Publications by authors named "Davy Vancampfort"

336 Publications

Endothelial dysfunction in people with depressive disorders: A systematic review and meta-analysis.

J Psychiatr Res 2021 Jun 26;141:152-159. Epub 2021 Jun 26.

Postgraduate Program in Functional Rehabilitation, Federal University of Santa Maria, Santa Maria, Brazil; Department of Sports Methods and Techniques, Federal University of Santa Maria, Santa Maria, Brazil. Electronic address:

The study aimed to identify whether people diagnosed with depression have endothelial dysfunction, assessed by the technique of flow-mediated dilation (FMD), when compared to controls without depression. In addition, to verify whether people with depressive symptoms have impaired endothelial function when compared to controls without symptoms. Also to explore the potential moderators of the association between depression and endothelial dysfunction. Systematic review and meta-analysis. We searched PubMed, PsycINFO, Embase and Web of Science, from inception to April 16, 2021, for studies in people with depression and controls evaluating endothelial function through FMD. The primary outcome was the percentage of change in FMD. Comparative random effects meta-analysis, calculating the mean difference (MD) of the FMD between depressed and controls was performed. Potential sources of heterogeneity were explored by meta-regressions and subgroup analyses. The study protocol was registered with PROSPERO (CRD42020192070). Nine studies evaluating 1367 participants (379 depressed and 988 controls) (median age = 39.8 years, 44.9% men) were included. People with depression had lower FMD = -1.48% (95%CI = -2.62 to -0.33). High density lipoprotein (HDL) cholesterol levels moderated the effect (beta = -0.408, 95%CI = -0.776 to -0.040). Differences in FMD were found when assessment was done in the first minute after release of the occlusion, when using occlusion position in distal forearm, and when using occlusion pressure between 250 and 300 mmHg. Those with clinical depression (established by diagnostic instruments) presented the greatest dysfunction. Individuals with depression have a more impaired endothelial dysfunction when compared to controls. HDL cholesterol levels and differences in FMD assessment modalities moderate the difference.
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http://dx.doi.org/10.1016/j.jpsychires.2021.06.045DOI Listing
June 2021

The anxiolytic effects of exercise for people with anxiety and related disorders: An update of the available meta-analytic evidence.

Psychiatry Res 2021 Aug 11;302:114046. Epub 2021 Jun 11.

Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium; University Psychiatric Center KU Leuven, Leuven, Belgium.

Exercise as a treatment option for people with mental disorders is a field of growing interest. The increased number of published randomized controlled trials (RCTs) evaluating the effects of exercise in the treatment of anxiety and related disorders in recent years calls for an update of the available meta-analytic evidence. Electronic databases (PubMed, CINAHL, PSYCArticles, and Embase) were searched up to 17.2.2021, for RCTs evaluating the effects of exercise on anxiety and stress symptoms in adults with anxiety and related disorders. A random effects meta-analysis was conducted. A total of 13 RCTs comprising 731 adult participants (exercise n=376; control n=355) were included. Exercise had a small, bordering medium, but statistically significant effect on decreasing anxiety symptoms compared to control condition (standardized mean difference=-0.425, 95%CI -0.67 to -0.17; I = 47.9%) in people with anxiety and related disorders. Our meta-analysis updates the existing evidence supporting exercise as an efficacious intervention for anxiety and related disorders. Although the updated meta-analytic evidence is less heterogenous than previously reported, future research is still needed to explore the factors moderating the effects of exercise on outcome such as frequency, intensity, duration of the sessions, and type of exercise and qualification of the provider in more detail.
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http://dx.doi.org/10.1016/j.psychres.2021.114046DOI Listing
August 2021

Cross-sectional associations of leisure and transport related physical activity with depression and anxiety.

J Psychiatr Res 2021 Aug 4;140:228-234. Epub 2021 Jun 4.

Departmento de Clínica Médica, Faculdade de Medicina da USP & Hospital Universitário, Universidade de São Paulo, São Paulo, Brazil; Laboratory of Neurosciences (LIM-27), Institute of Psychiatry, Hospital das Clínicas da Faculdade de Medicina da USP, Brazil.

Background: Previous evidence supports the notion that the physical activity (PA) domain (leisure-time or transport), and the amount of time spent in PA, influence the association of PA with depressive and anxiety symptoms. However, no study evaluated the associations of different volumes of leisure-time PA (LTPA) and transport PA (TPA) with prevalent depression, anxiety, and co-occurring depression and anxiety (D&A) disorders.

Aim: To investigate the associations between different volumes of LTPA and TPA with prevalent depression, anxiety, and D&A.

Methods: Cross-sectional study using baseline data of the ELSA-Brasil cohort. The International Physical Activity Questionnaire (IPAQ) long-form was used to assess PA levels in each domain. The Clinical Interview Scheduled Revised (CIS-R) was used to diagnose prevalent depressive, anxiety, and D&A disorders. Logistic regressions, adjusting for confounding factors, were employed. Results are expressed as adjusted odds ratios (aOR) and 95% confidence intervals (CI).

Results: A total of 14,381 adults (54.5% female, 67.5% aged 45-64 years) were assessed. T60-89min/week >300min/week p < 0.001). High volumes of LTPA were associated with a lower prevalence 270-299min/week; >300 minutes60-89min/week volumes of TPA were associated with lower prevalence of depression.

Limitations: Cross-sectional design and self-reported PA. Lack of assessment of sedentary behaviour or occupational PA.

Conclusions: The present study highlights the importance of contextual factors in the association between PA and mental health, particularly at higher levels.
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http://dx.doi.org/10.1016/j.jpsychires.2021.05.053DOI Listing
August 2021

Moderate to vigorous physical activity and sedentary behavior changes in self-isolating adults during the COVID-19 pandemic in Brazil: a cross-sectional survey exploring correlates.

Sport Sci Health 2021 Jun 5:1-9. Epub 2021 Jun 5.

The Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge, CB1 1PT UK.

Background: The 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.

Methods: A 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.

Results: A 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.

Conclusions: People 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 Information: The online version contains supplementary material available at 10.1007/s11332-021-00788-x.
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http://dx.doi.org/10.1007/s11332-021-00788-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8179086PMC
June 2021

Physical activity, exercise and mental disorders: It is time to move on.

Trends Psychiatry Psychother 2021 Apr 20. Epub 2021 Apr 20.

KU Leuven Department of Rehabilitation Sciences, Leuven, Belgium.

Physical activity, conceptualized as any bodily movement that results in energy expenditure, and its structured form, exercise are important in the prevention and treatment of a wide range of physical conditions, including metabolic and cardiovascular diseases and obesity. Compelling evidence has demonstrated that physical activity and exercise can also prevent common mental disorders, such as depression and anxiety disorders, and have multiple beneficial effects on physical and mental health of people with a wide range of mental disorders. This body of evidence has been incorporated in national and international guidelines over the last decades, recommending the inclusion of physical activity and exercise as therapeutic approaches for mental disorders, mainly for depression and schizophrenia. Nonetheless, implementation into clinical practice has been slow, probably due to mental health professionals and patients' barriers. This article aims to provide a brief overview and summary of the evidence on 1) the preventive effects of physical activity for a wide range of mental disorders; 2) the role of physical activity in physical health promotion of people with mental disorders; 3) the role of exercise as a strategy to manage mental health symptoms for a range of mental disorders; and 4) the challenges and barriers faced when implementing exercise in clinical practice.
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http://dx.doi.org/10.47626/2237-6089-2021-0237DOI Listing
April 2021

The Relationship between Motor Skills and Intelligence in Children with Autism Spectrum Disorder.

J Autism Dev Disord 2021 Apr 22. Epub 2021 Apr 22.

Department of Rehabilitation Sciences, University of Leuven, KU Leuven, ON IV Herestraat 49 - bus 1510, 3000, Leuven, Belgium.

This study explored the association between intelligence and motor skills in children with ASD after controlling for Attention Deficit and Hyperactivity Disorder (ADHD) and the associations between motor impairment and intellectual disability (ID) in this population. In total, 120 children with ASD (3-16 years; 81.7% boys) completed a standardized intelligence test, the Movement Assessment Battery for Children and Beery-Buktenica Developmental Test of Visual-Motor Integration. Variance in performance IQ was associated with 20.8% of the variance in motor skills while significant associations were found between comorbid ID and motor impairment (ɸ = 0.304). Manual Dexterity and Balance are moderately influenced by performance IQ in children with ASD. Furthermore, presence of ID is also moderately associated with motor impairment in this population.
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http://dx.doi.org/10.1007/s10803-021-05022-8DOI Listing
April 2021

A Mental Health-Informed Physical Activity Intervention for First Responders and Their Partners Delivered Using Facebook: Mixed Methods Pilot Study.

JMIR Form Res 2021 Apr 22;5(4):e23432. Epub 2021 Apr 22.

School of Psychiatry, University of New South Wales, Sydney, Australia.

Background: First responders (eg, police, firefighters, and paramedics) are at high risk of experiencing poor mental health. Physical activity interventions can help reduce symptoms and improve mental health in this group. More research is needed to evaluate accessible, low-cost methods of delivering programs. Social media may be a potential platform for delivering group-based physical activity interventions.

Objective: This study aims to examine the feasibility and acceptability of delivering a mental health-informed physical activity program for first responders and their self-nominated support partners. This study also aims to assess the feasibility of applying a novel multiple time series design and to explore the impact of the intervention on mental health symptoms, sleep quality, quality of life, and physical activity levels.

Methods: We co-designed a 10-week web-based physical activity program delivered via a private Facebook group. We provided education and motivation around different topics weekly (eg, goal setting, overcoming barriers to exercise, and reducing sedentary behavior) and provided participants with a Fitbit. A multiple time series design was applied to assess psychological distress levels, with participants acting as their own control before the intervention.

Results: In total, 24 participants (12 first responders and 12 nominated support partners) were recruited, and 21 (88%) completed the postassessment questionnaires. High acceptability was observed in the qualitative interviews. Exploratory analyses revealed significant reductions in psychological distress during the intervention. Preintervention and postintervention analysis showed significant improvements in quality of life (P=.001; Cohen d=0.60); total depression, anxiety, and stress scores (P=.047; Cohen d=0.35); and minutes of walking (P=.04; Cohen d=0.55). Changes in perceived social support from family (P=.07; Cohen d=0.37), friends (P=.10; Cohen d=0.38), and sleep quality (P=.28; Cohen d=0.19) were not significant.

Conclusions: The results provide preliminary support for the use of social media and a multiple time series design to deliver mental health-informed physical activity interventions for first responders and their support partners. Therefore, an adequately powered trial is required.

Trial Registration: Australian New Zealand Clinical Trials Registry (ACTRN): 12618001267246; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12618001267246.
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http://dx.doi.org/10.2196/23432DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8103303PMC
April 2021

Physical activity correlates in children and adolescents, adults, and older adults with an intellectual disability: a systematic review.

Disabil Rehabil 2021 Apr 16:1-12. Epub 2021 Apr 16.

Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium.

Purpose: Understanding enablers of and barriers for physical activity (PA) participation in people with intellectual disability (ID) is an essential first step to develop effective interventions. This systematic review examined correlates of PA across the socio-ecological model (i.e., intra-personal, inter-personal, environmental and policy level) in people with ID across the lifespan.

Material And Methods: Major electronic databases were searched from inception until 15 February 2021. Keywords included "physical activity" or "exercise" and "intellectual disability" or "mental retardation." A summary coding was used to analyze the data for adolescents (<18 years), adults (18 < 50 years), and older adults (50≤ years).

Results: Out of 83 PA correlates, retrieved from 39 studies ( = 26,456), only three consistent (i.e., reported in four or more studies) correlates were identified. In adults, older age (7/11, 64%), more severe ID (9/9, 100%) and the presence of physical mobility problems (3/4, 75%) were associated with decreased PA. From 38 correlates identified, no consistent correlates were identified for children and adolescents and older people.

Conclusions: Despite the abundance of evidence of the PA benefits for people with ID, we only found consistent evidence for three correlates reliably being related to PA in adults with ID. More research, particularly among young and older people is urgently needed.IMPLICATIONS FOR REHABILITATIONMore severe intellectual disability is an important barrier for being active in adults with intellectual disability.Presence of physical health problems is an important barrier for being active in adults with intellectual disability.
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http://dx.doi.org/10.1080/09638288.2021.1909665DOI Listing
April 2021

Correlates of missed HIV appointments in low-resource settings: a study from Uganda.

Afr J AIDS Res 2021 Jul 31;20(2):125-131. Epub 2021 Mar 31.

Department of Sociology and Social Administration, Kyambogo University, Kampala, Uganda.

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. Two hundred and ninety-five people living with HIV (median age 37.0 years; interquartile range 16.0; female 67.8% [ = 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. 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, = 0.01) for those who were physically inactive, and 2.29 (95% CI: 0.93-5.63, = 0.046) for those with depression. Targeting future rehabilitation studies for PLHIV around feelings of depression and around physical inactivity could be important in achieving optimal HIV treatment adherence.
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http://dx.doi.org/10.2989/16085906.2021.1895235DOI Listing
July 2021

Physical multimorbidity and social participation in adults aged ≥65 years from six low- and middle-income countries.

J Gerontol B Psychol Sci Soc Sci 2021 Mar 31. Epub 2021 Mar 31.

Research and Development Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, CIBERSAM, Barcelona, Spain.

Objectives: Multimorbidity is common among older adults from low- and middle-income countries (LMICs). Social participation has a role in protecting against negative health consequences, yet its association with multimorbidity is unclear, particularly in LMICs. Thus, this study investigated the relationship between physical multimorbidity and social participation among older adults across six LMICs.

Methods: Cross-sectional, community-based data including adults aged ≥65 years from six LMICs were analyzed from the WHO Study on Global AGEing and adult health (SAGE) survey. The association between 11 individual chronic conditions or the number of chronic conditions (independent variable) and social participation (range 0-10 with higher scores indicating greater social participation) (dependent variable) was assessed by multivariable linear regression analysis.

Results: 14,585 individuals [mean age 72.6 (SD 11.5) years; 54.9% females] were included. Among individual conditions, hearing problems, visual impairment, and stroke were significantly associated with lower levels of social participation. Overall, an increasing number of chronic conditions was dose-dependently associated with lower levels of social participation [e.g., ≥4 vs. 0 conditions ß=-0.26 (95%CI=-0.39, -0.13)]. The association was more pronounced among males than females.

Discussion: Older people with multimorbidity had lower levels of social participation in LMICs. Future longitudinal studies are warranted to further investigate temporal associations, and whether addressing social participation can lead to better health outcomes among older people with multimorbidity in LMICs.
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http://dx.doi.org/10.1093/geronb/gbab056DOI Listing
March 2021

The efficacy of exergaming in people with major neurocognitive disorder residing in long-term care facilities: a pilot randomized controlled trial.

Alzheimers Res Ther 2021 03 30;13(1):70. Epub 2021 Mar 30.

KU Leuven Department of Rehabilitation Sciences, Leuven, Belgium.

Background: It is currently unknown whether exergaming is efficacious in people with major neurocognitive disorder (MNCD) residing in long-term care facilities. This pilot randomized controlled trial (RCT) explored the efficacy of a stepping exergame program on gait speed, balance, mobility, reaction time, cognitive and neuropsychiatric outcomes, quality of life, and daily life functioning in people with MNCD residing in long-term care facilities.

Methods: Participants were randomly assigned to 8 weeks, three times weekly, 15 min of exergaming versus watching preferred music videos. The exergame device consisted of a pressure-sensitive step training platform on which participants performed stepping movements to play the games. The device automatically adapted the training level to the participants' capabilities. The Short Physical Performance Battery (SPPB), step reaction time test (SRTT), Montréal Cognitive Assessment (MoCA), Neuropsychiatric Inventory (NPI), Cornell Scale for Depression in Dementia (CSDD), Dementia Quality of Life (DQoL), and Katz Activities of Daily Living (Katz ADL) were assessed at baseline and post-intervention. A Quade's non-parametric ANCOVA controlling for baseline values with post hoc Bonferroni correction (p < 0.00625) was used to analyze pre- and post-differences between the groups. Partial eta-squared (ηp) effect sizes were calculated.

Results: Forty-five of 55 randomized inpatients with mild to moderate MNCD (Mini-Mental State Examination score = 17.2 ± 4.5; aged 70-91; 35 women) completed the study. The exergame group (n = 23) demonstrated improvements in gait speed (p < 0.001, η = 0.41), total SPPB (p < 0.001, η = 0.64), SRTT (p<0.001, η = 0.51), MoCA (p<0.001, η = 0.38), and reductions in CSDD (p<0.001, η = 0.43) compared to the control group (n = 22). There were no differences in NPI (p = 0.165, η = 0.05), DQoL (p = 0.012, η = 0.16), and ADL (p = 0.008, η = 0.16) post-intervention scores between the experimental and control group, albeit DQol and ADL measures showed large effect sizes in the exergame group. The mean attendance rate was 82.9% in the exergame group and 73.7% in the music control group. There were no study-related adverse events reported by the participants, nor observed by the research team.

Conclusions: The findings of this pilot RCT suggest that an individually adapted exergame training improves lower extremity functioning, cognitive functioning and step reaction time and symptoms of depression in inpatients with MNCD residing in long-term care facilities.

Trial Registration: ClinicalTrials.gov, NCT04436302.
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http://dx.doi.org/10.1186/s13195-021-00806-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8008333PMC
March 2021

Reliability and validity of physical fitness tests in people with mental disorders: A systematic review and meta-analysis.

Physiother Res Int 2021 Jul 27;26(3):e1904. Epub 2021 Mar 27.

Department of Sports Methods and Techniques, Federal University of Santa Maria, Santa Maria, Brazil.

Background: Several tests are available to assess the different components of physical fitness, including cardiorespiratory fitness, muscular strength, and flexibility. However, the reliability and validity of physical fitness tests in people with mental disorders has not been meta-analyzed.

Aims: To examine the reliability, concurrent, and convergent validity of physical fitness tests in people with mental disorders.

Methods: Studies evaluating the reliability, concurrent, and convergent validity of physical fitness tests in people with mental disorders were searched from major databases until January 20, 2020. Random-effects meta-analyses were performed pooling (1) reliability: test-retest correlations at two-time points, (2) convergent validity between submaximal tests and maximal protocols, or (3) concurrent validity between two submaximal tests. Associations are presented using r values and 95% confidence intervals. Methodological quality was assessed using the Quality Appraisal of Reliability Studies and the Critical Appraisal Tool.

Results: A total of 11 studies (N = 504; 34% females) were included. Reliability of the fitness tests, produced r values ranging from moderate (balance test-EUROFIT; [r = 0.75 (0.60-0.85); p = 0.0001]) to very strong (explosive leg power EUROFIT; [r = 0.96 (0.93-0.97); p = 0.0001]). Convergent validity between the 6-min walk test (6MWT) and submaximal cardiorespiratory tests was moderate (0.57 [0.26-0.77]; p = 0.0001). Concurrent validity between the 2-min walk test and 6MWT (r = 0.86 [0.39-0.97]; p = 0.0004) was strong.

Conclusion: The present study demonstrates that physical fitness tests are reliable and valid in people with mental disorders.
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http://dx.doi.org/10.1002/pri.1904DOI Listing
July 2021

Test-retest reliability and correlates of the 6-min walk test in people with alcohol use disorders.

Physiother Res Int 2021 Jul 27;26(3):e1900. Epub 2021 Feb 27.

Department of Rehabilitation Sciences, KU Leuven-University of Leuven, Leuven, Belgium.

Objectives: People with alcohol use disorders (AUD) are at a higher risk for physical co-morbidities. Consequently, their daily life functioning needs to be reliably assessed and followed-up. We examined the reliability of the 6-min walk test (6MWT) in a cohort of inpatients with AUD. Secondary aims were to assess minimal detectable changes (MDC ), practice effects and associations of the 6MWT with demographical and clinical variables.

Methods: Two 6MWTs were administered within 3 days to 45 (32♂) inpatients with a DSM-5 diagnosis of AUD. Physical complaints before and after the 6MWT were recorded. Patients performed a standing broad jump to assess muscle strength and completed the International Physical Activity Questionnaire, the Positive Affect and Negative Affect Schedule (PANAS) and Alcohol Use Disorders Identification Test.

Results: Patients walked 636.3 ± 82.3 meters and 638.1 ± 77.6 meters at the first and second test. The intraclass correlation coefficient was 0.94 (95% confidence interval 0.90-0.97). The MDC was 15 meters for men and 9 meters for women. No practice effect was detected. The presence of feet or ankle problems or pain before the test, dyspnea after the test, impaired muscle strength and lower PANAS positive affect scores were independently related to shorter 6MWT distance accounting for 67.3% of the variance.

Conclusion: The 6MWT is a reliable tool for evaluating the functional exercise capacity in inpatients with AUD. Health care professionals should consider musculoskeletal and respiratory symptoms when interpreting fitness test outcomes in this vulnerable population.
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http://dx.doi.org/10.1002/pri.1900DOI Listing
July 2021

Physical activity, physical fitness and quality of life in outpatients with a psychotic disorder versus healthy matched controls in a low-income country.

Schizophr Res 2021 03 17;229:1-2. Epub 2021 Feb 17.

Department of Sociology and Social Administration, Kyambogo University, Kampala, Uganda.

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http://dx.doi.org/10.1016/j.schres.2021.01.019DOI Listing
March 2021

Dropout from exercise randomized controlled trials among people with anxiety and stress-related disorders: A meta-analysis and meta-regression.

J Affect Disord 2021 03 6;282:996-1004. Epub 2021 Jan 6.

Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, UK; Health Service and Population Research Department, Institute of Psychiatry, King's College London, London, UK.

Objective: . Exercise has established efficacy in people with anxiety and stress-related disorders. Dropouts from randomized controlled trials (RCT's) pose a threat to the validity of the evidence, with dropout rates varying across studies. We conducted a meta-analysis to investigate the prevalence and predictors of dropout rates among adults with anxiety and stress-related disorders participating in exercise RCT's.

Methods: . Two authors searched major electronic databases up to 07/2020. We included RCT's of exercise interventions in people with anxiety and stress-related disorders that reported dropout rates. A random effects meta-analysis and meta-regression were conducted.

Results: . Fourteen RCT's involving 16 exercise interventions (n=369, mean age 20.7 to 67.7years; 38.4% male) were included. The trim-and-fill-adjusted prevalence of dropout across all studies was 22.4% (95%CI = 15.0% to 32.0%). Applying controlled motivation strategies (P<0.001) predicted higher dropout. Supervision during all sessions and by an expert in exercise prescription and applying autonomous motivation strategies predicted lower dropout (all P<0.001). Dropout was similar in exercise versus control conditions (OR = 0.84, 95%CI = 0.54 to 1.29, p = 0.42, I = 0%; N=16).

Limitations: . Potentially important moderators of dropout, such as the severity of mental health symptoms and illness duration were insufficiently available.

Conclusions: . Exercise is well tolerated by people with anxiety and stress-related disorders and drop out in RCT's is comparable to control conditions. Thus, exercise is a feasible treatment, in particular when autonomous motivation strategies are included and when the intervention is delivered by healthcare professionals with expertise in exercise prescription.
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http://dx.doi.org/10.1016/j.jad.2021.01.003DOI Listing
March 2021

The efficacy of a lay health workers - led physical activity counselling program in patients with HIV and mental health problems: a real-world intervention from Uganda.

AIDS Care 2021 Jan 23:1-7. Epub 2021 Jan 23.

Butabika National Referral and Mental Health Hospital, Kampala, Uganda.

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 farming community. In total 49 (35 women) community patients (40.0 ± 11.2 years) followed an 8-week once weekly LHW-led PA counselling program based on a self-determination theory and motivational interviewing framework. Participants completed the Simple Physical Activity Questionnaire, Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, HIV/AIDS Stress Scale and World Health Organization Disability Assessment Schedule 2 (WHODAS 2) pre- and immediately post-intervention. Small, significant (< 0.05) effect sizes were found for reductions in HIV/AIDS-related stress (Cohen's d = 0.26) and in global disability (Cohen's d = 0.46). Large effect sizes were observed for reductions in time spent sedentary (Cohen's d = 1.97) and reductions in depressive (Cohen's d = 2.04) and anxiety (Cohen's d = 1.47) symptoms and increases in time spent active (Cohen's d = 1.98). Greater decrease in sedentary time was associated with greater anxiety symptoms reduction ( = 0.32,  = 0.021). In physically inactive patients with HIV/AIDS and mental health problems, an LHW-led PA counselling program reduced stress, anxiety, depression and disability. Randomized controlled trials are needed to confirm these preliminary positive findings.
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http://dx.doi.org/10.1080/09540121.2021.1874268DOI Listing
January 2021

Effects of acute exercise on craving, mood and anxiety in non-treatment seeking adults with alcohol use disorder: An exploratory study.

Drug Alcohol Depend 2021 03 8;220:108506. Epub 2021 Jan 8.

Physical Activity for Health Research Cluster, Health Research Institute, University of Limerick, Ireland.

Background: Exercise is increasingly being used in the treatment of alcohol use disorder (AUD). We examined the short-term effects of acute exercise on alcohol craving, mood states and state anxiety in physically inactive, non-treatment seeking adults with AUD.

Methods: Exploratory, single-arm study. In total, 140 adults with AUD (53.7 ± 11.8 years; 70 % female) were included in a randomized controlled trial (RCT) to study effects of physical activity on alcohol consumption. This acute exercise study was nested within the larger RCT. The intervention was a 12-minute sub-maximal fitness test performed on a cycle ergometer. Participants self-rated their desire for alcohol (DAQ) and completed mood (POMS-Brief) and state anxiety (STAI-Y1) questionnaires 30-minutes before exercise, immediately before, immediately after, and 30-minutes post. Ratings of perceived exertion (RPE) were collected. Effects of exercise were assessed using RM-ANOVA and dependent sample t-tests with effect sizes (Hedges g).

Results: In total, 70.6 % had mild or moderate AUD (DSM-5 criteria = 4.9 ± 2). The intervention was generally perceived as 'strenuous' (RPE = 16.1 ± 1.6). In the total sample, there was a main effect of time with reductions in alcohol craving [F(3,411) = 27.33, p < 0.001], mood disturbance [F(3,411) = 53.44, p < 0.001], and state anxiety [F(3,411) = 3.83, p = 0.013]. Between-group analyses indicated larger magnitude effects in those with severe compared to mild AUD, however, AUD severity did not significantly moderate the within-group improvements: group x time interaction for alcohol craving [F(6,411) = 1.21, p = 0.305]. Positive effects of exercise were maintained 30-minutes post-exercise.

Conclusion: A short bout of aerobic exercise reduced alcohol craving and improved mood states in adults with AUD.
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http://dx.doi.org/10.1016/j.drugalcdep.2021.108506DOI Listing
March 2021

Test-retest reliability, concurrent validity and correlates of the two-minute walk test in outpatients with alcohol use disorder.

Alcohol 2021 02 8;90:74-79. Epub 2021 Jan 8.

Butabika National Referral and Mental Health Hospital, Kampala, Uganda; Faculty of Arts and Social Sciences, Kyambogo University, Kampala, Uganda.

We investigated the test-retest reliability of the 2-min walk test (2MWT) and its concurrent validity with the 6-min walk test (6MWT) in Ugandan outpatients with alcohol use disorder (AUD). We also explored practice effects, and assessed the minimal detectable change (MDC) and correlations with the 2MWT. Fifty outpatients [7 women; median age = 32.0 years] performed the 2MWT twice, the 6MWT once, and completed the Simple Physical Activity Questionnaire, Brief Symptoms Inventory-18 (BSI-18), and Alcohol Use Disorders Identification Test. The median (interquartile) 2MWT score on the first and second test were 162.0 (49.0) meters and 161.0 (58.0) meters, respectively, without significant difference between the two trials (p = 0.20). The intraclass correlation between the two 2MWTs was 0.96 (95% confidence interval = 0.94-0.98). The Spearman Rho correlation between the second 2MWT and the 6MWT was 0.91 (p < 0.001). The MDC for the 2MWT was 18 m. There was no evidence of a practice effect. Variance in BSI-18 depression and the presence of leg pain following the 2MWT explained 18.7% of 2MWT score variance. The 2MWT is a reliable and valid fitness test, which can be conducted without any special equipment or substantial time demands in outpatients with AUD.
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http://dx.doi.org/10.1016/j.alcohol.2020.12.001DOI Listing
February 2021

Physical Activity, Sedentary Behavior, and Cardiorespiratory Fitness in Hazardous and Non-Hazardous Alcohol Consumers.

Am J Health Promot 2021 06 7;35(5):669-678. Epub 2021 Jan 7.

Epidemiology of Psychiatric Conditions, Substance Use and Social Environment (EPiCSS), Department of Public Health Sciences, 27106Karolinska Institutet, Stockholm, Sweden.

Purpose: To describe physical activity habits, sedentary behavior, and cardiorespiratory fitness levels among alcohol abstainers, hazardous and non-hazardous drinkers.

Design: Cross-sectional study with data collected between 2017-19.

Setting: Sweden.

Subjects: Adults aged 18-65 years (n = 47,559; 59.4% male).

Measures: During a routine health assessment, participants answered validated single-item questions regarding: habitual physical activity, structured exercise, and the percentage of time spent sedentary during leisure-time (past 30 days), and completed a 6-minute cycle ergometer test (V02max) to determine cardiorespiratory fitness (CRF). Participants were categorized as alcohol abstainers, non-hazardous drinkers or hazardous drinkers (low/high) based on the Alcohol Use Disorders Identification Test (AUDIT-C) cut-points for men and women.

Analysis: Logistic regression models stratified by sex and age.

Results: Compared to non-hazardous drinkers, the heaviest drinkers were less physically active (males: OR = 1.38, CI = 1.13-1.67, p = .001; females: OR = 1.41, CI = 1.01-1.97, p = .040) and more sedentary during leisure time (males: OR = 1.94, CI = 1.62-2.32, p = .000; females: OR = 1.62, CI = 1.21-2.16, p = .001). Apart from young females, the heaviest drinkers also did less structured exercise than non-hazardous drinkers (males: OR = 1.22, CI = 1.15-1.51, p = .000; females: OR = 1.43, CI = 1.15-1.78, p = .001). The strongest associations were seen among adults aged 40-65 years (shown here). High-hazardous drinking was associated with low CRF among older males only (OR = 1.19, CI = 1.00-1.41).

Conclusion: Middle-aged adults with AUDIT-C scores of ≥6 (women) and ≥7 (men) were less physically active and more sedentary during leisure time and may be appropriate targets for physical activity interventions.
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http://dx.doi.org/10.1177/0890117120985830DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8165738PMC
June 2021

Test-retest reliability and correlates of the Simple Physical Activity Questionnaire in Ugandan out-patients with psychosis.

Afr Health Sci 2020 Sep;20(3):1438-1445

Kyambogo University, Kampala, Uganda.

Background: In order to facilitate people with psychosis to increase their physical activity (PA) levels, a reliable measurement 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 demographic 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<0.001) for structured exercise to 0.96 (P<0.001) for walking. Women, non-smokers and those without HIV/AIDS showed higher incidental PA than men, smokers and those with HIV/AIDS.

Conclusion: The SIMPAQ is a reliable tool to assess PA and sedentary levels in Ugandan outpatients with psychosis. Men, smokers and those with HIV/AIDS appear to be at risk for lower incidental PA.
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http://dx.doi.org/10.4314/ahs.v20i3.49DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7751552PMC
September 2020

Physical activity participation is associated with higher quality of life scores in men with alcohol use disorders: a study from Uganda.

Afr Health Sci 2020 Sep;20(3):1407-1415

Butabika National Referral Mental Hospital, Kampala, Uganda.

Background: There is a growing recognition of the importance of encouraging people with alcohol use disorders (AUD) to become more active as an achievable strategy to reduce the disability-associated burden.

Objective: We investigated whether physical activity and sedentary behaviour in men with AUD contribute to their quality of life (QoL).

Methods: Fifty male Ugandan inpatients with AUD (33.0±10.7 years) completed the World Health Organization Quality of Life Assessment brief version, Simple Physical Activity Questionnaire and the Alcohol Use Disorders Identification Test while waist circumference, body mass index and blood pressure were assessed. Linear multiple regression analysis explored the total variance in QoL explained by all predictor variables.

Results: SIMPAQ walking and SIMPAQ exercise explained 46% of the variability in physical QoL, 45% of the variability in psychological QoL, and 40% of the variability in environmental QoL. The SIMPAQ walking score predicted 37% of the variability in social QoL.

Conclusion: The current findings suggest that higher levels of walking and exercising are associated with a better QoL. Our study therefore provides a platform for future research to investigate the role of physical activity on QoL levels in people with AUD, also in low resourced settings in low-income countries such as Uganda.
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http://dx.doi.org/10.4314/ahs.v20i3.46DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7751549PMC
September 2020

The efficacy of meditation-based mind-body interventions for mental disorders: A meta-review of 17 meta-analyses of randomized controlled trials.

J Psychiatr Res 2021 02 21;134:181-191. Epub 2020 Dec 21.

NICM Health Research Institute, Western Sydney University, Westmead, Australia; Division of Psychology and Mental Health, University of Manchester, Manchester, UK.

There is increasing interest in the potential efficacy of meditation-based mind-body interventions (MBIs) within mental health care. We conducted a systematic metareview of the published randomized control trial (RCT) evidence. MEDLINE/PubMed, PsycARTICLES and EMBASE were searched from inception to 06/2020 examining MBIs (mindfulness, qigong, tai chi, yoga) as add-on or monotherapy versus no treatment, minimal treatment and passive and active control conditions in people with a mental disorder. The quality of the methods of the included meta-analyses using A Measurement Tool to Assess Systematic Reviews (AMSTAR) and the methodological quality of the RCTs using AMSTAR-Plus. Sixteen (94%) of 17 meta-analyses had good overall methodological quality. The content validity of the included RCTs was considered good in 9 (53%) meta-analyses. In meta-analyses with good methodological quality (AMSTAR 8≤) and content validity (AMSTAR+ 4≤), large effect sizes (0.80 or higher) were observed for mindfulness in schizophrenia and in ADHD, a moderate (0.50 ≤ 0.80) effect size for mindfulness in PTSD and a small (0.20 < 0.50) effect size for yoga in schizophrenia No serious adverse events were reported (n RCTs = 43, n in the MBI arms = 1774), while the attrition rates were comparable with the rates in passive and active control conditions. Our meta-review demonstrates that mindfulness and to a lesser extent yoga may serve as an efficacious supplement to pharmacotherapy, and psychotherapy and can be complementary in healthy lifestyle interventions for people with mental disorders. Meta-analytic evidence of high methodological quality and content validity of included trials is currently lacking for qigong and tai chi.
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http://dx.doi.org/10.1016/j.jpsychires.2020.12.048DOI Listing
February 2021

Independent and combined associations of sugar-sweetened beverage consumption, TV viewing, and physical activity with severe depressive symptoms among 59,402 adults.

Braz J Psychiatry 2020 Dec 18. Epub 2020 Dec 18.

Departamento de Educação Física, Universidade Federal de Sergipe (UFS), São Cristóvão, SE, Brazil.

Objective: Our aim was to analyze the association between sugar-sweetened beverage consumption and depressive symptoms, as well as the extent to which TV viewing and physical activity moderate this association.

Methods: We used cross-sectional data from the 2013 Brazilian National Survey (Pesquisa Nacional de Saúde) of 59,402 adults (33,482 women, mean age = 42.9 years, 95%CI 42.7-43.2 years). Depressive symptoms (Patient Health Questionnaire-9), physical activity, TV viewing, and sugar-sweetened beverage consumption, as well as potential confounders (chronological age, ethnicity, consumption of candy/sweets and fruit, multimorbidity, education, and employment status) were self-reported. Poisson regression models were used for association analyses.

Results: The consumption of 16 or more glasses/week of sugar-sweetened beverages was associated with higher levels of severe depressive symptoms among women compared to no consumption (prevalence ratio [PR] 1.71 [95%CI 1.38-2.11]). Consistent interactions were observed between 1-5 glasses and TV viewing (PR 2.09 [95%CI 1.06-4.12]) and between 11-15 glasses and TV viewing (PR 2.90 [95%CI 1.29-6.50]) among men compared to no consumption, given that the co-occurrence of sugar-sweetened beverage consumption and elevated TV viewing was associated with higher odds of severe depressive symptoms. Sugar-sweetened beverage consumption did not interact with physical activity, only presenting an independent association.

Conclusion: Sugar-sweetened beverage consumption was independently associated with severe depressive symptoms among women and interacted with TV viewing, but not with physical activity among men.
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http://dx.doi.org/10.1590/1516-4446-2020-1073DOI Listing
December 2020

Moderate to severe generalized anxiety disorder symptoms are associated with physical inactivity in people with HIV/AIDS: a study from Uganda.

Int J STD AIDS 2021 02 15;32(2):170-175. Epub 2020 Dec 15.

KU Leuven Department of Rehabilitation Sciences, Leuven, Belgium.

The aim of this cross-sectional study was to explore the prevalence of moderate to severe generalized anxiety disorder (GAD) symptoms and its association with physical activity in people living with HIV (PLHIV) in Uganda. Two hundred and ninety-five PLHIV (median [interquartile range] age = 37.0 years [16.0]; 200 women) completed the GAD-7, Physical Activity Vital Sign, Patient Health Questionnaire-9, and the Alcohol Use Disorders Identification Test. An adjusted odds ratio for physical inactivity in people with moderate to severe GAD symptoms was calculated using binary logistic regression analyses. The prevalence of moderate to severe GAD symptoms was 9.1%. Those with moderate to severe GAD symptoms had a 16.8 times higher odds (95% CI = 5.0-55.9) for not complying with the physical activity recommendations. The current study shows that moderate to severe GAD symptoms are strongly associated with physical inactivity in PLHIV living in a country such as Uganda.
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http://dx.doi.org/10.1177/0956462420942992DOI Listing
February 2021

Reliability and Convergent Validity of Self-Reported Physical Activity Questionnaires for People With Mental Disorders: A Systematic Review and Meta-Analysis.

J Phys Act Health 2020 12 1;18(1):109-115. Epub 2020 Dec 1.

Purpose: To examine the reliability and convergent validity of self-reported questionnaires (SRQs) to measure physical activity (PA).

Methods: Systematic review with meta-analysis. The validity and reliability of SRQs to assess PA in people with mental disorders (January 20, 2020). Random-effects meta-analyses were performed pooling (1) test-retest correlations or (2) the convergent validity between the SRQs and objective measures (eg, accelerometry). Associations were provided in r values with the 95% confidence interval. Methodological quality was assessed.

Results: A total of 9 unique studies (N = 1344; 40.5% females) were included. The authors found a moderate correlation test-retest reliability for PA SRQs in the assessment of vigorous PA (r = .69 [.38 to .85]; P = .001), moderate to vigorous PA (r = .63 [.25 to .84]; P = .003), moderate PA (r = .63 [.39 to .79]; P = .001), and good correlation total PA (r = .75 [.37 to .92]; P = .001). The SRQs have moderate correlations with objective measures for moderate to vigorous PA (r = .25 [.18 to .32]; P = .0001) and total PA (r = .47 [.28 to .62]; P = .005), a poor correlation for moderate PA (r = .18 [.03 to .36]; P = .047), and no correlation with vigorous PA (r = .06 [-.10 to .22]; P = .440).

Conclusion: Current evidence indicates that SRQs are reliable over time to assess moderate, vigorous, and total PA levels and valid when assessing moderate PA.
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http://dx.doi.org/10.1123/jpah.2020-0312DOI Listing
December 2020

Impact of Psychotropic Medication Effects on Obesity and the Metabolic Syndrome in People With Serious Mental Illness.

Front Endocrinol (Lausanne) 2020 9;11:573479. Epub 2020 Oct 9.

Department of Neurosciences, Center for Clinical Psychiatry, KU Leuven, Leuven, Belgium.

People with serious mental illness (SMI), including schizophrenia, bipolar disorder, and major depressive disorder, have a higher mortality rate and shortened life expectancy. This is mainly attributable to physical diseases, particularly cardiovascular diseases (CVDs). Important risk factors for CVDs are obesity and other metabolic abnormalities, which are especially prevalent in people with SMI. Several factors contribute to this increased risk, including unhealthy lifestyles. Psychotropic medication independently further increases this risk. In this review we want to examine the relationship between obesity and other components of the metabolic syndrome and psychotropic medication in people with SMI.
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http://dx.doi.org/10.3389/fendo.2020.573479DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7581736PMC
May 2021

Exergaming for people with major neurocognitive disorder: a qualitative study.

Disabil Rehabil 2020 Sep 23:1-9. Epub 2020 Sep 23.

Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium.

Purpose: This study investigated the experiences of participation in a standing balance exergame program amongst people with major neurocognitive disorder (MNCD) within residential care settings.

Materials And Methods: A qualitative descriptive study was conducted in participants with MNCD recruited from two residential settings. Participants exergamed for 15 min, three times per week for 8 weeks. Semi-structured interviews were conducted in all participants of the trial after 4 and 8 weeks. Audio files were transcribed and subsequently a thematic content analysis was performed using NVivo 12. Activity logs including adherence and attrition rates were kept.

Results: Thirty-one participants with MNCD participated (median age = 85 (67-93) years; 77.4% women; Mini-Mental State Examination score = 19 (10-25)). Four broad themes emerged: (1) cognitive effects; (2) physical effects; (3) psychosocial effects and (4) motivators. The tailored exergame program was perceived as enjoyable. It stimulated participants' attention, concentration, reaction time, and memory. Participants reported improvements in balance, flexibility, and gait. Exergaming made participants energetic and calm. The attrition rate was 0% and the mean attendance rate was 79.3%.

Conclusions: The results indicate that standing balance exergaming is feasible, beneficial, and engaging in people with MNCD.Implications for rehabilitationExergames present a personalised intervention for engaging people with major neurocognitive disorder in physical activity.An exergame intervention is feasible and highly appreciated in this population.Exergames should be adapted to the individuals' needs and possibilities in order to enhance motivation and learning.
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http://dx.doi.org/10.1080/09638288.2020.1822934DOI Listing
September 2020

A meta-review of "lifestyle psychiatry": the role of exercise, smoking, diet and sleep in the prevention and treatment of mental disorders.

World Psychiatry 2020 Oct;19(3):360-380

South London and Maudsley NHS Foundation Trust, London, UK.

There is increasing academic and clinical interest in how "lifestyle factors" traditionally associated with physical health may also relate to mental health and psychological well-being. In response, international and national health bodies are producing guidelines to address health behaviors in the prevention and treatment of mental illness. However, the current evidence for the causal role of lifestyle factors in the onset and prognosis of mental disorders is unclear. We performed a systematic meta-review of the top-tier evidence examining how physical activity, sleep, dietary patterns and tobacco smoking impact on the risk and treatment outcomes across a range of mental disorders. Results from 29 meta-analyses of prospective/cohort studies, 12 Mendelian randomization studies, two meta-reviews, and two meta-analyses of randomized controlled trials were synthesized to generate overviews of the evidence for targeting each of the specific lifestyle factors in the prevention and treatment of depression, anxiety and stress-related disorders, schizophrenia, bipolar disorder, and attention-deficit/hyperactivity disorder. Standout findings include: a) convergent evidence indicating the use of physical activity in primary prevention and clinical treatment across a spectrum of mental disorders; b) emerging evidence implicating tobacco smoking as a causal factor in onset of both common and severe mental illness; c) the need to clearly establish causal relations between dietary patterns and risk of mental illness, and how diet should be best addressed within mental health care; and d) poor sleep as a risk factor for mental illness, although with further research required to understand the complex, bidirectional relations and the benefits of non-pharmacological sleep-focused interventions. The potentially shared neurobiological pathways between multiple lifestyle factors and mental health are discussed, along with directions for future research, and recommendations for the implementation of these findings at public health and clinical service levels.
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http://dx.doi.org/10.1002/wps.20773DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7491615PMC
October 2020

Associations of moderate to vigorous physical activity and sedentary behavior with depressive and anxiety symptoms in self-isolating people during the COVID-19 pandemic: A cross-sectional survey in Brazil.

Psychiatry Res 2020 10 27;292:113339. Epub 2020 Jul 27.

The Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge, CB1 1PT, UK.

This is a cross-sectional study evaluating the associations of self-reported moderate to vigorous physical activity, and sedentary behavior with depressive, anxiety, and co-occurring depressive and anxiety symptoms (D&A) in self-isolating Brazilians during the COVID-19 pandemic. Depressive and anxiety symptoms were collected using the Beck Depression and Anxiety Inventories (BDI and BAI). Among the 937 participants (females=72.3%), those performing ≥30 min/day of moderate to vigorous or ≥15 min/day of vigorous physical activity had lower odds of prevalent depressive, anxiety, and co-occurring D&A symptoms. Those spending ≥10 h/day sedentary were more likely to have depressive symptoms.
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http://dx.doi.org/10.1016/j.psychres.2020.113339DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7384423PMC
October 2020

Exergames in people with major neurocognitive disorder: a systematic review.

Disabil Rehabil Assist Technol 2020 Jul 22:1-14. Epub 2020 Jul 22.

University Psychiatric Center, KU Leuven, Kortenberg, Belgium.

Purpose: To systematically evaluate the efficacy of exergames in individuals with major neurocognitive disorder.

Materials And Methods: PubMed, EMBASE and PEDro were systematically searched from inception until October 2019 for randomised and clinical controlled trials. Methodological quality of the trials was assessed with the PEDro rating scale or Risk of Bias in Nonrandomised Studies of Interventions-I (ROBINS-I), when appropriate. Grading of Recommendations Assessments, Development and Evaluation (GRADE) was used to assess the overall quality of the evidence.

Results: Eight trials, all of moderate to high methodological quality (i.e., PEDro score of 6 or higher or a Robins-I moderate quality score) were included. The overall quality of evidence was moderate to high according to the GRADE criteria. Improvements in gait, mobility and balance and beneficial effects on activities of daily living performance, cognitive function, fear of falls, quality of life and mood following exergaming were reported. Heterogeneity in outcome measures, intervention characteristics and included participants precluded a meta-analysis.

Conclusions: The current literature is of moderate to high quality and demonstrates that exergames have a wide range of physical and mental benefits in people with major neurocognitive disorder. More controlled trials are however needed to confirm the existing evidence before exergames can be recommended in treatment guidelines for people with major neurocognitive disorder.Implications for rehabilitationExergames have many physical and mental benefits in people with major neurocognitive disorderExergaming can enhance gait, mobility and balance in people with major neurocognitive disorderEvidence for beneficial cognitive effects of exergaming is emerging.
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http://dx.doi.org/10.1080/17483107.2020.1785566DOI Listing
July 2020
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