Abstract 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 (50 min/hr), 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/hr in higher ages. Decreasing sedentary behaviour and improving physical activity in this population should be a high priority in clinical practice.
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.
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.
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).
Mainly psychiatrists, affecting generalizability.
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.
•Referring HCP were slightly less physically active than the general population.•Women, interns/residents and HCP experiencing more stress were less likely to meet PA guidelines.•Patients' referral to PA interventions partly depends on PA levels of their HCP.
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.
Abstract
Background
Patients with severe mental illness (SMI) are characterized by an unhealthy lifestyle, which contributes to the widening mortality gap with the general population 1 Changing high ...levels of sedentary behaviour (SB) and lack of physical activity (PA) is very challenging 2–4.
Effective interventions improving lifestyle in inpatients are still limited, while of all patients with SMI, the hospitalized do have the worst health status.
We implemented a MUltidisciplinary Lifestyle Enhancing Treatment for Inpatients with SMI (MULTI), mainly including a daily structure, tailored sports- and work-related activities, attention to dietary habits, psycho-education and participation of staff. It involved a culture change which was implemented based on a ‘change-from-within’-principle, using multidisciplinary* cooperation within the current context and resources of inpatient mental healthcare.
* Psychiatrists, activity coordinators, nurse practitioners, dietician and nurses, some of them trained as lifestyle coach.
Aim
Evaluate changes in physical and mental health and functioning after 18 months compared to treatment as usual (TAU).
Methods
Observational controlled design including long-term hospitalised inpatients with SMI. We used data from routine screening and a previous cross-sectional study (2013), supplemented by a repeated accelerometer measurement (2015). Patients were included if they received no other intervention related to lifestyle within 18 months after the start of MULTI and if baseline accelerometer data was available. Patients were excluded from analysis if they had a lack of data after 18 months because they (1) were deceased, (2) moved or were discharged from the hospital or (3) had insufficient follow-up accelerometer data.
Measures:
Accelerometer-measured physical activity (PA) ActiGraph GT3X+
Metabolic health weight, abdominal girth, blood-pressure and -levels and metabolic syndrome criteria
Psychotic symptoms PANSS-r
Quality of life (QoL) EQ-5D & WHOQoL-Bref
Psychosocial functioning HoNOS
Analysis
hierarchical multilevel regression using change-scores, correcting for baseline outcome-value, age, diagnosis and baseline illness-severity.
Results
We had sufficient data of 65 patients receiving MULTI and 49 within TAU.
Significant (p < 0.05) improvements in total PA (B = 0.5), moderate-to-vigorous PA (B = 1.8%), weight (B = -4.2kg), abdominal girth (B = -3.5cm), systolic blood-pressure (B = -8.0mmHg), HDL-cholesterol (B = 0.1mmol/l) and psychosocial functioning on sums score (B = -3.6), impairment (B = -0.7) and social problems (B = -3.0). No improvements were observed in PA/metabolic health within TAU. Patients receiving MULTI had higher odds to recover from ≥1 metabolic syndrome criterion (OR = 2.06). There was no significant effect on psychotic symptoms. QoL improved significantly in both groups.
Discussion
Striking results for clinical practice, as much effort and attempts on lifestyle within inpatients with SMI failed to achieve desired improvements, especially in longer term.
A turnaround in inpatient mental healthcare: the negative trend of deterioration within these patients can be stopped, relevant parameters can even be positively reversed and negative effects are absent.
TAU does not improve physical health A sustainable solution towards a healthier lifestyle in inpatients with SMI at our fingertips, as MULTI was implemented using current context and resources.
More implementation research is needed to further close the gap between research and practice in lifestyle interventions for people with severe mental illness
Abstract
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.
The lack of adoption of eMental Health technologies by people with severe mental illness (SMI) might be explained by a mismatch between technology design and users' skills, context and preferences. ...Co-design can optimize this fit, but populations labelled as 'vulnerable' are often excluded or misrepresented. The goal of this study is to gain insight into best-practices for co-design with people with SMI. A qualitative, multi-method approach was used, consisting of a systematic scoping review of 21 included studies, 25 co-design expert surveys and six participant interviews. The results delivered 23 best-practices divided into four overarching aspects of co-design, namely: (1) activities to carry out before the start of a co-design study; (2) fruitful collaboration of the co-design team; (3) bespoke approach within co-design to accommodate the skills and abilities of SMI participants; and (4) mitigation of challenges surrounding power balance. The best-practices may help researchers and designers offer the SMI population a more specialized approach for co-design, which can cause the innovative output of eMH projects to be more effective and better adopted. Throughout the co-design process, more attention should be paid to the personal and clinical benefits of participation for the participants themselves.
Severe mental illness (SMI) imposes a significant burden on individuals, resulting in long-lasting symptoms, lower social functioning and impaired physical health. Physical activity (PA) ...interventions can improve both mental and physical health and care workers can serve as healthy role models. Yet, individuals with SMI face barriers to PA participation. This study evaluated the effects of Muva, and assessed if mental health worker's (MHW) characteristics were associated with clients' change in social functioning. Muva, an intervention package primarily created to increase PA of people with SMI, places a special focus on MHWs as they might play a key role in overcoming barriers. Other PA barrier-decreasing elements of Muva were a serious game app, lifestyle education, and optimization of the medication regime.
This study is a pragmatic stepped wedge cluster controlled trial. Controls received care as usual. Mixed-effects linear regressions were performed to assess changes in the primary outcome social functioning, and secondary outcomes quality of life, psychiatric symptoms, PA, body mass index, waist circumference, and blood pressure.
84 people with SMI were included in three intervention clusters, and 38 people with SMI in the control cluster. Compared to the control condition, there was significant clinical improvement of social functioning in interpersonal communication (p=<0.01) and independent competence (p=<0.01) in people receiving Muva. These outcomes were not associated with MHW's characteristics. There were no changes in the other outcome measures.
Muva improved social functioning in people with SMI compared to care as usual.
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•Muva physical activity intervention places a special focus on mental health workers.•Muva includes a serious game, lifestyle education and medication optimization.•The Muva intervention improved social functioning.•Health worker's physical activity did not impact patients' social functioning change.•Strategies are needed for better implementation of physical activity interventions.
Patients hospitalised with severe mental illness (SMI) have poor physical health. Recently, a multidisciplinary lifestyle enhancing treatment for inpatients with SMI (MULTI) was implemented after ...which improvements of physical health were observed in the longer term. As part of a comprehensive evaluation of MULTI, we aimed to additionally analyse changes in perceived psychosocial functioning and quality of life after 18 months of MULTI compared to treatment as usual (TAU). Furthermore, we explored whether increased physical activity mediated significant changes. In this observational study, we collected data on psychosocial functioning (HoNOS) and quality of life (EQ-5D and WHOQoL-Bref) within our cohort of inpatients with SMI. This was supplemented by repeated physical activity measurement (ActiGraph GT3X+). Data were analysed using linear multilevel regression, adjusting for baseline values of outcome and differences between groups. Patients receiving MULTI (n = 65) showed significantly improved functioning on sum score and subscales for impairment and social functioning compared to TAU (n = 47). Quality of life improved within MULTI but did not differ significantly from TAU. Changes in total activity did not mediate improvements in psychosocial functioning, suggesting that multiple components of MULTI contribute to these improvements. In addition to previously observed improvement of physical health, MULTI showed to be a feasible treatment to sustainably improve psychosocial functioning compared to TAU and increase the quality of life in inpatients with SMI.
•Evaluates a multidisciplinary lifestyle approach integrated into daily treatment.•Improved psychosocial functioning after 18 months compared to usual treatment.•Change in psychosocial functioning was not mediated by increased physical activity.•Quality of life improved but did not significantly differ from usual treatment.
Abstract
Economic evaluations of lifestyle interventions for people with mental illness are needed to inform policymakers and managers about implementing such interventions and corresponding reforms ...in routine mental healthcare. 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). 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 deterministic incremental cost-effectiveness ratios for previously shown changes in physical activity, metabolic health, psychosocial functioning, and additionally quality of life, and performed probabilistic sensitivity analyses including cost-effectiveness planes. Adjusted regression showed reduced total costs per patient per quarter year in favor of MULTI (B = –736.30, 95%CI: –2145.2 to 672.6). Corresponding probabilistic sensitivity analyses accounting for uncertainty surrounding the parameters showed statistically non-significant cost savings against health improvements for all health-related outcomes in MULTI compared to TAU. It is concluded that MULTI did not increase healthcare costs while improving 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.
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