Complex Case Scenario Presentation

Written Document
Student Name: Aaron Nicol
Student Number: N9749284

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Contents Page

Contents
Section 1: Medical History / Patient Summary................................................................................3
Appendix A – Patient Information.................................................................................................3
Section 2: Assessment.......................................................................................................................4
Section 3: Exercise Prescription and Programming.......................................................................8
Justification for Exercise Prescription..........................................................................................8
Section 4: Self Reflection.................................................................................................................12
Appendix C: Self Reflection.........................................................................................................12
Section 5: Bibliography....................................................................................................................15
Completed PowerPoint Slides.........................................................................................................17

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Section 1: Medical History / Patient Summary
Appendix A – Patient Information
Patient Details

Name: DM Gender: Male DOB: 11-Apr-1958

Reason for Presentation to the Community Care Unit

DM was allowed into the CCU in September 2019. The CCU is a live-in care facility focused on
equipping residents with the skills they need to self-manage in the community. This particular unit
focused primarily on those suffering from long term depression, anxiety and psychotic disorders. In
order to be allowed on site, residents must be ready to participate fully in all rehab activities and
sign contracts to that effect.

Principal Diagnosis (from Specialist - Psychiatrist)

Bipolar disorder with psychotic symptoms (dx 2019 Aug) Bipolar disorder involves depressive and
manic episodes. The DSM defines mania as a “distinct period of abnormally and persistently
elevated, expansive, or irritable mood.” Depressive episodes are defined by symptoms such as
decreased energy, feelings of worthlessness or guilt, changes in sleep, trouble thinking and
concentrating and preoccupation with death or suicidal thoughts and plans (American Psychiatric
Association, 2013). DM was also diagnosed with general anxiety disorder, characterised by fearful,
anxious, or avoidance of perceived threats in the environment (American Psychiatric Association,
2013). Additionally, DM was diagnosed with major depression, low mood, amotivation, weight loss
decreased sleep.

Medical History & Clinical Management / Investigations / Procedures

History of chronic depression-treated

with medication and ECT
Otherwise Nil

Medications

Medication
Lithium 250mg + 500mg nocte
Escitalopram 10mg mane
Lamotrigine 200mg mane
Testosterone 50mg mane
Promethazine 25mg PRN
Reason
Treatment of bipolar disorder, additional anti-psychotic
component
Antidepressant, primarily for treatment of anxiety in this case
Treatment of bipolar disorder
Hypogonadism
Sedative/sleeping aid & anti-anxiety

Additional Information Relevant to the Case

DM married, two daughters and one son all of which he has a close connection with.

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Section 2: Assessment
Mock GP Report:

14th November 2019 Coorparoo Mental Health &

Addiction Services Coorparoo Community Care Unit

14 Barragoola St
Coorparoo QLD 4120
Phone 1300 64 22 55
Fax 01 2386 3327

Dr Smith
1 Smith Road
Smithy QLD 4000
Fax 07 9999 9999

Re: Mr M. DOB 11/04/1958 Report: Review Assessment

Dear Mr Smith

Thank you for your referral of Mr. DM to the Coorparoo Mental Health & Addiction Services Coorparoo
CCU for Accredited Exercise Physiology services. Mr DM has been residing at the CCU since August
and has been engaging with resident AEPs for exercise management during this time.

A review of medical history, current medications and functional assessments were conducted. These
assessments included tests of strength, flexibility and pain. The results of these tests are included
below for your information.
Assessment Result/Classification Norm
BMI (kg.m-2) 26.1- overweight 18.5-24.19
Resting BP 108/75 – normal 120/80
SIMPAQ ~60mins PA per week NA
AMRAP pushup (against table) 14- normal 12-17
30s STS (repetitions) 11- normal 10-6
Lumbar Flexion 7cm 2/10 pain- below average 9.5cm pain free
Lumbar Extension 3cm no pain- below average 5.8cm pain free
BMI (Body Mass Index) | BP (Blood Pressure) at seated rest | 30STS (30 second sit to stand) ; lower limb strength measure
AMRAP push up (As many reps as possible push up test) upper body strength measure | SIMPAQ (Simple Physical Activity
Questionnaire)

An individualised facility exercise program has been developed for Mr M. based on his personal
health goals and the results of his objective assessment results.

We welcome communication regarding the health of Mr M, any medication changes, investigation

results or additional health developments.

Please send any correspondence to Coorparoo Mental Health & Addiction Services CCU offices Fax
01 2386 3327.

Kind Regards,

Aaron Nicol AEP

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Patient Report:

Engagement:

D engaged well in session, responding to all questions asked. Was polite and responded
appropriately to questions.

Assessment:

Presentation:

D presented in casual clothing appropriate for exercise. Self-care appeared attended to. Speech r/r/v
normal. Mood appeared congruent with affect which appeared euthymic. Dennis appeared
uncomfortable in interview setting this was shown through crossed arms and leaning away from
interviewer. Eye contact was appropriate.

Physical Health related risk:

Per BMI D is slightly overweight

Reports taking three medications, follow up on med specifics

D reports limited knowledge of exercise and low confidence in performing exercise. Demonstrated
good insight into the benefits of exercise for improving his mood and physical health. D was interested
in participating regular walking as well as group circuit classes. D reported history of social soccer but
would not participate in CCU sport outings to due lack of confidence in ability. D reported no past
injuries. Some pain in lower back and left shoulder blade which D reports is due to scoliosis. Pain
occurs usually while standing for some time or bending over.

Physical health assessments:

Ht = 176.3cm

Wt = 77.9kg

BP = 108/75

ESSA APS completed, stage 1 all no. Medical clearance to exercise not required

Modified SIMPAQ completed. D currently completes around 60 mins of regular PA per week.

Goals:

Improve mood and reduce anxiety

Get stronger for DIY around house

Get a routine

We discussed beginning with attempting to attend 1 or 2 of the 3 CCU weekly circuits every week for
the next 4 weeks and then reassessing. D was agreeable to this and we also agreed that we would

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also reassess his mood and anxiety, but that improving these he would work with the CCU
psychologist.

D explained that he felt that exercise was “the good thing for you” and that his main barriers to
exercise were motivation and getting things started. He did not have any pleasant or unpleasant
associations with exercise and was open to any sort of exercise type or structure stating “I’m happy to
try anything, just don’t expect me to be good at anything.”

Plans/Recommendation:

Support D in attending CCU circuits through door knocks and encouragement from support staff.

For EPS, building rapport with D through engaging in consumer interests such as art, reading.
Encourage participation, provide specific exercises for improving pain in back to complete either in
circuit or at home.

Performed Assessments:

Assessment Result/Classification Norm Literature: Patient: Clinician:

Resting BP 108/75 – normal 120/80 ACSM Part of pre-
(2013) screen
SIMPAQ ~60mins PA per week NA Australia’s Current PA
Physical amount and
Activity informs
and goals going
Sedentary forward
Behaviour
Guidelines
(2013)
AMRAP pushup 14 Average ACSM Interested Informative
(against table) (2013) in level of of total
strength upper body
strength
30s STS 11 Average ACSM As above, Informative
(2013) once of total
aware lower body
measure strength,
of total performance
strength, vis-à-vis
curious LBP
Lumbar Flexion 7cm 2/10 pain- below 9.5cm pain (Coyle et Interested Helps inform
average free al., 2016). in LBP practice vis-
cause à-vis LBP
cause
Lumbar 3cm no pain- below 5.8cm pain (Coyle et Interested Helps inform

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 Extension average free al., 2016). in LBP practice vis-
cause à-vis LBP
cause

Justification of Assessment:

Following subjective assessment and upon discovering that DM has undergone no previous objective
testing of any kind, I quickly selected a small battery of assessments that would develop baseline
measure of muscular strength and endurance and gain some insight into potential causes of DM’s
back pain. Due to my own experience level with this population and the cognitive deficit often evident
in SMI populations (Trivedi, 2006) all my tests had to be simple to understand, easy to perform and
require little equipment. Additionally, on advice from other allied health professionals on staff I
selected only the most important tests as after a long period of testing patients tended to “shut down”
and performed tests would usually not be accurate or even engaged in. Following these criteria, I
worked from ACSM’s health related physical fitness assessment manual, which I deemed a well-
researched and widely used guide containing baseline tests. DM’s primary goals were maintaining
strength and ability to perform ADLs as his age progressed, increasing the amount of activity he does,
and addressing his back pain. As such I selected the 30STS and AMRAP push up tests to provide a
gauge of lower and upper body strength respectively. I also felt that these tests would provide an
insight into DM’s movement quality and strength in regard to his back pain through assessing his
ability to maintain a straight back, hip hinge and assess for knee valgus or varus. There is strong
evidence that in older populations chronic LBP is associated with reduced mobility and that this
reduced mobility is associated with decreased performance of ADLs (Coyle et al., 2016). As such
lumbar flexion and extension were selected in order to assess if LBP had affected DM’s mobility and
for the clinician, gain further insight into DM’s pain, source and method of treatment through
assessing when in the movement the pain arose and what type of pain it was.

As per Australia’s Physical Activity and Sedentary Behaviour Guidelines (2013) DM’s weekly PA is far
below the guidelines. Their tests of strength are promising and indicate average levels of strength.
This is in line with their reported history of activity around the house and interest in DIY projects. DM
had significant issue with performing the hip hinge necessary in a correctly performed squat. ROM
tests showed below average and painful ROM in DM’s back. DM reported that pain felt like a dull ache
either side of spine that did not radiate and dissipated by the end of the consult. In my personal
experience and in the experience of my practicum supervisor this was in line with muscular weakness
as opposed to a structural injury.

Formulating his results, it appears that DM is a severely depressed male of 61 years old, mentally
primarily suffering from bipolar disorder, major depressive disorder and generalised anxiety.
Physically he is of average strength, with scoliosis and associated chronic LBP impacting mobility and
everyday function significantly. Subjectively patient also reports that this LBP has a strong negative
effect on his mental health as it is a cause of significant anxiety. DM is interested in increasing

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participation in exercise and PA, but currently participating in almost no PA and as such should be
gently introduced to more minutes of PA.

It should be noted that due to scheduling constraints at the CCU a final assessment could not be
conducted. Subjectively DM reported significantly improved mood state and confidence in his ability to
exercise. He reported his back pain at a 0/10 for the last three weeks of group exercise sessions.
Participating in three rounds of a circuit he would regularly perform ~30 push-ups, rows, sit ups and
squats through a session.

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Section 3: Exercise Prescription and Programming
Justification for Exercise Prescription
For sufferers of severe mental illness or SMI life expectancy is decreased by approximately 20 years.
This is primarily due to lack of physical health care and as a result of associated conditions such as
depression and anxiety which cause sufferers to participate in much less physical activity and be
highly sedentary (Vancampfort et al., 2015). This causes higher incidences of metabolic syndrome,
obesity, and hyperglycaemia often leading to cardiovascular disease (Firth et al., 2016). Due to the
nature of DM’s mental health conditions and his goals within the CCU it was important that I aligned
my goals with the goals of the rest of the allied health team and the patient.

Firth and colleague’s 2016 meta-analysis of motivating factors towards exercise in SMI populations
found that enjoyment of exercise scored highly as a reason for exercise. Additionally, ‘fitness’ and
stress reduction/mood enhancement were the most important motivating factors to SMI populations.
These is also strong evidence that social support, provided by others in the community, family
members and professionals involved in treatment is a strongly motivating factor that can enable
patients to overcome exercise barriers that would otherwise stop them from participating in exercise
(Soundy et al., 2014).

Meta-analysis of exercise interventions in this population have shown that interventions which provide
professional support have greater effects on measures of fitness and better adherence to PA (Stubbs
et al., 2016). Related research in this field has also shown that affecting long term adherence and
lifestyle change is best achieved through a self-determination theory guided approach (Vancampfort
et al., 2013). The idea simply being that patients whose motivation for exercise is intrinsic and based
on their own knowledge of the benefits of and their own enjoyment of exercise will be more likely to
adhere to long-term lifestyle changes around exercise participation.

As such I wanted to combine the outcomes of directly supervised exercise with the social benefits of
group exercise and the associated self-efficacy of being able to direct exercise to a degree and
excessive oversight to promote self-determination and confidence. As such when DM attended circuit
sessions intensity was self-directed and after some initial sessions DM was prompted to select
exercises that he enjoyed, constructing a full body circuit to participate in. My program was therefore
largely a collaborative effort between myself and DM to find and encourage physical activity that they
were willing and interested in participating in over a long-term period. Within these guidelines the
exercise program had to address two primary concerns. Firstly, meeting the guidelines recommended
by Rosenbaum and colleagues (2016). My programs were largely therefore a collaborate effort
between myself and DM to find and encourage physical activity which was realistic, beneficial and
most importantly sustainable for DM. Within that framework, from a clinical perspective, the exercise
programming had to address two main concerns, firstly, meet the guidelines recommended by
Rosenbaum and colleges (2015), 150 minutes of moderate activity per week or 75 minutes of
moderate to vigorous intensity PA to mitigate the symptoms of bipolar disorder and depression and as
a stretch goal move towards the PA guidelines for Australia (2014).

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The aim of this program was to gently increase PA from a reported 60 minutes of light walking by
adding around 30 minutes of moderate to vigorous exercise in order to DM’s confidence and self-
efficacy to improve mood and make exercise a more positive experience (Chan et al., 2018). DM was
interested in the social aspect of the circuit class and this was quickly seen to be a positive factor for
adherence as DM made friends with other group regulars. I provided significant education around
positive mental health attitudes towards recording exercise attendance and success, shifting focus
away from guilt and anxiety about performance towards a focus on improvement, health outcomes
and self-efficacy in line with research about SDT showing that guilt-based exercise is extrinsic, and
therefore is not beneficial to maintaining long term adherence (Wininger, 2007).

The tabled program is an example of a program commonly run for the patient in a group setting. Other
times we would instead go on a brisk walk, play table tennis or go on a social sport outing depending
on patient mental state and their desires. This was because the CCU’s primary goals are around
mental health and mood state as opposed to any physical performance goals, and as such exercise
amount was more important than modality, as the focus was on mood improvement (Chan et al.,
2018). As DM began to enjoy exercise more and more, they began organising regular walks with their
support worker, this was encouraged by me and by the end of my placement equated to an additional
60-90 minutes of PA per week.

DM was cleared for light and moderate exercise through the APSS pre screen and has no absolute or
relative contraindications to exercise as per the ACSM guidelines. Some of the medications DM is on
commonly cause drowsiness and sedation. DM developed a slight tremor as a side effect of lithium
but not significant enough to effect fine motor skills (Bowden et al., 2002). DM did not experience
drowsiness or sedation on their medications and as a result it did not affect exercise performance.

One of the strengths of the adaptable structure of the group class was that it gave the patient and I
the ability to create full body exercise programs that satisfied my goals for the patient while providing
the patient with a level of confidence, self-determination and mastery over their own exercise
participation (Wininger, 2007).

The first exercise was a hip hinge, providing both strengthening and stretching for the hamstrings, as
well as opening the way for conversations about healthy spine posture in ADLs. This exercise was
intended to combat maladaptive biomechanics, improve strength of the muscles of the posterior chain
to assist in alleviating backpain and also alleviate hamstring tightness due to their negative effect on
LBP (Jandre Reis and Macedo, 2015).

The glute bridge was part of DM’s program in order to address his anterior pelvic tilt. There is
evidence to suggest sufferers of chronic LBP have limited pelvic ROM and proprioception and in my
clinical experience this pelvic tilt puts the lower back under stress which can result in back pain (Laird
et al., 2014). As such the purpose of this exercise was to strength DM’s glutes in order to address
pelvic tilt and therefore back pain.

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The crunch was put into DM’s program for the purpose of strengthening the abdominal muscles as
strong trunk musculature is positively correlated with reduced LBP in exercise interventions for
sufferers of chronic LBP (Gordon and Bloxham, 2016).

The other three exercises, the push up, squat and banded row were selected based on my and my
supervisor’s experience in exercise prescription and supported by ACSM. Personally, as a strength
and conditioning coach I have found good success prescribing the push up, squat and banded row for
the improvement of chest, lower limb, and back strength respectively. There were no contraindications
identified for DM’s performance of the above exercises. Set and rep structure were informed by the
ACSM’s guidelines for frail adults, due to DM’s sedentary behaviour and a desire by practitioners to
avoid overwhelming him initially. Lastly, adherence was maintained through constantly highlighting the
value of these exercises for “fitness” which ranked highly as a motivator in the literature for SMI as
well as for DM.

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Exercise FITT. Literature Patient Clinician
Squat – cuing correct 12 or as many (American College of Sports Medicine 2013). Squat is an Enjoys the Resistance training with aerobic component,
pelvic tilt, knee as possible effective exercise for the increasing of lower limb movement, enjoys excellent for lower limb strength and postural
position, and back with good strength. going deep muscle component. Posterior chain
posture form over 30s (Gordon, R. and Bloxham, S. 2016). Posterior chain strengthening is shown to decrease LBP.
strengthening is shown to decrease LBP
Pushup 12 or as many (American College of Sports Medicine. 2013). The push Enjoyed being able Develop chest and upper back strength and
Elbows close, good as possible up is shown to be an effective exercise for improvement to increase amount, mobility, moderately intense exercise, Pt able to
hip and shoulder with good of upper body strength and a good predictor of overall likes being able to do perform without supervision after initial sessions
alignment, strong form over 30s upper body strength. push ups with cueing.
lower back posture.

Crunch 12 or as many (American College of Sports Medicine. 2013). Crunches Enjoyed knowing Abdominal exercise for reducing load on back, in
Effective engagement as possible are shown to increase abdominal strength, which is a would assist with line with literature, likes it
of abdominal muscles, with good goal to reduce back pain. back pain. Avoided
curling rather than form over 30s issue with
lifting, spine (Vancampfort et al. 2013). The patient was interested in coordination
awareness. exercises that directly had an effect on his back pain.

Glute bridge – 12 or as many (Laird et al., 2014). Addressing pelvic tilt is likely to Able to lie on floor Address pelvic tilt, address glute strength and
Maintain appropriate as possible reduce chronic LBP. and rest, also made manage lower back pain.
lower back curve, with good (Vancampfort et al. 2013). The patient was interested in back feel “easier to
monitor fatigue form over 30s exercises that directly influenced his back pain. This had move” for some time
the effect of increasing self-confidence and mastery over after exercise
symptoms.
Banded Row- 12 or as many (American College of Sports Medicine. 2013). Rows are Liked pulling weight, Strengthen upper back and shoulders as part of
Maintain shoulders as possible an effective exercise for improving upper body strength. ROM of ex, felt like it well-rounded whole body exercise program.
down, externally with good helped shoulder
rotated, standing tall form over 30s move a lot better
Hip hinge 3x12 (Jandre Reis, F. J., & Macedo, A. R. 2015). Lessening Improved ADLs Improving pt comfort and confidence in bending
Extreme focus on hip hamstring tightness and improving lower back through improving via increasing strength and movement quality.
hinge by minimal knee musculature strength known to have positive effect on movement quality
bend, maximum hinge. chronic LBP. while bending and
moving.

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Section 4: Self Reflection
Appendix C: Self Reflection
Appendix C: Reflection

1. Report.

What I have chosen to reflect on is how practicum experience at the CCU has altered my approach to exercise prescription and programming in SMI
populations. Initially I was guided by healthy population guidelines for PA and general experience of program design and prescription. I found that realigning
my and patient goals towards simply any PA, and more importantly PA that they were enjoying, and would therefore stick with, provided us both more
success and feelings of accomplishment for the patient. It was far more effective to praise small success than focus on failure. Prescriptions that were
individualised based on patient goals, patient psychology and the literature were met with much more success than simply going by the guidelines.
Additionally, being flexible around exercise type and structure while still working towards patient goals was a skill that this experience really helped me
develop.

2. Relate the issue / experience to your own skills, professional experience or discipline knowledge.

I found this practicum really helped me develop skills around patient engagement and constructing enjoyable sessions that patients wanted to attend. In close
cooperation with the resident OTs and psychologists I felt I have developed a lot of skill around the biopsychosocial model of exercise prescription and
delivery. Instead of just providing exercise for patients, I was able to improve their confidence and understanding of exercise and hopefully make a longer-
term impact.

3. Reason about (discuss) the issue / incident to show an understanding of how things work in this discipline or professional field.

Being presented with clients that often had very little intrinsic motivation or ability to tolerate unpleasant stimulus such as much exercise I needed a way to
guarantee engagement and enjoyment in my sessions. Finding the research that I found around exercising SMI groups when combined with my knowledge of
the biopsychosocial model helped informed my approach to motivating pts and fostering adherence.

4. Reconstruct your understanding or future practice

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This led me to develop more flexibility and redirected my focus to exercise generally away from any specific mode. PA became more PT selected and
contributed to my understanding of how to get PTs interested in my services and engage with and experience the benefits of regular PA. Ideally this model
provides them with self-efficacy necessary to continue participating in PA in the future

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Section 5: Bibliography
American College of Sports Medicine (Ed.). (2013). ACSM's health-related physical fitness
assessment manual. Lippincott Williams & Wilkins.
https://qut.primo.exlibrisgroup.com/permalink/61QUT_INST/1v44ke9/alma991009792520604001

American College of Sports Medicine. (2013). ACSM's guidelines for exercise testing and
prescription. Lippincott Williams & Wilkins.
https://qut.primo.exlibrisgroup.com/permalink/61QUT_INST/1v44ke9/alma991006315879704001

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th
ed.). Washington, DC: Author
https://qut.primo.exlibrisgroup.com/permalink/61QUT_INST/1v44ke9/alma991009327509004001

Australian Government. Australia’s Physical Activity and Sedentary Behaviour Guidelines.

Department of Health, editor 2014

Bowden, C., Gitlin, M., Hirschfield, R., Keck, P., Suppes, T. and Wagner, K. (2002). Treatment of
Patients with Bipolar Disorder

https://qut.primo.exlibrisgroup.com/permalink/61QUT_INST/1v44ke9/alma991007172009704001

Chan, J., Liu, G., Liang, D., Deng, K., Wu, J. and Yan, J. (2018). Special Issue – Therapeutic Benefits
of Physical Activity for Mood: A Systematic Review on the Effects of Exercise Intensity, Duration, and
Modality. The Journal of Psychology, 153(1), pp.102-125.

Coyle, P., Velasco, T., Sions, J. and Hicks, G. (2016). Lumbar Mobility and Performance-Based
Function: An Investigation in Older Adults with and without Chronic Low Back Pain. Pain Medicine,
18(1), pp.161-168.

https://qut.primo.exlibrisgroup.com/permalink/61QUT_INST/150fq0m/oxford10.1093%2Fpm
%2Fpnw136

Firth, J., Rosenbaum, S., Stubbs, B., Gorczynski, P., Yung, A. R., & Vancampfort, D. (2016).
Motivating factors and barriers towards exercise in severe mental illness: a systematic review and
meta-analysis. Psychological medicine, 46(14), 2869-2881
https://qut.primo.exlibrisgroup.com/permalink/61QUT_INST/150fq0m/cambridgeS0033291716001732

Gordon, R. and Bloxham, S. (2016). A Systematic Review of the Effects of Exercise and Physical
Activity on Non-Specific Chronic Low Back Pain. Healthcare, 4(2), p.22.
https://qut.primo.exlibrisgroup.com/permalink/61QUT_INST/150fq0m/doaj_soai_doaj_org_article_9ed
91c78c8ed4e08beb9687f49bc9eda

Jandre Reis, F. and Macedo, A. (2015). Influence of Hamstring Tightness in Pelvic, Lumbar and Trunk
Range of Motion in Low Back Pain and Asymptomatic Volunteers during Forward Bending. Asian
Spine Journal, 9(4), p.535.
https://qut.primo.exlibrisgroup.com/permalink/61QUT_INST/150fq0m/scopus2-s2.0-84946408439

Laird, R., Gilbert, J., Kent, P. and Keating, J. (2014). Comparing lumbo-pelvic kinematics in people
with and without back pain: a systematic review and meta-analysis. BMC Musculoskeletal Disorders,
15(1). https://qut.primo.exlibrisgroup.com/permalink/61QUT_INST/150fq0m/proquest1545087484

Rosenbaum, S., Lederman, O., Stubbs, B., Vancampfort, D., Stanton, R., & Ward, P. B. (2016). How
can we increase physical activity and exercise among youth experiencing first‐episode psychosis? A
systematic review of intervention variables. Early intervention in psychiatry, 10(5), 435-440.

Soundy, A., Freeman, P., Stubbs, B., Probst, M. and Vancampfort, D. (2014). The value of social
support to encourage people with schizophrenia to engage in physical activity: an international insight
from specialist mental health physiotherapists. Journal of Mental Health, 23(5), pp.256-260.
https://qut.primo.exlibrisgroup.com/permalink/61QUT_INST/150fq0m/informaworld_s10_3109_09638
237_2014_951481

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Stubbs, B., Vancampfort, D., Rosenbaum, S., Ward, P., Richards, J., Soundy, A., Veronese, N.,
Solmi, M. and Schuch, F. (2016). Dropout from exercise randomized controlled trials among people
with depression: A meta-analysis and meta regression. Journal of Affective Disorders, 190, pp.457-
466.
https://qut.primo.exlibrisgroup.com/permalink/61QUT_INST/150fq0m/elsevier_sdoi_10_1016_j_jad_2
015_10_019

Trivedi, J. (2006). Cognitive deficits in psychiatric disorders: Current status. Indian Journal of

Psychiatry, 48(1), p.10.
https://qut.primo.exlibrisgroup.com/permalink/61QUT_INST/150fq0m/pubmed_central2913637

Vancampfort, D., De Hert, M., Vansteenkiste, M., De Herdt, A., Scheewe, T. W., Soundy, A., ... &
Probst, M. (2013). The importance of self-determined motivation towards physical activity in patients
with schizophrenia. Psychiatry Research, 210(3), 812-818.
https://qut.primo.exlibrisgroup.com/permalink/61QUT_INST/150fq0m/elsevier_sdoi_10_1016_j_psych
res_2013_10_004

Vancampfort, D., Stubbs, B., Mitchell, A. J., De Hert, M., Wampers, M., Ward, P. B., ... & Correll, C. U.
(2015). Risk of metabolic syndrome and its components in people with schizophrenia and related
psychotic disorders, bipolar disorder and major depressive disorder: a systematic review and meta‐
analysis. World Psychiatry, 14(3), 339-347.
https://qut.primo.exlibrisgroup.com/permalink/61QUT_INST/150fq0m/wj10.1002/wps.20252

Wininger, S. (2007). Self-Determination Theory and Exercise Behavior: An Examination of the

Psychometric Properties of the Exercise Motivation Scale. Journal of Applied Sport Psychology, 19(4),
pp.471-486.

https://qut.primo.exlibrisgroup.com/permalink/61QUT_INST/150fq0m/informaworld_s10_1080_10413
200701601466

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Completed PowerPoint Slides

Com plex Ca se
Scena r io
P resen t a t ion
Ca pst on e Un it
XNH 480
Aa r on Nicol
Clin ica l E xer cise P h ysiology St u den t
QUT, 2019

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