Sedentary behavior and physical activity levels in people with schizophrenia, bipolar disorder and major depressive disorder: a global systematic review and meta‐analysis

Abstract

People with severe mental illness (schizophrenia, bipolar disorder or major depressive disorder) die up to 15 years prematurely due to chronic somatic comorbidities. Sedentary behavior and low physical activity are independent yet modifiable risk factors for cardiovascular disease and premature mortality in these people. A comprehensive meta-analysis exploring these risk factors is lacking in this vulnerable population. We conducted a metaanalysis investigating sedentary behavior and physical activity levels and their correlates in people with severe mental illness. Major electronic databases were searched from inception up to April 2017 for articles measuring sedentary behavior and/or physical activity with a self-report questionnaire or an objective measure (e.g., accelerometer). Random effects meta-analyses and meta-regression analyses were conducted. Sixty-nine studies were included (N535,682; 39.5% male; mean age 43.0 years). People with severe mental illness spent on average 476.0 min per day (95% CI: 407.3-545.4) being sedentary during waking hours, and were significantly more sedentary than age-and gender-matched healthy controls (p50.003). Their mean amount of moderate or vigorous physical activity was 38.4 min per day (95% CI: 32.0-44.8), being significantly lower than that of healthy controls (p50.002 for moderate activity, p<0.001 for vigorous activity). People with severe mental illness were significantly less likely than matched healthy controls to meet physical activity guidelines (odds ratio 5 1.5; 95% CI: 1.1-2.0, p<0.001, I 2 595.8). Lower physical activity levels and non-compliance with physical activity guidelines were associated with male gender, being single, unemployment, fewer years of education, higher body mass index, longer illness duration, antidepressant and antipsychotic medication use, lower cardiorespiratory fitness and a diagnosis of schizophrenia. People with bipolar disorder were the most physically active, yet spent most time being sedentary. Geographical differences were detected, and inpatients were more active than outpatients and those living in the community. Given the established health benefits of physical activity and its low levels in people with severe mental illness, future interventions specifically targeting the prevention of physical inactivity and sedentary behavior are warranted in this population.Key words: Physical activity, sedentary behavior, severe mental illness, schizophrenia, bipolar disorder, major depressive disorder, physical activity guidelines, cardiovascular disease, premature mortality (World Psychiatry 2017;16:308-315) People with severe mental illness (schizophrenia, bipolar disorder or major depressive disorder) have higher levels of somatic comorbidities and premature mortality than the general population 1-3 . A recent meta-analysis 4 documented that mortality rates are approximately two to three times increased in these people. The higher premature mortality rates are largely attributable to cardiovascular disease 5 .In the general populati...

What is the risk‐benefit ratio of long‐term antipsychotic treatment in people with schizophrenia?

“…Individuals with schizophrenia have a greater prevalence of sedentary lifestyle, obesity, cardiovascular illness, diabetes, nicotine smoking and tobacco‐related disorders, sexually transmitted diseases, obstetric complications, and altered pain sensitivity, while also having lower rates of health care services utilization and medical treatment for such conditions, which results in large unaddressed gaps in medical care. While it is unclear the role that differences in health care systems play in physical morbidity in schizophrenia, given the limited availability of comparable data from a variety of countries, it seems clear that this morbidity plays an important role in reducing the life expectancy of individuals with schizophrenia across different settings.…”

Patients with schizophrenia have impaired muscle force‐generating capacity and functional performance

“…However, it is unclear whether this accelerated aging expands also to functional performance of daily activities such as walking, stair climbing, chair raising, and balance in the patient group. If the performance of such simple daily activities is experienced as strenuous, it may lead to less physical activity, being one more contributing factor to the reduced life expectancy . It is therefore crucial to investigate whether the performance of such simple functional daily activities is impaired in patients with schizophrenia spectrum disorder and identify factors important for functional performance that could be targeted in maintenance or rehabilitation programs.…”

Gender differences in metabolic syndrome risk factors among patients with serious mental illness

“…A global systematic review revealed that a higher BMI was associated with lower levels of physical activity in patients with serious mental illness (Vancampfort et al . ). However, only 9.6% of the patients in the present study engaged in moderate to vigorous physical activity—much lower than the level in Taiwan’s general population (64.5%; Chang et al .…”

“…The potential reason is that male patients with bipolar disorder tend to have low physical activity levels and noncompliance with physical activity guidelines, particularly those who have low education levels (Vancampfort et al . ). Moreover, here, men with prolonged illness and history of medical illness were more likely to have MetS, potentially because patients with prolonged illness receive more psychotropic medication and experience high levels of sedation, which contributes to a sedentary lifestyle and results in poor physical health (Bai et al .…”