Early Intervention in Psychosis: Effectiveness and Implementation of a Combined Exercise and Health Behavior Intervention Within Routine Care

Abstract

Aim: Young people with psychosis have higher rates of obesity, premature cardiovascular disease, and death compared to non-psychotic peers in the general population due to changes in metabolic regulation linked to antipsychotic medication and adverse health risk behaviors. The aim of this paper is to outline the development, implementation, and evaluation of a combined 12-week exercise and health behavior intervention delivered as part of an Early Intervention in Psychosis (EIP) routine service, within the UK. Methods: Participants (n = 27) completed a 12-week combined intervention program, engaging in weekly, 90-min sessions comprising a healthy behavior education session (45 min), followed by a facilitated exercise session (45 min). Anthropometric data from participants (n = 26) were collected at baseline, 12 weeks, and 12 months postintervention. Health behaviors and clinical measurements were assessed at baseline and 12 months. Results: Mean baseline data suggests participants were at an increased health risk on entry to the program, with elevated values in mean body mass index (BMI; 70% overweight/obese), waist circumference, resting heart rate, and triglycerides. Fifty percent reported smoking daily, 64% ate < 5 fruits/vegetables per day, and 52% of participants were prescribed highly obesogenic antipsychotic medications (i.e., Olanzapine). At 12 weeks and 12 months, no changes were observed in mean BMI, waist circumference or any other clinical variable (p > 0.05). At 12 months, participants reported a positive impact on health behaviors including improved diet, increased physical activity levels, and cessation of substance use (n = 2), alcohol use (n = 2), and smoking (n = 4). Focus groups captured participant experiences, engagement with and satisfaction with the program, including challenges/barriers to program adherence. Conclusions: The 12-week exercise and health behaviors program supported participants to attenuate their physical health risk which was sustained at 12-month

Integrated Review of Lifestyle Interventions Targeting Diet and Exercise in Early or First-Episode Psychosis

“…Nevertheless, patients reported goal-setting to be a helpful tool [46]. Weekly sessions containing safe behaviour education and a facilitated exercise session produced no changes in clinical variables, but participants reported it had a positive effect on their health behaviours [53]. Overall, these studies show that engaging in exercise and adopting a healthier diet (positive behaviour change) and subsequent beneficial outcomes is possible for some participants, but improved outcomes can be difficult to achieve for many people with early or first-episode psychosis.…”

“…Efforts to improve physical health have encountered patient related barriers on both a practical (money for clothing, equipment and travel) and psychological level (psychotic symptoms, feelings of vulnerability, social anxiety, depression, generalised anxiety, low motivation, and low self-efficacy) [52] [53]. Additionally, service-level barriers exist, including a lack of: resources to adopt and scale-up successful intervention programs, appropriate facilities, staff capacity, trained staff, and leadership engagement [53]. Important factors in patient engagement and retainment are flexible attendance, scheduling and progression, and priority for enjoyment, choice, and autonomy [52].…”

Improving the physical health of young people with early psychosis with lifestyle interventions: Scoping review

“…The benefits of self-initiated lifestyle intervention incorporating self-determination theory have been specifically highlighted in four studies (Firth et al 2018b;Lederman et al 2020;Smith et al 2020;Watkins et al 2019). Baumeister & Leary (1995) state that there are three fundamental psychological needs according to the self-determination theoryrelatedness, competence and autonomy.…”

“…The studies conducted by Lederman et al (2020) and Smith et al (2020) also highlighted the importance of self-determination in health behaviour change. Both studies emphasized participants' freedom of choice over their preferred exercise form, which promotes autonomy and their ability to achieve their perceived benefits through exercise with social interactions and support during the programme.…”

“…Participants with a diagnosis of FEP or at-risk mental state or other were recruited from a UK-based Early Intervention in Psychosis (EIP) clinic. Benefits on attenuation of physical health risks and barriers such as accessibility were identified (Smith et al 2020).…”