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People with severe mental illness (SMI), including schizophrenia and related psychoses and bipolar disorder, are at greater risk for obesity compared with people without mental illness. An altered resting metabolic rate (RMR) may be a key driving factor; however, published studies have not been systematically reviewed. This systematic review and meta-analysis aimed to determine whether the RMR of people with SMI assessed by indirect calorimetry differs from (i) controls, (ii) predictive equations and (iii) after administration of antipsychotic medications. Five databases were searched from database inception to March 2022. Thirteen studies providing nineteen relevant datasets were included. Study quality was mixed (62 % considered low quality). In the primary analysis, RMR in people with SMI did not differ from matched controls (n 2, standardised mean difference (SMD) = 0·58, 95 % CI −1·01, 2·16, P = 0·48, I2 = 92 %). Most predictive equations overestimated RMR. The Mifflin–St. Jeor equation appeared to be most accurate (n 5, SMD = −0·29, 95 % CI −0·73, 0·14, P = 0·19, I2 = 85 %). There were no significant changes in RMR after antipsychotic administration (n 4, SMD = 0·17, 95 % CI −0·21, 0·55, P = 0·38, I2 = 0 %). There is little evidence to suggest there is a difference in RMR between people with SMI and people without when matched for age, sex, BMI and body mass, or that commencement of antipsychotic medication alters RMR.

ISSUES ADDRESSED: People with severe mental illness have adverse health outcomes compared to the general population. Lifestyle interventions are effective in improving health outcomes in this population. Current cultural processes in mental health services do not generally incorporate physical health care practices. Innovative education is required to improve knowledge and confidence of staff in the delivery of preventative health measures. METHODS: The Keeping our Staff in Mind (KoSiM) program delivered a brief lifestyle intervention to mental health staff. A qualitative analysis following the Standards for Reporting Qualitative Research was undertaken. Semi-structured interviews designed to elicit information about the acceptability of the program and the impact of the intervention on participants' personal and professional lives. The interviews were analysed using thematic analysis, with coding independently developed and reviewed by three authors. RESULTS: Of the 103 eligible participants, 75 were interviewed. Responses revealed four main themes: (i) positive changes in clinician's approach to physical health care, (ii) improvements in attitudes to self-care and family wellbeing, (iii) positive changes in workplace culture associated with physical health care delivery and (iv) high levels of acceptability of the program. CONCLUSION: The KoSiM model may be useful in other settings as a means of changing the culture of mental health services to better integrate physical health care as a core part of mental health service provision. SO WHAT?: A novel approach using staff focussed lifestyle interventions model may cut through the resistance that is encountered when implementing proven methods of clinical intervention where cultural barriers exist.

Background/Aims As mental health services focus on recovery orientated service delivery, there is a need to adopt recovery orientated approaches in interventions that promote physical activity. This article presents a process of using and modifying an experience-based co-design approach to develop an intervention that can be used to promote physical activity in mental health services: the ‘Move with Recovery’ programme. Methods A facilitated experience-based co-design approach was undertaken over four sessions. This approach included the use of a trigger film of touchpoints and sample physical activity experiences of service users, in addition to the use of a storyboard for emotional mapping and prioritising exercises. The final two co-design sessions involved programme prototyping and development using the TIDieR framework. Results The outcome of this process, the Move with Recovery programme, was a peer-developed and peer-led, community-focused programme structured around nine action points. It is made up of a combination of motivation, education and support sessions, together with light intensity aerobic activity sessions that is structured using the TIDieR framework, and intended for implementation in the recovery college. In this regard, the developed programme is inherently recovery orientated in its design and its aim. Conclusions The developed programme can be embedded into existing mental health services that lack integrated exercise resources. This articles details the experience-based co-design process undertaken here and offers future learning for using experience-based co-design to promote physical activity in mental health.

ObjectiveTo estimate the efficacy of exercise on depressive symptoms compared with non-active control groups and to determine the moderating effects of exercise on depression and the presence of publication bias.DesignSystematic review and meta-analysis with meta-regression.Data sourcesThe Cochrane Central Register of Controlled Trials, PubMed, MEDLINE, Embase, SPORTDiscus, PsycINFO, Scopus and Web of Science were searched without language restrictions from inception to 13 September2022 (PROSPERO registration no CRD42020210651).Eligibility criteria for selecting studiesRandomised controlled trials including participants aged 18 years or older with a diagnosis of major depressive disorder or those with depressive symptoms determined by validated screening measures scoring above the threshold value, investigating the effects of an exercise intervention (aerobic and/or resistance exercise) compared with a non-exercising control group.ResultsForty-one studies, comprising 2264 participants post intervention were included in the meta-analysis demonstrating large effects (standardised mean difference (SMD)=−0.946, 95% CI −1.18 to −0.71) favouring exercise interventions which corresponds to the number needed to treat (NNT)=2 (95% CI 1.68 to 2.59). Large effects were found in studies with individuals with major depressive disorder (SMD=−0.998, 95% CI −1.39 to −0.61, k=20), supervised exercise interventions (SMD=−1.026, 95% CI −1.28 to −0.77, k=40) and moderate effects when analyses were restricted to low risk of bias studies (SMD=−0.666, 95% CI −0.99 to −0.34, k=12, NNT=2.8 (95% CI 1.94 to 5.22)).ConclusionExercise is efficacious in treating depression and depressive symptoms and should be offered as an evidence-based treatment option focusing on supervised and group exercise with moderate intensity and aerobic exercise regimes. The small sample sizes of many trials and high heterogeneity in methods should be considered when interpreting the results.

Purpose Lack of knowledge about and confidence in physical activity (PA) prescription for people with mental illness are important barriers for clinical practice in low-income countries. The aim of this study was to evaluate whether a 10-hour workshop improved the knowledge and confidence in PA prescription among health care professionals in 13 regional referral hospitals across Uganda. Material and methods 260 health care professionals (age = 40.4 ± 10.8 years; 48% women; 63.8% nurses, 10% social workers, 8.1% psychologists, 7.3% medical doctors, 5.8% psychiatrists, 5% physical or occupational therapists) completed the Exercise in Mental Illness Questionnaire - Health Professionals Version (EMIQ-HP) pre- and post-workshop. Results The EMIQ-HP PA knowledge score (3.1 ± 0.7 versus 1.3 ± 1.3, p Conclusions Training in PA counselling improved the knowledge and confidence in PA prescription in Ugandan health care professionals. Future research should investigate whether PA uptake in people with mental illness can be improved via additional training of health care professionals.IMPLICATIONS FOR REHABILITATIONThe majority of mental health professionals never recommend physical activity to their patients in low-resourced settings and increased awareness is needed to improve rehabilitation programs.Training in prescribing physical activity using the 5A framework improves knowledge about physical activity prescription in mental health professionals at all levels of care.Training in prescribing physical activity using motivational interviewing improves confidence in physical activity prescription in rehabilitation programs.Training in prescribing physical activity reduces perceived barriers for prescribing in rehabilitation programs in low-resourced settings.

Purpose This paper aims to examine student exercise physiologists (EPs) and student dietitians’ confidence regarding working with people with severe mental illness (SMI) pre- and post-practicum in a mental health service. Design/methodology/approach This single-arm, quality improvement project included students completing practicum within a lifestyle programme embedded in mental health services. Student EPs completed 100 h of practicum across 15 weeks as part requirement for their Bachelor of Exercise Physiology degree and student dietitians completed six weeks full-time (40 h/week) for the part requirement of their Master of Nutrition and Dietetics. Students completed the Dietetic Confidence Scale (terminology was adapted for student EPs) pre- and post-practicum. Findings In total, 27 student EPs and 13 student dietitians completed placement and returned pre- and post-practicum questionnaires. Pre-practicum confidence scores were 90.8 ± 17.1 and 86.9 ± 18.9 out of a possible 140 points for student EPs and student dietitians, respectively. Confidence scores increased substantially post-practicum for both student EPs [mean difference (MD) = 29.3 ± 18.8, p < 0.001, d = 1.56] and dietitian students (MD = 26.1 ± 15.9, p = 0.002, d = 1.64). There were significant improvements in confidence across all domains of the confidence questionnaire for both EPs and dietitian students. Originality/value There is a research gap in understanding the confidence levels of student EPs’ and student dietitians’ when working with people with mental illness and the impact that undertaking a practicum in a mental health setting may play. To the best of the authors’ knowledge, this is the first study to explore student EP and student dietitian confidence in working with people with SMI pre- and post-practicum in a mental health setting.

Objective: To describe and compare the health profiles and health service use of people hospitalised with severe mental illness, with and without psychotic symptoms. Methods: We conducted a historical cohort study using linked administrative datasets, including data on public hospital admissions, emergency department presentations and ambulatory mental health service contacts in New South Wales, Australia. The study cohort comprised 169,306 individuals aged 12 years and over who were hospitalised at least once with a mental health diagnosis between 1 July 2002 and 31 December 2014. Of these, 63,110 had a recorded psychotic illness and 106,196 did not. Outcome measures were rates of hospital, emergency department and mental health ambulatory service utilisation, analysed using Poisson regression. Results: People with psychotic illnesses had higher rates of hospital admission (adjusted incidence rate ratio (IRR) 1.26; 95% confidence interval [1.23, 1.30]), emergency department presentation (adjusted IRR 1.17; 95% confidence interval [1.13, 1.20]) and ambulatory mental health treatment days (adjusted IRR 2.90; 95% confidence interval [2.82, 2.98]) than people without psychotic illnesses. The higher rate of hospitalisation among people with psychotic illnesses was driven by mental health admissions; while people with psychosis had over twice the rate of mental health admissions, people with other severe mental illnesses without psychosis (e.g. mood/affective, anxiety and personality disorders) had higher rates of physical health admissions, including for circulatory, musculoskeletal, genitourinary and respiratory disorders. Factors that predicted greater health service utilisation included psychosis, intellectual disability, greater medical comorbidity and previous hospitalisation. Conclusion: Findings from this study support the need for (a) the development of processes to support the physical health of people with severe mental illness, including those without psychosis; (b) a focus in mental health policy and service provision on people with complex support needs, and (c) improved implementation and testing of integrated models of care to improve health outcomes for all people experiencing severe mental illness.

Objective: Little research has examined the physical and mental comorbidities, and health service use patterns, of people diagnosed with psychotic disorder subtypes other than schizophrenia spectrum disorders. This study aims to examine the physical and mental comorbidities, and subsequent hospital service use patterns, of individuals previously hospitalised with various psychotic disorder subtypes using linked health service data. Methods: We included individuals hospitalised with a psychotic disorder in New South Wales, Australia, between 1 July 2002 and 31 December 2014 (N = 63,110). We examined the demographic profile of the cohort and rates of subsequent acute hospital care and ambulatory mental health service use. We compared the rates of subsequent hospital admissions, emergency department presentations and ambulatory mental health treatment days of people hospitalised with different psychotic disorder subtypes to people hospitalised with schizophrenia spectrum disorders using Poisson regression. Results: People most recently hospitalised with mood/affective disorders and psychotic symptoms had a higher rate of subsequent hospital admissions than those most recently hospitalised with schizophrenia spectrum and delusional disorders (adjusted incident rate ratio = 1.06; 95% confidence interval = [1.02, 1.10]), while people most recently hospitalised with drug-induced and other organic (adjusted incident rate ratio = 1.19; 95% confidence interval = [1.12, 1.27]) and acute psychotic disorders (adjusted incident rate ratio = 1.10; 95% confidence interval = [1.03, 1.18]) had more subsequent emergency department presentations than those most recently hospitalised with schizophrenia spectrum and delusional disorders. All three groups had fewer subsequent mental health ambulatory days than those most recently hospitalised with schizophrenia spectrum and delusional disorders (adjusted incident rate ratios = 0.85–0.91). Conclusion: The health profiles and subsequent hospital service use patterns of people previously hospitalised with different psychotic disorder subtypes are heterogeneous, and research is needed to develop targeted health policies to meet their specific health needs.

This study explored the efficacy of a lay health worker (LHW)-led physical activity (PA) counselling program for inactive patients with HIV/AIDS and mental health problems living in a Ugandan farmi...

BackgroundThe COVID-19 pandemic imposed major changes on daily-life routine worldwide. To the best of our knowledge, no study quantified the changes on moderate to vigorous physical activity (MVPA) and sedentary behaviors (SB) and its correlates in Brazilians. This study aimed to (i) evaluate the changes (pre versus during pandemic) in time spent in MVPA and SB in self-isolating Brazilians during the COVID-19 pandemic, and (ii) to explore correlates.MethodsA cross-sectional, retrospective, self-report online web survey, evaluating the time spent in MVPA and SB pre and during the COVID-19 pandemic in self-isolating people in Brazil. Sociodemographic, behavioral, and clinical measures, and time in self-isolation were also obtained. Changes in MVPA and SB and their correlates were explored using generalized estimating equations (GEE). Models were adjusted for covariates.ResultsA total of 877 participants (72.7% women, 53.7% young adults [18-34 years]) were included. Overall, participants reported a 59.7% reduction (95% CI 35.6-82.2) in time spent on MVPA during the pandemic, equivalent to 64.28 (95% CI 36.06-83.33) minutes per day. Time spent in SB increased 42.0% (95% CI 31.7-52.5), corresponding to an increase of 152.3 (95% CI 111.9-192.7) minutes per day. Greater reductions in MVPA and increases in SB were seen in younger adults, those not married, those employed, and those with a self-reported previous diagnosis of a mental disorder.ConclusionsPeople in self-isolation significantly reduced MVPA levels and increased SB. Public health strategies are needed to mitigate the impact of self-isolation on MVPA and SB.Supplementary informationThe online version contains supplementary material available at 10.1007/s11332-021-00788-x.

ISSUES ADDRESSED 1) Describe the dietary intake of mental health staff within South Eastern Sydney Local Health District and 2) Evaluate the impact of an individualised staff lifestyle program on the following nutrition parameters; (i) energy, (ii) core food groups and (iii) discretionary foods. METHODS This was a pragmatic single-arm intervention study, conducted for all staff working in a public mental health service, in Sydney, Australia. A five-session individualised lifestyle intervention delivered over 5 weeks incorporated nutritional counselling delivered by a dietitian. Participants were assessed at baseline, following the intervention, and at follow-up using diet history to assess dietary intake. RESULTS Eighty-eight staff completed the dietary intervention and follow-up. An intake of core food groups significantly below national recommendations was reported for total vegetables (-1.75 ± 0.14 serves, P

PurposePhysical activity is increasingly recognised as critical to improving physical and mental health (MH). Understanding the education and training requirements of exercise professionals will support better integration of these emerging MH professionals within the multidisciplinary MH team. The purpose of this study was to determine the exposure to, knowledge and attitudes of final year exercise physiology students towards people with mental illness (MI).Design/methodology/approachStudent exposure to and knowledge and attitudes of people living with MH were assessed via a 24-item online questionnaire.FindingsIn total,n= 63 out of 78 eligible students participated (81%). Of the participants, 81% (n= 51) showed a favourable attitude towards people with MI and 68% (n= 43) of participants had good knowledge of topics relating to MI. Significant correlations existed between the total score for attitude and any exposure to MH issues and having undertaken placement as part of university training and knowledge and total scores. Further training and education are needed to better equip exercise physiology graduates to work with people with MI.Originality/valueThis is the first study to examine the attitudes and knowledge of exercise physiology students towards people living with MI and their association with exposure to MI. Given the growing number of exercise professionals being integrated into multidisciplinary MH teams, this study may help to direct the delivery of associated training and education services.

People living with a severe mental illness experience a life expectancy gap compared to the rest of the population that is largely driven by preventable cardiovascular diseases stemming from lifestyle factors, and the side effects of psychotropic medications. Mental health nurses are well positioned to help address the gap using lifestyle interventions. However, many nurses don't prioritise delivering such care, or lack the skills and confidence to implement these strategies. This study used a mixed method approach to determine the effectiveness of 2-day metabolic workshops that aimed to provide nurses with the skills to provide lifestyle interventions. The quantitative component compares pre and post measures of attitudes, confidence, knowledge and perceived barriers of providing metabolic care using a validated tool (M-BACK) and the qualitative component to elicit more details of the needs, expectations and plans of participants. Fifty-six nurse participants demonstrated statistically significant improvements in M-BACK post scores (p 0.001), with 53 of the 56 participants (95%) achieving improved M-BACK scores. Participants identified three primary barriers to delivering metabolic care, related to individual staff members, consumers, and system issues. Prior to the course participants stated they hoped to improve their knowledge, enhance their practical skills and provide education for others. Following completion of the course participants planned to implement lifestyle education and interventions for consumers, provide education and support to other staff and integrate metabolic health care into clinical reviews and planning. This study demonstrates that education on metabolic health care can be effective in improving the attitudes, confidence, and knowledge of mental health nursing in providing metabolic health care and a decrease in the perceived barriers to delivering that care.

Objective: The aim of this paper was to cross-sectionally examine the association between physical health indicators and PTSD symptomatology. Method: A cross-sectional study was conducted among inpatients of a service related trauma-focused ward. Physical and mental health indicators including sleep quality, fitness, physical activity, body mass index and PTSD symptomatology were assessed. Results: Among 60 inpatients, significant associations were found between sedentary time ( r = 0.42; p < .001) and sleep quality ( r = 0.40; p < .001) with PTSD symptomatology. The vast majority of inpatients ( n = 56; 93%) were found to be either overweight or obese according to body mass index. Conclusion: Inpatients of a PTSD treatment facility had extremely high rates of obesity, physical inactivity, poor cardiorespiratory fitness and poor sleep quality. Sedentary behaviour is a modifiable risk factor associated with symptoms and physical health.

ISSUE ADDRESSED People living with mental illness die on average 15 years earlier than the general population, primarily due to preventable and premature cardiovascular disease. Lifestyle interventions can be effective in reducing cardiovascular risk, yet mental health services do not routinely provide targeted lifestyle interventions. Exposing mental health staff to lifestyle interventions prior to targeting patients may be critical to changing culture and improving patient outcomes. This study aimed to improve the physical health of mental health staff through a targeted lifestyle intervention. METHODS A pragmatic single-arm intervention study was conducted in a public mental health service, including inpatient and community settings, in Sydney, Australia. Participants in this study were n = 212 clinical and non-clinical staff. A five-session individualised lifestyle intervention (delivered over 5 weeks) incorporating physical activity and nutritional counselling was delivered by multidisciplinary teams. Participants were assessed at baseline, following the intervention, and at follow-up (mean = 16.7 weeks). The primary outcome was the barriers, attitudes, knowledge and confidence regarding screening, promoting and intervening to improve physical health outcomes of patients (M-BACK questionnaire). Secondary outcomes included anthropometric measures, cardiorespiratory fitness, sedentary time and nutritional intake. Repeated measures ANCOVAs were performed. RESULTS A total of 212 staff (79% female) participated in this study. M-BACK total score significantly increased from baseline to follow-up (P

The life expectancy gap experienced by people living with severe mental illness is primarily a result of cardiometabolic disease that is often exacerbated by side effects of antipsychotic medication. Commencement of atypical antipsychotic medication is commonly associated with weight gain. The Keeping the Body in Mind programme has demonstrated that early intervention with lifestyle activities can attenuate this weight gain and potentially improve long-term health outcomes. The aim of this study was to explore the experiences of young people who participated in the Keeping the Body in Mind programme, a targeted lifestyle intervention programme. A qualitative approach was used employing a semi-structured interview format. The interview schedule included questions related to four topics: aspects of the programmes that were useful, attributes of staff members that influenced the programme, changes in attitudes towards their own physical health, and suggestions for programme improvements. Interviews were recorded with duration ranging from 40 to 65 min. Thematic analysis was used to detect and assemble codes. These were then synthesized and classified into themes. Eleven participants were interviewed (seven males), aged between 18 and 25 years. Thematic analysis revealed four main themes: the role of physical health in mental health recovery; the importance of staff interactions; the value of peer interaction; and graduation to a sustainable healthy lifestyle. Study participants reported that they valued the programme for both their physical health and mental health recovery.

Objective: The number of people suffering from depression and/or anxiety has increased steadily due to the coronavirus disease 2019 (COVID-19) pandemic. In this context, web-based exercise interventions have emerged as a potential treatment strategy. The objective of this study was to synthetize evidence from randomized controlled trials regarding the effects of web-based exercise interventions on patients with depressive and/or anxiety disorders. Methods: Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Six databases were searched (Cochrane Library, EBSCO, PubMed, SciELO, Scopus, and Web of Science), and eligible articles were identified according to a PICOS inclusion-exclusion approach (participants with depressive or anxiety disorders; web-based exercise interventions; active or passive control group; assessment of changes in depressive or anxiety disorders; randomized design). Primary outcomes were depressive and/or anxiety symptoms. The quality of evidence was assessed with Grading of Recommendations Assessment, Development, and Evaluation. Results: Of 7,846 search results, three studies met the inclusion criteria (172 participants between 18 and 65 years of age, 95.9% women). The web-based exercise interventions lasted 8-12 weeks and involved endurance training, yoga, or combined endurance and strength training. The comparators involved non-exercise controls or active controls. Compliance rates were low. Web-based exercise interventions were not superior to controls regarding anxiety symptoms, and only one study found benefits for depressive symptoms (p ≤ 0.05). The quality of the cumulative evidence was low. Conclusion: The available data regarding the effects of web-based exercise interventions on depression and/or anxiety symptoms is scarce, the risk of bias is high, and the quality of the cumulative results is low. Currently, no clear recommendations can be provided. Registration number: PROSPERO CRD42021225938.

Increasing prevalence rates of mental health problems among adolescents is an issue of growing concern. Surf therapy is a novel intervention that may provide tangible benefits to address this problem. Congruent with the ecological dynamics perspective (EDP), the existing research postulates that surf therapy yields psychological benefits in part due to the unique affordances of immersion in a blue space such as the ocean. Evidence worldwide has validated the use of surfing as a therapeutic mediator to achieve positive change, however, no such research has been conducted on Australian adolescents. The current study aimed to evaluate the impact of the Waves of Wellness (WOW) Foundation's 8 week surf therapy program on mental health outcomes in Australian at-risk youth. The study employed a mixed-methods design to examine the experiences of participants. Nine adolescents (Mage= 14.9;SD= 1.2; 8 female) participated in the quantitative stage, with four completing the qualitative interview. Results indicated positive changes in resilience, self-esteem, social connectedness, and depressive symptoms post-intervention, however, improvements were not maintained at follow-up. Participants unanimously agreed that the program normalised their experiences with mental health through the unique leaning environment and fostered personal growth through mastery experiences and the development of healthy relationships. The EDP provided the most compelling explanation of the results denoting that benefits arise from the reciprocal relationship between individual, task, and environment. Despite the small and heterogenous sample, the findings provided preliminary evidence of the efficacy of surf therapy among Australian youth and offer a potential starting point for further research utilising larger more diverse samples.

Older Australians with intellectual disabilities experience high rates of lifestyle-related illness, yet generally have poor diets and participate in limited physical activity. Eliciting the perspe...

Despite widespread recognition of the usefulness of a biopsychosocial approach in social work, there are limited studies exploring how social workers can use this approach to support the health and...

People living with mental illness often experience poor sleep quality compared to the general population. Poor sleep quality exacerbates symptoms of mental illness and contributes to increased physical comorbidities. Exercise has been shown to be an effective non-pharmacological treatment for managing poor sleep in the general population. Little is known regarding the efficacy of targeted exercise interventions for improving sleep quality amongst individuals with a mental illness. We conducted a systematic review and meta-analysis of randomised controlled trials (RCTs) examining the impact of exercise on sleep quality in people with mental illness. Major electronic databases were searched from inception until June 2018 for exercise-based RCTs that included either subjective and/or objective measures of sleep quality in people with severe mental illness (SMI). Eight RCT's were included in the meta-analysis, involving use of a range of exercise modalities in people with SMI diagnoses. Overall, exercise had a large statistically significant effect on sleep quality (hedges g = 0.73, 95% CI; (0.18, 1.28), p-value = 0.01; N = 8, n = 1,329, I2 = 91.15%). The beneficial effect of exercise on sleep quality outlined in this study highlights the important role exercise has in improving health outcomes for people living with mental illness. Further research is required to determine the efficacy of exercise on sleep in people experiencing a psychiatric illness and to explore the effects of exercise intervention elements such as modality, frequency, intensity and delivery settings.

Freezing of gait (FOG) in Parkinson's disease (PD) is frequently triggered upon passing through narrow spaces such as doorways. However, despite being common the neural mechanisms underlying this phenomenon are poorly understood. In our study, 19 patients who routinely experience FOG performed a previously validated virtual reality (VR) gait paradigm where they used foot-pedals to navigate a series of doorways. Patients underwent testing randomised between both their "ON" and "OFF" medication states. Task performance in conjunction with blood oxygenation level dependent (BOLD) signal changes between "ON" and "OFF" states were compared within each patient. Specifically, as they passed through a doorway in the VR environment patients demonstrated significantly longer "footstep" latencies in the OFF state compared to the ON state. As seen clinically in FOG this locomotive delay was primarily triggered by narrow doorways rather than wide doorways. Functional magnetic resonance imaging revealed that footstep prolongation on passing through doorways was associated with selective hypoactivation in the presupplementary motor area (pSMA) bilaterally. Task-based functional connectivity analyses revealed that increased latency in response to doorways was inversely correlated with the degree of functional connectivity between the pSMA and the subthalamic nucleus (STN) across both hemispheres. Furthermore, increased frequency of prolonged footstep latency was associated with increased connectivity between the bilateral STN. These findings suggest that the effect of environmental cues on triggering FOG reflects a degree of impaired processing within the pSMA and disrupted signalling between the pSMA and STN, thus implicating the "hyperdirect" pathway in the generation of this phenomenon. ispartof: HUMAN BRAIN MAPPING vol:40 issue:7 pages:2055-2064 ispartof: location:United States status: published

Emergency service workers (ESWs) are at high risk of experiencing poor mental health, including posttraumatic stress disorder (PTSD). Programs led by ex-service organizations may play an unrecognized but critical role in mental health prevention and promotion. Behind the Seen (BTS) is an Australian ex-service organization that runs workshops to raise awareness and facilitate conversations around the mental health of ESWs. The purpose of the study is to conduct a qualitative evaluation of workshop participants’ experiences, to understand the acceptability and perceived usefulness over the immediate- (within 1 month), intermediate- (6 months) and longer-terms (12 months). Participants (n = 59 ESWs) were recruited using purposive sampling across five fire and rescue services in metropolitan, regional, and rural locations. Focus groups methodology was used for data collection and data were analyzed using iterative categorization techniques. Participants reported (i) a high perceived need for education about PTSD, (ii) highly salient aspects of the presentation that made for a positive learning experience, including the importance of the lived experiences of the facilitators in the learning process, (iii) key features of changes to intentions, attitudes, and behavior, and (iv) major aspects of the organizational context that affected the understanding and uptake of the program’s key messages. BTS was perceived as an acceptable means of delivering mental health, PTSD, and help-seeking information to ESWs. The program is a promising candidate for scaling-up and further translation.

Aims: Alarming reports of antiretroviral treatment failure have recently emerged in sub-Saharan Africa. The onset of virologic failure has multiple causes but suboptimal treatment adherence is one of the leading causes. This study aimed to explore correlates of adherence to HIV appointments in community care patients living with HIV/AIDS in Uganda.Methods: Two hundred and ninety-five people living with HIV (median age 37.0 years; interquartile range 16.0; female 67.8% [n = 200]) reported whether they had missed any of their four-weekly appointments during the past 24 weeks. They also completed the Internalized AIDS-Related Stigma Scale, Generalized Anxiety Disorder-7, the Patient Health Questionnaire-9, the Alcohol-Use Disorders Identification Test, and the Physical Activity Vital Sign.Results: Thirty-three (11.2%) patients missed at least one of their six scheduled appointments in the 24-week period. The adjusted odds ratio for missing at least one of six appointments was 3.03 (95% CI: 1.21-8.43, p = 0.01) for those who were physically inactive, and 2.29 (95% CI: 0.93-5.63, p = 0.046) for those with depression.Conclusions: Targeting future rehabilitation studies for PLHIV around feelings of depression and around physical inactivity could be important in achieving optimal HIV treatment adherence. ispartof: AJAR-AFRICAN JOURNAL OF AIDS RESEARCH vol:20 issue:2 pages:125-131 ispartof: location:South Africa status: published

Objectives: To examine the relationship of food insecurity with sexual intercourse, multiple sexual partners and non-condom use. Methods: Data on food insecurity (hunger) and sexual behaviors from 205,296 adolescents from 53 countries. Associations were analyzed using meta-analysis. Results: Overall, 16.0% of the adolescents ever had sexual intercourse and the prevalence of moderate and severe food insecurity was 44.9% and 6.2%, respectively. Moderate and severe food insecurity was associated with higher odds for sexual intercourse. Any food insecurity was significantly associated with condom nonuse at last sex. Conclusions: Food insecurity was associated with higher odds of ever having sexual intercourse dose-dependently.

Background Identifying correlates of sexual behavior among young adolescents is critical for preventing adverse outcomes linked to such behavior. Aim This study examined the relationship of bullying victimization with sexual intercourse, multiple sexual partners, and non-condom use in adolescents aged 12–15 years across 53 countries. Methods Cross-sectional data from 145,342 adolescents aged 12–15 years participating in the Global School-based Student Health Survey 2003–2016 were analyzed. Data on bullying victimization were assessed by the question “During the past 30 days, on how many days were you bullied?” Outcomes Data on several sexual behaviors were collected: (i) ever having had intercourse, among those who reported having had intercourse; (ii) multiple (≥2) lifetime sexual partners; and (iii) condom use in last sexual intercourse. Results Multivariable logistic regression analyses were used to assess the associations. The overall prevalence of any bullying in the past 30 days and lifetime sexual intercourse were 28.8% and 13.1%, respectively. Compared with those who were not bullied in the past 30 days, those who were bullied for 20–30 days were 2.08 (95% CI = 1.65–2.63), 1.70 (95% CI = 1.10–2.63), and 1.72 (95% CI = 1.12–2.67) times more likely to report sexual intercourse, non-condom use, and multiple sex partners, respectively. Clinical Implications This study provides further evidence that bullying victimization is a global phenomenon and interventions are required to reduce its prevalence and unwanted consequences. Strengths & Limitations The main strength was the large sample of young adolescents across 53 countries. However, findings from the present study should be interpreted in light of its limitations. First, the study was cross-sectional in nature and thus the direction of the association cannot be established. Second, the data only included young adolescents who attend school. Third, data were self-reported and thus reporting bias may exist. Fourth, the measure of sexual activity used was not able to distinguish between penetrative and nonpenetrative sex. Fifth, adolescents who are victims of bullying may also be exposed to other types of violence such as child maltreatment and sexual assaults, for which data were not available. Finally, the present data set did not contain data on sexual orientation. Conclusion These findings highlight the need for interventions either acting to educate about the potential negative consequences or to prevent risky sexual behavior in young adolescents who experience bullying victimization.

Background The novel coronavirus pandemic calls for a rapid adaptation of conventional medical practices to meet the evolving needs of such vulnerable patients. People with coronavirus disease (COVID-19) may frequently require treatment with psychotropic medications, but are at the same time at higher risk for safety issues because of the complex underlying medical condition and the potential interaction with medical treatments. Methods In order to produce evidence-based practical recommendations on the optimal management of psychotropic medications in people with COVID-19, an international, multi-disciplinary working group was established. The methodology of the WHO Rapid Advice Guidelines in the context of a public health emergency and the principles of the AGREE statement were followed. Available evidence informing on the risk of respiratory, cardiovascular, infective, hemostatic, and consciousness alterations related to the use of psychotropic medications, and drug–drug interactions between psychotropic and medical treatments used in people with COVID-19, was reviewed and discussed by the working group. Results All classes of psychotropic medications showed potentially relevant safety risks for people with COVID-19. A set of practical recommendations was drawn in order to inform frontline clinicians on the assessment of the anticipated risk of psychotropic-related unfavorable events, and the possible actions to take in order to effectively manage this risk, such as when it is appropriate to avoid, withdraw, switch, or adjust the dose of the medication. Conclusions The present evidence-based recommendations will improve the quality of psychiatric care in people with COVID-19, allowing an appropriate management of the medical condition without worsening the psychiatric condition and vice versa.

Background: In order to facilitate people with psychosis to increase their physical activity (PA) levels, a reliable measure- ment of these levels is of relevance. Objectives: The primary aim of current study was to explore the test-retest of the Simple Physical Activity Questionnaire (SIMPAQ) in Ugandan outpatients with psychosis. A second aim was to explore correlates of the SIMPAQ, including de- mographic variables and antipsychotic medication dose. Methods: Thirty-four women (33.9±8.0 years) and 21 men completed the SIMPAQ twice in a day. The test-retest reliability was assessed using Spearman Rho correlations coefficients. Differences in subgroups were analysed with Mann Whitney U tests. Results: The SIMPAQ showed a good test-retest reliability with correlates ranging from 0.78 (P

Objective Posttraumatic stress disorder (PTSD) and psychological injuries are debilitating health problems facing police officers. There is increasing interest in the role of exercise as an intervention. We aimed to determine the preliminary effectiveness of the RECONNECT exercise program for NSW Police Officers experiencing PTSD or psychological injury. Methods An open trial was conducted between 2016 and 2017 across three NSW sites. RECONNECT consisted of twice weekly, supervised exercise sessions for three months. Outcomes were assessed at baseline, week 6 and week 12 (intervention completion) and included PTSD symptoms, depression, anxiety and stress, insomnia severity and alcohol use. Data were analysed using linear mixed models. Results In total, n = 60 Officers were consecutively referred to the program (35% female, mean age 42.0 ± 8.9 years). The majority had a clinical diagnosis of PTSD (n = 48, 80%). A clinically significant reduction in PTSD (Cohen's d = 0.96), depression (d = 0.71), anxiety (d = 0.55) and stress (d = 0.69) symptoms was found from baseline to week 12. Drop-out and lost to follow-up was high. Higher baseline PTSD severity was associated with an increased likelihood to complete postintervention assessment. Conclusions RECONNECT appears to be effective in reducing symptoms of PTSD. Exercise may be an effective component of PTSD treatment.

BackgroundSelf-distancing measures imposed major changes in daily life. This study aimed to (i) evaluate the changes (pre-versus during pandemic) in time spent in moderate to vigorous physical activity (MVPA) and sedentary behavior (SB) in self-isolating Brazilians during the COVID-19 pandemic, and (ii) to explore correlates of MVPA and SB.MethodsA cross-sectional self-report online survey, evaluating the time spent in MVPA and SB pre and during the COVID-19 pandemic. Sociodemographic, behavioral, clinical, variables, and time in self-isolation were also obtained. Changes in MVPA and SB and their correlates were explored using generalized estimating equations (GEE).ResultsA total of 877 participants (72.7% women, 53.7% young adults [18-34 years]) were included. Overall, participants reported a 59.7% reduction (95%CI:35.6 to 82.2) in time spent on MVPA during the pandemic. Time spent in SB increased 42.0% (95%CI:31.7 to 52.5). Greater reductions in MVPA and/or increases in SB were seen in younger adults, those not married, those employed and those with a self-reported previous diagnosis of a mental disorder.ConclusionsPeople in self-isolation significantly reduced MVPA levels and increased SB. Public health strategies should be implemented during epidemic times to mitigate the impact of self-isolation on MVPA and SB, particularly in vulnerable groups.

BackgroundPeople with mental illness die on average 15 years less than the general population, primarily to cardiometabolic disease. Lifestyle interventions are effective in reducing cardiometabolic risk but are not routinely provided to mental health consumers. Lifestyle interventions targeting mental health staff may be beneficial in changing culture surrounding physical health and subsequently improving consumer outcomes. This study examines exercise and fitness outcomes of a targeted lifestyle intervention directed at Australian mental health staff.MethodsA pragmatic single-arm intervention study was conducted within an Australian public mental health service. Mental health staff were provided a five-session individualised lifestyle intervention (incorporating exercise and nutritional counselling) over 5 weeks. Two waves of the programme were delivered between 2015 and 2016. This paper examines the exercise and fitness outcomes of the second wave of the study. Participants were assessed at baseline and at a 16-week follow-up. The primary exercise outcome was a measurement of cardiorespiratory fitness. Secondary outcomes included self-reported physical activity and a measurement of handgrip strength.ResultsA total of 106 staff participated in this component of the study. Cardiorespiratory fitness increased significantly from baseline to follow-up (pConclusionLifestyle interventions incorporating exercise counselling may improve the physical health of mental health staff. Such strategies may be effective in improving culture surrounding physical health and/or increasing the effectiveness of lifestyle interventions targeting mental health consumers.

The transtheoretical model (TTM) of behavioral change posits that individuals move through five stages of change when adopting new behaviors: pre-contemplation, contemplation, preparation, action, and maintenance. The aim of this study was to determine the proportion of patients with HIV/AIDS within a Ugandan fishing community in the different physical activity (PA) stages. We also explored differences in variables, motives, and barriers for PA across the stages.In total, 256 individuals (77 men, 40.5 ± 10.3 years) completed the Patient-centered Assessment and Counseling for Exercise Questionnaire, the Patient Health Questionnaire-9 (PHQ-9) to assess depressive symptoms, and the Alcohol Use Disorders Identification Test. They were also asked about their most important PA motive and barrier.Seventy-five individuals (29%) were in the (pre-)preparatory stages, 140 (55%) in the action and 41 (16%) in the maintenance stage. Those in the (pre-)preparatory stages had higher PHQ-9 total scores (Depression and barriers to PA should be considered in people with HIV/AIDS in low-resource settings when implementing interventions to assist them to become more active.Implications for rehabilitationPeople with HIV/AIDS are among the most physically inactive clinical populations.Clinicians should consider depression when motivating patients with HIV in low resourced settings to become active.Clinicians should consider body weakness when motivating patients with HIV in low resourced settings to become active.

People with severe mental illness (SMI) have numerous risk factors that may predispose them to food insecurity (FI); however, the prevalence of FI and its effects on health are under-researched in this population. The present study aimed to describe the prevalence of FI and its relationship to lifestyle factors in people with SMI. This cross-sectional study recruited people with SMI receiving long-acting injectable (LAI) antipsychotic medication from community services at three sites in Sydney, Australia. Assessments were completed on physical health and lifestyle factors. χ2 Tests, independent-samples t tests and binary logistic regression analyses were calculated to examine relationships between lifestyle factors and FI. In total, 233 people completed the assessments: 154 were males (66 %), mean age 44·8 (sd 12·7) years, and the majority (70 %) had a diagnosis of schizophrenia. FI was present in 104 participants (45 %). People with FI were less likely to consume fruits (OR 0·42, 95 % CI 0·24, 0·74, P = 0·003), vegetables (OR 0·39, 95 % CI 0·22, 0·69, P = 0·001) and protein-based foods (OR 0·45, 95 % CI 0·25, 0·83, P = 0·011) at least once daily, engaged in less moderate to vigorous physical activity (min) (OR 0·997, 95 % CI 0·993, 1·000, P = 0·044), and were more likely to smoke (OR 1·89, 95 % CI 1·08, 3·32, P = 0·026). FI is highly prevalent among people with SMI receiving LAI antipsychotic medications. Food-insecure people with SMI engage in less healthy lifestyle behaviours, increasing the risk of future non-communicable disease.

People with mental illness are at an increased risk for developing cardio-metabolic disorders. Routine screening following pharmacotherapy is however unacceptably low in Sub-Saharan African countries with less than 1% adequately screened. It is unknown whether this is due to a lack of adequate competences. Objectives: The aim of this pilot study was to assess the barriers, attitudes, confidence, and knowledge of nurses regarding metabolic health, prevention and treatment in Uganda. Methods: Twenty-eight nurses (39% female, 30.9±6.9 years) completed the Metabolic – Barriers, Confidence, Attitudes and Knowledge Questionnaire and the physical activity prescription rate item of the Exercise in Mental Illness Questionnaire. Results: More than 75% had a positive attitude towards metabolic screening and intervention and more than 50% were confident in providing smoking cessation advice, and physical activity and nutritional counseling. However, 57% stated that their heavy workload prevented them from doing health screening and promotion activities. There was a negative correlation (ρ=-0.54, P=0.003) between the frequency of physical activity prescription and the perception of the inability of patients to change. Conclusions: The present findings suggest that nurses are generally supportive of metabolic health screening and intervention but their high workload prevents them from implementing metabolic health interventions. ispartof: African Health Sciences vol:19 issue:19(3) pages:2546-2554 ispartof: location:Uganda status: published

Background The novel coronavirus pandemic calls for a rapid adaptation of conventional medical practices to meet the evolving needs of such vulnerable patients. People with coronavirus disease (COVID-19) may frequently require treatment with psychotropic medications, but are at the same time at higher risk for safety issues because of the complex underlying medical condition and the potential interaction with medical treatments. Methods In order to produce evidence-based practical recommendations on the optimal management of psychotropic medications in people with COVID-19, an international, multi-disciplinary working group was established. The methodology of the WHO Rapid Advice Guidelines in the context of a public health emergency and the principles of the AGREE statement were followed. Available evidence informing on the risk of respiratory, cardiovascular, infective, hemostatic, and consciousness alterations related to the use of psychotropic medications, and drug–drug interactions between psychotropic and medical treatments used in people with COVID-19, was reviewed and discussed by the working group. Results All classes of psychotropic medications showed potentially relevant safety risks for people with COVID-19. A set of practical recommendations was drawn in order to inform frontline clinicians on the assessment of the anticipated risk of psychotropic-related unfavorable events, and the possible actions to take in order to effectively manage this risk, such as when it is appropriate to avoid, withdraw, switch, or adjust the dose of the medication. Conclusions The present evidence-based recommendations will improve the quality of psychiatric care in people with COVID-19, allowing an appropriate management of the medical condition without worsening the psychiatric condition and vice versa.

Background: Physical inactivity is a key contributor to the global burden of disease and disproportionately impacts the wellbeing of people experiencing mental illness. Increases in physical activity are associated with improvements in symptoms of mental illness and reduction in cardiometabolic risk. Reliable and valid clinical tools that assess physical activity would improve evaluation of intervention studies that aim to increase physical activity and reduce sedentary behaviour in people living with mental illness. Methods: The five-item Simple Physical Activity Questionnaire (SIMPAQ) was developed by a multidisciplinary, international working group as a clinical tool to assess physical activity and sedentary behaviour in people living with mental illness. Patients with a DSM or ICD mental illness diagnoses were recruited and completed the SIMPAQ on two occasions, one week apart. Participants wore an Actigraph accelerometer and completed brief cognitive and clinical assessments. Results: Evidence of SIMPAQ validity was assessed against accelerometer-derived measures of physical activity. Data were obtained from 1010 participants. The SIMPAQ had good test-retest reliability. Correlations for moderate-vigorous physical activity was comparable to studies conducted in general population samples. Evidence of validity for the sedentary behaviour item was poor. An alternative method to calculate sedentary behaviour had stronger evidence of validity. This alternative method is recommended for use in future studies employing the SIMPAQ. Conclusions: The SIMPAQ is a brief measure of physical activity and sedentary behaviour that can be reliably and validly administered by health professionals., Universidad Pablo de Olavide de Sevilla. Departamento de Deporte e Informática

Background: Physical activity (PA) significantly improves physical health and clinical symptoms across mental disorders. Accredited Exercise Physiologists (AEPs) are trained to lead PA interventions for people with mental illness, but referrals to AEPs are low. Aims: To determine the knowledge and attitudes of delegates attending the 2017 Royal Australian and New Zealand College of Psychiatrists (RANZCP) conference toward physical health monitoring and exercise interventions for people with mental illness. Methods: A cross-sectional survey of RANZCP delegates investigated knowledge and attitudes toward PA for people with mental illness, self-reported PA, and their understanding of AEP’s role within mental health settings. A subgroup of delegates underwent fitness assessments. Results: Seventy-three delegates completed surveys and 24 underwent fitness assessments. Delegates demonstrated good knowledge regarding associations between PA and cardiovascular disease risk. Delegates were less knowledgeable of AEP’s role within mental health settings. Forty-six participants (63%) did not meet the Australian recommended guidelines for PA. No association between referrals to AEPs and self-reported PA or fitness measures were evident. Conclusions: Promoting PA participation for mental health professionals, coupled with education on the important role AEPs play in the multidisciplinary treatment of mental health consumers is vital to improve health outcomes for this vulnerable group.

This study explored the efficacy of lay health worker (LHW)-led physical activity (PA) counselling for primary care patients with mental health problems (PCMH) and their support partners. Forty-nine (41♀, median age=47, interquartile range=22) PCMH and 49 support partners [9♀, 31(9)years] participated in once weekly counselling based on the mental contrasting and implementation of intentions framework for 8 weeks. All participants completed the Simple Physical Activity Questionnaire (SIMPAQ) and World Health Organization Disability Assessment Schedule 2 (WHODAS 2), while PCMH completed the Multidimensional Scale for Perceived Social Support (MSPSS), Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and Alcohol Use Disorders Identification Test (AUDIT) pre- and immediately post-intervention. In PCMH significant (P0.001) increases in walking, exercising and incidental PA (SIMPAQ) levels, reductions in depressive (PHQ-9) and anxiety (GAD-7) symptoms and improvements in mobility and participation (WHODAS 2) were observed. Perceived support from significant others (MSPSS) significantly increased. In support partners, a significant reduction in time spent sedentary, increase in incidental PA (SIMPAQ) and improvement in the perception of getting alone with others (WHODAS 2) was seen. Our study demonstrates that LHW-led PA counselling is beneficial for PCMH and their support partners. Randomized controlled trials are warranted to confirm these positive findings.

Purpose People with severe mental illness (SMI) can benefit from meeting the recommended guidelines on physical activity; yet meeting these guidelines for this population is challenging in practice. We examined the difference between outpatients with SMI that meet and do not meet physical activity guidelines in relation to barriers to physical activity in domain areas that are theoretically-informed from determinant areas of physical activity behaviour change. We aimed to identify clinical and demographic variables of less active people with SMI and domains where less active people with SMI have heightened barriers to physical activity. Methods A self-report survey comprised of clinical and demographic variables, a brief 3-item measure of physical activity (3Q), and the Determinants of Physical Activity Questionnaire (DPAQ) was administered to a sample of outpatients with SMI (N = 105) in Ireland. Results The findings show 72% of the sample did not meet recommended physical activity guidelines. No differences between active and less active participants were found in relation to demographic and clinical variables measured. Participants that did not meet physical activity guidelines reported stronger barriers in the areas ‘Beliefs in the consequences of physical activity’ and ‘Motivation and goals to physical activity’ (P ≤ 0.001). Discussion This is the first study to use the DPAQ tool to examine the differences between active and inactive people with SMI in relation to physical activity barriers, with clear implications for tailoring intervention specifically for less active people with SMI.

Estimates indicate the lifespan of individuals with psychotic illness is reduced by approximately 15-20 years. Consequently there is a need to address the physical health of those who live with a mental illness, like psychosis. The Bondi Centre provides an integrated model of care to young people with a first episode of psychosis. The Keeping the Body In Mind program focuses on prevention and early intervention of physical health issues and is offered alongside treatment for mental health and social issues as part of routine care. We used body mapping, an arts-based research method, to explore the complexity of this physical health intervention. Our aim was to develop an in-depth understanding of experiences of young clients of the early intervention centre, with a particular focus on the embodied relationship between physical and mental health. Six young people engaged in creating life-sized body maps depicting their experience of the physical intervention program over four 3-hour sessions, followed by an in-depth interview. Analysis of our body maps drew on thematic analysis and narrative inquiry. The narrative trope was one of recovery, highlighting the importance of the link between body and mind, individual and community, and the balance between light and darkness. There was an emphasis on developing feelings of connectedness (to self and others), hope and optimism for the future, a sense of having an identity, and a sense of meaning and empowerment. Recovery was conceptualised as an ongoing process rather than an end product or fixed state. Involvement in the body mapping process was consistently identified as therapeutic, offering an opportunity for reflection on the journey to recovery with a focus on past, present and imagined storylines of the future.

Objective:University study is often accompanied by a decline in physical activity (PA) levels but can offer the opportunity to promote a lifelong active lifestyle. This review aims to summarize controlled trials of interventions promoting PA among university students, describing the quality of the evidence, effective strategies, and deficiencies in the interventions employed, to provide directions for future research and for practical implementations.Data Source:PubMed, PsychINFO, Cochrane Library, Education Source, and SPORTDiscus.Study Inclusion Criteria:Randomized or nonrandomized controlled trial, describing an intervention to promote PA in university students, where PA was one of the outcomes and results were published in English.Data Extraction:Country, study design, participants’ inclusion criteria, participation rate and characteristics, randomization, blinding, theoretical framework, intervention characteristics, participant retention rate and withdrawal reasons, measures employed, data analysis, PA results, and findings regarding PA correlates.Data Synthesis:Data were synthetized considering study characteristics, strategies used, and outcomes.Results:Two thousand five hundred eighty-five articles were identified. Twenty-seven studies met the inclusion criteria. Sixteen studies reported an increase in PA levels.Conclusion:Physical Activity promotion interventions should address a range of behavioral determinants. Personalized approaches and PA sessions should be considered in future studies. The high risk of bias of many studies (mainly due to attrition and poor reporting) and missing information about intervention components limit the strength of conclusions about the most effective strategies and the evidence of effectiveness, highlighting the need for further high-quality studies.

Background Severe mental illness is characterised by a 15-year mortality gap driven by cardiometabolic disease. Antipsychotic treatment leads to increased appetite and rapid weight gain. The 12-week lifestyle pilot intervention improved dietary intake and prevented antipsychotic-induced weight gain. Here we report two-year outcomes. Method Participants were exposed to an extended program. Weight and waist circumference were measured, and food frequency questionnaire completed. Results Diet quality was higher, and discretionary food intake was 40% lower, at two-years compared to baseline. Weight and waist-circumference did not increase. Conclusion This pilot study demonstrated sustained effectiveness of a dietetic intervention in youth with first-episode psychosis with improvements in diet quality and no increase in weight secondary to antipsychotic medication initiation.

Young people experiencing psychotic illness engage in low amounts of physical activity have poor fitness levels and poor sleep quality. This study aimed to determine the prevalence of these modifiable cardiometabolic risk factors among individuals with at-risk mental states (ARMS), who are at increased risk of developing psychosis. A cross-sectional study was conducted in a community-based youth mental health service. Thirty participants (23%♀, 21.3 ± 1.7 years old) were recruited, 10 with ARMS, 10 with first-episode psychosis (FEP) and 10 healthy volunteers. Physical activity levels were assessed using self-report and objective measures. Aerobic capacity, upper body strength, hamstring flexibility, forearm grip strength and core endurance were assessed. Sleep quality, depression and anxiety were measured by self-report questionnaire. The ARMS group did not differ significantly on anthropometric measures from FEP or healthy volunteers. They engaged in significantly less physical activity (p < 0.05) and had poorer sleep quality (p < 0.05) than healthy volunteers. Our results are consistent with other studies that found that youth with ARMS are at greater cardiometabolic risk. Interventions aimed at improving these modifiable risk factors may assist with preventing the decline in physical health associated with the development of psychiatric illness.

Objectives: Evaluation of physical activity (PA) programs among populations with severe mental illness (SMI) has predominately focused on efficacy and therapeutic benefits. There is now strong evidence to support the benefits of PA in people with SMI. What remains is a gap in the implementation of pragmatic and sustainable PA interventions in mental-health settings. The current paper provides examples of interventions that have been successfully implemented in Australian settings, identifies key components of successful PA interventions and outlines practical strategies that can assist with widespread implementation of PA interventions in mental-health settings. Conclusions: There is an emergence of PA interventions being imbedded within a variety of mental-health settings. These interventions vary in terms of mode and intensity of service delivery. Yet, all aim to increase PA and reduce sedentary behaviour. Adopting the identified strategies may help facilitate successful implementation and increase access to PA interventions for mental-health service users.

People experiencing a severe mental illness (SMI), such as schizophrenia, schizoaffective disorder, bipolar affective disorder or depression with psychotic features, have a 20-year mortality gap compared to the general population. This 'scandal of premature mortality' is primarily driven by preventable cardiometabolic disease, and recent research suggests that the mortality gap is widening. Multidisciplinary mental health teams often include psychiatrists, clinical psychologists, specialist mental health nurses, social workers and occupational therapists, offering a range of pharmacological and nonpharmacological treatments to enhance the recovery of clients who have experienced, or are experiencing a SMI. Until recently, lifestyle and life skills interventions targeting the poor physical health experienced by people living with SMI have not been offered in most routine clinical settings. Furthermore, there are calls to include dietary intervention as mainstream in psychiatry to enhance mental health recovery. With the integration of dietitians being a relatively new approach, it is important to review and assess the literature to inform practice. This review assesses the dietary challenges experienced by people with a SMI and discusses potential strategies for improving mental and physical health.

BACKGROUND: Low levels of physical activity (PA) and sedentary behavior (SB) are independent risk factors for cardiovascular disease and premature mortality in people with major depressive disorder (MDD).AIMS: Investigate levels of PA and SB and their predictors in people with MDD.METHODS: Electronic databases were searched from inception till 04/2016 for articles measuring PA and SB with a self-report questionnaire (SRQ) or objective measure (e.g. accelerometer) in people with MDD. Random-effects meta-analyses and meta-regression analyses were conducted.RESULTS: Twenty-four eligible studies were identified including 2901 people with MDD (78.4% female, mean age=54 years; range: 21-77 years). People with MDD spent 126.0min (95%CI=91.9-160.1) per day engaging in all types of PA and spent 8.5hours (95%CI=7.51-9.62) during their waking day being sedentary. Compared to controls, people with MDD spent less time in total PA (SMD=-0.25, 95%CI=-0.03 to 0.15) and moderate to vigorous PA (SMD=-0.30, 95%CI=-0.40 to 0.21) and engaged in higher levels of SB (SMD=0.09, 95%CI=0.01-0.18). The proportion of people with MDD not meeting the recommended PA guidelines was 67.8% (n=13 studies), which was higher in studies relying on objective versus self-report measures (85.7% v 62.1%, p=0.04). People with MDD were less likely than controls to meet recommended PA guidelines (OR=-1.50, 95%CI=-1.10 to -2.10).LIMITATIONS: Heterogeneity was evident in most analyses.CONCLUSIONS: Adults with MDD engage in low levels of PA and high levels of SB. PA and SB are independent predictors of mortality, therefore, future lifestyle interventions targeting both the prevention of SB and adoption and maintenance of PA are warranted.