Cardiorespiratory Fitness in Severe Mental Illness: A Systematic Review and Meta-analysis

Abstract

Background Cardiorespiratory fitness (CRF) among people with severe mental illness (SMI) (i.e., schizophrenia, bipolar disorder, and major depressive disorder) is a critical clinical risk factor given its relationship to cardiovascular disease and premature mortality.Objectives This study aimed to: (1) investigate the mean CRF in people with SMI versus healthy controls; (2) explore moderators of CRF; and (3) investigate whether CRF improved with exercise interventions and establish if fitness improves more than body mass index following exercise interventions. Methods Major electronic databases were searched systematically. A meta-analysis calculating Hedges' g statistic was undertaken.Results Across 23 eligible studies, pooled mean CRF was 28.7 mL/kg/min [95 % confidence interval (CI) 27.3 to 30.0 mL/kg/min, p\0.001, n = 980]. People with SMI had significantly lower CRF compared with controls (n = 310) (Hedges' g = -1.01, 95 % CI -1.18 to -0.85, p \ 0.001). There were no differences between diagnostic subgroups. In a multivariate regression, first-episode (b = 6.6, 95 % CI 0.6-12.6) and inpatient (b = 5.3, 95 % CI 1.6-9.0) status were significant predictors of higher CRF. Exercise improved CRF (Hedges' g = 0.33, 95 % CI = 0.21-0.45, p = 0.001), but did not reduce body mass index. Higher CRF improvements were observed following interventions at high intensity, with higher frequency (at least three times per week) and supervised by qualified personnel (i.e., physiotherapists and exercise physiologists). Conclusion The multidisciplinary treatment of people with SMI should include a focus on improving fitness to reduce all-cause mortality. Qualified healthcare professionals supporting people with SMI in maintaining an active lifestyle should be included as part of multidisciplinary teams in mental health treatment.

Cardiometabolic Risks in Schizophrenia and Directions for Intervention, 2: Nonpharmacological Interventions

“…Nonetheless, 10-24 weeks of exercise as a solitary behavioral intervention does not seem promising as a physical health intervention for patients with major mental illness. It may also be noted that although cardiovascular fitness is poor in patients with major mental illness, 14 the dropout rate from physical activity interventions is high in this population. 15 In the general population, in contrast, exercise training improves cardiorespiratory fitness and biomarkers of cardiovascular health.…”

Health status and mobility limitations are associated with residential and employment status in schizophrenia and bipolar disorder

“…Given the high prevalence of obesity (De Hert et al, 2010; Allison et al, 2009; Fagiolini et al, 2008) and poor physical functioning in individuals with SPMI (Vancampfort et al, 2017; Strassnig et al, 2014), we hypothesized that physical health limitations may have an even greater influence on disability in SPMI groups than in mentally healthy individuals (Scott et al, 2009) (Figure 1). Individuals with SPMI often have a poor diet, are sedentary, engage in little or no physical exercise, and are persistent smokers (Newcomer & Hennekens, 2007), and these risk factors are exacerbated by cognitive deficits and clinical symptoms (Harvey & Strassnig, 2012), as well as chronic treatment with sedating and obesogenic psychotropic medications.…”

Cardiorespiratory benefits of group exercise among adults with serious mental illness

“…(Ussher et al, 2007, Daumit et al, 2005, Stubbs, et al, 2016, Vancampfort et al, 2012) Despite the growing body of evidence that exercise programs are being conducted with this population, evaluation of long term changes in cardiorespiratory fitness (CRF) from these programs are scant. (Firth et al, 2015, Vancampfort et al, 2015c, Vancampfort et al, 2017, Pearsall et al, 2014) As aerobic conditioning is effective in improving CRF which in turn is associated with decreased cardiovascular disease it serves as a modifiable factor with a large potential impact on this population. (Vancampfort et al, 2017) Although efforts to increase CRF in persons with serious mental illness have included a range of modalities, group exercise, despite being a mainstream offering in commercial markets, has been largely absent from the literature.…”

“…(Firth et al, 2015, Vancampfort et al, 2015c, Vancampfort et al, 2017, Pearsall et al, 2014) As aerobic conditioning is effective in improving CRF which in turn is associated with decreased cardiovascular disease it serves as a modifiable factor with a large potential impact on this population. (Vancampfort et al, 2017) Although efforts to increase CRF in persons with serious mental illness have included a range of modalities, group exercise, despite being a mainstream offering in commercial markets, has been largely absent from the literature.…”