Obligatory Aerobics For The Depressed

30. October 2017
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The doctor advises doing sport – the patient nods, but not much ends up happening. For people with mental illness, regular sport can have as much impact as medications. Getting back up on their feet, however, is very difficult for them, because of their illness. Time for sports as prescription?

Regular exercise has proven to be as efficient as drug therapy for patients with depression; this was the result of a comprehensive meta-analysis which was published three years ago. Although sport is more cost-effective when compared to medicines and does not have any side effects, its healing potential is not made use of in many cases.

Training in the clinic, still-stand at home

It is often difficult for those affected by mental illness to exercise regularly and to move around more in general. This aspect still comes into physicians’ considerations too rarely in their therapeutic recommendations. During normal treatment, regular exercise is part of the treatment concept. Yet as soon as the patients are discharged, regular training programs and the stimulation and motivation for regular physical exercise fall by the wayside.

More sport – really, this time

An actual meta-analysis by Davy Vancampfort and his team at the University of Leuven in Belgium has now investigated sedentary habituation and physical activity in patients with severe mental illness (recurrent depression, to be precise) bipolar disorder and schizophrenia. 69 studies involving a total of 35,682 participants were included in the evaluation. 39.5 percent of them were male and all participants were on average 43 years of age. On average the participants spent 476 minutes, or nearly 8 hours of their awake time, in a sedentary state and only 38 minutes per day doing moderate to strong physical activity. They were therefore significantly more sedentary and significantly less physically active than healthy controls comparable by age and gender. Approximately half of the patients did not reach the WHO recommendation of 150 minutes of moderate to strong physical activity per week.

Lower physical activity was linked to prolonged periods of illness, taking antidepressants or antipsychotic medication, being overweight, a lower level of education, unemployment, being male, and being single. “The results could help in developing tailor-made interventions to improve the physical health of these patients in the long term”, Vancampfort and his team say. “It is important to develop evidence-based measures in the future in order to increase physical activity in patients with severe mental illness and to reduce their sedentary behaviour. This should be a priority in the public health sector worldwide”.

Stress and lack of support demotivate

Patients with severe mental illness experience a number of hurdles that prevent them from being physically active on a regular basis. Another current investigation by Joseph Firth and his team at the University of Manchester and the University of Leuven has dealt with the motivating factors and hurdles for physical activity in this patient group. In a meta-analysis involving 12 studies taking in a total of 6431 patients, the researchers found that the affected persons gave as the main reasons for more physical activity the desire to improve their health, decrease weight, improve mood and to eliminate stress. Negative moods, subjectively high stress load, and a lack of social support were most frequently cited as hurdles for regular physical activity.

“Those aspects which can be improved by sports – achieving a reduction in stress, improvement in mood and having more energy – are ironically the same ones which hinder the patient from realising their intentions – namely, a depressive mood, stress and lack of energy”, the authors write. “Therefore, it is important that patients receive professional support to overcome these psychological hurdles and to maintain the motivation for regular physical activity in the long term”.

“No patient should leave the clinic without recommendation to more exercise”

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Valentin Markser of the Institute for Sports Psychiatry in Cologne is committed to making people with mental illness become more active. © Valentin Markser

Yet this is precisely the problem, says Valentin Markser from the Institute for Sports Psychiatry in Cologne (Germany): until now, things have not been structured in Germany to ensure that patients with mental illness regularly participate in training after discharge from hospital treatment, or are at least motivated to be regularly physically active themselves. “It would be very important to develop and establish suitable training programs for those affected and at the same time to ensure that they are also covered by the health insurance companies”, the sports psychiatrist emphasises.

In his view, medical practitioners who care for patients with psychiatric disorders are still not sufficiently aware of the importance of regular exercise for their patients’ mental and physical health. “Regardless whether it is the family doctor, a psychiatrist, a psychotherapist or a neurologist, no patient should leave the clinic without the recommendation for sports and exercise therapy”, Markser says. “In doing so, doctors should be aware that such a measure is cost-effective, has no side effects and is accessible to almost everyone”.

Ideally, training programs should be developed by experts and designed to have significant physiological effects – such as improving cardiorespiratory fitness, Firth and his colleagues write. The training should not be aimed at performance, but above all else should aim to increase well-being, according to Markser, and should preferably be done in small units, for example three to four times a week for 30 minutes.

Specialists’ target: sport by prescription

“Such programs should first of all provide information on the health benefits that patients get from regular physical activity”, Markser explains. “Furthermore, the programs should help those affected to choose a sport with which they feel comfortable. During the training period, patients should provide us with regular feedback on how the program is going, so that efforts are made to keep them motivated. “It is also important that the fitness programs have a rewarding effect. Studies have shown that people with severe mental illness experience training programs as positive predominantly when these programs improve self-esteem and their physical image. “In addition, it is often beneficial for patients to have more contact with other people and perceive for themselves that they are active and able to improve their health through their own efforts”, Markser says.

In addition, it is also important to motivate those affected to take measures to reduce sedentary behaviour in everyday life, according to Vancampfort and his team. “The first simple measures could be to encourage those affected to stand up and walk around during television breaks when watching television, or to walk short distances instead of driving”. Furthermore, factors that hinder regular physical activity should be looked at more seriously, according to the Dutch scientists. These might include side effects, such as fatigue, due to taking medications.

A working group of the German Society for Psychiatry and Psychotherapy, Psychosomatics and Neurology Treatment (DGPPN) is currently already working toward having patients with mental illness receive “sport” as prescription – as is already possible with chronic physical disorders such as cardiovascular disease. “The costs we hope will increasingly and more often be covered by the health insurance companies”, according to Markser.

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Image copyright: ePi.Longo, flickr / Licence: CC BY-SA
General medicine, Research

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2 comments:

Bmed science Hons OMPRAKASH CHADY
Bmed science Hons OMPRAKASH CHADY

HI Christine

Very interesting articles that a great tools to motivate patient suffering from depression and other psychiatric illness. Please send me more details on the Institute of sport Psychiatry

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Employee of DocCheck

Hi there, thank you very much for your feedback! Here you can find a link to the website of the Institute of Sports Psychiatry: https://www.institut-sportpsychiatrie.de/english/ Best wishes, your DocCheck Team

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