Using exercise to protect physical and mental health in youth at risk for psychosis

  • Joseph Firth | joseph.firth@manchester.ac.uk Division of Psychology and Mental Health, University of Manchester, Manchester, UK; NICM Health Research Institute, Western Sydney University, Westmead, United Kingdom.
  • Felipe Schuch Department of Sports Methods and Techniques, Federal University of Santa Maria, Santa Maria, Brazil.
  • Vijay A. Mittal Department of Psychology and Institute for Policy Research, Northwestern University, Evanston, IL; Department of Psychiatry, Department of Medical Social Sciences, Institute for Innovations in Developmental Sciences, Northwestern University, Chicago IL, United States.

Abstract

A large body of literature has demonstrated that exercise interventions can improve a broad range of outcomes in people with established schizophrenia, including reducing psychiatric symptoms, increasing cognitive functioning, and improving physical health. Furthermore, these benefits seem just as pronounced in first-episode psychosis. However, there have been few clinical studies to date examining the effects of exercise in those found to be ‘at-risk’ of psychosis, particularly for those meeting the criteria for ‘Clinical High Risk’ (CHR) state (a classification which includes both those meeting the ‘ultra-high risk for psychosis’ criteria and/or those with ‘atrisk mental states’). This is surprising, as a proportion of those in the CHR state go on to develop psychotic disorders, and a growing body of evidence suggests that early interventions in this period have significant potential to improve the course of illness. In this article, we shall review the existing literature for i) exercise as an adjunctive intervention for those treated for psychosis; ii) exercise as a standalone intervention in CHR groups; and iii) the rationale and supportive evidence for widescale use of exercise to preserve physical and mental health in those identified as at risk for psychosis. From this, we will put forth how the CHR phase represents an under-researched but highly-suitable timepoint for administering structured exercise interventions, in order to improve physical, psychological and neurocognitive outcomes; while also potentially reducing the odds of transition to full-threshold psychotic disorders. Following this, directions, recommendations and considerations around both the clinical implementation and future research around exercise in CHR individuals will be discussed.

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References

O'Donovan G, Lee IM, Hamer M, et al.: Association of "Weekend Warrior" and Other Leisure Time Physical Activity Patterns With Risks for All-Cause, Cardiovascular Disease, and Cancer Mortality. JAMA Intern Med 177:335-42, 2017 DOI: https://doi.org/10.1001/jamainternmed.2016.8014

Pedersen BK, Saltin B: Exercise as medicine–evidence for prescribing exercise as therapy in 26 different chronic diseases. Scand J Med Sci Sports 25:1-72, 2015 DOI: https://doi.org/10.1111/sms.12581

Ashdown-Franks G, Firth J, Carney R, et al.: Exercise as medicine for mental and substance use disorders: a meta-review of the benefits for neuropsychiatric and cognitive outcomes. Sports Med:1-20, 2019

Stubbs B, Vancampfort D, Hallgren M, et al.: EPA guidance on physical activity as a treatment for severe mental illness: a meta-review of the evidence and Position Statement from the European Psychiatric Association (EPA), supported by the International Organization of Physical Therapists in Mental Health (IOPTMH). Eur Psychiatry 54:124-44, 2018

Firth J, Cotter J, Elliott R, et al.: A systematic review and meta-analysis of exercise interventions in schizophrenia patients. Psychol Med 45:1343-61, 2015 DOI: https://doi.org/10.1017/S0033291714003110

Firth J, Stubbs B, Rosenbaum S, et al.: Aerobic exercise improves cognitive functioning in people with schizophrenia: a systematic review and meta-analysis. Schizophr Bull 43:546-56, 2016

Brokmeier L, Firth J, Vancampfort D, et al.: Does physical activity reduce the risk of psychosis? A systematic review and meta-analysis of prospective studies. Psychiatry Res in press, 2020 DOI: https://doi.org/10.1016/j.psychres.2019.112675

Keskinen E, Marttila R, Koivumaa‐Honkanen H, et al.: Search for protective factors for psychosis–a population‐based sample with special interest in unaffected individuals with parental psychosis. Early Interv Psychiatry 12:869-78, 2018 DOI: https://doi.org/10.1111/eip.12380

Firth J, Carney R, Elliott R, et al.: Exercise as an intervention for first‐episode psychosis: a feasibility study. Early Interv Psychiatry 12:307-15, 2018

Nuechterlein KH, Ventura J, McEwen SC, et al.: Enhancing cognitive training through aerobic exercise after a first schizophrenia episode: theoretical conception and pilot study. Schizophr Bull 42:S44-S52, 2016

Lin J, Chan SK, Lee EH, et al.: Aerobic exercise and yoga improve neurocognitive function in women with early psychosis. NPJ Schizophrenia 1:15047, 2015 DOI: https://doi.org/10.1038/npjschz.2015.47

Yung AR, Nelson B, Stanford C, et al.: Validation of “prodromal” criteria to detect individuals at ultra high risk of psychosis: 2 year follow-up. Schizophr Res 105:10-7, 2008

Van Der Gaag M, Smit F, Bechdolf A, et al.: Preventing a first episode of psychosis: Meta-analysis of randomized controlled prevention trials of 12month and longer-term follow-ups. Schizophr Res 149:56-62, 2013 DOI: https://doi.org/10.4324/9780203503478

Mittal VA, Dean DJ, Mittal J, et al.: Ethical, legal, and clinical considerations when disclosing a high‐risk syndrome for psychosis. Bioethics 29:543-56, 2015 DOI: https://doi.org/10.1111/bioe.12155

Firth J, Teasdale S, Allot K, et al.: The efficacy and safety of nutrient supplements in the treatment of mental disorders: a meta-review of meta-analyses of randomized controlled trials. World Psychiatry 18: doi: 10.1002/wps.20672, 2019 DOI: https://doi.org/10.1002/wps.20672

Thompson E, Millman ZB, Okuzawa N, et al.: Evidence-based early interventions for individuals at clinical high risk for psychosis: a review of treatment components. The Journal of nervous and mental disease 203:342-51, 2015

Mittal VA, Gupta T, Orr JM, et al.: Physical activity level and medial temporal health in youth at ultra high-risk for psychosis. Journal of abnormal psychology 122:1101, 2013 DOI: https://doi.org/10.1037/a0034085

Dean DJ, Bryan AD, Newberry R, et al.: A supervised exercise intervention for youth at risk for psychosis: an open-label pilot study. The Journal of clinical psychiatry 78:e1167, 2017

Vargas T, Dean DJ, Osborne KJ, et al.: Hippocampal subregions across the psychosis spectrum. Schizophrenia bulletin 44:1091-9, 2017 DOI: https://doi.org/10.1093/schbul/sbx160

Lin A, Wood SJ, Nelson B, et al.: Outcomes of nontransitioned cases in a sample at ultra-high risk for psychosis. Am J Psychiatry 172:249-58, 2015 DOI: https://doi.org/10.1176/appi.ajp.2014.13030418

Lederman O, Ward PB, Rosenbaum S, et al.: Stepping up early treatment for help‐seeking youth with at‐risk mental states: Feasibility and acceptability of a real‐world exercise program. Early Interv Psychiatry, 2019 DOI: https://doi.org/10.1111/eip.12871

Carney R, Cotter J, Bradshaw T, et al.: Cardiometabolic risk factors in young people at ultra-high risk for psychosis: A systematic review and meta-analysis. Schizophr Res 170:290-300, 2016

Firth J, Siddiqi N, Koyanagi A, et al.: The Lancet Psychiatry Commission: a blueprint for protecting physical health in people with mental illness. The Lancet Psychiatry 6:675-712, 2019

Stubbs B, Vancampfort D, Rosenbaum S, et al.: Dropout from exercise randomized controlled trials among people with depression: a meta-analysis and meta regression. J Affect Disord 190:457-66, 2016

Firth J, Carney R, French P, et al.: Long‐term maintenance and effects of exercise in early psychosis. Early Interv Psychiatry 12:578-85, 2018 DOI: https://doi.org/10.1111/eip.12365

Newberry RE, Dean DJ, Sayyah MD, et al.: What prevents youth at clinical high risk for psychosis from engaging in physical activity? An examination of the barriers to physical activity. Schizophrenia research 201:400-5, 2018 DOI: https://doi.org/10.1016/j.schres.2018.06.011

By "Mike" Michael L. Baird, CC BY 2.0, https://commons.wikimedia.org/w/index.php?curid=11219680
Published
2020-05-20
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Special Section: Clinical high risk for mental illness
Keywords:
Physical Activity, fitness, aerobic, psychotic disorders, youth mental health
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How to Cite
Firth, J., Schuch, F., & Mittal, V. A. (2020). Using exercise to protect physical and mental health in youth at risk for psychosis. Research in Psychotherapy: Psychopathology, Process and Outcome, 23(1). https://doi.org/10.4081/ripppo.2020.433