Lack of Efficacy for Current Physical Activity Interventions in Persons Diagnosed with Severe Mental Illness

Review finds a need for more rigorous research to increase physical activity in people diagnosed with a severe mental illness (SMI)

Bernalyn Ruiz
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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.

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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.

Controlled Trials

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.

Uncontrolled Trials

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.

 

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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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Bernalyn Ruiz
MIA-UMB News Team: Bernalyn Ruiz is a doctoral student at the University of Massachusetts Boston and has a master’s degree in clinical psychology from Columbia University. She is engaged in research on psychosis and stigma from a social justice perspective. She is a proud daughter of Mexican immigrants and hopes to play her small part in improving Latinx mental health.

17 COMMENTS

  1. “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.”

    There is something that you can do. The drugs create the “sedentary behavior,” the apathy, via neuroleptic induced deficit syndrome.

    https://en.wikipedia.org/wiki/Neuroleptic-induced_deficit_syndrome

    When you wean people off the drugs, the neuroleptic induced apathy goes away. And weaning people off these drugs can also create a drug withdrawal induced super sensitivity mania. And a mania is like having tons of extra energy, which can be put to good use, via exercise. (As long as the person is kept away from doctors who want to strap the person to a bed, and drug the person, to stop the mania.) Nonetheless, if you wean people off these apathy and sleep inducing drugs, you can get them to exercise.

    I know my drug withdrawal induced mania did result in my exercising a lot, as well as about a ten pound weight loss. This is your solution, wean people off the drugs that are causing the “sedentary” problem in the first place.

    • The aim was for 150 mins per week. That’s 21 minutes per day. When you say “were they on antipsychotics”, the real question should be at what dosage?. 2 mg haldol is vastly different than 6 mg. And when talking about the atypicals, olanzapine below 5 mg per day is essentially no longer an antipsychotic. It doesn’t block dopamine. It does act as a sedative, though.

    • I’m just curious, what were you on and at what dosage when you slept 15 hours / day. It’s relevant. Seroquel is highly sedative, but only becomes antipsychotic at higher doses. Antipsychotic is code for “brain damage”. In the past, haldol and thorazine were administered at insanely high doses.

      • 5 to 20mg./day stelazine. This was before the days of the atypicals. Even on the 5mg. dose I still slept the 15 hours. On the 20mg. I was never really awake, which is why I went to the 5mg. size. I could now be awake 9 hours/day once I did so, which is why I ditched the zine and stuck with the B3/C regimen that most shrinks despise.

  2. As to the type of comments you are likely to receive, it should be more than obvious that ANY link between improved fitness and the types of drugs that those with SMI are taking is bound to be weak. Metabolic syndrome, for instance, as if the name weren’t enough of a hint already, basically shuts down your system. Massive increased weight gain, lethargy, high blood pressure, high cholesterol, and diabetes . . . although it may be only anecdotal (will it be more official if I call it a “case study”?) after a couple years on antipsychotics I could not keep up on a walk with my 70 year old mother when previously I had been very fit, and in less than six months off them I was back to my old self — after a lot of work, of course. Add this neuroleptic malignant syndrome, with its loss of pleasure in any activities, including physical, and you not only largely account for what are called negative symptoms but which I believe are actually drug effects, and you describe a situation in which any studies of the effect of physical activity on those with SMI are bound to have weak results. Sorry to go on so long, but I figured I night just as well simply sum up the responses you should be able to expect since they are all so familiar to me.

  3. It never ceases to amaze me that one of the largest contributors to early death in people labeled as being severely “mentally ill” is never mentioned, the drugs given to people. It’s not just that they cause people to put on weight that’s a problem, they in themselves cause a myriad of physical problems but no one is allowed to discuss this out loud. I’ve tried it before and learned my lesson very quickly.

  4. I think its fairly easy to argue that physical exercise, in and of itself, has limited impact. The type of exercise really matters: it should be enjoyable, ideally it should have a social element, and should be matched to the abilities of the patient, who will be significantly physically impaired by antipsychotics.

    I have seen a highly professional exercise based project that in my view is very effective indeed and becomes the main route to recovery. And the social element really matters as it helps restore confidence to people who may have been hospitalised or isolated. Its hard to get these people moving again but a joy to behold. It is thought-provoking to see people clearly hampered by the medication working so hard, against the odds, to get back into life.

    I wish psychiatrists would see how their medications stop people moving, but they don’t care. My experience is that they actively want to discourage you from too much activity where you might think you need to work and on occasion fail to meet your target. They would rather shut you up frankly.

    • My experience was also one of psychiatrists actively trying to get you to stop exercising, too. To the extent that when I refused to stop exersizing, I was given some drug that was supposed to harm you if you did exercise. I forget how right now, I researched it long ago. I think it was supposed to make you overheat somehow, if you exercised when on that drug.

      But I guess it’s good the psychiatrists are now trying to get people to exercise, although they do seem to be failures at everything, except harming and mass murdering their patients.

  5. Maybe they dont want to exercise, because it is silly when you want to die. Jesus Christ. Psychiatrists are so childish, the want to rule the psyche even thoug they do not have power over it. People beyond apollonian ego archetype should have right to do many things, many more things than normal people, BECAUSE THE PAID THE HUGE PRICE, and that price should be noticed by normal people. I want titans and psychological socialism with hierarchisation of the psyche, because normal people are damaged by money and false ideologies. They do not know what is the psyche, and psyche is controlled by ego only on apollonian level – the rest is beyond jurisdiction of the medicine and the law. This is not your playground, authoritarians. Give in to psyche. I write it because of Anneliese Michel. This is psyche, this is not your playground, kids. How do you think, what was happend to her? Her ego was devastated by reality that is beyond your shallow imagination Try to show some respect toward unknown. I want psychological justice, not brain BS.

    Re- Visioning psychology. Suicide and the soul –James Hillman und Shalom.

  6. How about this: STOP “diagnosing” people with “mental illness,” and then those people will be free to do whatever physical activity they like instead of rolling around on the ground in agony in a psychiatric prison. STOP labeling, drugging, incarcerating, and killing innocent people. Psychiatry is state sponsored torture and a pseudo-scientific system of slavery. If you want people to exercise, a good place to start is to allow them to make that choice for themselves instead of enslaving them through psychiatric “treatments.”

    In any case, an article in a publication called “Schizophrenia Research” might as well be published in other great scientific journals such as “Santa Claus Sightings,” “Easter Bunny Quarterly,” or “The Journal of Tooth Fairy Studies.”

  7. To ask the SMI to exercise while they are drugging them is like asking your prisoner that you put balls and chains (weights) to exercise. Those in control are just as insane as those that they say are insane.

    You take the drugs? No?

    Exercise (voluntary) helps anyone and everyone. “Better to wear out than rust out.”Jack LaLanne

    To find no evidence of benefit for those that do exercise is bizarre.

    I walk every day, without chains.

    • I always found it particularly egregious when they’d put someone on Zyprexa or some other fat-inducing antipsychotic drug, and then talk to the client about “bad food choices” and “needing healthy exercise,” as if being fat were somehow the fault of poor eating habits or laziness. I often brought that point up, but it only seemed to get the staff upset with me. Almost no one (except me or my CASA volunteers) ever told the kid they were beefing up due to the drugs.

  8. The industry trashing exercise and other things that improve human health is disingenuous and self-serving. Considering that what they are doing to people is inhumane to begin with, its not surprising that they dismiss anything that doesn’t lead to their victims early demise; after all there’s an endless supply of disposable people to experiment on.
    It’s isn’t clear if the writer supporting not exercising for “SMI” because what’s the point anyway? I find it deeply disturbing.

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