SEMS-journal

SSSPP Position paper: Physical activity and mental health

by Swiss Society for Sports Psychiatry and Psychotherapy SSSPP

Imboden Christian1, Claussen Malte Christian2, Gerber Markus3, Gonzalez Hofmann Carlos4, Hemmeter Ulrich5, Seifritz Erich6
1 Private Clinic Wyss AG, Münchenbuchsee, Switzerland
2 Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland, Private Clinic Wyss AG, Münchenbuchsee and Psychiatric Services Grisons, Chur, Switzerland
3 Department of Sport, Exercise and Health, University of Basel, Switzerland
4 Practice for Psychiatry and Psychotherapy, Romanshorn, Switzerland
5 Department for Geriatric Psychiatry and Psychotherapy, Psychiatry St. Gallen North, Wil, Switzerland
6 Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich

Abstract

Promoting physical activity (PA) has not yet been established as a standard procedure in psychiatric care. Psychiatric patients are at higher chance to be physically inactive which contributes to increased morbidity and mortality. Regular PA has shown to improve mental wellbeing in the general population and reduce the risk to develop several mental disorders. Assessing PA and motivation for change should be ­established as routine in psychiatric practice. The recommended dose of exercise for optimal health benefits should be achieved and recommendations on exercise-prescription as well as coaching-programs tailored for mentally ill patients should be developed. Structured exercise therapies should become part of standard psychiatric care. A network of “mental health friendly” sports-clubs could help to facilitate PA for psychiatric populations. Public awareness of mental health benefits of exercise specifically in the prevention of mental disorders is an important topic addressed by the Swiss Society for Sports Psychiatry and Psychotherapy. This includes interdisciplinary and interprofessional coordination of efforts to bring more PA into mental health.

Zusammenfassung

Das Fördern von körperlicher Aktivität ist noch keine reguläre Methode in der psychiatrischen Praxis. Psychiatrische Patienten sind körperlich weniger aktiv, was wiederum zu einer erhöhten Morbidität und Mortalität mit beiträgt. Regelmässige Bewegung kann psychisches Wohlbefinden in der Allgemeinbevölkerung verbessern und reduziert das Risiko, verschiedene psychiatrische Erkrankungen zu entwickeln. Das Erfassen körperlicher Aktivität und diesbezüglicher Veränderungsmotivation sollte in der psychiatrischen Praxis Einzug halten. Es ist anzustreben, dass psychisch erkrankte Menschen die Bewegungsempfehlungen erreichen und diesbezüglich spezifische Coaching-Programme für psychisch kranke Menschen entwickelt werden. Strukturierte Sporttherapien sollten Teil der Strandardbehandlung in der Psychiatrie werden, dabei kann ein Netzwerk von «Psychiatrie-freundlichen» Sportvereinen helfen, körperliche Aktivität in psychiatrischen Populationen zu fördern. Die öffentliche Wahrnehmung psychischer Effekte von Sport, besonders in der Prävention psychischer Erkrankungen sowie das Fördern der interdisziplinären und interprofessionellen Koordination sind wichtige Ziele der Schweizerischen Gesellschaft für Sportpsychiatrie und -psychotherapie.

Promoting physical activity (PA) has not yet been established as a standard procedure in psychiatric care. Psychiatric patients are at higher chance to be physically inactive [1] which contributes to increased morbidity and mortality in psychiatric patients. [2,3] On the other hand, regular PA has shown to improve mental wellbeing in the general population [4] and reduce the risk to develop several mental disorders. This has been shown so far for depression [5], anxiety disorders [6], Insomnia [7] and even dementia [8). In addition, structured and supervised physical exercise might be an alternative or additional treatment strategy for depression [9], dementia [10], cognitive symptoms of schizophrenia [11] and maybe other psychiatric disorders such as anxiety disorders, substance use disorders and posttraumatic stress disorder. Considering the large body of evidence, recommendations to establish PA in psychiatric care have been published [12]. Since PA yields a broad array of mental and physical health benefits, it is high time to move it closer to the focus of treating physicians and treatment networks.

Background

At present, PA plays a role in inpatient treatment regimes. In Switzerland most clinics have already established therapies including physical activity (i.e. sports therapy, physiotherapy, body therapies, far-east techniques such as yoga and hippotherapy). However, in a survey conducted in n=55 German-speaking Swiss clinics, only 25% of patients participated in those programs [13]. A later study conducted at three psychiatric clinics in the German-speaking part of Switzerland with n=107 psychiatric inpatients, a total of 57% met physical activity recommendations and 55% participated in structured exercise and sport therapy activities. Those who took part in those programs were significantly more likely to meet recommended levels of PA than those not participating [14]. Establishing a treatment regime with aerobic exercise 3 times per week at moderate intensity levels in Swiss clinics is feasible for psychiatric inpatients suffering from depression, however dropout rates around 20% might be a matter of concern [15]. In the future, motivational and volitional coaching programs specifically tailored for patients with psychiatric disorders might help to further improve PA levels in this population [16]. Such programs should be applicable in inpatient and outpatient settings.

Problematic areas

Considering the role of PA in prevention and treatment of mental disorders the following problem areas can be identified:

Interprofessional coordination

Supporting an increased use of PA as a therapeutic and preventive agent involves several professions. General practitioners, sports and exercise physicians and psychiatrists, sports psychologists and sport and exercise scientists should not only develop techniques to assess PA levels of patients with mental disorders and offer specified exercise prescriptions. They are also required to be informed about the local network of exercise facilities, clubs and organizations as well as have access to specialized exercise coaches for mental health. In order to achieve this, cooperation is needed with other professions such as physiotherapists, sports therapists and body therapists. Psychiatric nurses may also play an important role in motivating patients to increase PA and support them to implement activities in order to reach individual goals considering PA. Sports and exercise scientists and/or clinical psychologists may support patients with motivational techniques to change their physical activity behavior and with volitional techniques to sustain achieved change over a longer period of time.

Approaches

Recommendations

Our main recommendations can be linked directly to the proposed starting points. The Swiss Society for Sports Psychiatry and Psychotherapy SSSPP is ready to take a coordinating role in the efforts to achieve those goals in close collaboration with other professional societies (such as the Swiss Society for Sports Medicine, the Swiss Society of Sport Science, universities and psychiatric institutions located in Switzerland) [see box]. The society will offer regular symposia and courses as part of the ongoing formation of psychiatrists, sports physicians and general practitioners focusing on the importance of PA for mental health and will coordinate the development of implementable recommendations on the assessment of PA and exercise-prescription in daily practice. The initiative “Exercise is Medicine” (exerciseismedicine.org) by the American College of Sports Medicine can act as a good example on how to establish awareness about the importance of PA for general health benefits including mental health.
The SSSPP will lobby for the implementation of sports psychiatry related topics at the university level for medical students and in the formation (postgraduate curricula) of residents. At the same time a structured program for psychiatrists wishing to obtain a specialty for sports psychiatry will focus on mental health in elite athletes, as well as physical activity and mental health. [37,38]
Networking with clubs and other institutions offering sports for people with mental disorders (such as PluSport) will be another important topic for the SSSPP, aiming at better access to popular sports for mentally handicapped persons.
Clinical research on the effects of PA in mental health and evaluation of programs aiming at improvement of PA in psychiatric patients will be supported by the SSSPP. Support may take part on methodological, clinical and by obtaining funding sources on a financial level. Last but not least, the SSSPP will engage itself in public awareness programs on the benefits of PA for mental health.
Taken together those proposed steps should enhance mental health in the general population and sensitize the various medical and paramedical disciplines involved in the treatment of patients with mental disorders to the abovementioned topics in order to increase physical fitness of psychiatric patients and therefore improve psychiatric treatment quality. 

 

Corresponding author

Dr. med. Christian Imboden
EMBA, Private Clinic Wyss AG
Münchenbuchsee, Switzerland
christian.imboden@pkwyss.ch

 

 

References

  1. Vancampfort D, Firth J, Schuch FB, Rosenbaum S, Mugisha J, Hallgren M, et al. Sedentary behavior and physical activity levels in people with schizophrenia, bipolar disorder and major depressive disorder: a global systematic review and meta-analysis. World Psychiatry. 2017;16(3):308-15.
  2. Murray CJL, Lopez AD. Global mortality, disability, and the contribution of risk factors: Global burden of disease study. Lancet. 1997;349:1436-42.
  3. Walker ER, McGee RE, Druss BG. Mortality in mental disorders and global disease burden implications: A systematic review and meta-analysis. JAMA Psychiatry. 2015;72:334-41.
  4. Chekroud SR, Gueorguieva R, Zheutlin AB, Paulus M, Krumholz HM, Krystal, J.H., et al. Association between physical exercise and mental health in 1·2 million individuals in the USA between 2011 and 2015: a cross-sectional study. Lancet Psychiatry. 2018;5:739-46.
  5. Schuch FB, Vancampfort D, Firth J, Rosenbaum S, Ward PB, Silva ES, et al. Physical Activity and Incident Depression: A Meta-Analysis of Prospective Cohort Studies. Am J Psychiatry. 2018:appiajp201817111194.
  6. Schuch FB, Stubbs B, Meyer J, Heissel A, Zech P, Vancampfort D, et al. Physical activity protects from incident anxiety: A meta-analysis of prospective cohort studies. Depress Anxiety. 2019;36(9):846-58.
  7. Tsunoda K, Kitano N, Kai Y, Uchida K, Kuchiki T, Okura T, et al. Prospective study of physical activity and sleep in middle-aged and older adults. Am J Prev Med. 2015;48(6):662-73.
  8. Buchman AS, Boyle PA, Yu L, Shah RC, Wilson RS, Bennett DA. Total daily physical activity and the risk of AD and cognitive decline in older adults. Neurology. 2012;78(17):1323-9.
  9. Morres ID, Hatzigeorgiadis A, Stathi A, Comoutos N, Arpin-Cribbie C, Krommidas C, et al. Aerobic exercise for adult patients with major depressive disorder in mental health services: A systematic review and meta-analysis. Depress Anxiety. 2019;36(1):39-53.
  10. Groot C, Hooghiemstra AM, Raijmakers PG, van Berckel BN, Scheltens P, Scherder EJ, et al. The effect of physical activity on cognitive function in patients with dementia: A meta-analysis of randomized control trials. Ageing Res Rev. 2016;25:13-23.
  11. Firth J, Stubbs B, Rosenbaum S, Vancampfort D, Malchow B, Schuch F, et al. Aerobic Exercise Improves Cognitive Functioning in People With Schizophrenia: A Systematic Review and Meta-Analysis. Schizophr Bull. 2017;43(3):546-56.
  12. Stubbs B, Vancampfort D, Hallgren M, Firth J, Veronese N, Solmi M, et al. EPA guidance on physical activity as a treatment for severe mental illness: A meta-review of the evidence and Position Statement from the European Psychiatric Association (EPA), supported by the International Organization of Physical Therapists in Mental Health (IOPTMH). European Psychiatry. 2018;54:124-44.
  13. Brand S, Colledge F, Beeler N, Pühse U, Kalak N, Sadeghi Bahmani D, et al. The current state of physical activity and exercise programs in German-speaking, Swiss psychiatric hospitals: Results from a brief online survey. Neuropsychiatric Disease and Treatment. 2016;12:1309-17.
  14. Ehrbar J, Brand S, Colledge F, Donath L, Egger ST, Hatzinger M, et al. Psychiatric in-patients are more likely to meet recommended levels of health-enhancing physical activity if they engage in exercise and sport therapy programs. Frontiers in Psychiatry. 2018;9:doi:10.3389/fpsyt.2018.00322.
  15. Imboden C, Gerber M, Beck J, Eckert A, Puhse U, Holsboer-Trachsler E, et al. Effects of Aerobic Exercise as Add-On Treatment for Inpatients With Moderate to Severe Depression on Depression Severity, Sleep, Cognition, Psychological Well-Being, and Biomarkers: Study Protocol, Description of Study Population, and Manipulation Check. Front Psychiatry. 2019;10:262.
  16. Gerber M, Beck J, Brand S, Cody R, Donath L, Eckert A, et al. The impact of lifestyle Physical Activity Counselling in IN-PATients with major depressive disorders on physical activity, cardiorespiratory fitness, depression, and cardiovascular health risk markers: study protocol for a randomized controlled trial. Trials. 2019;20(1):367.
  17. Gerber M, Minghetti A, Beck J, Zahner L, Donath L. Is improved fitness following a 12-week exercise program associated with decreased symptom severity, better wellbeing, and fewer sleep complaints in patients with major depressive disorders? A secondary analysis of a randomized controlled trial. Journal of psychiatric research. 2019;113:58-64.
  18. Rosenbaum S, Morell R, Abdel-Baki A, Ahmadpanah M, Anilkumar TV, Baie L, et al. Assessing physical activity in people with mental illness: 23-country reliability and validity of the simple physical activity questionnaire (SIMPAQ). BMC Psychiatry. 2020;20(1):108.
  19. Gerber M, Minghetti A, Beck J, Zahner L, Donath L. Sprint Interval Training and Continuous Aerobic Exercise Training Have Similar Effects on Exercise Motivation and Affective Responses to Exercise in Patients With Major Depressive Disorders: A Randomized Controlled Trial. Front Psychiatry. 2018;9:694.
  20. Nebiker L, Lichtenstein E, Minghetti A, Zahner L, Gerber M, Faude O, et al. Moderating Effects of Exercise Duration and Intensity in Neuromuscular vs. Endurance Exercise Interventions for the Treatment of Depression: A Meta-Analytical Review. Front Psychiatry. 2018;9:305.
  21. Gerber M, Holsboer-Trachsler E, Pühse U, Brand S. Exercise is medicine for patients with major depressive disorders. But only if the “pill” is taken! Neuropsychiatric Disease and Treatment. 2016;12:1977-81.
  22. Chalder M, Wiles NJ, Campbell J, Hollinghurst SP, Haase AM, Taylor AH, et al. Facilitated physical activity as a treatment for depressed adults: randomised controlled trial. Bmj. 2012;344:e2758.
  23. Krämer LV, Helmes AW, Bengel J. Understanding activity limitations in depression. European Psychologist. 2014.
  24. Gerber M, Ehrbar J, Brand R, Antoniewicz F, Brand S, Colledge F, et al. Implicit attitudes towards exercise and physical activity behaviour among in-patients with psychiatric disorders. Mental Health and Physical Activity. 2018;15:71-7.
  25. Fryers T, Melzer D, Jenkins R, Brugha T. The distribution of the common mental disorders: social inequalities in Europe. Clinical practice and epidemiology in mental health : CP & EMH. 2005;1:14.
  26. Peirce N, Lester C, Seth A, Turner P, The Sports and Exercise Psychiatry Special Interest Group of the Royal College of Psychiatrists. The Role of Physical Activity and Sport in Mental Health 2018 [Available from: https://www.fsem.ac.uk/position_statement/the-role-of-physical-activity-and-sport-in-mental-health/.
  27. Public Health Australia Association. Physical Activity and Mental Health
    Policy Position Statement 2018 [Available from: https://www.phaa.net.au/documents/item/2818.
  28. Rosenbaum S, Ward PB, International Working G. The Simple Physical Activity Questionnaire. The lancet Psychiatry. 2016;3(1):e1-e.
  29. Craig CL, Marshall AL, Sjostrom M, Bauman AE, Booth ML, Ainsworth BE, et al. International physical activity questionnaire: 12-country reliability and validity. Medicine and science in sports and exercise. 2003;35(8):1381-95.
  30. Nigg CR, Fuchs R, Gerber M, Jekauc D, Koch T, Krell-Roesch J, et al. Assessing physical activity through questionnaires–A consensus of best practices and future directions. Psychology of Sport and Exercise. 2020:101715.
  31. Dunn AL, Trivedi MH, Kampert JB, Clark CG, Chambliss HO. Exercise treatment for depression. Efficacy and dose response. American Journal of Preventive Medicine. 2005;28:1-8.
  32. Mota-Pereira J, Silverio J, Carvalho S, Ribeiro JC, Fonte D, Ramos J. Moderate exercise improves depression parameters in treatment-resistant patients with major depressive disorder. Journal of psychiatric research. 2011;45(8):1005-11.
  33. Hallgren M, Vancampfort D, Stubbs B. Exercise is medicine for depression: even when the “pill” is small. Neuropsychiatric disease and treatment. 2016;12:2715-21.
  34. Hoffman BM, Babyak MA, Craighead WE, Sherwood A, Doraiswamy PM, Coons MJ, et al. Exercise and pharmacotherapy in patients with major depression: one-year follow-up of the SMILE study. Psychosomatic medicine. 2011;73(2):127-33.
  35. Lindegård A, Jonsdottir IH, Börjesson M, Lindwall M, Gerber M. Changes in mental health in compliers and non-compliers with physical activity recommendations in patients with stress-related exhaustion. BMC Psychiatry. 2015;15:doi:10.1186/s12888-015-0642-3.
  36. Chalder M, Wiles NJ, Campbell J, Hollinghurst SP, Searle A, Haase AM, et al. A pragmatic randomised controlled trial to evaluate the cost-effectiveness of a physical activity intervention as a treatment for depression: the treating depression with physical activity (TREAD) trial. Health Technol Assess. 2012;16(10):1-164, iii-iv.
  37. Claussen MC, Imboden C, Seifritz E, Hemmeter U, Gonzalez Hofmann C. SGSPP Curriculum Sportpsychiatrie und -psychotherapie: Stufe 1. Swiss Arch Neurol Psychiatr Psychother. 2020;68(3):48-52.
  38. Claussen MC, Imboden C, Seifritz E, Hemmeter U, Gonzalez Hofmann C. Swiss Society for Sports Psychiatry and Psychotherapy SSSPP. SSSPP Curriculum Sports Psychiatry And Psychotherapy: Level 1. Swiss Sports & Exercise Medicine. 2020;68(3):48–52.
Zur Werkzeugleiste springen