Exercise Prescription for Persons with Chronic Disease and Disability – Theory

Bewegen bij Bijzondere Groepen

Mental health part: class 2

Prof. Dr. D. Vancampfort

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What is mental illness?

Mental illness

Mood
(affective Anxiety Psychotic Substance use Eating
disorders) disorders disorders disorders disorders
What is mental illness?

Mental illness

Mood
(affective Anxiety Psychotic Substance use Eating
disorders) disorders disorders disorders disorders
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Specific aims were:

1. To establish the updated effects of exercise on depression comparing exercise versus non-active control
groups.

2. To identify moderators including sample characteristics and exercise intervention variables (FITT,
supervision or not) that could impact the effects of exercise on depression.

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1. Exercise demonstrates a large anti-depressant effect.

2. Exercise is also efficacious in major depressive disorder.

3. Exercise should be a first-line treatment in people with mild to moderate levels of depression, while in people
with high levels of depression, medication might be needed in order to provide the conditions for early non-
pharmacological (i.e. lifestyle) interventions.

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 Discussion

1. Exercise should be at least of moderate intensity. However, for motivational reasons starting with light intensity
and progressing towards moderate intensity is ok.

2. There should be at least an aerobic component in the exercise program. However, an RCT exploring strength
training alone is currently missing.

3. Both individual and group exercise are beneficial: offer choices.

4. Supervised exercise is better than unsupervised exercise.

5. Supervision by an exercise expert is better than by a non-exercise expert.

6. Somatic co-morbidities should be considered.

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 Discussion

• Physical activity had a protective effect against the emergence of depression in:

• youth (adjusted odds ratio=0.90, 95% CI=0.83, 0.98).

• adults (adjusted odds ratio=0.78, 95% CI=0.70, 0.87).
• persons at older age (adjusted odds ratio=0.79, 95%CI=0.72, 0.86).

• Evidence supports the notion that physical activity can confer important protection against the emergence of
depression regardless of geographical region.

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• 33,000 people with no mental health conditions were
followed up for ~11 years.

• Those who reported no exercise at baseline had 44%

higher odds of developing depression compared with
those who were exercising 1-2 hours a week.

• 12% of depression cases could be prevented with at

least 1 hour exercise per week.

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What is mental illness?

Mental illness

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

• The current review provides evidence to suggest that traditional treatment for trauma (typically involving a
combination of trauma-focused cognitive behavioural therapy and pharmacological treatments) may benefit from
the inclusion of physical activity interventions as adjunctive treatments.

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What is mental illness?

Mental illness

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

• 90 mins/week of moderate-vigorous exercise (30 min and this 3x /week for 12 weeks) = improvements in
symptomatology.

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 Exercise significantly improves global cognition g = 0.33

For example:
• Working memory (g = 0.39, i.e. a small effect)
• Attention (g = 0.66, i.e. a moderate effect)

Factors associated with intervention efficacy:

• Exercise dose (mins/week): 30 min * 3 week

• Qualification of supervisor (e.g. physiotherapist)

Firth et al 2016 Schizoprenia Bulletin

What is mental illness?

Mental illness

Mood
(affective Anxiety Psychotic Substance use Eating
disorders) disorders disorders disorders disorders
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• The aim of this meta-analysis was to verify the treatment effects of exercise on various SUD by analyzing RCTs.

• Abstinence rates, withdrawal symptoms, anxiety and depression levels were the primary outcomes.

• The authors aimed to perform sub-analyses of exercise intensities and exercise types to provide details of
potential optimal exercise prescriptions for specific drug addictions.

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Abstincence rate

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 Discussion

• Exercise, irrespective of type and intensity increases abstinence and reduces withdrawal in people with SUD.

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What is mental illness?

Mental illness

Mood
(affective Anxiety Psychotic Substance use Eating
disorders) disorders disorders disorders disorders
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But what if your patient struggles with excessive hyperactivity and what if he / she is
excessively concerned about any weight gain and changes in body shape?

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Would you allow your patient to exercise?

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 No?

• They exercise excessively (e.g. up to 9000 sit ups per day),

not to experience any pleasure or health benefits. It is a
compulsive behavior due to an excessive obsession to avoid
weight gain.

• Excessive exercising has important health risks.

Sculpture made by one of our anorexia patients during the creative therapy.

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 Yes? At least if supervised!

The advantages of supervised physical activity:

1. The physical activity intensity and the heart rate are controlled
and patients can be asked to exercise first at light and
afterwards at moderate intensity.
2. The likelihood patients engage in hidden or ‘secret’ physical
activities decreases,
3. The drive to exercise might reduce and may redirect the
patients’ hyperactivity in a healthy way, reducing their fears of
weight gain and improving their sense of self control.
4. Compliance to treatment is enhanced.
5. It positively influences their physical and psychological well-
being while regaining or maintaining a good physical condition,
6. It stimulates social contacts
7. No negative side-effects if supervised.

Painting made by one of our anorexia patients during the creative therapy.

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Recommendations for clinical practice

• BMI <12: limited very light intensity aerobic training only after medical clearance (e.g. walking, cycling on a
cycle ergometer)

• BMI <14: light intensity aerobic training and promotion of household chores

• BMI = 14 - 16: light intensity aerobic training and strength training supervised by a specialized professional
(e.g., physiotherapist or exercise physiologist)

• BMI = 16 - 18: Strength and aerobic training at moderate intensity

• BMI > 18: no restrictions

 Children

Mental illness

Autism Spectrum
Disorders

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 Elderly

Mental illness

Major neurocognitive
disorder

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In conclusion

• Physical activity has trans-diagnostically important benefits in people with mental health disorders.

• It should be first-line treatment in adults iwth mild to moderate depression.

• It is an important complementary treatment in adults with major depression, anxiety and stress-related
disorders, psychotic disorders, substance use disorders and eating disorders.

• It is an important complementary treatment in children with autism.

• It is an important complementary treatment in older adults with major neurocognitive disorders.