New guidelines for mental health

Based on an extensive structured review of existing research, the European Psychiatric Association (EPA) has issued new guidelines to promote physical activity as a key additional treatment for severe mental illness.

NICM Health Research Institute’s Senior Postdoctoral Research Fellow, Dr Joseph Firth was part of a team of the global researchers who conducted the meta-review of studies focusing on major depressive disorder, schizophrenia-spectrum disorders and bipolar disorder.

Based on their analysis, the authors advised there was considerable evidence to support structured physical activity to be used as an adjunct treatment to reduce symptoms in people suffering from major depression and schizophrenia. Further to this, for optimal outcomes the activity should be aerobic exercise and/or aerobic and resistance training exercise at moderate to vigorous intensity, two-three times per week for a total of 150 minutes. Exercise should be supervised by a qualified trainer such as a physiotherapist or exercise specialist.

The EPA Guidelines were published in European Psychiatry in October 2018 and were endorsed by the International Organization of Physical Therapists in Mental Health (IOPTMH).

When reviewing the literature specifically on major depressive disorder, exercise was shown to be effective in reducing depressive symptoms, with effects comparable to that of treatment with antidepressants and psychotherapy. It also improved cardiorespiratory fitness and quality of life.

For schizophrenia disorders, aerobic exercise was seen to reduce psychiatric symptoms, improve cardiorespiratory fitness, and improve global cognition including working memory.

In relation to people with bipolar disorder, the current evidence is very limited. It was suggested that exercise may improve depressive symptoms and reduce stress but additional research is required.

Leading very sedentary lifestyles, less than half the people with severe mental illness undertake adequate exercise levels and this results in low levels of cardiorespiratory fitness.

Long-term outcomes for people with severe mental illness are poor. In addition to symptoms that their specific condition causes, mental illness has a negative effect on daily functioning and increased risk of premature death by up 20 years.  Cardiovascular and metabolic diseases account for much of this.

The authors of the meta-review made a number of recommendations for future research and clinical practice. These included the effects of exercise on patients with bipolar disorder, on anthropometric measures (such as BMI) as well as its long-term impact and cost effectiveness. A future study into a better understanding of the neurobiological mechanism by which exercise affects mental health was also recommended.

With the study providing significant evidence that physical activity plays an important role in managing depression and schizophrenia, the authors suggest people suffering from mental illness should be screened for levels of exercise in clinical practice and ensure that exercise be incorporated into their future treatment regime.

As Dr Firth commented: "For a long time, research has shown that exercise is likely beneficial for people with mental illness. However, its use in psychiatric care has been limited, due to the lack of consensus for exercise treatments by international psychiatry associations. So, the recent guidelines produced for the European Psychiatric Association represent a huge step forward for the field; finally giving exercise the formal acknowledgement it requires to become recognised as a core aspect of mental healthcare. Whereas at present this extends only to Europe, we are currently undertaking further efforts to produce global guidelines through the World Psychiatric Association (WPA)."