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  • European Psychiatrists Recommend Physical Activity in the Treatment of Severe Mental Illness

    Could the effect of physical activity (PA) on the brain extend beyond a general sense of well-being? The European Psychiatric Association (EPA) thinks so and has issued guidance that recommends supervised PA as potentially effective treatment for individuals with severe mental illnesses (SMIs) such as schizophrenia and major depression. The recommendations are supported by the International Organization of Physical Therapists in Mental Health.

    The recommendations, appearing in European Psychiatry (abstract only available for free), are based on a review of 20 meta-analyses and systematic reviews gathered through January 2018. Researchers began with a pool of more than 2,000 studies but narrowed their review to studies of randomized controlled trials that specifically addressed exercise interventions for individuals with schizophrenia, major depressive disorder (MDD), and bipolar disorder (BP).

    Authors of the recently released guidelines were interested in the role of PA among the population of individuals with SMI not only in relation to its ability to lessen symptoms, but also as an intervention that could extend lifespans in that population. According to the researchers, individuals with SMI face an increased risk of early mortality by as much as 10 to 20 years, with physical disorders accounting for as much as 70% of those early deaths.

    The type of PA analyzed was focused on aerobic exercise, high-intensity exercise, resistance exercise, and mixes of aerobic and high-intensity exercise. Researchers excluded mind-body PA such as yoga and tai-chi, "since these activities are presumed to exert beneficial effects on mental health through additional factors distinct from the [PA] itself."

    In the end, authors found good evidence to support PA as a treatment for both schizophrenia and MDD, particularly when supervised by an exercise professional such as a physical therapist. For MDD, authors recommend 45- to 60-minute sessions of supervised aerobic training or aerobic and resistance training at moderate intensity 2-3 times per week. Research on optimal PA frequency, duration, and intensity for individuals with schizophrenia was harder to find, but authors make a general recommendation for 150 minutes per week of aerobic exercise to improve symptoms, cognition, and quality of life. Authors were unable to find sufficient research to reach a conclusion on the effects of PA among individuals with BP.

    Additionally, the researchers issued a recommendation, based on "some evidence," that PA should be used to improve the physical health of individuals with SMI—a recommendation that was limited by what authors describe as the "paucity of studies that have targeted this important topic." The set of guidelines also includes a recommendation, "based on expert opinion," that individuals with SMI should be routinely screened for PA habits in both primary and secondary care.

    Authors also include a set of 6 recommendations to address what they believe are the current gaps in research around PA and SMI. Recommended areas for research are investigation into the effects of PA in the early stages of SMI, the development of "pragmatic, scalable methods" for PA in the SMI population, establishment of optimal dose-response relationship between PA and SMI, exploration of interventions to reduce sedentary behaviors, identification of the underlying neurobiological mechanisms at work, and an analysis of the long-term cost-effectiveness of PA as a treatment for SMI.

    Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.