Objectively Assessed Daily Steps—Not Light Intensity Physical Activity, Moderate-to-Vigorous Physical Activity and Sedentary Time—Is Associated With Cardiorespiratory Fitness in Patients With Schizophrenia

People with schizophrenia often have an unhealthy sedentary lifestyle with low level of physical activity and poor cardiorespiratory fitness—an important predictor of cardiovascular disease. We investigated the relations between cardiorespiratory fitness and both sedentary time and different aspects of physical activity, such as daily steps, light intensity physical activity, and moderate-to-vigorous physical activity. Using accelerometer as an objective measure of sedentary time and physical activity we estimated their relations to cardiorespiratory fitness in 62 patients with schizophrenia with roughly equal gender distribution, mean age of 36 and 15 years illness duration. We found a significant association between daily steps and cardiorespiratory fitness when accounting for gender, age, sedentary time, light intensity physical activity, and respiratory exchange ratio (maximal effort). Moderate-to-vigorous physical activity was not significantly associated with cardiorespiratory fitness. In conclusion, the amount of steps throughout the day contributes to cardiorespiratory fitness in people with schizophrenia, independently of light intensity physical activity and sedentary time. We did not find a significant relationship between moderate-to-vigorous physical activity and cardiorespiratory fitness. This may have implications for the choice of strategies when helping patients with schizophrenia improve their cardiorespiratory fitness

Changes in Physical Fitness, Bone Mineral Density and Body Composition During Inpatient Treatment of Underweight and Normal Weight Females with Longstanding Eating Disorders

The purpose of this study was to examine changes in aerobic fitness, muscular strength, bone mineral density (BMD) and body composition during inpatient treatment of underweight and normal weight patients with longstanding eating disorders (ED). Twenty-nine underweight (BMI < 18.5, n = 7) and normal weight (BMI ≥ 18.5, n = 22) inpatients (mean (SD) age: 31.0 (9.0) years, ED duration: 14.9 (8.8) years, duration of treatment: 16.6 (5.5) weeks) completed this prospective naturalistic study. The treatment consisted of nutritional counseling, and 2 × 60 min weekly moderate intensive physical activity in addition to psychotherapy and milieu therapy. Underweight patients aimed to increase body weight with 0.5 kg/week until the weight gain goal was reached. Aerobic fitness, muscular strength, BMD and body composition were measured at admission and discharge. Results showed an increase in mean muscular strength, total body mass, fat mass, and body fat percentage, but not aerobic capacity, among both underweight and normal weight patients. Lumbar spine BMD increased among the underweight patients, no changes were observed in BMD among the normal weight patients. Three out of seven underweight patients were still underweight at discharge, and only three out of nine patients with excessive body fat (i.e., >33%) managed to reduce body fat to normal values during treatment. These results calls for a more individualized treatment approach to achieve a more optimal body composition among both underweight and normal to overweight patients with longstanding ED

Using motivational techniques to reduce cardiometabolic risk factors in long term psychiatric inpatients: A naturalistic interventional study

Background People with severe mental illness have markedly reduced life expectancy; cardiometabolic disease is a major cause. Psychiatric hospital inpatients have elevated levels of cardiometabolic risk factors and are to a high degree dependent of the routines and facilities of the institutions. Studies of lifestyle interventions to reduce cardiometabolic risk in psychiatric inpatients are few. The current study aimed at assessing the feasibility and effects of a lifestyle intervention including Motivational Interviewing (MI) on physical activity levels, cardiometabolic risk status and mental health status in psychotic disorder inpatients. Methods Prospective naturalistic intervention study of 83 patients at long term inpatient psychosis treatment wards in South-Eastern Norway. Patients were assessed 3–6 months prior to, at start and 6 months after a life-style intervention program including training of staff in MI, simple changes in routines and improvements of facilities for physical exercise. Assessments were done by clinical staff and included level of physical activity, motivation, life satisfaction, symptom levels (MADRS, AES-C, PANSS, and GAF) as well as anthropometric and biochemical markers of cardiometabolic risk. A mixed model was applied to analyze change over time. Results A total of 88% of patients received MI interventions, with a mean of 2.5 MI interventions per week per patient. The physical activity level was not increased, but activity level was positively associated with motivation and negatively associated with positive symptoms. Triglyceride levels and number of smokers were significantly reduced and a significant decrease in symptom levels was observed. Conclusions The current results suggest that a simple, low cost life-style intervention program focusing on motivational change is feasible and may reduce symptoms and improve lifestyle habits in psychosis patients in long term treatment facilities. Similar programs may easily be implemented in other psychiatric hospitals.submittedVersio

Illness perception among patients with chest pain and palpitations before and after negative cardiac evaluation

Background Patients with chest pain or palpitations often have poor outcomes following a negative cardiac evaluation, with symptom persistence, limitations in everyday activities, and reduced health-related quality of life. The aims of this study were to evaluate illness perceptions before and after negative cardiac evaluations and measure the ability of a self-report questionnaire to predict outcomes. Methods Patients (N = 138) referred for chest pain or palpitations to a cardiac outpatient clinic were assessed before and six months after a negative cardiac evaluation. In addition to Brief Illness Perception Questionnaire (BIPQ), all patients completed the Beck Depression Inventory and SF-36 Health Survey. Results The emotional reactions to and understanding of symptoms had not improved six months after a negative cardiac evaluation. A stronger correlation between illness perceptions and health at follow-up than before the cardiac evaluation might explain the tendency for poor outcomes among these patients. Most of the eight BIPQ item scores before the negative cardiac evaluation were predictive of the outcome six months later. A single question asking about the perceived consequences of the complaints (BIPQ Item 1) rated before the cardiac evaluation was collapsed into a dichotomous variable with a cut-off at ≥4 which yields a sensitivity of 51%, a specificity of 85%, a positive predictive value of 71%, a negative predictive value of 69%, and an odds ratio of 5.7 (r = .38, p < .001) in predicting poor outcomes. Conclusions Assessing illness perceptions is important in patients with negative cardiac tests for understanding and predicting outcomes

Depression and exercise

Tese de doutoramento em Sistemas Sustentáveis de Energia, apresentada à Faculdade de Ciências e Tecnologia da Universidade de CoimbraEste trabalho propõe uma metodologia para avaliar os recursos de energia e de potência que podem ser disponibilizados através da disseminação e utilização de um sistema de gestão de energia no sector residencial, como a Energy Box (EB) proposta por Livengood & Larson (2009). O impacto de tal tecnologia sobre o sistema de distribuição de energia elétrica irá resultar de mudanças no uso da eletricidade por utilização final de clientes em resposta a estímulos como mudanças em tempo real no preço da electricidade, correspondendo ao amplamente conhecido conceito de gestão da procura (DR). No entanto, a natureza dispersa e não controlada da gestão destas cargas exige uma abordagem que tenha em conta o caráter aleatório do comportamento desta procura para efetuar uma estimativa agregada do consumo de energia e da potência causados por um elevado número de dispositivos EB. A abordagem que foi seguida exigiu a simulação de um determinado universo de consumidores de uma determinada cidade, utilizando informações sobre o consumo total de energia eléctrica, bem como o consumo por eletrodoméstico. A metodologia proposta faz uso de dados consultados sobre a disponibilidade dos consumidores para adiar o início da operação dos seus aparelhos, bem como de protótipos horários de diagramas de preços. Esses protótipos foram obtidos através de um exercício de agrupamento de dados que também foi proposto como parte da metodologia. O possível impacto ambiental da utilização agregada das EB também foi estimado. Os resultados da metodologia fornecem a gama de energia libertada e da potência adicional requerida como resultado agregado das EB, sendo o último um fenómeno relevante que apresenta novos desafios para a gestão da rede, e para o qual foram sugeridas algumas medidas preventivas. A análise ambiental do recurso EB agregada mostra que a DR não é por si só uma ferramenta para reduzir as emissões de CO2, sendo fortemente dependente das tecnologias de geração que são utilizadas para compensar as variações de procura. O trabalho futuro sugere investigação para atuais e para novos tipos de cargas, bem como o estudo para as técnicas de controlo não consideradas. Esta visão alargada irá fornecer uma imagem mais ampla do potencial crescente para os sistemas de gestão de energia, como a Energy Box.This work proposes a methodology to evaluate the energy and power resources that can be made available through the deployment and use of a residential energy management system, as the Energy Box (EB) proposed by Livengood & Larson (2009). The impact on the electricity distribution system of such technology will result of changes in the electricity usage by end-use customers in response to stimuli like real-time changes in the electricity price, corresponding to the widely known demand response (DR). However, due to the dispersed and uncontrolled nature of the management of end-use appliances, estimating the energy and power output of the aggregation of a high number of EB’s requires a specific approach which can take into account the random nature of load response. The approach that was followed simulated a certain universe of consumers from one particular city, using information regarding total electricity consumption as well as the segregated consumption per main appliance. The proposed methodology makes use of queried data regarding the willingness of consumers to postpone the start of appliances, as well as prototypes of hourly price diagrams. These prototypes were obtained through a data clustering exercise that was also proposed as part of the methodology. The possible environmental impact of the aggregated use of EB’s was also estimated. The output of the methodology includes the range of released network capacity as well as load rebound, both caused by the aggregated EB response. In particular, load rebound is a relevant phenomenon that presents new challenges to the management of the grid, and for which some preventive measures are suggested. The analysis of the environmental significance of the aggregated EB resource shows that DR is not per se a tool to reduce CO2 emissions, being strongly dependent of the generation technologies that are used to compensate demand variations. Future work is also proposed including new load research for existing and for new types of loads, as well as for control techniques not considered. This extended view seeks to provide a wider image of the increasing potential of energy management systems such as the Energy Box

Cognitive behavioral group therapy for panic disorder in a general clinical setting: a prospective cohort study with 12 to 31-years follow-up

Background The long-term prognosis after cognitive behavioral therapy (CBT) in outpatient groups for panic disorder and agoraphobia is not well known. The purpose of this study was to assess long-term outcomes in terms of psychological health, health-related quality of life (HRQoL), quality of life (QoL) and treatment satisfaction after CBT for panic disorder and agoraphobia. Methods The sample consisted of 68 patients (61% response rate), who were assessed at pretreatment; at the start and end of treatment; and after 3 months, after 1 year, and over the long term (M = 24 years; SD = 5.3; range: 12 to 31 years). The main outcome was the total score on the Phobic Avoidance Rating Scale (PARS-total). At long-term follow-up, HRQoL was measured with the RAND-12 questionnaire, and QoL was measured with two questions from the “Study on European Union Statistics on Income and Living Conditions”. Patient experiences and treatment satisfaction were assessed by the Generic Short Patient Experiences Questionnaire. A marginal longitudinal model was applied to study the main outcome. Results The effect size of the long-term change (mean change/ pooled SD) in the PARS-total score was (− 1.6, p < 0.001) and was stable over time. A PARS-total score reduction of 50% was found in 98% of patients at the long-term follow-up. The patients’ HRQoL and QoL were similar to the expected scores for the general Norwegian population. Of the patients, 95% reported high to very high satisfaction with the CBT, and 93% reported large treatment benefits. Conclusions To the best of our knowledge, this study has the longest follow-up after group CBT for panic disorder and agoraphobia, showing a good prognosis in ≥93% of the participating patients