Exercise-Based Interventions for Mental Illness: Physical Activity as Part of Clinical Treatment

Exercise-Based Interventions for Mental Illness: Physical Activity as Part of Clinical Treatment
Copyright
List of Contributors
Dedication
Foreword
Introduction
	Why Mental Health?
	Mental Illness and Mental Health
	Integrating Mind and Body: Mental and Physical Ill-Health
	Mental Illness Is All of Our Business
	References
1. Exercise for the Prevention and Treatment of Depression
	Introduction
	Relationship Between Physical Activity and Depression
		Physical Activity and the Prevalence of Depression
		Physical Activity and the Incidence of Depression
	Exercise as a Treatment for MDD
		Evidence From Meta-Analyses
		Exercise for Symptom Management
		Exercise Training for Depression: Historical Development and Potential Prescriptions
		Potential Mechanisms
		Barriers/Facilitators
	Summary and Future Directions
	References
2. Exercise for the Management of Anxiety and Stress-Related Disorders
	Anxiety: What Is It and Why Do We Care?
		Definition and Conceptualizations
		Etiology and Development
		Anxiety and Stress-Related Disorders
		Traditional Treatment of Anxiety and Stress-Related Disorders
		Measurement of Anxiety Symptoms and Anxiety and Stress-Related Disorders
			Diagnostic Interviews
			Diagnostic Screeners
			Measures of Anxiety Symptoms
			Disorder-Specific Symptom Inventories
	Exercise Effects in Anxiety and Stress-Related Disorders
		Exercise Effects on Anxiety and Among Patients With Anxiety and Stress-Related Disorders
			Exercise Effects on Anxiety
			Exercise Effects Among Patients With Anxiety and Stress-Related Disorders
			Early Studies
			Studies of Mixed Samples of SAD, GAD, and PD Patients
			Specific Phobias
			SAD Patients
			GAD Patients
			OCD Patients
			PTSD Patients
			PD Patients
		Plausible Mechanisms of the Anxiolytic Effects of Exercise
			Self-Concept/Self-Esteem
			Exposure
			Expectation/Placebo Effect
			Adaptations in the GABA Neurotransmitter System
			Adaptations in the Norepinephrine Neurotransmitter System
			Adaptations in the Serotonin Neurotransmitter System
		Exercise Prescription, Dose, and Compliance
	Summary
	References
3. Bipolar Disorder and Physical Activity
	Introduction
	Clinical Features
	Epidemiology, Burden, and Risk Factors
	Physical Health of People With Bipolar Disorder
		Current Treatments for Bipolar Disorder
	Physical Activity and Bipolar Disorder
	Examples of Trials Including a Physical Activity Component in People With Bipolar Disorder
	Future Directions
	Conclusions
	References
4. Schizophrenia and Exercise
	INTRODUCTION
	CLINICAL FEATURES
		Positive Symptoms
		Negative Symptoms
		Cognitive Impairment
	EPIDEMIOLOGY AND RISK FACTORS
	CURRENT TREATMENT STRATEGIES FOR SCHIZOPHRENIA
	PHYSICAL HEALTH OF PEOPLE WITH SCHIZOPHRENIA
	PHYSICAL ACTIVITY AND SCHIZOPHRENIA
		Factors Influencing Physical Activity Participation
		Benefits of Physical Activity for People with Schizophrenia
	EXAMPLES OF PA INTERVENTION STUDIES
		Keeping the Body in Mind
	FUTURE DIRECTION—SUSTAINABLE IMPLEMENTATION
	CONCLUSION
	References
5. Exercise for Alcohol Use Disorders
	Alcohol Use Disorders: Definition, Prevalence, and Societal Impact
	Help-Seeking Is Poor and Treatment Response Limited
	Comorbid Health Problems Are Common in AUDs
		Psychiatric Comorbidity and Cognitive Deficits
	Current Treatment Options for AUDs
		Brief Interventions and Internet-Based Support
	Evidence of the Benefits of Exercise From Intervention Studies
	Reviews of the Evidence—Positive Effects on Health, Depression, and Physical Fitness
		Dropout and Treatment Adherence
		Safety and Adverse Effects
	Mechanisms of Action: Mood States, Inflammation, and Cognition
	Alcohol Consumption and Physical Activity in the General Population
	Conclusions and Clinical Implications
	References
6. Sedentary Behavior and Mental Health
	Sedentary Behavior
	Sedentary Behavior and Mental Health in Adults
		Depression and Anxiety
	Bipolar Disorder
	Schizophrenia
		Sedentary Behavior and Mental Health in Children and Adolescents
		General Limitations of Current Research
		Strategies to Reduce Sedentary Behavior in Those With Mental Health Disorders
	Summary
	References
7. Exercise for Older People With Mental Illness
	Introduction
		Benefits of Physical Activity and Exercise
	Methods
		Search Strategy
		Selection Criteria
		Data Extraction and Appraisal
	Results
		Effects of Exercise on Severity of Depression
		Effects of Exercise on the Cognitive Function of Older Adults With Dementia
	Discussion
		Main Findings
		Recommendations for Clinical Practice
		Implications for Research
	Conclusions
	References
8. Exercise for Adolescents and Young People With Mental Illness
	EXERCISE FOR ADOLESCENTS AND YOUNG PEOPLE WITH MENTAL ILLNESS
	YOUNG PEOPLE AND MENTAL ILL HEALTH
	EXERCISE FOR DEPRESSION IN YOUNG PEOPLE: THE EVIDENCE
	EXERCISE FOR ANXIETY IN YOUNG PEOPLE: THE EVIDENCE
	EXERCISE FOR BIPOLAR AFFECTIVE DISORDER IN YOUNG PEOPLE: THE EVIDENCE
	EXERCISE FOR EARLY PSYCHOSIS IN YOUNG PEOPLE: THE EVIDENCE
	EXERCISE FOR SUBSTANCE USE/ABUSE: THE EVIDENCE
	SUMMARY OF THE EVIDENCE BASE FOR EXERCISE INTERVENTIONS IN YOUTH MENTAL HEALTH
	APPLICATION IN CLINICAL PRACTICE
	CONCLUSIONS
	References
9. Eating Disorders and Exercise—A Challenge
	Introduction
	Eating Disorders: Diagnostic Characteristics
	Exercise in the Diagnostic Criteria of Eating Disorders
	The Meaning of Exercise and Eating Disorders in Clinical Practice
	Prevalence of High Levels of Exercise in Eating Disorders
	How Should the Level of Activity in Patients With Eating Disorders Be Measured?
		Different Questionnaires Assessing the Context of Physical Activity Are Available
	How Much Exercise Is Too Much and When Does Physical Activity Become Unhealthy and/or Harmful in Patients With Eating Disor ...
	References
10. Behavioral and Psychological Approaches in Exercise-Based Interventions in Severe Mental Illness
	Barriers and Obstacles to PA
	Motivational Correlates of PA in Mental Disorders
	Social-Cognitive Theories and PA
	BCTs as a Practical Component to Implement PA Interventions
	PA Preferences May Be the Next Step to Maximize Long-Term Adherence
	A Framework for Exercise Interventions for Adults With severe mental illness (SMI)
	Initiation: To Fill the Gym
		Exercise
			Collective Endorsement of Exercise as Treatment by Care Providers
		Behavior Change Techniques
			Initial Interview
			Implementation Intentions
	Development: Let\'s Talk About Pleasure in Exercise
		Exercise
			A Self-Paced Intensity During First Sessions
		Behavior Change Techniques
	Adherence: I Feel Confident in My Ability to Come Back to the Next Session
		Exercise
			Delivery Style of Behavioral Support
		Behavior Change Techniques
	Maintenance: From Gym to Green (Football, Park, Garden)
		Exercise
			The Exercise Professional as a Counselor
		Behavior Change Techniques
	References
11. Exercise Interventions in Secure and Forensic Services
	Secure and Forensic Services
	Physical Health of Secure Forensic Service Users
	The Potential and Importance of Exercise in Secure Care
	Developing Physical Activity Programs for People With Mental Illness in Secure Care
	Conclusion
	References
12. mHealth and Physical Activity Interventions Among People With Mental Illness
	Introduction
	What Is mHealth?
		mHealth Technologies
			Smartphone Devices
			Internet-Delivered Education
			Smartphone “Apps”
			Wearable Technology
		mHealth for Physical Health Care
	Summary
		What Can mHealth Be Used for?
	mHealth for Mental Health Care
		mHealth Uses for People With SMI
		Ownership and Endorsement of mHealth Technologies for People With SMI
			Questions
			Ownership
			Endorsement
			Barriers for People With SMI
		mHealth Interventions in Mental Health Settings
			Smartphone Apps for SMI
			Symptom Monitoring
			Intervention Delivery
			Other Uses
	Summary
		Mobile Technology for Mental Health
	How can mHealth Increase Physical Activity in People With SMI?
		Why Is It Important to Increase Physical Activity in People With SMI?
		Current Physical Activity Interventions in SMI
		Using mHealth to Increase Physical Activity
		Previous Research Using mHealth to Increase Physical Activity in People With SMI
			Smartphone Apps
			Wearable Devices
		Other Technological Approaches to Increase Physical Activity in People With SMI
	Summary
		Increasing Physical Activity in People With SMI
	Conclusions and Future Directions
		Recommendations
	Conclusions
	References
	Further Reading
13. Integration of the Exercise Professional Within the Mental Health Multidisciplinary Team
	Introduction
		Meeting Needs and Role Delineation
	What Is an Exercise Professional?
		Why the Need for an Exercise Professional?
			Clinicians Beliefs of Exercise in Mental Health
		What Are Important Attributes of Exercise Professionals?
	Examples of Integration
		The Keeping the Body in Mind Example
		The Secure Extended Care Facility Example
		The Forensic Secure Facility Example
		The Inpatient Example
		Community Linkage Example
		A Common Theme
		Practice Considerations
	Future Steps
	References
14. Integrating Physical Activity Into Routine Medical Care: The Physician\'s Perspective
	Introduction
	Research Evidence
		Physician Counselling
		Evidence-Based Lifestyle Interventions
	“Exercise Is Medicine”
		Barriers: Patient Factors
	Overcoming Barriers
		Assess
		Advise
		Agree
		Assist
		Arrange
		Evidence-Based Lifestyle Interventions
		Optimizing Pharmacotherapy for Psychosis
		Addressing Social Determinants of Health
		Barriers: Provider Factors
	Training and Education
		Current Graduate and Postgraduate Training Programs
		Curricular Content
		Barriers: Systems Factors
	Conclusion/Summary
	References
15. Overview of Mechanisms of Action of Exercise in Psychiatric Disorders and Future Directions for Research
	Effects of Exercise on the Serotonin System
	Exercise Effects on the Dopaminergic System
	Effects of Exercise on Hypothalamic-Pituitary-Adrenal Axis
	Endocannabinoids and Exercise
	BDNF and Exercise
	Informing Clinical Treatment Decisions Using Biological Mechanisms
	References
16. Research and Evaluation in Exercise and Mental Health
	Introduction
	Designing an Evaluation Framework: Beyond the Randomized Controlled Trial
	What to Measure? Selecting Appropriate Outcomes
		Objective Versus Subjective Assessments
		Measuring Physical Activity Participation and Sedentary Behavior
		International Physical Activity Questionnaire
		Physical Activity as a Vital Sign
		The Simple Physical Activity Questionnaire
		Cardiorespiratory Fitness and Exercise Capacity
		Quality of Life
		Sleep Behavior
	Putting It All Together: Planning for and Conducting an Evaluation
		Asking the Right Question
		Ensuring the Method Matches the Aim
		Choosing the Right Outcome Measure
		Developing a Protocol and Submitting for Ethical Review
		Data Collection, Analysis, and Dissemination
	References
17. Research to Practice: Case Studies*
	Exercise Counselling for People Living With a Diagnosis of Schizophrenia: A Case Study
		Session 1: Build Rapport and Gather Knowledge
		Session 2: Goal Setting
		Sessions 3 and 4: Evaluate, Revise, Inform
	Maximal Strength Training in Recovery of Eating Disorders
	Including Exercise in Early Intervention for Young People With a First-Episode Psychosis: A Case Study
		Prescreening
		Session 2
		Session 3
		Session 4: Motivational Interviewing
		Outcome
	Lifestyle Changes and Cardiovascular Health in a Woman With Bipolar Disorder: A Case Study of the PsychoActive Project
	Results
	Discussion
	References
Index
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