A recent systematic review published in Schizophrenia Research finds weak evidence that interventions aimed at increasing levels of physical activity/decreasing sedentary behavior in individuals diagnosed with a severe mental illness (SMI) are useful. This review of 16 studies included interventions consisting primarily of sessions of behavioral counseling, guidance, motivational interventions, health coaching, dietetic support/intervention, and educational programs.
“Of concern, a recent global meta-analysis demonstrated that people with SMI engage in significantly less moderate, vigorous and total PA per week and are much less likely to meet recommended guidelines of 150 min of moderate to vigorous PA each week,” the researchers write.
Authors of the present study note that individuals diagnosed with a severe mental illness (e.g., schizophrenia-spectrum disorders, bipolar disorder) have premature deaths due to physical diseases, notably cardiovascular disease. While rates of sedentary behavior are high within this population which contribute to these higher rates of cardiovascular disease, previous research has demonstrated that being on antipsychotics (as individuals with SMI often are) contributes to an increased risk of cardiovascular issues.
Given the benefits of physical activity in decreasing the risk of the physical illnesses often associated with SMI, the researchers aimed to assess the efficacy of interventions aimed at increasing physical activity in persons diagnosed with SMI.
Researchers conducted a systematic review of controlled trials and pre- and post-intervention studies conducted with individuals diagnosed with either schizophrenia/psychosis spectrum, bipolar disorder spectrum or major depressive disorder. These studies included interventions aimed at increasing physical activity/decreasing sedentary behavior. Sixteen controlled trials and 16 uncontrolled trials were included in the analysis.
The controlled trials included in the analysis were aimed at improving cardiorespiratory fitness and weight and Body Mass Index (BMI), decreasing depression scores, diabetes management, and improving quality of life. Of the 16 controlled trials, only 7 showed significant improvements in levels of physical activity. However, only three studies utilized objective measures of physical activity while four were based solely on self-report.
Sixteen of the included studies were uncontrolled trials. Four of the included studies utilized objective measures of physical activity. A significant increase in physical activity was found in 3 of these studies, with only one of the three including an objective measure of physical activity.
Overall, there is little and low-quality evidence that interventions to increase physical activity/decrease sedentary behavior can be effective. Many of the studies included in this review utilized self-report. In the uncontrolled trials, only 1 of the three studies that showed a significant increase in physical activity employed an objective measure while 4 of the 16 of the controlled trials used an objective measure of physical activity.
While self-report is a valid method for assessing levels of physical activity, it is not free of issues. Generally, people are likely to present themselves as engaging in more ‘desirable’ behavior. Given that participants were likely aware that the intervention aimed to increase physical activity, the likelihood of error in these self-reports is high.
The authors of this review conclude that “there is inconsistent and low-quality evidence to show that interventions can be effective in changing [physical activity] PA or [sedentary behavior] SB” in persons diagnosed with an SMI.
Bueno-Antequera, J., Oviedo-Caro, M. Á., & Munguía-Izquierdo, D. (2017). The relationship between objectively measured sedentary behavior and health outcomes in schizophrenia patients: The PsychiActive project. Schizophrenia research. (Link)
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