented as intended. Most patients and all healthcare professionals believed that patients' lifestyle should be part of treatment, but implementation was primarily (in)directly hindered by organisational factors (e.g. staff shortages, complexity of participation, lack of time and difficulty getting patients involved).

CONCLUSIONS

MULTI_sh was not implemented as intended and no clinical health improvements were found. Organisations are decisive in the success or failure of the implementation of lifestyle interventions for people with SMI. More intensive implementation strategies on this level are warranted in sheltered housing.

Cardiorespiratory fitness and self-reported physical activity levels of referring mental healthcare professionals, and their attitudes and referral practices related to exercise and physical health

BACKGROUND

Physical activity (PA) interventions can improve mental and physical health of people with mental illness, especially when delivered by qualified exercise professionals. Also, the behaviour, engagement and support of referring mental healthcare professionals (HCP) seem essential, but research is scarce. We aimed to study HCP physical fitness and PA, and associations with their attitudes and referral practices related to physical health and PA interventions.

METHODS

HCP at the Dutch Association for Psychiatry congress (2019) were invited to an online questionnaire (demographic/work characteristics, stress, PA levels, knowledge/attitudes regarding PA, referral practices) and cycle ergometer test. Strongest associations were analysed using linear and logistic regression.

RESULTS

Of the 115 HCP who completed the questionnaire (40 also completed the ergometer test), 43% (n = 50) met PA guidelines (i.e., ≥150min moderate-to-vigorous PA and ≥2x bone/muscle-strengthening exercises/week). Women, HCP interns/residents and HCP experiencing more stress were less active and less likely to meet PA guidelines. Conversely, there were positive associations with personal experience with an exercise professional. Knowledge/attitudes on physical health and PA were positive. HCP were more likely to refer patients to PA interventions if they met PA guidelines (OR = 2.56, 95%BI = 0.85-7.13) or had higher beliefs that exercise professionals can increase adherence to PA interventions (OR = 3.72, 95%BI = 1.52-9.14).

LIMITATIONS

Mainly psychiatrists, affecting generalizability.

CONCLUSIONS

HCP report the importance and relevance of PA in mental healthcare. Despite strong evidence and guidance for PA interventions in prevention and treatment, referral to such interventions partly depends on the PA behaviour and attitude of patient's physician/clinician.

Thirty years of research on physical activity, mental health, and wellbeing: A scientometric analysis of hotspots and trends

The sheer volume of research publications on physical activity, mental health, and wellbeing is overwhelming. The aim of this study was to perform a broad-ranging scientometric analysis to evaluate key themes and trends over the past decades, informing future lines of research. We searched the Web of Science Core Collection from inception until December 7, 2021, using the appropriate search terms such as "physical activity" or "mental health," with no limitation of language or time. Eligible studies were articles, reviews, editorial material, and proceeding papers. We retrieved 55,353 documents published between 1905 and 2021. The annual scientific production is exponential with a mean annual growth rate of 6.8% since 1989. The 1988-2021 co-cited reference network identified 50 distinct clusters that presented significant modularity and silhouette scores indicating highly credible clusters (Q = 0.848, S = 0.939). This network identified 6 major research trends on physical activity, namely cardiovascular diseases, somatic disorders, cognitive decline/dementia, mental illness, athletes' performance, related health issues, and eating disorders, and the COVID-19 pandemic. A focus on the latest research trends found that greenness/urbanicity (2014), concussion/chronic traumatic encephalopathy (2015), and COVID-19 (2019) were the most active clusters of research. The USA research network was the most central, and the Chinese research network, although important in size, was relatively isolated. Our results strengthen and expand the central role of physical activity in public health, calling for the systematic involvement of physical activity professionals as stakeholders in public health decision-making process.

Effectiveness and implementation of a MUltidisciplinary Lifestyle focused approach in the Treatment of Inpatients with mental illness (MULTI+): a stepped wedge study protocol

Introduction

People with mental illness (MI) have a reduced life expectancy compared to the general population, mostly attributable to somatic diseases caused by poor physical health. Modifiable lifestyle factors are increasingly associated with the onset of somatic diseases in people with MI. Despite the increasing evidence for the efficacy of lifestyle interventions there is little change in routine clinical care. This discrepancy is referred to as the implementation gap and has caused a need for effectiveness and implementation research in real-world settings.

Objectives

This study investigates the health outcomes and implementation of a multidisciplinary lifestyle focused approach in treatment of inpatients with mental illness (MULTI+).

Methods

This is an open cohort stepped wedge cluster randomized trial in inpatients psychiatric wards of GGz Centraal. Three clusters are randomly allocated to one of the three pre-defined steps to integrate MULTI+. MULTI+ can be tailored to fit individual psychiatric wards and includes 10 core components aimed at improving lifestyle factors. The primary outcome is to investigate whether there is a greater decrease in the QRISK3 cardiovascular risk score after receiving MULTI+ as compared to treatment as usual. Secondary outcomes include somatic and mental health outcomes, lifestyle factors, and implementation factors.

Results

First results expected in 2022.

Conclusions

To our knowledge, this will be the first large-scale study evaluating the long-term effects of a multidisciplinary, multicomponent approach aimed at improving lifestyle factors. We expect that this approach will increase long-term sustainability and can serve as a potential blueprint for future implementation of lifestyle interventions to improve routine clinical care.

Disclosure

No significant relationships.

The feasibility of an implementation fidelity tool for the monitoring of a multidisciplinary lifestyle focused approach for inpatients with mental illness

Introduction

Lifestyle behaviours (e.g. physical activity and dietary habits) play a major role in the well-known premature mortality caused by poor physical health in people with mental illness. There is increasing evidence for the efficacy of lifestyle interventions on both physical and mental health, and consensus about important factors for success (e.g. targeting multiple lifestyle behaviours). However, implementation remains challenging and there is little change in clinical care. Studies that include measures of fidelity (the extent to which an intervention is implemented as intended) are able to gain insight in variations in actual implementation, which may affect intended health outcomes. However, there is currently no suitable fidelity tool for our lifestyle intervention.

Objectives

A pilot study to evaluate the feasibility of a tool that assesses and monitors the implementation fidelity of a multidisciplinary lifestyle focused approach (MULTI+).

Methods

MULTI+ can be tailored to various psychiatric wards and consists of 10 essential components based on scientific evidence, existing guidelines and consensus in the field of ‘lifestyle psychiatry’. We developed a tool to assess the 10 components and thereby the implementation fidelity of MULTI+. Qualitative observational data about compliance to these components are collected in 45 psychiatric wards. Adherence is converted to a gradual score (0-50). A higher score indicates higher fidelity.

Results

Preliminary results show that the tool is feasible for use in clinical practice. Scores give insight in how various wards have implemented MULTI+.

Conclusions

These outcomes can be used to further improve and understand the implementation and effectiveness of lifestyle interventions.

Disclosure

No significant relationships.

Cost-effectiveness of a multidisciplinary lifestyle-enhancing treatment for inpatients with severe mental illness: the MULTI study V

Introduction

Economic evaluations of lifestyle interventions for people with mental illness are needed to inform policy makers and managers about implementing such interventions and corresponding reforms in routine mental healthcare.

Objectives

We aimed to evaluate changes in healthcare costs 18 months after the implementation of a multidisciplinary lifestyle-enhancing treatment for inpatients with severe mental illness (MULTI) versus treatment as usual (TAU).

Methods

In a cohort study (n=114; 65 MULTI, 49 TAU), we retrospectively retrieved cost data in Euros on all patient sessions, ward stay, medication use, and hospital referrals in the quarter year at the start of MULTI (Q1 2014) and after its evaluation (Q3 2015). We used linear regression analyses correcting for baseline values and differences between groups, calculated quality-adjusted life years (QALY) and deterministic incremental cost-effectiveness ratios, and performed probabilistic sensitivity analyses.

Results

Adjusted regression showed reduced total costs per patient per quarter year in favor of MULTI (B=-736.30, 95%CI: -2145.2–672.6). Corresponding probabilistic sensitivity analysis accounting for uncertainty surrounding the parameters showed MULTI was dominant over TAU with a saving in total costs of €417.48 (95%-CI: -2,873.2–2,042.1) against 0.06 improvement in QALY (95%-CI: -0.08–0.20). Costs saving estimates were statistically non-significant showing wide confidence intervals.

Conclusions

Regardless of cost savings, MULTI did not increase healthcare costs while improving QALY and additional previously observed health outcomes. This indicates that starting lifestyle interventions does not need to be hampered by costs. Potential societal and economic value may justify investment to support implementation and maintenance. Further research is needed to study this hypothesis.

Disclosure

No significant relationships.

Cardiorespiratory fitness and self-reported physical activity levels of referring mental healthcare professionals, and their attitudes and referral practices related to exercise and somatic care

Introduction

Physical activity (PA) interventions can improve mental and physical health in people with mental illness, especially when delivered by qualified exercise professionals. Also, the behaviour, engagement and support of referring mental healthcare professionals (HCP) seems essential, but research is scarce.

Objectives

Studying the physical fitness and PA of HCP and the relationship with their attitudes and referral practices related to PA interventions

Methods

HCP at the Dutch Association for Psychiatry conference (2019) were invited to an online questionnaire (demographic/work characteristics, stress, PA levels, knowledge/attitudes regarding PA and referral practices) and cycle ergometer test. Linear and logistic regression were used to study the strongest associations.

Results

115 HCP completed the questionnaire. 40 also completed the ergometer test. 43% (n=50) met the national PA guidelines (≥150min moderate-to-vigorous PA and ≥2x bone/muscle-strengthening exercises a week). Women, HCP in training and HCP with more stress were less active and less likely to meet PA guidelines. HCP with personal experience with an exercise professional were more active and met guidelines more often. Knowledge/attitudes on physical health and PA were positive. Patients were more often referred to PA interventions by HCP who met PA guidelines (OR=2.56, 95%BI=0.85–7.13) or had higher beliefs that exercise professionals can increase adherence to PA interventions (OR=3.72, 95%BI=1.52–9.14).

Conclusions

It’s positive that HCP report importance and relevance of PA in mental healthcare. Although there is strong evidence for PA interventions in the treatment of people with mental illness, referral to such interventions can partly depend on the PA behaviour and attitude of patients’ physician/clinician.

Disclosure

No significant relationships.

Perceived barriers and facilitating factors prior to the implementation of a lifestyle focused approach in the treatment of inpatients with mental illness

Introduction

Despite the increasing evidence for the efficacy of lifestyle interventions for people with mental illness (MI), there has been little change in routine clinical care. There are several factors that can complicate or facilitate the implementation of a lifestyle intervention. Gaining insight into such factors can contribute to effective integration into clinical practice.

Objectives

To assess the perceived barriers and facilitating factors of healthcare professionals (HCPs) and inpatients of psychiatric wards for the use of a lifestyle focused approach, prior to its implementation.

Methods

Baseline data from an open cohort cluster randomized stepped wedge study. Barriers and facilitators with regards to the intervention, HCPs and inpatients, and the organization were assessed with the measurement instrument for determinants of innovations, online, or through a semi-structured interview.

Results

Initial results show that inpatients (N=167) experience both barriers and facilitating factors with regards to themselves and the innovation. They perceive the innovation as complex and see few personal benefits, but indicate that they consider it part of their treatment. Healthcare workers (N=77) perceive facilitating factors related to themselves and the organization, such as expected support, but were not sufficiently aware of the content of the innovation. More detailed exploration of relationships with demographic and disease-related factors are currently being conducted.

Conclusions

These findings provide insight into the perceived barriers and facilitators of inpatients and HCPs regarding a lifestyle focused approach, prior to its implementation. More insight into relationships with demographic and disease-related factors can benefit application into routine clinical care.

Disclosure

No significant relationships.

The association between lifestyle factors, and physical and mental health in inpatients with MI: a network analysis

Introduction

People with mental illness (MI) have a reduced life expectancy compared to the general population, mostly attributable to somatic diseases caused by poor physical health. Lifestyle factors (exercise, sleep, diet, substance use) are associated with poor physical and mental health. Although lifestyle factors, and physical and mental health are believed to be interconnected, research has mainly focused on one-sided relationships. Currently, we are implementing a lifestyle focussed approach in treatment, in which we assess lifestyle factors as well as physical and mental health of people with MI on a large scale (˜850 places of residence).

Objectives

To investigate the association between lifestyle factors, and physical and mental health in people with MI.

Methods

Baseline data from an open cohort cluster randomized stepped wedge study. Lifestyle factors (exercise, sleep, diet, substance use), physical health, medication use and psychological health (symptoms, quality of life) were assessed using data from patient files and questionnaires. Associations will be analysed with network analyses.

Results

First results (N≈1600) show that 54% of patients have high blood pressure, 51% have excessive waist circumference, 46% are experiencing sleep problems, 71% smoke and 88% do not meet exercise guidelines. Patients experience a lower quality of life compared to the general population.

Conclusions

Initial results show that patients have poor physical health, low quality of life and an unhealthy lifestyle. Further analyses are currently being conducted to gain insight in the complex pattern between lifestyle factors, and physical and mental health. This can contribute to the improvement of routine clinical care.

Disclosure

No significant relationships.

Effectiveness and implementation of a multidisciplinary lifestyle focused approach in the treatment of inpatients with mental illness (MULTI +): a stepped wedge study protocol

BACKGROUND

People with mental illness have a reduced life expectancy compared to the general population. Despite the increasing evidence for the efficacy of lifestyle interventions there is little change in routine clinical care. This discrepancy is often referred to as the implementation gap and has caused a need for effectiveness and implementation research in real-world settings. Our study assesses the effectiveness and implementation of a multidisciplinary lifestyle focused approach in the treatment of inpatients with mental illness (MULTI +).

METHODS

An open cohort stepped wedge cluster randomized trial in inpatients psychiatric wards of GGz Centraal, the Netherlands. The wards are divided into three clusters based on geographical region. These clusters are randomly allocated to one of the three pre-defined steps to integrate MULTI + . MULTI + can be tailored to fit individual psychiatric wards and includes 10 core components aimed at improving lifestyle factors. The primary outcome is to investigate the difference in the mean QRISK3 score of patients receiving MULTI + compared to patients receiving TAU. Secondary outcomes include somatic and mental health outcomes, lifestyle factors, and implementation factors. Findings will be analysed using mixed model analyses.

DISCUSSION

The MULTI + study is the first large-scale study evaluating the long-term effects of a multidisciplinary, multicomponent approach aimed at improving lifestyle factors in routine inpatient mental health care. A limitation of this study is the risk of missing data due to the large-scale, real-world setting of this study. Furthermore, implementation monitoring and external events that may influence outcomes could be difficult to account for. Strengths of this study are the focus on effectiveness as well as implementation and the inclusion of both patient and health care professionals' perspectives. Effectiveness studies in routine clinical care can advance our knowledge on lifestyle interventions in real-world settings.

TRIAL REGISTRATION

ClinicalTrials.gov registration. Identifier: NCT04922749 . Retrospectively registered 3th of June 2021.

A mobile self-control training app to improve self-control and physical activity in people with severe mental illness: Protocol for two single-case experiment designs (Preprint)

BACKGROUND

Lack of physical activity is a common issue with detrimental consequences for the health of people with severe mental illness (SMI). Existing physical activity interventions show suboptimal effects as they require substantial cognitive skills, including goal setting and writing, whereas cognitive deficits are common in this population. To bolster the effectiveness of physical activity interventions, self-control training (SCT), in which users practice the ability to override unwanted thoughts and behaviors, can be used in addition. Recent research has demonstrated the initial effectiveness of a mobile SCT app, but this has not been studied in psychiatric clinical practice.

OBJECTIVE

This study aims to evaluate to what extent adding a mobile SCT app designed for and with people with SMI to a mobile lifestyle intervention aimed at increasing physical activity increases physical activity and self-control levels.

METHODS

A mixed methods approach incorporating 2 single-case experimental designs (SCEDs) and qualitative interviews was used to evaluate and optimize SCT. Overall, 12 participants with SMI will be recruited from 2 organizations offering outpatient and inpatient care to people with SMI. Each experiment will include 6 patients. SCED I is a concurrent multiple-baseline design across participants that explores initial effectiveness and optimal intervention duration. Using accelerometry and experience sampling questionnaires, participants' physical activity and self-control will be monitored for ≥5 days from baseline, followed by the sequential introduction of Google Fit, the physical activity intervention, for 7 days and the addition of SCIPP: Self-Control Intervention App for 28 days. SCED II is an introduction/withdrawal design in which optimized SCT will be introduced and withdrawn to validate the findings from SCED I. In both experiments, the daily average of total activity counts per hour and the state level of self-control will serve as the primary and secondary outcome measures. Data will be analyzed using visual analysis and piecewise linear regression models.

RESULTS

The study was designated as not subject to the Dutch Medical Research Involving Human Subjects Act by the Medical Research Ethical Committee Oost-Nederland and approved by the Ethics Committee/domain Humanities and Social Sciences of the Faculty of Behavioural, Management, and Social Sciences at the University of Twente. Participant recruitment started in January 2022, and we expect to publish the results in early 2023.

CONCLUSIONS

The mobile SCT app is expected to be feasible and effective. It is self-paced and scalable and can increase patient motivation, making it a suitable intervention for people with SMI. SCED is a relatively novel yet promising method for gaining insights into whether and how mobile apps work that can handle heterogeneous samples and makes it possible to involve a diverse population with SMI without having to include a large number of participants.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/37727.

Lifestyle interventions for people with a severe mental illness living in supported housing: A systematic review and meta-analysis

Although supported housing facilities (SHF) appear to be an ideal setting for supporting people with severe mental illness (SMI) to obtain a healthier lifestyle, little is known about the effects of lifestyle interventions in SHF and the factors contributing to successful implementation. We performed a systematic review and meta-analysis to assess the effect of lifestyle interventions on mental and physical health in people with SMI in SHF, and reviewed which intervention factors contribute to successful implementation. A meta-analysis using a random effects model was undertaken. Discussions were reviewed to identify factors that foster successful implementation. Of 7401 identified studies, 9 RCTs (n = 1260) were included for the systematic review and 8 (n = 1187) for the meta-analysis. Improvements in weight (n = 3), BMI (n = 1), 6-Min Walk Test (n = 1) and metabolic criteria (n = 2) were seen. In the meta-analysis we only found a small effect for a decrease in waist circumference. Reviewing factors involved with the implementation showed that the most successfully implemented interventions were multidisciplinary and integrated into standard care. In conclusion, we found limited evidence for the effectiveness of lifestyle interventions on physical health for those living in SHF. To reliably examine the effects on mental and physical health, more studies with high involvement of staff and participants are needed.

[Symptom monitoring by patients with a psychiatric disorder in palliative care]

BACKGROUND

Hardly any research has been conducted into systematic symptom monitoring in palliative care for patients with a psychiatric disorder.

AIM

To gain insight into the usefulness of the Utrecht Symptom Diary (USD) and the symptom burden of patients with a psychiatric disorder in the palliative phase.

METHOD

A pragmatic retrospective study using completed USDs by patients (USD-P) and/or caregivers (USD-Z) at the palliative unit and three clinical departments of geriatric psychiatry of GGz Centraal, from October 2011 to January 2018. Analysis was performed using completed USDs, from 3 months to 14 days before death and &le; 14 days before death. The first measurement was used in both periods. Primary outcomes: prevalence of symptoms (score &gt; 0) and clinical relevance of symptoms (score &gt; 3).

RESULTS

50 USD&rsquo;s from 38 patients were included, 9 USD-Ps and 41 USD-Zs were analysed. Self-reporting was usually not possible due to psychotic experiences, forms of denial, difficulty with concentration, weakness or fatique. Fatigue and loss of appetite were the most common in USD-Ps and USD-Zs. Fatigue reached most often clinically relevant intensity in USD-Ps and USD-Zs.

CONCLUSION

If the patient cannot fill in the USD-P, the USD-Z can be an alternative to systematically monitor symptoms. Application of the USD-Z requires good observation and awareness of differences in interpretation between healthcare providers and patients in a target group that has difficulty in expressing complaints clearly. Psychical symptoms are reported more often as clinically relevant than psychological symptoms. Fatigue is the most frequently and most unequivocally scored by patients and healthcare providers in terms of presence and clinically relevant intensity.

From impact factors to real impact: translating evidence on lifestyle interventions into routine mental health care

The scandal of premature mortality in people with serious mental illness is well established. Despite an increase in studies evaluating the efficacy of lifestyle interventions, translating this evidence into routine clinical care and policies is challenging, in part due to limited effectiveness or implementation research. We highlight the challenge of implementation that is increasingly recognized in clinical practice, advocate for adopting implementation science to study the implementation and systematic update of effective interventions in practice and policy, and provide directions for future research.

Exploring the Relationship Between Movement Disorders and Physical Activity in Patients With Schizophrenia: An Actigraphy Study

Low physical activity (PA) and sedentary behavior (SB) are major contributors to mental health burden and increased somatic comorbidity and mortality in people with schizophrenia and related psychoses. Movement disorders are highly prevalent in schizophrenia populations and are related to impaired functioning and poor clinical outcome. However, the relationship between movement disorders and PA and SB has remained largely unexplored. Therefore, we aimed to examine the relationship between movement disorders (akathisia, dyskinesia, dystonia, and parkinsonism) and PA and SB in 216 patients with schizophrenia and related psychoses. Actigraphy, the St. Hans Rating Scale for extrapyramidal syndromes, and psychopathological ratings (PANSS-r) were applied. Data were analyzed using multiple linear regression, adjusting for sex, age, negative symptoms, and defined daily dose of prescribed antipsychotics. Parkinsonism was significantly associated with decreased PA (β = -0.21, P < .01) and increased SB (β = 0.26, P < .001). For dystonia, only the relationship with SB was significant (β = 0.15, P < .05). Akathisia was associated with more PA (β = 0.14, P < .05) and less SB (β = -0.15, P < .05). For dyskinesia, the relationships were non-significant. In a prediction model, akathisia, dystonia, parkinsonism and age significantly predicted PA (F(5,209) = 16.6, P < .001, R2Adjusted = 0.27) and SB (F(4,210) = 13.4, P < .001, R2Adjusted = 0.19). These findings suggest that movement disorders, in particular parkinsonism, are associated with reduced PA and increased SB in patients with psychotic disorders. Future studies should take movement disorders into account when examining PA and SB, to establish the clinical value of movement disorders in activating people with psychotic disorders to improve their mental and somatic health.

Study protocol of a randomized, double-blind, placebo-controlled, multi-center trial to treat antipsychotic-induced weight gain: the Metformin-Lifestyle in antipsychotic users (MELIA) trial

BACKGROUND

Antipsychotic-induced Weight Gain (AiWG) is a debilitating and common adverse effect of antipsychotics. AiWG negatively impacts life expectancy, quality of life, treatment adherence, likelihood of developing type-2 diabetes and readmission. Treatment of AiWG is currently challenging, and there is no consensus on the optimal management strategy. In this study, we aim to evaluate the use of metformin for the treatment of AiWG by comparing metformin with placebo in those receiving treatment as usual, which includes a lifestyle intervention.

METHODS

In this randomized, double-blind, multicenter, placebo-controlled, pragmatic trial with a follow-up of 52 weeks, we aim to include 256 overweight participants (Body Mass Index (BMI) > 25 kg/m²) of at least 16 years of age. Patients are eligible if they have been diagnosed with schizophrenia spectrum disorder and if they have been using an antipsychotic for at least three months. Participants will be randomized with a 1:1 allocation to placebo or metformin, and will be treated for a total of 26 weeks. Metformin will be started at 500 mg b.i.d. and escalated to 1000 mg b.i.d. 2 weeks thereafter (up to a maximum of 2000 mg daily). In addition, all participants will undergo a lifestyle intervention as part of the usual treatment consisting of a combination of an exercise program and dietary consultations. The primary outcome measure is difference in body weight as a continuous trait between the two arms from treatment inception until 26 weeks of treatment, compared to baseline. Secondary outcome measures include: 1) Any element of metabolic syndrome (MetS); 2) Response, defined as ≥5% body weight loss at 26 weeks relative to treatment inception; 3) Quality of life; 4) General mental and physical health; and 5) Cost-effectiveness. Finally, we aim to assess whether genetic liability to BMI and MetS may help estimate the amount of weight reduction following initiation of metformin treatment.

DISCUSSION

The pragmatic design of the current trial allows for a comparison of the efficacy and safety of metformin in combination with a lifestyle intervention in the treatment of AiWG, facilitating the development of guidelines on the interventions for this major health problem.

TRIAL REGISTRATION

This trial was registered in the Netherlands Trial Register (NTR) at  https://www.trialregister.nl/trial/8440 as NTR NL8840 on March 8, 2020.

Associations of moderate to vigorous physical activity and sedentary behavior with depressive and anxiety symptoms in self-isolating people during the COVID-19 pandemic: A cross-sectional survey in Brazil

This is a cross-sectional study evaluating the associations of self-reported moderate to vigorous physical activity, and sedentary behavior with depressive, anxiety, and co-occurring depressive and anxiety symptoms (D&A) in self-isolating Brazilians during the COVID-19 pandemic. Depressive and anxiety symptoms were collected using the Beck Depression and Anxiety Inventories (BDI and BAI). Among the 937 participants (females=72.3%), those performing ≥30 min/day of moderate to vigorous or ≥15 min/day of vigorous physical activity had lower odds of prevalent depressive, anxiety, and co-occurring D&A symptoms. Those spending ≥10 h/day sedentary were more likely to have depressive symptoms.

Does physical activity reduce the risk of psychosis? A systematic review and meta-analysis of prospective studies

Longitudinal prospective cohorts have suggested that physical activity (PA) may be a protective factor against psychosis and schizophrenia. However, no meta-analysis has been conducted. The study aims to examine the prospective relationship between PA and incident psychosis/schizophrenia. Major databases were searched from inception to July 2019 for prospective studies that calculated the odds ratio (OR) or the adjusted odds ratio (AOR) of incident psychosis/schizophrenia in people with higher PA against people with lower PA. Methodological quality was assessed using the Newcastle-Ottawa Scale (NOS). A random-effects meta-analysis was conducted, for OR and AOR, separately. Across 4 cohorts (N = 30,025 median males = 50%, median follow-up = 32 years), people with high self-reported PA (versus low PA) were at reduced odds of developing psychosis/schizophrenia (OR = 0.73, 95%CI 0.532 to 0.995, p = 0.047). Analysis including 2 cohorts presenting AOR were not statistically significant (AOR = 0.59, 95%CI 0.253 to 1.383, p = 0.226). Overall study quality was high (mean NOS = 7.0). The literature on the topic is scarce, whilst crude analysis suggests that PA may be a protective factor against the emergence of psychosis/schizophrenia, but when adjusting for covariates, the association is no longer significant. Further studies with objective physical activity and adjustment for confounders are needed.

[The efficacy of physical activity on psychiatric symptoms and physical health in people with psychiatric disorders: a systematic review of recent meta-analyses]

Physical activity (PA) has been introduced in the sixties as standard care in the mental health care systems of The Netherlands and Belgium.<br/> AIM: To summarize the recent meta-analytic evidence of PA in the prevention and treatment of depressive disorders, anxiety disorders, psychotic disorders, bipolar disorders, substance use disorders, adhd, autism, and eating disorders.<br/> METHOD: medline/PubMed, Psycarticles and Embase were searched from January 1st, 2015 until January 31st, 2020 for meta-analyses of randomized controlled trials and cohort studies.<br/> RESULTS: There is strong evidence for the beneficial effects of PA in the treatment of mild and moderate depression in children / adolescents and adults, severe depression, anxiety disorders and psychotic disorders in adults and reductions in adhd-symptoms in children. PA reduces the risk for depression, anxiety and to a lesser extent also psychosis. PA also improves cardiorespiratory fitness and quality of sleep in people with a psychiatric disorder.<br/> CONCLUSION: There is trans-diagnostic scientific evidence for the beneficial effects of PA on psychiatric symptoms and physical health in people with a psychiatric disorder.

[The art of endurance: implementation of lifestyle interventions in mental healthcare]

An increasing number of studies in people with mental illness have demonstrated the efficacy of lifestyle interventions for both mental and physical health. However, implementing and sustaining such interventions in routine mental healthcare is challenging.<br/> AIM: To describe implementation barriers and facilitators of various lifestyle interventions in routine mental healthcare.<br/> METHOD: In this paper we summarise the results of three recent doctoral theses and provide recommendations for routine mental healthcare.<br/> RESULTS: Enabling factors and barriers for successful implementation appeared to be universal across various settings and patient populations. Mental healthcare professionals and patients appreciated and supported the lifestyle interventions. A lack of priority, recognition and support on the organisational level were reported as barriers in all the studies. Addressing various lifestyle behaviours simultaneously (e.g. physical activity and diet), personalised to the patients' abilities and preferences, and setting measurable and attainable goals, were important for success. Moreover, involving qualified professionals (e.g. exercise professionals and dietitians with expertise in mental healthcare) and ensuring cooperation between patients and healthcare professionals and disciplines within and outside mental healthcare appeared crucial.<br/> CONCLUSION: Successful implementation of lifestyle interventions in mental healthcare requires changes in culture and behaviour, a long-term strategy and endurance.

[Thinking inside the box: improving the lifestyle of inpatients with severe mental illness]

An unhealthy lifestyle plays an important role in the substantially reduced life-expectancy of inpatients with severe mental illness (SMI). However, there is a lack of evidence on the long-term effectiveness and implementation of lifestyle improvements in inpatient mental healthcare.<br/> AIM: Increasing knowledge and understanding of (the implementation of) lifestyle changes in inpatients with SMI in longer-term clinical care.<br/> METHOD: Cross-sectional research followed by an observational study to evaluate a multidisciplinary lifestyle enhancing treatment (MULTI) for both changes in health-related outcomes after 18 months compared to treatment as usual (TAU), and the implementation barriers and facilitators.<br/> RESULTS: Patients were very sedentary and less physically active compared to people without SMI. After 18 months, MULTI showed significant improvements in total physical activity, cardiometabolic risk factors, psychosocial functioning and mediation use, compared to TAU. Physical health did not improve in TAU. The implementation of MULTI was hampered by organisational factors and facilitated by positive attitudes of healthcare professionals and patients towards MULTI and their own role in it.<br/> CONCLUSION: Using a multidisciplinary integrated approach, it is possible to improve the lifestyle, and thus the health status, of SMI inpatients, within the current context of routine mental healthcare.

Implementation barriers and facilitators of an integrated multidisciplinary lifestyle enhancing treatment for inpatients with severe mental illness: the MULTI study IV

BACKGROUND

Despite an increase in studies showing the efficacy of lifestyle interventions in improving the poor health outcomes for people with severe mental illness (SMI), routine implementation remains ad hoc. Recently, a multidisciplinary lifestyle enhancing treatment for inpatients with SMI (MULTI) was implemented as part of routine care at a long-term inpatient facility in the Netherlands, resulting in significant health improvements after 18 months. The current study aimed to identify barriers and facilitators of its implementation.

METHODS

Determinants associated with the implementation of MULTI, related to the innovation, the users (patients, the healthcare professionals (HCPs)), and the organisational context, were assessed at the three wards that delivered MULTI. The evidence-based Measurement Instrument for Determinants of Innovations was used to assess determinants (29 items), each measured through a 5-point Likert scale and additional open-ended questions. We considered determinants to which ≥20% of the HCPs or patients responded negatively ("totally disagree/disagree", score < 3) as barriers and to which ≥80% of HCPs or patients responded positively ("agree/totally agree", score > 3) as facilitators. We included responses to open-ended questions if the topic was mentioned by ≥2 HCPs or patients. In total 50 HCPs (online questionnaire) and 46 patients (semi-structured interview) were invited to participate in the study.

RESULTS

Participating HCPs (n = 42) mentioned organisational factors as the strongest barriers (e.g. organisational changes and financial resources). Patients (n = 33) mentioned the complexity of participating in MULTI as the main barrier, which could partly be due to organisational factors (e.g. lack of time for nurses to improve tailoring). The implementation was facilitated by positive attitudes of HCPs and patients towards MULTI, including their own role in it. Open responses of HCPs and patients showed strong commitment, collaboration and ownership towards MULTI.

CONCLUSIONS

This is the first study analysing the implementation of a pragmatic lifestyle intervention targeting SMI inpatients in routine clinical care. Positive attitudes of both HCPs and patients towards such an approach facilitated the implementation of MULTI. We suggest that strategies addressing organisational implementation barriers are needed to further improve and maintain MULTI, to succeed in achieving positive health-related outcomes in inpatients with SMI.

Physical activity protects from incident anxiety: A meta-analysis of prospective cohort studies

BACKGROUND

Prospective cohorts have suggested that physical activity (PA) can decrease the risk of incident anxiety. However, no meta-analysis has been conducted.

AIMS

To examine the prospective relationship between PA and incident anxiety and explore potential moderators.

METHODS

Searches were conducted on major databases from inception to October 10, 2018 for prospective studies (at least 1 year of follow-up) that calculated the odds ratio (OR) of incident anxiety in people with high PA against people with low PA. Methodological quality was assessed using the Newcastle-Ottawa Scale (NOS). A random-effects meta-analysis was conducted and heterogeneity was explored using subgroup and meta-regression analysis.

RESULTS

Across 14 cohorts of 13 unique prospective studies (N = 75,831, median males = 50.1%) followed for 357,424 person-years, people with high self-reported PA (versus low PA) were at reduced odds of developing anxiety (adjusted odds ratio [AOR] = 0.74; 95% confidence level [95% CI] = 0.62, 0.88; crude OR = 0.80; 95% CI = 0.69, 0.92). High self-reported PA was protective against the emergence of agoraphobia (AOR = 0.42; 95% CI = 0.18, 0.98) and posttraumatic stress disorder (AOR = 0.57; 95% CI = 0.39, 0.85). The protective effects for anxiety were evident in Asia (AOR = 0.31; 95% CI = 0.10, 0.96) and Europe (AOR = 0.82; 95% CI = 0.69, 0.97); for children/adolescents (AOR = 0.52; 95% CI = 0.29, 0.90) and adults (AOR = 0.81; 95% CI = 0.69, 0.95). Results remained robust when adjusting for confounding factors. Overall study quality was moderate to high (mean NOS = 6.7 out of 9).

CONCLUSION

Evidence supports the notion that self-reported PA can confer protection against the emergence of anxiety regardless of demographic factors. In particular, higher PA levels protects from agoraphobia and posttraumatic disorder.

Changes in physical and psychiatric health after a multidisciplinary lifestyle enhancing treatment for inpatients with severe mental illness: The MULTI study I

Patients hospitalized with severe mental illness (SMI) often have an unhealthy lifestyle. Changing their sedentary behavior and deficiency in physical activity is challenging and effective interventions are lacking. We evaluated changes in sedentary behavior, physical activity, metabolic health and psychotic symptoms after 18 months of Multidisciplinary Lifestyle enhancing Treatment for Inpatients with SMI (MULTI) compared to treatment as usual (TAU) and explored mediation by change in total activity. We measured sedentary behavior and physical activity using accelerometry (ActiGraph GT3X+), reflected in total activity counts. Data on metabolic health and psychotic symptoms were retrieved from routine screening data within our cohort of inpatients with SMI. Of 65 patients receiving MULTI versus 43 receiving TAU, data were analyzed using linear and logistic multilevel regression, adjusting for baseline values of outcome and differences between groups. Compared to TAU, in which no improvements were observed, we found significantly (p < 0.05) improved total activity (B = 0.5 standardized total activity counts per hour), moderate-to-vigorous physical activity (B = 1.8%), weight (B = -4.2 kg), abdominal girth (B = -3.5 cm), systolic blood pressure (B = -8.0 mmHg) and HDL cholesterol (B = 0.1 mmol/l). No changes in psychotic symptoms were observed. Changes in total activity did not mediate metabolic improvements, suggesting that multiple components of MULTI contribute to these improvements. In contrast to previously unsuccessful attempts to change lifestyle behavior in inpatients with SMI in the longer term, MULTI showed to be a feasible treatment to sustainably improve PA and metabolic health.

Low Physical Activity and Cardiorespiratory Fitness in People With Schizophrenia: A Comparison With Matched Healthy Controls and Associations With Mental and Physical Health

Introduction: The aim of this study was to objectively assess time spent in physical activity (PA) and sedentary behavior (SB) in patients with schizophrenia compared to healthy controls matched for age, gender and socioeconomic status. Associations between both PA and cardiorespiratory fitness (CRF) and mental and physical health parameters in patients with schizophrenia were examined. Materials and Methods: Moderate and vigorous PA (MVPA), moderate PA, vigorous PA, total and active energy expenditure (TEE and AEE), number of steps, lying down and sleeping time was assessed with SenseWear Pro-2 body monitoring system for three 24-h bouts in patients with schizophrenia (n = 63) and matched healthy controls (n = 55). Severity of symptoms (Positive and Negative Syndrome Scale and Montgomery and Åsberg Depression Rating Scale), CRF (peak oxygen uptake, VO_2peak), body mass index (BMI), and metabolic syndrome were assessed. Results: Patients with schizophrenia performed less MVPA and moderate activity had lower TEE and AEE, spent more time per day lying down and sleeping, and had poorer CRF compared to healthy controls. The amount of MVPA, but especially CRF was associated with severity of negative symptoms in patients with schizophrenia. Only CRF was associated with BMI. Discussion: The current data offer further evidence for interventions aiming to increase physical activity and decrease sedentary behavior. Given strong associations of CRF with both negative symptoms and BMI, treatment aimed at CRF-improvement may prove to be effective.

Less Medication Use in Inpatients With Severe Mental Illness Receiving a Multidisciplinary Lifestyle Enhancing Treatment. The MULTI Study III

Besides having an unhealthy lifestyle contributing to premature mortality, inpatients with severe mental illness (SMI) use high dosages of medication. Previous research has shown improved health after lifestyle improvements in SMI. In addition, we aimed to retrospectively study whether a multidisciplinary lifestyle enhancing treatment (MULTI) was associated with changes in medication use after 18 months, as compared with patients that continued treatment as usual (TAU) and explored mediation by a change in physical activity. We conducted an observational study within a cohort of inpatients with SMI, who received MULTI (N = 65) or continued TAU (N = 49). Data on their somatic and psychotropic medications were collected, converted into defined daily dose (DDD), and analyzed using linear multilevel regression, correcting for baseline value and differences between groups in age, diagnosis, and illness severity. Compared with TAU, the DDD for psychotropic medication significantly decreased with MULTI (B = -0.55, P = 0.02). Changes in total activity did not mediate this association, suggesting that multiple components of MULTI contributed. Corrected between-group analyses for subgroups of medication were not possible due to lack of power and skewed distributions. Within-group data showed a decreased proportion of users as well as median DDD in both groups for almost all medications. In addition to previously reported health improvements after 18 months of MULTI, we observed a significant decrease in dose of psychotropic medication in MULTI compared to TAU. This first study evaluating a wide range of medications indicates a possible effect of lifestyle improvements on medication use in inpatients with SMI. Findings need to be confirmed in future controlled studies, however.

Physical activity and quality of life in long-term hospitalized patients with severe mental illness: a cross-sectional study

BACKGROUND

Increasing physical activity in patients with severe mental illness is believed to have positive effects on physical health, psychiatric symptoms and as well quality of life. Till now, little is known about the relationship between physical activity and quality of life in long-term hospitalized patients with severe mental illness and knowledge of the determinants of behavioural change is lacking. The purpose of this study was to elucidate the relationship between objectively measured physical activity and quality of life, and explore modifiable psychological determinants of change in physical activity in long-term hospitalized patients with severe mental illness.

METHODS

In 184 inpatients, physical activity was measured using an accelerometer (ActiGraph GTX+). Quality of life was assessed by EuroQol-5D and WHOQol-Bref. Attitude and perceived self-efficacy towards physical activity were collected using the Physical Activity Enjoyment Scale and the Multidimensional Self Efficacy Questionnaire, respectively. Patient and disease characteristics were derived retrospectively from electronic patient records. Associations and potential predictors were analysed using hierarchical regression.

RESULTS

Physical activity was positively related with and a predictor of all quality of life outcomes except on the environmental domain, independent of patient and disease characteristics. However, non-linear relationships showed that most improvement in quality of life lies in the change from sedentary to light activity. Attitude and self-efficacy were not related to physical activity.

CONCLUSIONS

Physical activity is positively associated with quality of life, especially for patients in the lower spectrum of physical activity. An association between attitude and self-efficacy and physical activity was absent. Therefore, results suggest the need of alternative, more integrated and (peer-)supported interventions to structurally improve physical activity in this inpatient population. Slight changes from sedentary behaviour to physical activity may be enough to improve quality of life.

Accelerometer-measured sedentary behaviour and physical activity of inpatients with severe mental illness

Sedentary behaviour and lack of physical activity threatens health. Research concerning these behaviours of inpatients with severe mental illness is limited but urgently needed to reveal prevalence and magnitude. In total, 184 inpatients (men n =108, women n =76, mean age 57,4, 20% first generation antipsychotics, 40% second generation antipsychotics, 43% antidepressants, mean years hospitalisation 13 years), with severe mental illness of a Dutch psychiatric hospital wore an accelerometer for five days to objectively measure total activity counts per hour and percentages in sedentary behaviour, light intensity physical activity and moderate to vigorous physical activity. Accelerometer data were compared with data of 54 healthy ward employees. Patients showed significantly less activity counts per hour compared to employees (p=0.02), although the differences were small (d=0.32). Patients were sedentary during 84% of the wear time (50min/h), spend 10% in light intensity physical activity and 6% in moderate to vigorous physical activity. Age was the only significant predictor, predicting less total activity counts/h in higher ages. Decreasing sedentary behaviour and improving physical activity in this population should be a high priority in clinical practice.