EPA guidance on physical activity as a treatment for severe mental illness: a meta-review of the evidence and Position Statement from the European Psychiatric Association (EPA), supported by the International Organization of Physical Therapists in Mental Health (IOPTMH)

Physical activity (PA) may be therapeutic for people with severe mental illness (SMI) who generally have low PA and experience numerous life style-related medical complications. We conducted a meta-review of interventions and their impact on health outcomes for people with SMI, including schizophrenia-spectrum disorders, major depressive disorder (MDD) and bipolar disorder. We searched major electronic databases until January 2018 for systematic reviews with/without meta-analysis that investigated PA for any SMI. We rated the quality of studies with the AMSTAR tool, grading the quality of evidence, and identifying gaps, future research needs and clinical practice recommendations. For MDD, consistent evidence indicated that PA can improve depressive symptoms versus control conditions, with effects comparable to those of antidepressants and psychotherapy. PA can also improve cardiorespiratory fitness and quality of life in people with MDD, although the impact on physical health outcomes was limited. There were no differences in adverse events versus control conditions. For MDD, larger effect sizes were seen when PA was delivered at moderate-vigorous intensity and supervised by an exercise specialist. For schizophrenia-spectrum disorders, evidence indicates that aerobic PA can reduce psychiatric symptoms, improves cognition and various subdomains, cardiorespiratory fitness, whilst evidence for the impact on anthropometric measures was inconsistent. There was a paucity of studies investigating PA in bipolar disorder, precluding any definitive recommendations. No cost effectiveness analyses in any SMI condition were identified. We make multiple recommendations to fill existing research gaps and increase the use of PA in routine clinical care aimed at improving psychiatric and medical outcomes

Additional file 1: of Physical activity as treatment for alcohol use disorders (FitForChange): study protocol for a randomized controlled trial

SPIRIT 2013 Checklist: recommended items to address in a clinical trial protocol and related documents. (DOC 120 kb

Sticking with it? Factors associated with exercise adherence in people with alcohol use disorder

 Background: Emerging evidence suggests that exercise may be an efficacious treatment for alcohol use disorder  (AUD), but adherence is suboptimal. We examined factors associated with adherence to an exercise intervention  for non-treatment seeking adults with AUD.  Methods: This secondary analysis of a randomized controlled trial included 95 physically inactive adults aged  18–75 years with clinician-diagnosed AUD. Study participants were randomly assigned to 12-weeks fitness  centre-based, supervised aerobic exercise or yoga classes and asked to attend at least three times/week.  Adherence was assessed both objectively (based on use of a keycard at entry) and subjectively using an activity  calendar. The association between AUD and other predictor variables with adherence was assessed using logistic  and Poisson regression models.  Results: Just under half of participants (47/95, 49%) completed ≥ 12 supervised exercise sessions. When both  supervised classes and self-reported sessions were included, 32/95 (34%) participants completed ≤ 11 sessions,  28/95 (29%) did 12–23 sessions and 35/95 (37%) completed ≥ 24 sessions. In univariate logistic regression  analyses, lower education was associated with non-adherence (<12 sessions) (OR = 3.02, 95%CI = 1.19–7.61).  In models adjusted for demographic and clinical variables, moderate AUD (OR = 0.11, 95%CI = 0.02–0.49) and  severe AUD (OR = 0.12, 95%CI = 0.02–0.69) were associated with non-adherence, when compared to low  severity AUD. Higher body mass index (OR = 0.80, 95%CI = 0.68–0.93) was also associated with non-adherence.  Results were materially the same when objective and subjective adherence data were combined.  Conclusion: Adults with AUD can be supported to engage in yoga and aerobic exercise. Additional support may be  required for those with moderate or severe AUD, higher BMI, and lower education.  </p

Moving to beat anxiety: epidemiology and therapeutic issues with physical activity for anxiety

Purpose of Review The purpose of this paper was to provide a comprehensive narrative review of the relationship between physical activity (PA) and anxiety and the rationale for including it as a treatment option for anxiety disorders. Several gaps in the literature are highlighted alongside recommendations for future research. Recent Findings PA in the general population has established efficacy in preventing and managing cardiovascular disease and improving wellbeing. Recent epidemiological data further suggests that people who are more active may be less likely to have anxiety disorders. In addition, evidence from systematic reviews of randomised control trials suggests that exercise training, a subset of PA, can reduce symptoms in anxiety and stress-related disorders, such as post-traumatic stress disorder, agoraphobia and panic disorder. Summary Anxiety disorders are common, burdensome and costly to individuals and wider society. In addition to the profound negative impact on individuals’ wellbeing and functioning, they are associated with worsened physical health, including a higher risk for cardiovascular diseases and premature mortality. Although pharmacotherapy and psychological interventions are helpful for many, these treatment approaches are not effective for everyone and are insufficient to address common physical health complications, such as the elevated risk of cardiovascular disease. Given the combined anxiolytic and physical health benefits of increased activity, PA presents a promising additional treatment option for people with anxiety disorders. However, there remain key gaps in the literature regarding the mechanisms underlying the effects of PA, optimal PA protocols, methods of improving adherence and the importance of physical fitness. These must be addressed for PA to be successfully implemented in mental health services

Effects of acute exercise on craving, mood and anxiety in non-treatment seeking adults with alcohol use disorder: An exploratory study

Background: Exercise is increasingly being used in the treatment of alcohol use disorder (AUD). We examined the short-term effects of acute exercise on alcohol craving, mood states and state anxiety in physically inactive, nontreatment seeking adults with AUD. Methods: Exploratory, single-arm study. In total, 140 adults with AUD (53.7 ± 11.8 years; 70 % female) were included in a randomized controlled trial (RCT) to study effects of physical activity on alcohol consumption. This acute exercise study was nested within the larger RCT. The intervention was a 12-minute sub-maximal fitness test performed on a cycle ergometer. Participants self-rated their desire for alcohol (DAQ) and completed mood (POMS-Brief) and state anxiety (STAI-Y1) questionnaires 30-minutes before exercise, immediately before, immediately after, and 30-minutes post. Ratings of perceived exertion (RPE) were collected. Effects of exercise were assessed using RM-ANOVA and dependent sample t-tests with effect sizes (Hedges g). Results: In total, 70.6 % had mild or moderate AUD (DSM-5 criteria = 4.9 ± 2). The intervention was generally perceived as ‘strenuous’ (RPE = 16.1 ± 1.6). In the total sample, there was a main effect of time with reductions in alcohol craving [F(3,411) = 27.33, p < 0.001], mood disturbance [F(3,411) = 53.44, p < 0.001], and state anxiety [F(3,411) = 3.83, p = 0.013]. Between-group analyses indicated larger magnitude effects in those with severe compared to mild AUD, however, AUD severity did not significantly moderate the within-group improvements: group x time interaction for alcohol craving [F(6,411) = 1.21, p = 0.305]. Positive effects of exercise were maintained 30-minutes post-exercise. Conclusion: A short bout of aerobic exercise reduced alcohol craving and improved mood states in adults with AUD

Changes in craving following acute aerobic exercise in adults with alcohol use disorder

Aims: Exercise is increasingly being studied as treatment for alcohol use disorder (AUD). We examined the effects of an acute bout of exercise on alcohol craving, heterogeneity of response, and factors associated with reductions in craving. Methods: Within the context of a randomized controlled trial, we conducted an exploratory, single-arm study. In total, 117 adults with AUD (52.7 years; SD = 12.3; 68.4% female) and indications of alcohol craving (Desire for Alcohol Questionnaire, DAQ-short version total score >8) were included. The intervention was a 12-min sub-maximal fitness test performed on a cycle ergometer. We examined changes in participant’s self-rated desire for alcohol immediately before and after exercise. Personal, clinical, and exercise-related factors associated with reductions (≥0.5 SD) in craving were identified using hierarchical logistic regression. Results: In the total sample craving reduced from pre-to post-exercise (p < 0.001, g = 0.60 [0.40–0.79]). Three groups were observed: those whose craving decreased (70.1%; p < 0.001, g = 1.12 [0.85–1.40]), increased (16.2%; p < 0.001, g = 1.08 [0.51–1.64]), or did not change (13.7%). Forty percent experienced clinically meaningful reductions in craving (≥0.5 SD). In fully adjusted models, two factors were associated with these reductions: higher pre-exercise cravings (OR = 1.15 [1.07–1.23], p < 0.001) and lower cardiorespiratory fitness (OR = 0.88 [0.79–1.00], p = 0.043). Conclusions: In most adults with AUD, short bouts of moderately intense aerobic exercise helps reduce cravings for alcohol. Those with higher cravings and lower cardiorespiratory fitness are most likely to benefit

Physical activity and sleep problems in 38 low- and middle-income countries

Objective: Although physical activity (PA) is associated with a reduction of a wide range of sleep problems, it remains uncertain whether complying with the international guidelines of 150 min of moderate to vigorous PA per week can reduce sleep problems in adults. This research investigated the relationship between compliance with the PA recommendations of the World Health Organization and sleep problems in 38 low- and middle-income countries (LMICs). Methods: Cross-sectional, community-based data from the World Health Survey were analyzed. Adjusted logistic regression analyses were undertaken to explore the relationship between PA levels using the International Physical Activity Questionnaire and self-reported sleep problems (such as difficulties falling asleep, waking up frequently during the night or waking up too early in the morning) in the last 30 days. Results: Across 204,315 individuals (38.6 ± 16.1 years; 49.3% males), the overall prevalence (95% CI) of low PA and sleep problems were 29.9% (29.1-30.8%) and 7.5% (7.2-7.9%), respectively. After adjusting for socio-demographics, obesity, chronic physical conditions, depression, and anxiety; not complying with PA recommendations was associated with higher odds for sleep problems overall [odds ratio (OR) =1.23, 95% CI= 1.10-1.38] as well as across the entire age range: 18-34 years (OR = 1.26; 95% CI= 1.02-1.57); 35-64 years (OR =1.17; 95% CI= 1.01-1.35); age ≥ 65 years (OR = 1.40; 95% CI =1.11-1.76). Conclusions: Not complying with international PA recommendations is associated with higher odds of sleep problems, independently of depression and anxiety in LMICs. Future longitudinal and interventional studies are warranted to assess whether increasing PA levels may improve sleep problems in this setting

Exercise, physical activity, and sedentary behavior in the treatment of depression: broadening the scientific perspectives and clinical opportunities

Research exploring links between exercise and depression now span several decades, yet several clinically relevant research questions remain unanswered. This opinion article briefly describes the status of selected research issues from the exercise depression literature and offer insights into research areas that are currently lacking. We draw particular attention to the potential of research exploring links between sedentary behavior and depression

Mild cognitive impairment and sedentary behavior: a multinational study.

Background Sedentary behavior (SB) is associated with poor cognitive performance. However, the contribution of sedentary time to risk of mild cognitive impairment (MCI) remains unclear. This study assessed the association of SB with MCI in six low- and middle-income countries. Methods The Study on Global Ageing and Adult Health (SAGE) survey included 34,129 adults aged ≥50 years [mean (SD) age 62.1 (15.6) years; 51.7% females]. SB was self-reported and expressed as a categorical variable [<8 or ≥8 h per day (high SB)]. The definition of MCI was based on the recommendations of the National Institute on Ageing-Alzheimer's Association. Multivariable logistic regression analysis was conducted to assess the association between SB and MCI. Results The overall prevalence (95%CI) of MCI and high SB (i.e., ≥8 h/day) were 15.3% (14.4%–16.3%) and 10.1% (9.0%–11.3%), respectively. After adjustment for potential confounders, being sedentary for ≥8 h/day was associated with a 1.56 (95%CI = 1.27–1.91) times higher odds for MCI. A one-hour increase in SB was associated with a 1.08 (95%CI = 1.05–1.11) times higher odds for MCI. Conclusion Our study results highlight the need to further explore a sedentary lifestyle as a potential risk factor for MCI or subsequent dementia. Longitudinal and intervention studies are warranted to confirm/refute the current findings