4. Jahrestagung der SGSPP

SGSPP-Nachrichten Nr. 20/1-202

Sports psychiatry: Discipline, areas of activity, collaboration, and training

Introduction: Sports psychiatry, a field of psychiatry, is a young medical discipline. The aim of this study was to gauge opinions on the following: sports psychiatry as a specialized subdiscipline, its areas of activity among professionals, the desire for interdisciplinary and interprofessional cooperation, and the need for specific sports psychiatry training. Methods: An online survey was performed to assess the views on sports psychiatry of German-speaking professionals in Switzerland, Germany, and Austria in the field of sports psychiatry. Results: Data from 183 professionals were included in the analysis. Most participants classified sports psychiatry as a field of psychiatry (89%), followed by sports medicine (61%) and child and adolescent psychiatry (49%). Mental health and disorders in competitive and elite sport (94%), sport and exercise for the prevention of and as therapy for mental disorders (84%), and sport-specific mental health problems and disorders in popular sport (80%) were reported by all the participants as areas of activity within sports psychiatry. Most of the participants stated the importance of interdisciplinary and interprofessional collaboration with sports psychiatry’s areas of activity. While 84% of the participants emphasized the necessity for specific training in sports psychiatry, a different picture emerged as to whether such training should be independent or integrated with postgraduate training for psychiatric or sports medicine. Conclusion: The results provide insight into sports psychiatry and its areas of activity and should be used for, and integrated with, the further development of the field

SSSPP Position paper: Physical activity and mental health

Promoting physical activity (PA) has not yet been established as a standard procedure in psychiatric care. Psychiatric patients are at higher chance to be physically inactive which contributes to increased morbidity and mortality. Regular PA has shown to improve mental wellbeing in the general population and reduces the risk to develop several mental disorders. Assessing PA and motivation for change should be ­established as routine in psychiatric practice. The recommended dose of exercise for optimal health benefits should be achieved and recommendations on exercise-prescription as well as coaching-programs tailored for mentally ill patients should be developed. Structured exercise therapies should become part of standard psychiatric care. A network of “mental health friendly” sports-clubs could help to facilitate PA for psychiatric populations. Public awareness of mental health benefits of exercise specifically in the prevention of mental disorders is an important topic addressed by the Swiss Society of Sports-Psychiatry and -Psychotherapy. This includes interdisciplinary and interprofessional coordination of efforts to bring more PA into mental health

Effects of Aerobic Exercise as Add-On Treatment for Inpatients With Moderate to Severe Depression on Depression Severity, Sleep, Cognition, Psychological Well-Being, and Biomarkers: Study Protocol, Description of Study Population, and Manipulation Check

Background: Aerobic exercise (AE) may be a non-pharmacological strategy to improve depression treatment and lessen the burden of somatic comorbidity of depression. Only few studies have examined the effect of AE as an add-on treatment for moderate to severe depression in an inpatient setting, and most studies have focused on depression severity and cardiovascular parameters. The purpose of the present article is to present the study protocol, to provide information about the assessed study population, and to perform a manipulation check in order to examine whether the intervention program was properly implemented.Methods: We conducted a randomized controlled trial in two centers comparing 6 weeks of AE to a placebo control intervention (stretching) as an add-on to standardized inpatient treatment of moderate to severe depression. Besides depression severity, several other psychological and biological variables were measured such as salivary cortisol, brain-derived neurotropic factor, cognitive tests, and polysomnography. To evaluate long-term effects of the intervention, we also scheduled a follow-up 6 months after completion of the study intervention.Results: Forty-five patients were randomized to either AE (n = 23) or the placebo intervention (n = 22); 36 patients completed the 6-week intervention. In the AE group, 65% completed all 18 training sessions. Patients who were less physically active prior to admission were less likely to complete the study. With regard to energy expenditure, mean kcal/kg/week was 16.4 kcal/kg/week (range: 13.8–17.7), coming close to the targeted dose of 17.5 kcal/kg/week.Conclusions: Overall, patients showed good adherence to the intervention protocol despite at least moderate depression severity. However, the dropout rate suggests that depressed inpatients may need special support to adhere to a structured exercise intervention program. This study will add evidence on the effects of AE as an add-on to inpatient treatment of moderate to severe depression. Besides antidepressant effects, potentially beneficial effects of AE on a broad array of further variables associated with depression will be evaluated.Clinical Trial Registration:www.ClinicalTrials.gov, identifier NCT02679053

The modifying role of physical activity in the cross-sectional and longitudinal association of health-related quality of life with physiological functioning-based latent classes and metabolic syndrome

Single cardio-metabolic risk factors are each known modifiable risk factors for adverse health and quality of life outcomes. Yet, evidence on the clustered effect of these parameters and the metabolic syndrome (MetS) on health-related quality of life (HRQoL) is still limited and mostly cross-sectional. The objectives of this study were to identify clusters of cardio-metabolic physiological functioning, to assess their associations with HRQoL in comparison with the MetS, to elucidate the modifying role of physical activity, and to assess differences in health service utilization.; This study is based on longitudinal data from two time points (2010/11 & 2017/18) of the Swiss Study on Air Pollution and Lung and Heart Diseases (SAPALDIA). Latent class analysis (LCA) grouped participants based on a priori selected cardio-metabolic and MetS related physiological functioning variables (Body mass index, body fat, glycated hemoglobin, blood triglycerides, blood pressure). The 36-item Short-Form Health Survey (SF-36) was used to assess HRQoL. Quantile regressions were performed with and without adjustment for physical activity, to detect independent associations of the latent classes, MetS and physical activity with HRQoL. To assess the modifying role of physical activity, we additionally grouped participants based on the combination of physical activity and latent classes or MetS, respectively. Logistic regressions were used to investigate health service utilization as outcome.; The LCA resulted in three classes labeled "Healthy" (30% of participants in 2017/18), "At risk" and "Unhealthy" (29%). The Unhealthy class scored lowest in all physical component scores of HRQoL. Compared to healthy and active participants, inactive participants in the "Unhealthy" class showed lower scores in the physical functioning domain both cross-sectionally (- 9.10 (- 12.02; - 6.18)) and longitudinally. This group had an odds ratio of 2.69 (1.52; 4.74) for being hospitalized in the previous 12 months.; These results point to subjects with adverse cardio-metabolic physiological functioning and low activity levels as an important target group for health promotion and maintenance of well-being. The promotion of physical activity at the early stages of aging seems pivotal to mitigate the impact of the MetS on HRQoL at higher age

Physical activity for the treatment and prevention of depression: a rapid review of meta-analyses

Aim: We conducted an umbrella review of 55 meta-analyses to summarize current evidence on the effects of exercise on depression. Results: Aerobic, resistance or combined exercise for several weeks as well as mind-body exercise has shown to yield significant moderate effects on depression severity in adult patients, including the elderly. The effect diminishes when only high-quality studies are analyzed but reaches similar magnitude of other efficacious treatments. Additionally, exercise showed positive effects on sleep, cardiorespiratory fitness and quality of life in depressed patients. In children and adolescents and during the peripartum period, exercise interventions have been found have small-to-moderate effects, but studies varied in methodology and methodical quality could be improved (heterogeneous samples, blinding). Regular physical activity has been shown to have a protective effect on incident depression in adults, reducing odds by 17 to 21%. In children and adolescents, the effect tends to be smaller. Across 15 meta-analyses in samples with physical diseases, exercise-regimes have been shown to have positive effects on depressive symptoms in chronic conditions (such as pain, obesity or cardiovascular disease), cancer survivors, and in post-stroke, neurological and cardiovascular conditions, as well as in diabetes, chronic kidney disease, arthritis and HIV. Discussion: Exercise and physical activity have a wide range of benefits for depression and depressive symptoms in at-risk populations. Further research is needed to find optimal dose and duration of exercise-treatment and ways to sustainably increase physical activity in psychiatric populations and patients with chronic diseases. Key Words: Exercise, Aerobic, Resistance, Depressive Symptoms, At-Risk Populatio

Perspectives on mental health and well-being

Abstract: Introduction: The aim of this study is to provide an overview of Paralympic athletes’ views on mental health in a competitive sport context. Although research in the field of Paralympic sport has increased exponentially over the last two decades, mental health and its promotion have hardly been the subject of research so far. Previous research shows that the practice of competitive sports influences the mental health of Paralympic athletes both positively and negatively. Mental disorders are no exception, even in elite sports. Well-coordinated health care for the prevention and treatment of mental health challenges and mental disorders in elite sports is crucial for this purpose. Methods: The methodological approach of the present study is based on a qualitative research design. The data was collected through semi-structured interviews and their evaluation with the help of applied thematic analysis. For the interviews, 15 active, adult, Swiss elite Para athletes were recruited. Results: The results suggest that athletic success, the athletic activity itself and an improvement in physical health can lead to an increase in mental well-being. On the other hand, athletic failure, pressure to perform, and physical problems can cause psychological stress and facilitate mental disorders. Conclusion: In particular, the coordinated handling of mental health challenges and mental disorders among Paralympic athletes seems to need improvement, especially regarding the use of sports psychiatry and psychotherapy services