Exercise Prescription for Persons with Chronic Disease and Disability – Theory

Bewegen bij Bijzondere Groepen

Mental health part: class 1

Prof. Dr. D. Vancampfort

Course outline

• Class 1: - Mental health versus mental disorder

• Class 2: What is the evidence for physical activity in the prevention and treatment of mental
health problems and mental disorders.

• Class 3: - What are the underlying mechanisms of mental health benefits of physical activity?
- What are the associations between mental health and sedentary behavior?

• Class 4: How can we prescribe physical activity for people with mental health problems?
Content

• Slides on Toledo.

• Presence during the lectures is needed:

• What will be discussed during the lectures is part of the content and can be examinated, even if
not presented on the slides.
Exams

• See class Prof. Dr. J Seghers and Toledo.

• Multiple choice.
 “Without mental health
there can be no true physical health!”

Brock Chisholm
First Director-General of the World Health Organization
1954
 What is mental health?

What is mental illness / disorder?

Mental health versus mental illness / disorder?

Mental health and mental illness are related, but distinct

dimensions: one continuum indicates the presence or
absence of mental health, the other the presence or
absence of mental illness.

Mental health is more than just the absence of a mental

illness.
What is mental health?

• Mental health is described by the World Health Organization (2004) as:

… a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of
life, can work productively and fruitfully, and is able to make a contribution to his or her community.

• In this positive sense mental health is the foundation for well-being and effective functioning for an individual
and for a community.
Mental health as well-being (1/4)

Two traditions of well-being research are currently distinguished:

hedonic well-being eudaimonic well-being

Mental health as well-being (2/4)
Mental health as well-being (3/4)

• Hedonic well-being involves pleasure attainment and pain avoidance.

• In the 1980’s and 1990’s there was some discomfort with the narrow portrayal of well-being in the hedonic
tradition.

• In 2000’s well-being was defined in terms of individual strivings and optimal functioning = eudaimonic well-
being.
Mental health as well-being (4/4)

Eudaimonic well-being encompasses 6 elements:

Having insight into one’s own A positive and acceptant attitude toward
potential for self-development. aspects of the self in past and present.

Having goals and beliefs that Self-direction as guided by one’s own

affirm a sense of direction and socially accepted internal standards
meaning in life. (able to resist social pressures to think
and act in certain ways).

Having satisfying personal The capability to manage the complex

relationships in which empathy and environment according to one’s own needs, e.g.
intimacy are expressed. “In general, I feel I am in charge of the situation in
which I live.”
What is mental illness?

• A mental illness is a disorder diagnosed by a psychiatrist / psychologist.

• The disorder significantly interferes with a person’s cognitive, emotional, social and often also motor abilities:
mental disorders are worldwide the leading cause of years lived with disability (Global Burden of Disease
Study; Whiteford et al., 2015).
What is mental illness?

• They encompass a wide variety of signs, symptoms and experiences.

• They are typically classified according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5;
American Psychiatric Association) or International Classification of Diseases ( ICD-10, World Health
Organization).
From a mental health problem to a mental illness: different stages
Mental health problem

Mental disorder
Prevalence rates mental disorders
Yearly prevalence of a mental disorder
Lifetime prevalence of a mental disorder
What is mental illness?

Mental illness

Mood
(affective Anxiety Psychotic Substance use Eating
disorders) disorders disorders disorders disorders
•Common risk factors can contribute to both mental illness and substance use
disorders.

•Many genes can contribute to the risk of developing both a substance use
disorder and a mental illness.
•Environmental factors, such as stress or trauma, can cause genetic changes
that are passed down through generations and may contribute to the
development of mental illnesses or a substance use disorder.

•Mental illnesses can contribute to drug use and substance use disorders.

•Research suggests that people with mental illness may use drugs or alcohol as
a form of self-medication.
•Although some drugs may help with mental illness symptoms, sometimes this
can also make the symptoms worse.
•When a person develops a mental illness, brain changes may enhance the
rewarding effects of substances, predisposing the person to continue using the
substance.

•Substance use and addiction can contribute to the development of mental

illness.
•Substance use may change the brain in ways that make a person more likely
to develop a mental illness.
(*) Somatic complaints: unexplained physical complaints such as headache, stomach ache, chronic pain
What is mental illness?

Mental illness

Mood
(affective Anxiety Psychotic Substance use Eating
disorders) disorders disorders disorders disorders
Children

Mental illness

Autism

25
 Elderly

Mental illness

Major neurocognitive
disorder

26
Mood disorders
Depression has also physical features… some of them are important to consider in a physical
activity program
Moreover… people with depression are at high risk for chronic non-communicable diseases

Risk for the onset of myocardial infarctions (OR=1.60, 95%CI 1.34–1.92)

32
The opposite is also true…

33
What is mental illness?

Mental illness

Mood
(affective Anxiety Psychotic Substance use Eating
disorders) disorders disorders disorders disorders
Anxiety disorders
PTSD
Changes in physical activity following a traumatic event and the development of
PTSD
People with anxiety are at high risk for chronic non-communicable diseases

39
The importance of a holistic approach in physical activity programs
Considering depression and anxiety

40
What is mental illness?

Mental illness

Mood
(affective Anxiety Psychotic Substance use Eating
disorders) disorders disorders disorders disorders
Psychosis
Psychosis
Psychosis
The scandal of premature mortality in people with schizophrenia

1. People with schizophrenia have a more or less 15

year shortened life expectancy (Lawrence, 2015).

2. The mortality gap still is widening between people

with and without schizophrenia is still increasing.

Lawrence D. Excess mortality, mental illness and global burden of disease. Epidemiol Psychiatr Sci. 2015;24(2):141-3.
Saha S, Chant D, McGrath J. A systematic review of mortality in schizophrenia: is the differential mortality gap worsening over time? Arch Gen Psychiatry. 2007;64(10):1123-31.
Swaraj S, Chung D, Curtis J, Firth J, Ramanuj PP, Sara G, Wang M, Large M. Meta-analysis of Natural, Unnatural, and Cause Specific
Mortality Rates Following DischargeFrom Inpatient Psychiatric Facilities. Acta Psychiatr Scand. 2019 Jul 20. doi: 10.1111/acps.13073
What is mental illness?

Mental illness

Mood
(affective Anxiety Psychotic Substance use Eating
disorders) disorders disorders disorders disorders
Substance use disorders
What is a substance use disorder?
Reflection on the video “The nuggets”

• The concept of this video succinctly captures the heartbreaking reality of a substance use disorder.

• Things start off rather innocuously. There is the initial lure: the effect is immediate and it is delicious.

• It however turns out quickly to be too delicious to resist, but the highs steadily decrease in time and pleasure.

• Afterwards, a tunnel vision follows: all the bird can think about, all he can see are “the golden nuggets”.

• Finally, there is inevitable conclusion: the bird, clearly in the depths of despair and in a very bad health condition
because of his abuse, suffers immensely along the road that leads to emptiness.
Substance use disorders

DSM-5 Criteria (within a 12-month period, at least 2 criteria)

1. Taking the substance in larger amounts or for longer than you're meant to.
2. Wanting to cut down or stop using the substance but not managing to.
3. Spending a lot of time getting, using, or recovering from use of the substance.
4. Cravings and urges to use the substance.
5. Not managing to do what you should at work, home, or school because of substance use.
6. Continuing to use, even when it causes problems in relationships.
7. Giving up important social, occupational, or recreational activities because of substance use.
8. Using substances again and again, even when it puts you in danger.
9. Continuing to use, even when you know you have a physical or psychological problem that could have been
caused or made worse by the substance.
10. Needing more of the substance to get the effect you want (tolerance).
11. Development of withdrawal symptoms, which can be relieved by taking more of the substance.
Types of substance use disorders

The DSM-5 establishes the following substance use disorders:

1. Alcohol
2. Cannabis (e.g., marijuana)
3. Hallucinogens
4. Inhalants
5. Opioids (e.g., heroin)
6. Sedatives, Hypnotics, or Anxiolytics (e.g., valium, "qualudes")
7. Stimulants (cocaine, methamphetamine)
8. Tobacco

*Substance use disorder does not apply to caffeine

What is mental illness?

Mental illness

Mood
(affective Anxiety Psychotic Substance use Eating
disorders) disorders disorders disorders disorders
Eating disorders
 Comparison chart anorexia – bulimia – binge eating disorder
Anorexia Nervosa
About Eating disorder wherein
sufferers fear weight gain and
avoid eating and exercise
heavily as a result.
Onset Early teen years
Behavioral and Obsession with food, weight,
psychological and a "thin" body image;
symptoms extreme fear of weight gain;
compulsive exercise;
depression and anxiety; low
self-esteem; body dysmorphic
disorder.
Bulimia Nervosa Binge Eating Disorder
Eating disorder wherein sufferers go Eating disorder wherein sufferers
through a cycle of binging (overeating) binge without compensating.
followed by purging / laxatives / heavy
exercising due to a fear of weight gain.
Late teen years Late teen years; early twenties.
Obsession with food, weight, and a Depression and anxiety; low self-
"thin" body image; extreme fear of esteem.
weight gain; compulsive
exercise; depression and anxiety; low
self-esteem; body dysmorphic disorder.
Anorexia Nervosa Bulimia Nervosa Binge Eating Disorder
Children

Mental illness

Autism

67
What is autism?

68
 Elderly

Mental illness

Major neurocognitive
disorder

74
In conclusion

• All mental health problems and mental disorders are risk factors for either physical inactivity or hyperactivity.

• Most mental health problems and mental disorders are risk factors for a sedentary lifestyle.

• Screening for physical activity and sedentary levels in people with mental health problems and mental disorders
is important.