Cardiorespiratory Fitness in Severe Mental Illness: A Systematic Review and Meta-analysis
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SYSTEMATIC REVIEW
Cardiorespiratory Fitness in Severe Mental Illness: A Systematic Review and Meta-analysis Davy Vancampfort1,2 • Simon Rosenbaum3 • Felipe Schuch4,5 • Philip B. Ward3 Justin Richards6 • James Mugisha7 • Michel Probst1 • Brendon Stubbs8,9
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Ó Springer International Publishing Switzerland 2016
Abstract Background Cardiorespiratory fitness (CRF) among people with severe mental illness (SMI) (i.e., schizophrenia, bipolar disorder, and major depressive disorder) is a critical clinical risk factor given its relationship to cardiovascular disease and premature mortality.
Electronic supplementary material The online version of this article (doi:10.1007/s40279-016-0574-1) contains supplementary material, which is available to authorized users. & Davy Vancampfort [email protected] 1
Department of Rehabilitation Sciences, KU LeuvenUniversity of Leuven, Leuven, Belgium
2
KU Leuven-University of Leuven, University Psychiatric Centre, 517 Leuvensesteenweg, Kortenberg 3070, Belgium
3
School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
4
Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
5
Programa de Pos Graduacaoem Ciencias Medicas: Psiquiatria, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
6
School of Public Health and Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia
7
Butabika National Referral and Mental Health Hospital, Kampala, Uganda
8
Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, UK
9
Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
Objectives This study aimed to: (1) investigate the mean CRF in people with SMI versus healthy controls; (2) explore moderators of CRF; and (3) investigate whether CRF improved with exercise interventions and establish if fitness improves more than body mass index following exercise interventions. Methods Major electronic databases were searched systematically. A meta-analysis calculating Hedges’ g statistic was undertaken. Results Across 23 eligible studies, pooled mean CRF was 28.7 mL/kg/min [95 % confidence interval (CI) 27.3 to 30.0 mL/kg/min, p\0.001, n = 980]. People with SMI had significantly lower CRF compared with controls (n = 310) (Hedges’ g = -1.01, 95 % CI -1.18 to -0.85, p \ 0.001). There were no differences between diagnostic subgroups. In a multivariate regression, first-episode (b = 6.6, 95 % CI 0.6–12.6) and inpatient (b = 5.3, 95 % CI 1.6–9.0) status were significant predictors of higher CRF. Exercise improved CRF (Hedges’ g = 0.33, 95 % CI = 0.21–0.45, p = 0.001), but did not reduce body mass index. Higher CRF improvements were observed following interventions at high intensity, with higher frequency (at least three times per week) and supervised by qualified personnel (i.e., physiotherapists and exercise physiologists). Conclusion The multidisciplinary treatment of people with SMI should include a focus on improving fitness t
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