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Cardiorespiratory Fitness in Severe Mental Illness: A Systematic Review and Meta-analysis

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.

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 (β = 6.6, 95 % CI 0.6–12.6) and inpatient (β = 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 to reduce all-cause mortality. Qualified healthcare professionals supporting people with SMI in maintaining an active lifestyle should be included as part of multidisciplinary teams in mental health treatment.

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Correspondence to Davy Vancampfort.

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Funding

Davy Vancampfort has support from the Research Foundation-Flanders (FWOVlaanderen). Brendon Stubbs was supported by the Collaboration for Leadership in Applied Health Research and Care South London for this article. No other sources of funding were used to assist in the preparation of this article.

Conflict of interest

Davy Vancampfort, Simon Rosenbaum, Felipe Schuch, Philip Ward, Justin Richards, James Mugisha, Michel Probst, and Brendon Stubbs declare that they have no conflicts of interest relevant to the content of this review.

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Vancampfort, D., Rosenbaum, S., Schuch, F. et al. Cardiorespiratory Fitness in Severe Mental Illness: A Systematic Review and Meta-analysis. Sports Med 47, 343–352 (2017). https://doi.org/10.1007/s40279-016-0574-1

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Keywords

  • Bipolar Disorder
  • Major Depressive Disorder
  • Aerobic Exercise
  • Exercise Intervention
  • Severe Mental Illness