Institute of Psychiatry , Psychology and Neuroscience Biomedical - - PowerPoint PPT Presentation

E VIDE NCE BASE D LIFE STYLE INTE RVE NTIONS: A CE NTRAL ROLE IN IMPROVING PHYSICAL HE AL TH AND RE DUCING PRE MATURE MORTALITY

DR BR BRE NDON S STUBBS BBS M MCSP , P PHD HE AD O OF F PHYS YSIOTHE RAPY Y – SL SLAM NHS F FOU OUNDATION T TRU RUST NIH IHR CLIN INIC ICAL L LE CTU TURE R E R

Institute of Psychiatry, Psychology and Neuroscience

Biomedical Research Centre for Mental Health and Dementia Unit at South London and Maudsley NHS Foundation Trust the Institute of Psychiatry, King’s College London brc.slam.nhs.uk

“Lack of activity destroys the good condition of every human being, while movement and methodical physical exercise save it and preserve it.”

• Plato (~400bc)

H E A L T H Y B O D Y

Biomedical Research Centre for Mental Health and Dementia Unit at South London and Maudsley NHS Foundation Trust the Institute of Psychiatry, King’s College London brc.slam.nhs.uk

Biomedical Research Centre for Mental Health and Dementia Unit at South London and Maudsley NHS Foundation Trust the Institute of Psychiatry, King’s College London brc.slam.nhs.uk

Scandal of premature mortality

4

Nielsen et al. Increasing mortality gap for patients diagnosed with schizophrenia over the last three decades--a Danish nationwide study from 1980 to

• 2010. Schiz Res 2013; 146(1-3):22-7

Biomedical Research Centre for Mental Health and Dementia Unit at South London and Maudsley NHS Foundation Trust the Institute of Psychiatry, King’s College London brc.slam.nhs.uk

Patients with SMI:

• 53% higher risk of having CVD
• 78% higher risk of developing CVD
• 85% higher risk of death from CVD

Correll et al 2017 World Psychiatry

Biomedical Research Centre for Mental Health and Dementia Unit at South London and Maudsley NHS Foundation Trust the Institute of Psychiatry, King’s College London brc.slam.nhs.uk

Biomedical Research Centre for Mental Health and Dementia Unit at South London and Maudsley NHS Foundation Trust the Institute of Psychiatry, King’s College London brc.slam.nhs.uk

Biomedical Research Centre for Mental Health and Dementia Unit at South London and Maudsley NHS Foundation Trust the Institute of Psychiatry, King’s College London brc.slam.nhs.uk

People with SMI engage in

• Less moderate-vigorous PA
• More sedentary behaviour
• 50% less likely meet international recommendations of weekly PA

Biomedical Research Centre for Mental Health and Dementia Unit at South London and Maudsley NHS Foundation Trust the Institute of Psychiatry, King’s College London brc.slam.nhs.uk

Benefits of physical activity in people with Schizophrenia

Symptoms of Schizophrenia SMD = 1.0 (95% CI, 0.37–1.64) Quality of life SMD = 0.64; (95% CI, 0.35 to 0.92; I2 = 0%). Anthropometric measures SMD = 0.24; (95% CI, 0.06–0.41; I2 = 0%) Depressive symptoms SMD = 0.80 (95% CI, 0.47–1.13, I2 = 84%;

Biomedical Research Centre for Mental Health and Dementia Unit at South London and Maudsley NHS Foundation Trust the Institute of Psychiatry, King’s College London brc.slam.nhs.uk

Biomedical Research Centre for Mental Health and Dementia Unit at South London and Maudsley NHS Foundation Trust the Institute of Psychiatry, King’s College London brc.slam.nhs.uk

Biomedical Research Centre for Mental Health and Dementia Unit at South London and Maudsley NHS Foundation Trust the Institute of Psychiatry, King’s College London brc.slam.nhs.uk

Dropout from physical activity interventions

Biomedical Research Centre for Mental Health and Dementia Unit at South London and Maudsley NHS Foundation Trust the Institute of Psychiatry, King’s College London brc.slam.nhs.uk

Optimal exercise programme

Individualised Aerobic exercise > 12 weeks moderate/high intensity Resistance training Supervised by recognised professional

Biomedical Research Centre for Mental Health and Dementia Unit at South London and Maudsley NHS Foundation Trust the Institute of Psychiatry, King’s College London brc.slam.nhs.uk

Biomedical Research Centre for Mental Health and Dementia Unit at South London and Maudsley NHS Foundation Trust the Institute of Psychiatry, King’s College London brc.slam.nhs.uk

Biomedical Research Centre for Mental Health and Dementia Unit at South London and Maudsley NHS Foundation Trust the Institute of Psychiatry, King’s College London brc.slam.nhs.uk

Biomedical Research Centre for Mental Health and Dementia Unit at South London and Maudsley NHS Foundation Trust the Institute of Psychiatry, King’s College London brc.slam.nhs.uk

Poor and excessive dietary intake in people with SMI

Firth et al 2018

5 10 15 20 25 30 35 MDD* BPD SZ* MDD* BPD* SZ* MDD* BPD* SZ* Protein Carbohydrates Sugars

Grams per day more than controls

1 2 3 4 5 6 7 8 9 10 MDD BPD SZ MDD* BPD SZ* MDD* BPD* SZ* Fibre Fats (all) Saturated fats

Grams per day more than controls

Biomedical Research Centre for Mental Health and Dementia Unit at South London and Maudsley NHS Foundation Trust the Institute of Psychiatry, King’s College London brc.slam.nhs.uk

Biomedical Research Centre for Mental Health and Dementia Unit at South London and Maudsley NHS Foundation Trust the Institute of Psychiatry, King’s College London brc.slam.nhs.uk

Biomedical Research Centre for Mental Health and Dementia Unit at South London and Maudsley NHS Foundation Trust the Institute of Psychiatry, King’s College London brc.slam.nhs.uk

Summary

• Physical activity and nutrition are leading causes of mortality and risk

factors for years lived with disability

• People with SMI are at profound risk of poor lifestyle.
• Physical activity and nutrition interventions WORK and as close to

Polypills as we have.

• They work best when specialists (e.g. physio, dietitians) deliver

these.

• Early intervention also key

Biomedical Research Centre for Mental Health and Dementia Unit at South London and Maudsley NHS Foundation Trust the Institute of Psychiatry, King’s College London brc.slam.nhs.uk

Acknowledgements

Dr Simon Rosenbaum, UNSW Scott Teasdale, UNSW Dr Joe Firth, Western Sydney University Dr Davy Vancampfort, KU Leuven Prof Phil Ward, UNSW Prof Felipe Schuch, Brazil

Conflict of interest None Funding – NIHR Lectureship