Researchers Call for Youth Exercise Programs in Inpatient Mental Health

Researchers explore the preliminary evidence for physical activity and diet-oriented interventions in inpatient mental health facilities for youth.

Sadie Cathcart
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A new article provides an overview of the small number of existing studies investigating physical health and lifestyle interventions in adolescent inpatient mental health facilities. The researchers Rebekah Carney, Sherman Imran, Heather Law, Joseph Firth, and Sophie Parker systematically reviewed all relevant publications to date. This first-of-its-kind study was published last month in Early Intervention in Psychiatry.

There have been increased calls to implement exercise and lifestyle interventions to improve mental health, based on both the emerging evidence for their efficacy and on human rights grounds. However, there are currently only three examples of lifestyle interventions implemented in inpatient settings reported in peer-reviewed publications. The authors suggest that much more research is needed to understand the feasibility and impact of these interventions.

“People with mental health conditions experience significant physical health inequalities compared with the general population,” the researchers explain. “The physical health disparities have been labeled a ‘human rights scandal’ resulting in multiple national and international health bodies publishing new guidelines for reducing the incidence and impact of physical comorbidities in people with mental illness.”
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Many studies have shown promising results for exercise-oriented programming for improving a broad spectrum of psychological concerns affecting young adults (e.g., general wellbeing, depression, and early psychosis) across diverse settings (e.g., schools and fitness facilities in the context of outpatient intervention).

Research has also established that characteristics of a healthy lifestyle, including exercise and a nutritious diet, are associated with reduced anxious and depressive symptoms. Yet, fewer studies have been done looking at directionality, outcomes over time, and examining exercise and mental disorders prospectively.

Carney and colleagues make the case that individuals with mental health conditions live strikingly shorter lives on average compared to the general population. This may be due to a variety of factors including, but not limited to, “side-effects of medication, poor monitoring of physical health (such as fewer physical health assessments, inability to access adequate healthcare and prioritizing mental health care over physical health), and unhealthy lifestyles.”

Physical inactivity, confinement, and reduced access to healthy food options are also highlighted as areas of increased vulnerability impacting adolescents and young adults in inpatient facilities. The authors refer to the health disparities associated with mental health conditions as physical comorbidities.

“To date, there have been a plethora of studies highlighting the benefits of promoting a healthy lifestyle for children and young people. However, the majority of this work has focused on young people receiving community care, via specialist outpatient services, or on general population studies conducted in schools.”

Carney and team aimed to examine the extent to which (and to establish a general picture of how) physical activity and lifestyle interventions were being applied in inpatient mental health settings with young people. The researchers kept the scope of their search broad, focusing on exercise and diet interventions targeting all manner of significant mental health conditions in inpatient facilities, so as not to exclude relevant literature and based on general awareness of what little research existed. They searched databases, including Ovid MEDLINE, PsycINFO, Embase, Cochrane Central Register of Controlled Trials, and AMED.

Articles identified were considered eligible if they were written in English and addressed exercise interventions targeting young people (between the ages of eight and 25) receiving inpatient mental health services. Studies with various methodologies were included as long as they explored “any form of activity designed to increase activity levels or improve diet quality.”

The search produced three eligible studies; one conducted in Australia, one in New Zealand, and another in the United States. Two comprised of predominately female samples, while the third was 81% male. The setting, length of stay among participants represented in the sample, intervention type, intervention aim, and results documented varied considerably across the studies described. One intervention was sports-oriented, one was yoga-oriented, and one included a hybrid fitness approach.

Two of the studies described programs that were woven into pre-existing activities, and the third outlined an intervention piloted in addition to pre-existing programming. Although diet and nutrition were accounted for in the search process, none of the studies eligible for the review focused on nutrition or related outcomes.

Although all studies (exclusively pre-post in design) accounted for a variety of health and physiological outcomes, with apparent implications for physical comorbidities, only one included psychological outcomes as variables of interest.

“The aim of this review was to identify studies that reported lifestyle interventions (physical activity and diet) administered within child and adolescent inpatient units. There is a paucity of evidence for the implementation of lifestyle interventions in this setting. However, preliminary work suggests lifestyle interventions may be feasible within routine inpatient care. Therefore, this could potentially benefit young people’s mental and physical health, as observed in other populations and care settings.”

This publication highlights theoretical support for the implementation of non-pharmacological, lifestyle interventions targeting adolescent health in inpatient settings based on documented success with other similar populations in outpatient environments. It also reveals pockets of potential established in a small number of pre-post studies with inpatient samples.

However, the authors point out numerous other research areas in which additional study is needed to establish what programming should look like and how various populations served may be differentially impacted.

 

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Carney, R., Imran, S., Law, H., Firth, J., & Parker, S. (2020). Physical health interventions on adolescent mental health inpatient units: A systematic review and call to action. Early Intervention in Psychiatry. DOI:10.1111/eip.12981 (Link)

10 COMMENTS

  1. What a shocker, regular moderate exercise is a good thing for all humans. Let’s, at a minimum, hope the psychiatrists stop telling people to quit exercising. Although, you do know your psychiatrist does not have your best interest at heart when he does that. And what’s good is that does make it clear that he is, in fact, your enemy, as opposed to being a doctor who had promised to “first and foremost, do no harm,” as he had pretended.

  2. “The aim of this review was to identify studies that reported lifestyle interventions (physical activity and diet) administered within child and adolescent inpatient units. There is a paucity of evidence for the implementation of lifestyle interventions in this setting. However, preliminary work suggests lifestyle interventions may be feasible within routine inpatient care. Therefore, this could potentially benefit young people’s mental and physical health, as observed in other populations and care settings.”

    So money is ACTUALLY spent on “studies” that “determine” whether exercise and good food is good for living things?
    And then those studies get “reviewed” to look for “paucity of evidence”?
    And there are people working with these young kids in a “medical” way?
    What is “medical” about keeping anyone locked up? These are jails and if psychiatry has to be forced to
    give each of their “criminals” daily freedoms to fresh air, sun, laughter, joy, good food, visitors, play, then it is obvious what the climate is about.
    Above all, does everyone not deserve love? Who gives that to the people inside?
    Perhaps one or two clients that “deserve” love, get a little eye wink?

    So all the workers that take “care” of their charges go home to their families and enjoy their “free time”?

    Sad to say, but perhaps no one is as jailed as psychiatry and it’s minions.
    To be so stuck that studies have to be done around your field, PROVING to you that someone deserves more than the chicken at a chicken farm?

    Perhaps in some sick way, people that feel they need to cure people just need companionship. That constant enforced neediness must have a purpose in a psychological way.

    • That was my immediate take – we have to STUDY to see if playing games and interacting positively with other people and eating well are going to be helpful? And yet “ECT” is considered “helpful” until proven otherwise???? Some people really have got their priorities out of whack!

  3. I experienced five juvenile psychiatric hospitals and the best one hands down was the state hospital in Maryland that had a volleyball team and tournaments. We weren’t just exercising, we were cooperating, building team spirit and having a great time. We also had an ice cream parlor on campus that you could earn trips out to. Seems a lot more humane than what passes for treatment now. That was almost 30 years ago and I was one of the last patients on that unit as we were all transferred or released so it could be converted to a geriatric only campus.

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