Top

European Archives of Psychiatry and Clinical Neuroscience

Published in:

01-08-2019 | Original Paper

Increasing physical activity and healthy diet in outpatients with mental disorders: a randomized-controlled evaluation of two psychological interventions

Authors: Moritz Bruno Petzold, Jennifer Lara Maria Mumm, Sophie Bischoff, Julia Große, Jens Plag, Ralf Brand, Andreas Ströhle

Published in: European Archives of Psychiatry and Clinical Neuroscience | Issue 5/2019

Abstract

Introduction

While physical activity (PA) can play an important role in the treatment of mental disorders (MD), large proportions of patients with MD do not meet PA recommendations. The aim of this trial was to evaluate whether structured psychological intervention (MoVo-LISA) is effective in helping outpatients with MD to increase their level of PA. As active control group (CG) we modified MoVo-LISA to target healthy diet behavior.

Methods

N = 83 outpatients with MD (F1–F4) were randomized to the two conditions. PA (self-report and accelerometry), dietary behavior, social-cognitive determinants of health behavior change, psychiatric symptoms and health-related quality of life were assessed at baseline, 1 and 12 weeks after the intervention.

Results

Significant time*group interaction effects for objectively measured PA, dietary behavior and fruit and vegetable consumption indicated differential effects of the interventions on these outcomes. PA increased in the MoVo-LISA group (IG) from baseline to follow-up while it decreased in CG. IG showed a significant higher level of objectively measured PA at follow-up compared to CG. Dietary behavior and fruit and vegetable consumption significantly increased from baseline to follow-up in CG, but not IG. IG showed a significant increase in some, but not all social cognitive determinants of health behavior change.

Conclusions

MoVo-LISA is effective in helping outpatients with MD to increase their level of PA in short- and mid-term. The used intervention strategies are effective for the promotion of healthy diet in patients with MD as well.

Colditz GA, Nguyen N, Dart H (2017) Physical activity and health. In: Quah SR (ed) International encyclopedia of public health, 2nd edn. Elsevier, Heidelberg, pp 463–472CrossRef

World Health Organization (2009) Global health risks—mortality and burden of disease attributable to selected major risks, Geneva

Ströhle A (2018) Sports psychiatry: mental health and mental disorders in athletes and exercise treatment of mental disorders. Eur Arch Psychiatry Clin Neurosci. https://doi.org/10.1007/s00406-018-0891-5 CrossRefPubMed

Ströhle A, Höfler M, Pfister H et al (2007) Physical activity and prevalence and incidence of mental disorders in adolescents and young adults. Psychol Med 37(11):1657–1666. https://doi.org/10.1017/S003329170700089X CrossRefPubMed

Meng X, D’Arcy C (2013) The projected effect of increasing physical activity on reducing the prevalence of common mental disorders among Canadian men and women: a national population-based community study. Prev Med 56(1):59–63. https://doi.org/10.1016/j.ypmed.2012.11.014 CrossRefPubMed

Martin H, Beard S, Clissold N et al (2017) Combined aerobic and resistance exercise interventions for individuals with schizophrenia. A systematic review. Ment Health Phys Act 12:147–155. https://doi.org/10.1016/j.mhpa.2017.04.003 CrossRef

Firth J, Cotter J, Elliott R et al (2015) A systematic review and meta-analysis of exercise interventions in schizophrenia patients. Psychol Med 45(7):1343–1361. https://doi.org/10.1017/S0033291714003110 CrossRefPubMed

Stubbs B, Vancampfort D, Rosenbaum S et al (2017) An examination of the anxiolytic effects of exercise for people with anxiety and stress-related disorders: a meta-analysis. Psychiatry Res 249:102–108. https://doi.org/10.1016/j.psychres.2016.12.020 CrossRefPubMed

Schuch FB, Vancampfort D, Richards J et al (2016) Exercise as a treatment for depression: a meta-analysis adjusting for publication bias. J Psychiatr Res 77:42–51. https://doi.org/10.1016/j.jpsychires.2016.02.023 CrossRefPubMed

10.

Zschucke E, Gaudlitz K, Ströhle A (2013) Exercise and physical activity in mental disorders: clinical and experimental evidence. J Prev Med Public Health 46(Suppl 1):12–21. https://doi.org/10.3961/jpmph.2013.46.S.S12 CrossRef

11.

Garber CE, Blissmer B, Deschenes MR et al (2011) American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. Med Sci Sports Exerc 43(7):1334–1359. https://doi.org/10.1249/MSS.0b013e318213fefb CrossRefPubMed

12.

Stubbs B, Vancampfort D, Firth J et al (2017) Physical activity correlates among people with psychosis: data from 47 low- and middle-income countries. Schizophr Res. https://doi.org/10.1016/j.schres.2017.06.025 CrossRefPubMed

13.

Vancampfort D, Stubbs B, Firth J et al (2017) Physical activity correlates among 24,230 people with depression across 46 low- and middle-income countries. J Affect Disord 221:81–88. https://doi.org/10.1016/j.jad.2017.06.012 CrossRefPubMed

14.

Jerome GJ, Young DR, Dalcin A et al (2009) Physical activity levels of persons with mental illness attending psychiatric rehabilitation programs. Schizophr Res 108(1–3):252–257. https://doi.org/10.1016/j.schres.2008.12.006 CrossRefPubMedPubMedCentral

15.

Kruisdijk F, Deenik J, Tenback D et al (2017) Accelerometer-measured sedentary behaviour and physical activity of inpatients with severe mental illness. Psychiatry Res 254:67–74. https://doi.org/10.1016/j.psychres.2017.04.035 CrossRefPubMed

16.

Mangerud WL, Bjerkeset O, Lydersen S et al (2014) Physical activity in adolescents with psychiatric disorders and in the general population. Child Adolesc Psychiatry Ment Health 8(1):2. https://doi.org/10.1186/1753-2000-8-2 CrossRefPubMedPubMedCentral

17.

Scott D, Happell B (2011) The high prevalence of poor physical health and unhealthy lifestyle behaviours in individuals with severe mental illness. Issues in mental health nursing 32(9):589–597. https://doi.org/10.3109/01612840.2011.569846 CrossRefPubMed

18.

Walker ER, McGee RE, Druss BG (2015) Mortality in mental disorders and global disease burden implications: a systematic review and meta-analysis. JAMA Psychiatry 72(4):334–341. https://doi.org/10.1001/jamapsychiatry.2014.2502 CrossRefPubMedPubMedCentral

19.

Lee I-M, Shiroma EJ, Lobelo F et al (2012) Effect of physical inactivity on major non-communicable diseases worldwide. An analysis of burden of disease and life expectancy. Lancet 380(9838):219–229. https://doi.org/10.1016/S0140-6736(12)61031-9 CrossRefPubMedPubMedCentral

20.

Hillsdon M, Foster C, Thorogood M (2005) Interventions for promoting physical activity. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD003180.pub2 CrossRefPubMed

21.

Kahn EB, Ramsey LT, Brownson RC et al (2002) The effectiveness of interventions to increase physical activity. A systematic review. Am J Prev Med 22(4 Suppl):73–107CrossRefPubMed

22.

Müller-Riemenschneider F, Reinhold T, Nocon M et al (2008) Long-term effectiveness of interventions promoting physical activity: a systematic review. Prev Med 47(4):354–368. https://doi.org/10.1016/j.ypmed.2008.07.006 CrossRefPubMed

23.

McDevitt J, Snyder M, Miller A et al (2006) Perceptions of barriers and benefits to physical activity among outpatients in psychiatric rehabilitation. J Nurs Scholarsh 38(1):50–55. https://doi.org/10.1111/j.1547-5069.2006.00077.x CrossRefPubMed

24.

Roberts SH, Bailey JE (2011) Incentives and barriers to lifestyle interventions for people with severe mental illness: a narrative synthesis of quantitative, qualitative and mixed methods studies. J Adv Nurs 67(4):690–708. https://doi.org/10.1111/j.1365-2648.2010.05546.x CrossRefPubMed

25.

Ussher M (2007) Physical activity preferences and perceived barriers to activity among persons with severe mental illness in the United Kingdom. Psychiatr Serv 58(3):405. https://doi.org/10.1176/appi.ps.58.3.405 CrossRefPubMed

26.

Bradshaw T, Lovell K, Bee P et al (2010) The development and evaluation of a complex health education intervention for adults with a diagnosis of schizophrenia. J Psychiatr Ment Health Nurs 17(6):473–486. https://doi.org/10.1111/j.1365-2850.2009.01543.x CrossRefPubMed

27.

Brown S, Chan K (2009) A randomized controlled trial of a brief health promotion intervention in a population with serious mental illness. J Ment Health 15(5):543–549. https://doi.org/10.1080/09638230600902609 CrossRef

28.

Kerr J, Calfas KJ, Caparosa S et al (2008) A pilot study to assess the feasibility and acceptability of a community based physical activity intervention (involving internet, telephone, and pedometer support), integrated with medication and mood management for depressed patients. Ment Health Phys Act 1(1):40–45. https://doi.org/10.1016/j.mhpa.2008.06.002 CrossRef

29.

Vickers KS, Patten CA, Lewis BA et al (2009) Feasibility of an exercise counseling intervention for depressed women smokers. Nicotine Tob Res 11(8):985–995. https://doi.org/10.1093/ntr/ntp101 CrossRefPubMedPubMedCentral

30.

Bartels SJ, Pratt SI, Aschbrenner KA et al (2013) Clinically significant improved fitness and weight loss among overweight persons with serious mental illness. Psychiatr Serv 64(8):729–736. https://doi.org/10.1176/appi.ps.003622012 (Washington DC)CrossRefPubMedPubMedCentral

31.

Speyer H, Christian Brix Nørgaard H, Birk M et al (2016) The CHANGE trial: no superiority of lifestyle coaching plus care coordination plus treatment as usual compared to treatment as usual alone in reducing risk of cardiovascular disease in adults with schizophrenia spectrum disorders and abdominal obesity. World Psychiatry 15(2):155–165. https://doi.org/10.1002/wps.20318 CrossRefPubMedPubMedCentral

32.

Vanroy J, Seghers J, Bogaerts A et al (2017) ‘Join The Walk?’: short-term and follow-up effects of a 10-week walking intervention in patients with a mental disorder. Ment Health Phys Act 12:73–82. https://doi.org/10.1016/j.mhpa.2017.02.005 CrossRef

33.

Verhaeghe N, Clays E, Vereecken C et al (2013) Health promotion in individuals with mental disorders: a cluster preference randomized controlled trial. BMC Public Health 13:657. https://doi.org/10.1186/1471-2458-13-657 CrossRefPubMedPubMedCentral

34.

Bonfioli E, Berti L, Goss C et al (2012) Health promotion lifestyle interventions for weight management in psychosis: a systematic review and meta-analysis of randomised controlled trials. BMC Psychiatry 12:78. https://doi.org/10.1186/1471-244X-12-78 CrossRefPubMedPubMedCentral

35.

Cabassa LJ, Ezell JM, Lewis-Fernández R (2010) Lifestyle interventions for adults with serious mental illness: a systematic literature review. Psychiatr Serv 61(8):774–782. https://doi.org/10.1176/ps.2010.61.8.774 CrossRefPubMedPubMedCentral

36.

Happell B, Davies C, Scott D (2012) Health behaviour interventions to improve physical health in individuals diagnosed with a mental illness: a systematic review. Int J Ment Health Nurs 21(3):236–247. https://doi.org/10.1111/j.1447-0349.2012.00816.x CrossRefPubMed

37.

Rosenbaum S, Newby JM, Steel Z et al (2015) Online physical activity interventions for mental disorders. A systematic review. Internet Interv 2(2):214–220. https://doi.org/10.1016/j.invent.2015.04.001 CrossRef

38.

Verhaeghe N, Maeseneer J de, Maes L et al (2011) Effectiveness and cost-effectiveness of lifestyle interventions on physical activity and eating habits in persons with severe mental disorders: a systematic review. Int J Behav Nutr Phys Act 8:28. https://doi.org/10.1186/1479-5868-8-28 CrossRefPubMedPubMedCentral

39.

Göhner W, Fuchs R (eds) (2007) Aufbau eines körperlich-aktiven Lebensstils: Theorie, Empirie und Praxis. Hogrefe, Göttingen

40.

Fuchs R (2013) Das Motivations-Volitions-Konzept. Public Health Forum 21(2):179. https://doi.org/10.1016/j.phf.2013.03.004 CrossRef

41.

Petzold MB, Bischoff S, Rogoll J et al (2017) Physical activity in outpatients with mental disorders: status, measurement and social cognitive determinants of health behavior change. Eur Arch Psychiatry Clin Neurosci 267(7):639–650. https://doi.org/10.1007/s00406-017-0772-3 CrossRefPubMed

42.

Göhner W, Seelig H, Fuchs R (2009) Intervention effects on cognitive antecedents of physical exercise. A 1-year follow-up study. Appl Psychol Health Well-Being 1(2):233–256. https://doi.org/10.1111/j.1758-0854.2009.01014.x CrossRef

43.

Fuchs R, Goehner W, Seelig H (2011) Long-term effects of a Psychological Group intervention on physical exercise and health: the MoVo concept. J Phys Act Health 8:794–803CrossRefPubMed

44.

Göhner W, Dietsche C, Fuchs R (2015) Increasing physical activity in patients with mental illness—a randomized controlled trial. Patient Educ Couns 98(11):1385–1392. https://doi.org/10.1016/j.pec.2015.06.006 CrossRefPubMed

45.

Dawson SL, Dash SR, Jacka FN (2016) The importance of diet and gut health to the treatment and prevention of mental disorders. Int Rev Neurobiol 131:325–346. https://doi.org/10.1016/bs.irn.2016.08.009 CrossRefPubMed

46.

Göhner W, Mahler C, Fuchs R (2007) MoVo-LISA: Ein Kleingruppenprogramm zur Änderung des Bewegungsverhaltens. In: Göhner W, Fuchs R (eds) Aufbau eines körperlich-aktiven Lebensstils: Theorie, Empirie und Praxis. Hogrefe, Göttingen, pp 340–353

47.

Fuchs R, Seelig H, Göhner W et al (2012) Cognitive mediation of intervention effects on physical exercise: causal models for the adoption and maintenance stage. Psychol Health 27(12):1480–1499. https://doi.org/10.1080/08870446.2012.695020 CrossRefPubMed

48.

Craig CL, Marshall AL, Sjöström M et al (2003) International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc 35(8):1381–1395. https://doi.org/10.1249/01.MSS.0000078924.61453.FB CrossRefPubMed

49.

ActiGraph (2008) ActiLife users manual. ActiGraph, LLC Engineering, Pensacola, Fl

50.

Silva P, Mota J, Esliger D et al (2010) Technical reliability assessment of the actigraph GT1M accelerometer. Measurement 14(2):79–91. https://doi.org/10.1080/10913671003715524 CrossRef

51.

Kaminsky LA, Ozemek C (2012) A comparison of the Actigraph GT1M and GT3X accelerometers under standardized and free-living conditions. Physiol Meas 33(11):1869–1876. https://doi.org/10.1088/0967-3334/33/11/1869 CrossRefPubMed

52.

Mota-Pereira J, Ribeiro JC, Fonte D et al (2012) P-506–12 Weeks of moderate intensity exercise improves treatment-resistant major depressive disorder (MDD). daily use of accelerometers contributes to 97% adherence. Eur Psychiatry 27:1. https://doi.org/10.1016/S0924-9338(12)74673-4 CrossRef

53.

Mâsse LC, Fuemmeler BF, Anderson CB et al (2005) Accelerometer data reduction: a comparison of four reduction algorithms on select outcome variables. Med Sci Sports Exerc 37(11 Suppl):S544–S554CrossRefPubMed

54.

Winkler G, Döring A (1995) Kurzmethoden zur Charakterisierung des Ernaehrungsmusters. Einsatz und Auswertung eines Food-Frequency-Fragebogens. Ernährungs-Umschau 42(8):289–291

55.

Steptoe A, Perkins-Porras L, McKay C et al (2003) Psychological factors associated with fruit and vegetable intake and with biomarkers in adults from a low-income neighborhood. Health Psychol 22(2):148–155CrossRefPubMed

56.

Parschau L, Fleig L, Warner LM et al (2014) Positive exercise experience facilitates behavior change via self-efficacy. Health Educ Behav 41(4):414–422. https://doi.org/10.1177/1090198114529132 CrossRefPubMed

57.

Lippke S, Ziegelmann JP, Schwarzer R (2005) Stage-specific adoption and maintenance of physical activity. Testing a three-stage model. Psychol Sport Exerc 6(5):585–603. https://doi.org/10.1016/j.psychsport.2004.11.002 CrossRef

58.

Schüz B, Wurm S, Warner LM et al (2014) Health motives and health behaviour self-regulation in older adults. J Behav Med 37(3):491–500. https://doi.org/10.1007/s10865-013-9504-y CrossRefPubMed

59.

Sniehotta FF, Schwarzer R, Scholz U et al (2005) Action planning and coping planning for long-term lifestyle change. Theory and assessment. Eur J Soc Psychol 35(4):565–576. https://doi.org/10.1037/0882-7974.22.3.482 CrossRef

60.

Renner B, Spivak Y, Kwon S et al (2007) Does age make a difference? Predicting physical activity of South Koreans. Psychol Aging 22(3):482–493. https://doi.org/10.1037/0882-7974.22.3.482 CrossRefPubMed

61.

Seelig H, Fuchs R (2006) Messung der sport- und bewegungsbezogenen Selbstkonkordanz. Zeitschrift für Sportpsychologie 13(4):121–139. https://doi.org/10.1026/1612-5010.13.4.121 CrossRef

62.

Hardt J, Gerbershagen HU (2001) Cross-validation of the SCL-27: a short psychometric screening instrument for chronic pain patients. Eur J pain 5(2):187–197. https://doi.org/10.1053/eujp.2001.0231 CrossRefPubMed

63.

Ware J, Kosinski M, Keller SD (1996) A 12-Item short-form health survey: construction of scales and preliminary tests of reliability and validity. Med Care 34(3):220–233CrossRefPubMed

64.

Faul F, Erdfelder E, Lang A-G et al (2007) G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods 39(2):175–191CrossRefPubMed

65.

Enders CK (2010) Applied missing data analysis. The Guilford Press, New York

66.

Painter J, Rah J-H, Lee Y-K (2002) Comparison of international food guide pictorial representations. J Am Diet Assoc 102(4):483–489. https://doi.org/10.1016/S0002-8223(02)90113-6 CrossRefPubMed

67.

Firth J, Stubbs B, Vancampfort D et al (2017) The validity and value of self-reported physical activity and accelerometry in people with schizophrenia: a population-scale study of the UK Biobank. Schizophr Bull. https://doi.org/10.1093/schbul/sbx149 CrossRefPubMedPubMedCentral

68.

Duncan MJ, Arbour-Nicitopoulos K, Subramanieapillai M et al (2017) Revisiting the International Physical Activity Questionnaire (IPAQ): assessing physical activity among individuals with schizophrenia. Schizophr Res 179:2–7. https://doi.org/10.1016/j.schres.2016.09.010 CrossRefPubMed

69.

van Sluijs EM, van Poppel MN, Twisk JW et al (2006) Physical activity measurements affected participants’ behavior in a randomized controlled trial. J Clin Epidemiol 59(4):404–411. https://doi.org/10.1016/j.jclinepi.2005.08.016 CrossRefPubMed

70.

Trost SG (2016) State of the art reviews. Measurement of physical activity in children and adolescents. Am J Lifestyle Med 1(4):299–314. https://doi.org/10.1177/1559827607301686 CrossRef

71.

Tucker P, Gilliland J (2007) The effect of season and weather on physical activity: a systematic review. Public Health 121(12):909–922. https://doi.org/10.1016/j.puhe.2007.04.009 CrossRefPubMed

72.

Naslund JA, Whiteman KL, McHugo GJ et al (2017) Lifestyle interventions for weight loss among overweight and obese adults with serious mental illness. A systematic review and meta-analysis. Gen Hosp Psychiatry 47:83–102. https://doi.org/10.1016/j.genhosppsych.2017.04.003 CrossRefPubMedPubMedCentral

73.

Strath SJ, Kaminsky LA, Ainsworth BE et al (2013) Guide to the assessment of physical activity. Clin Res Appl Circ 128(20):2259–2279. https://doi.org/10.1161/01.cir.0000435708.67487.da CrossRef

74.

Thompson FE, Subar AF (2008) Dietary assessment methodology. Nutr Prev Treat Dis 2: 5–46. https://doi.org/10.1016/B978-0-12-391884-0.00001-9 CrossRef

75.

Keller-Varady K, Hasan A, Schneider-Axmann T et al (2016) Endurance training in patients with schizophrenia and healthy controls: differences and similarities. Eur Arch Psychiatry Clin Neurosci 266(5):461–473. https://doi.org/10.1007/s00406-015-0651-8 CrossRefPubMed

Title: Increasing physical activity and healthy diet in outpatients with mental disorders: a randomized-controlled evaluation of two psychological interventions
Authors: Moritz Bruno Petzold
Jennifer Lara Maria Mumm
Sophie Bischoff
Julia Große
Jens Plag
Ralf Brand
Andreas Ströhle
Publication date: 01-08-2019
Publisher: Springer Berlin Heidelberg
Published in: European Archives of Psychiatry and Clinical Neuroscience / Issue 5/2019
Print ISSN: 0940-1334
Electronic ISSN: 1433-8491
DOI: https://doi.org/10.1007/s00406-018-0941-z

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Increasing physical activity and healthy diet in outpatients with mental disorders: a randomized-controlled evaluation of two psychological interventions

Abstract

Introduction

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 5/2019

Effects of physical activity on cognitive performance: a controlled clinical study in depressive patients

12-year changes in cardiovascular risk factors in people with major depressive or bipolar disorder: a prospective cohort analysis in Germany

Neurobiological effects of aerobic exercise, with a focus on patients with schizophrenia

Effects of exercise-based interventions in severe mental illness: a feasibility study

A randomized controlled trial of training of affect recognition (TAR) in schizophrenia shows lasting effects for theory of mind

Sports psychiatry: mental health and mental disorders in athletes and exercise treatment of mental disorders