BUDAPEST, Hungary — Low- to moderate-intensity physical exercise in patients with severe mental illness is linked to improved medication adherence, regardless of medication type or duration of illness, new research shows.
“The positive association between adherence and moderate physical activity emphasizes that physical activity improves overall health and functional status. Promoting physical activity can be a valuable and integrated strategy that can be easily implemented into our routine clinical practice,” said study investigator Rebecca Silvestro, MD, Department of Psychiatry, Università degli studi della Campania Luigi Vanvitelli in Naples, Italy.
The findings were presented at the European Psychiatric Association 2024 Congress.
A Major Problem
The lack of treatment adherence in chronic disease is a “worldwide of problem of striking magnitude,” said Silvestro.
Nonadherence, she continued, is linked to poor clinical and functional outcomes, more relapses, declining health, and increased medical costs.
Among patients with severe mental disorders, rates of nonadherence in those with major depression are upward of 50% and as high as 70% in those with schizophrenia.
Overall, approximately 40% of patients stop taking their medication within a year, and up to 75% within 2 years, Silvestro said.
Although psychoeducational approaches have been widely used in several mental disorders, so far they have had little impact on adherence rates, she added.
The researchers decided to focus on physical activity as a means of improving treatment adherence, noting that it improves overall health, reduces anxiety and depressive symptoms, increases motivation and self-esteem, and promotes healthy habits.
The study included 401 people aged 18–65 years with a body mass index (BMI) > 25. Diagnoses included schizophrenia or other psychotic disorders (29.6%), bipolar disorder (43.3%), or major depression. The mean age was 45.6 years, and 57.0% of participants were female. The average duration of illness was 16.3 years.
Participants were randomly assigned to an experimental or control group. The experimental group underwent a 90-minute lifestyle psychosocial intervention every 7-10 days for approximately 6 months. This intervention focused on a wide range of lifestyle behaviors. Each session ended with a supervised 20-minute session of low- to moderate-intensity exercise led by a psychiatrist, psychologist, or nurse.
Participants in the control group received a brief psychoeducational intervention every 7 days for approximately 2 months. The intervention included guidance on the benefits of a healthy lifestyle, early detection of clinical relapse, effects of pharmacologic treatment, and management of adverse effects.
All participants completed a range of assessments and questions about lifestyle behaviors, psychiatric and psychosocial outcomes, and cardiometabolic parameters.
Across the whole study period, 39.8% of participants showed good medication adherence. Bivariate analysis suggested that patient age, gender, duration of illness, and psychiatric diagnosis had no impact on adherence.
However, adherence improved significantly in the intervention group, increasing from 35.8% at baseline to 47.6% at 6 months (P
Although the increase in physical activity across the study period, from 6.3% at baseline to 9.7% at 6 months, was not significant, patients in the experimental group did experience a significant reduction in BMI, body weight, and waist circumference.
A generalized estimating equations model revealed that treatment adherence was positively associated with moderate-intensity physical activity (odds ratio, 1.542; P = .003).
Adherence was not associated with the type of medication used (P = .008), duration of illness (P = .042), or time in the mental health service (P = .045).
However, Silvestro said other factors common to severe mental disorders, but not captured in the study, may play a significant role in treatment adherence, including reducing stigma and misconceptions about psychiatric treatment.
Breaking Exercise Stigma
Session chair Tamás Kurimay, MD, PhD, head of the Buda Family Centred Mental Health Centre, Semmelweis University, Budapest, Hungary, told Medscape Medical News that he was not surprised by the results.
He said the literature shows that “physical activity is very important, not only in our lives and but also fortreatment success.”
“I think we would suggest to everybody to undertake physical activity, and not just because of those reasons but also to help develop the brain.”
Including physical exercise in the intervention sessions, rather than leaving it to the patients to undertake it at another time, was a key factor in the study’s success, he said.
It breaks the stigma around exercise, Kurimay said. In addition, the participation of healthcare professionals in the intervention provides patients with a role model.
Physical activity is also likely to benefit the staff by helping to increase their physical and mental resources. It provides patients and healthcare providers alike with the opportunity to have shared experiences.
No funding or relevant financial relationships were declared.
Source link : https://www.medscape.com/viewarticle/exercise-may-boost-psychiatric-medication-adherence-2024a100071u?src=rss
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Publish date : 2024-04-12 14:09:50
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