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.
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.
OBJECTIVE:To investigate the effectiveness of a combined social and physical environmental intervention as well as the effectiveness of both separate interventions.
METHODS:In a 2 × 2 factorial ...design, 412 office employees were allocated to the combined social and physical environmental intervention, to the social environmental intervention only, to the physical environmental intervention only, or were part of the control group. Data on presenteeism, absenteeism, work performance, and work engagement were obtained with questionnaires at baseline, 6, and 12 months. Multilevel analyses were performed.
RESULTS:The combined intervention showed a decrease in contextual performance and dedication. The social environmental intervention showed an improvement in task performance. The physical environmental intervention revealed an improvement in absorption.
CONCLUSION:Although the study showed some promising results, it is not recommended to implement the current interventions.
OBJECTIVE:To evaluate the process of implementation of a social and physical environmental intervention and to explore differences regarding this process between both interventions.
METHODS:Context, ...recruitment, dose delivered, fidelity, reach, dose received, satisfaction, and implementation barriers were investigated.
RESULTS:Reach for the social and physical environmental interventions ranged from 45% to 76%. Mean satisfaction for the social environmental intervention was 6.0 and for the physical environmental intervention was 7.0. Generally, the results were higher for team leaders than for employees. Furthermore, the implementation of the physical intervention was better at the departments that additionally received the social intervention.
CONCLUSION:Both interventions were better implemented on the level of the team leader than that of the employees. Furthermore, the combined interventions received higher evaluation scores. To increase satisfaction and participation, attention should be paid to both employees and team leaders during implementation.
Abstract Objective To study the association between commuter cycling and all-cause sickness absence, and the possible dose–response relationship between absenteeism and the distance, frequency and ...speed of commuter cycling. Method Cross-sectional data about cycling in 1236 Dutch employees were collected using a self-report questionnaire. Company absenteeism records were checked over a one-year period (May 2007–April 2008). Propensity scores were used to make groups comparable and to adjust for confounders. Zero-inflated Poisson models were used to assess differences in absenteeism between cyclists and non-cyclists. Results The mean total duration of absenteeism over the study year was more than 1 day shorter in cyclists than in non-cyclists. This can be explained by the higher proportion of people with no absenteeism in the cycling group. A dose–response relationship was observed between the speed and distance of cycling and absenteeism. Compared to people who cycle a short distance (≤ 5 km) three times a week, people who cycle more often and longer distances are absent for fewer days on average. Conclusion Cycling to work is associated with less sickness absence. The more often people cycle to work and the longer the distance travelled, the less they report sick.
Daily cycling to work has been shown to improve physical performance and health in men and women. It is very common in the Netherlands: the most recent data show that one quarter of commuting ...journeys are by bicycle. However, despite the effort going into campaigns to promote commuter cycling, about 30% of commuter journeys up to 5 kilometers are still by car. The question is how to stimulate commuter cycling more effectively. This article aims to contribute to a better understanding of the perceived barriers and facilitators of cyclists/non-cyclists and personal factors associated with commuter cycling.
A random sample of 799 Dutch employees (response rate 39.6%) completed an internet survey, which comprised two parts. One part of the questionnaire focused on the determinants of cycling behavior including equal numbers of personal, social factors and environmental factors. The other component focused on assessing data on physical activity (PA) behavior. Descriptive and logistic regression analyses were used to analyze factors associated with commuter cycling.
Meeting the physical activity guideline was positively associated with commuter cycling. Television viewing and working full-time were negatively associated. Twenty-six percent of the participants met the PA guideline simply by cycling to work, with health as the main reason. The main barriers for non-cyclists (60%) were perspiration when arriving at work, weather and travelling time. Shorter travelling times compared with other transportation modes were an important facilitator. Environmental factors were positively related to more frequent and more convenient commuter cycling, but they were hardly mentioned by non-cyclists.
This study shows that a relatively large group fulfils the PA recommendations merely by cycling to work. Personal factors (i.e., perceived time and distance) are major barriers to commuter cycling and should be targeted in cycling campaigns, especially in subgroups living within cycling distance to work. Targeting environmental determinants in such campaigns seems to be less important in the Netherlands.
The objective of this study was to examine which factors during pregnancy and postpartum predict pelvic girdle pain (PGP) at 12 weeks postpartum among working women. A total of 548 Dutch pregnant ...employees were recruited in 15 companies, mainly health care, child care, and supermarkets. The definition of PGP was any pain felt in the pelvic girdle region at 12 weeks postpartum. Participants received questionnaires at 30 weeks of pregnancy and at 6 and 12 weeks postpartum with demographic, work-related, pregnancy-related, fatigue, psychosocial, PGP-related and delivery-related questions. Univariate and multiple logistic regression analyses were performed. Almost half of the women experienced pain in their pelvic girdle at 12 weeks postpartum. However, the level of pain and the degree of disability due to postpartum PGP was low. Pregnancy-related predictors for PGP at 12 weeks were history of low back pain, higher somatisation, more than 8 hours of sleep or rest per day, and uncomfortable postures at work. The pregnancy and postpartum-related predictors were: more disability at 6 weeks, having PGP at 6 weeks, higher mean pain at 6 weeks, higher somatisation during pregnancy and at 6 weeks postpartum, higher birth weight of the baby, uncomfortable postures at work and number of days of bed rest. Based on these results, it is concluded that extra attention should be given to women who experience PGP during pregnancy to prevent serious PGP during late pregnancy and postpartum. More research is needed to confirm the roles of hours of sleep, somatisation, and bed rest in relation to PGP.
To recover from work stress, a worksite health program aimed at improving physical activity and relaxation may be valuable. However, not every program is effective for all participants, as would be ...expected within a "one size fits all" approach. The effectiveness of how the program is delivered may differ across individuals. The aim of this study was to identify subgroups for whom one intervention may be better suited than another by using a new method called QUalitative INteraction Trees (QUINT).
Data were used from the "Be Active & Relax" study, in which 329 office workers participated. Two delivery modes of a worksite health program were given, a social environmental intervention (group motivational interviewing delivered by team leaders) and a physical environmental intervention (environmental modifications). The main outcome was change in Need for Recovery (NFR) from baseline to 12 month follow-up. The QUINT method was used to identify subgroups that benefitted more from either type of delivery mode, by incorporating moderator variables concerning sociodemographic, health, home, and work-related characteristics of the participants.
The mean improvement in NFR of younger office workers in the social environmental intervention group was significantly higher than younger office workers who did not receive the social environmental intervention (10.52; 95 % CI: 4.12, 16.92). Furthermore, the mean improvement in NFR of older office workers in the social environmental intervention group was significantly lower than older office workers who did not receive the social environmental intervention ( -10.65; 95 % CI: -19.35, -1.96). The results for the physical environmental intervention indicated that the mean improvement in NFR of office workers (regardless of age) who worked fewer hours overtime was significantly higher when they had received the physical environmental intervention than when they had not received this type of intervention (7.40; 95 % CI: 0.99, 13.81). Finally, for office workers who worked more hours overtime there was no effect of the physical environmental intervention.
The results suggest that a social environmental intervention might be more beneficial for younger workers, and a physical environmental intervention might be more beneficial for employees with a few hours overtime to reduce the NFR.
NTR2553.
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 (
= 65) or continued TAU (
= 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,
= 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.
Abstract Objectives The aim of this study was to investigate which prepartum determinants contribute to the development of postpartum (PP) fatigue among working women in the Netherlands. Methods A ...prospective cohort study in 15 Dutch companies was conducted to measure different potential predictors using self-administrated questionnaires at baseline and at 30 weeks of pregnancy. Fatigue was measured at 12 (N = 523) and 52 weeks (N = 436) PP using the Checklist Individual Strength (CIS). A CIS score > 76 was defined as fatigue. Results The prevalence of fatigue at 12 and 52 weeks PP was 24.5% and 18.1%, respectively. Fourteen predictive factors were found for fatigue (R2 = 0.37) at 12 weeks PP. Ten predictive factors were found for fatigue at 52 weeks PP (R2 = 0.36). In general, less favourable work relationships and characteristics, poorer mental health, more passive coping styles, more sleeping problems, more fatigue during pregnancy, and beliefs about child care arrangements were related to PP fatigue. At 30 weeks of pregnancy, only more fatigue (OR = 3.69, p < 0.001; OR = 2.68, p = 0.02) and poorer mental health (OR = 0.50, p = 0.02; OR = 0.90, p = 0.78) predicted fatigue both at 12 and 52 weeks PP. Conclusions A large number of predictive factors for PP fatigue were found. These findings indicate that different aspects can contribute to being fatigued after pregnancy. Further research is needed to investigate the effect of possible interventions by employers and/or occupational physicians.
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