Dietary intake, physical activity and sedentary behaviour patterns in a sample with established psychosis and associations with mental health symptomatology

Abstract Background People with psychosis experience cardiometabolic comorbidities, including metabolic syndrome, coronary heart disease and diabetes. These physical comorbidities have been linked to diet, inactivity and the effects of the illness itself, including disorganisation, impairments in global function and amotivation associated with negative symptoms of schizophrenia or co-morbid depression. Methods We aimed to describe the dietary intake, physical activity (PA) and sedentary behaviour patterns of a sample of patients with established psychosis participating in the Improving Physical Health and Reducing Substance Use in Severe Mental Illness (IMPaCT) randomised controlled trial, and to explore the relationship between these lifestyle factors and mental health symptomatology. Results A majority of participants had poor dietary quality, low in fruit and vegetables and high in discretionary foods. Only 29.3% completed ⩾150 min of moderate and/or vigorous activity per week and 72.2% spent ⩾6 h per day sitting. Cross-sectional associations between negative symptoms, global function, and PA and sedentary behaviour were observed. Additionally, those with more negative symptoms receiving IMPaCT therapy had fewer positive changes in PA from baseline to 12-month follow-up than those with fewer negative symptoms at baseline. Conclusion These results highlight the need for the development of multidisciplinary lifestyle and exercise interventions to target eating habits, PA and sedentary behaviour, and the need for further research on how to adapt lifestyle interventions to baseline mental status. Negative symptoms in particular may reduce patient's responses to lifestyle interventions.

[1]  C. Pariante,et al.  Diet and depression: exploring the biological mechanisms of action , 2020, Molecular Psychiatry.

[2]  A. Carvalho,et al.  A meta‐review of “lifestyle psychiatry”: the role of exercise, smoking, diet and sleep in the prevention and treatment of mental disorders , 2020, World psychiatry : official journal of the World Psychiatric Association.

[3]  J. Hendrikse,et al.  Physical activity and depression: Towards understanding the antidepressant mechanisms of physical activity , 2019, Neuroscience & Biobehavioral Reviews.

[4]  J. Boer,et al.  Association Between Soft Drink Consumption and Mortality in 10 European Countries. , 2019, JAMA internal medicine.

[5]  E. Stip,et al.  Effects of high intensity interval training among overweight individuals with psychotic disorders: A randomized controlled trial , 2019, Schizophrenia Research.

[6]  A. Carvalho,et al.  The Lancet Psychiatry Commission: a blueprint for protecting physical health in people with mental illness. , 2019, The lancet. Psychiatry.

[7]  M. D. Forti,et al.  Effect of lifestyle, medication and ethnicity on cardiometabolic risk in the year following the first episode of psychosis: prospective cohort study , 2019, British Journal of Psychiatry.

[8]  M. Martínez-González,et al.  Association between consumption of ultra-processed foods and all cause mortality: SUN prospective cohort study , 2019, BMJ.

[9]  M. Touvier,et al.  Ultra-processed food intake and risk of cardiovascular disease: prospective cohort study (NutriNet-Santé) , 2019, BMJ.

[10]  L. G. Vu,et al.  Health effects of dietary risks in 195 countries, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017 , 2019, The Lancet.

[11]  Peter B. Jones,et al.  Cross-sectional study of diet patterns in early and chronic schizophrenia , 2019, Schizophrenia Research.

[12]  B. Stubbs,et al.  Dietary intake of people with severe mental illness: systematic review and meta-analysis , 2019, The British Journal of Psychiatry.

[13]  J. Naslund,et al.  Digital technology for health promotion: opportunities to address excess mortality in persons living with severe mental disorders , 2018, Evidence-Based Mental Health.

[14]  Michael Berk,et al.  Diet as a hot topic in psychiatry: a population‐scale study of nutritional intake and inflammatory potential in severe mental illness , 2018, World psychiatry : official journal of the World Psychiatric Association.

[15]  Marcos del Pozo Banos,et al.  Premature Mortality among People with Severe Mental Illness – New Evidence from Linked Primary Care Data , 2018, International Journal of Population Data Science.

[16]  M. Owen,et al.  Premature mortality among people with severe mental illness — New evidence from linked primary care data , 2018, Schizophrenia Research.

[17]  Trishan Panch,et al.  Using Smartphone Apps to Promote Psychiatric Rehabilitation in a Peer-Led Community Support Program: Pilot Study , 2018, JMIR mental health.

[18]  Amy N. Cohen,et al.  Impact of Online Weight Management With Peer Coaching on Physical Activity Levels of Adults With Serious Mental Illness. , 2018, Psychiatric services.

[19]  J. C. van der Pols Nutrition and mental health: bidirectional associations and multidimensional measures , 2018, Public Health Nutrition.

[20]  Susan Michie,et al.  Clinical and cost-effectiveness of an intervention for reducing cholesterol and cardiovascular risk for people with severe mental illness in English primary care: a cluster randomised controlled trial. , 2018, The lancet. Psychiatry.

[21]  R. Murray,et al.  Randomised control trial of the effectiveness of an integrated psychosocial health promotion intervention aimed at improving health and reducing substance use in established psychosis (IMPaCT) , 2017, BMC Psychiatry.

[22]  S. Yusuf,et al.  The effect of physical activity on mortality and cardiovascular disease in 130 000 people from 17 high-income, middle-income, and low-income countries: the PURE study , 2017, The Lancet.

[23]  D. Vancampfort,et al.  The Validity and Value of Self-reported Physical Activity and Accelerometry in People With Schizophrenia: A Population-Scale Study of the UK Biobank , 2017, Schizophrenia bulletin.

[24]  Joseph Firth,et al.  Sedentary behavior and physical activity levels in people with schizophrenia, bipolar disorder and major depressive disorder: a global systematic review and meta‐analysis , 2017, World psychiatry : official journal of the World Psychiatric Association.

[25]  Eyal Oren,et al.  Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016 , 2017, Lancet.

[26]  R. Dutta,et al.  Contributions of specific causes of death to lost life expectancy in severe mental illness , 2017, European Psychiatry.

[27]  D. Vancampfort,et al.  How much physical activity do people with schizophrenia engage in? A systematic review, comparative meta-analysis and meta-regression , 2016, Schizophrenia Research.

[28]  D. Vancampfort,et al.  Diabetes mellitus in people with schizophrenia, bipolar disorder and major depressive disorder: a systematic review and large scale meta‐analysis , 2016, World psychiatry : official journal of the World Psychiatric Association.

[29]  J. Naslund,et al.  A Pilot Study of a Peer-Group Lifestyle Intervention Enhanced With mHealth Technology and Social Media for Adults With Serious Mental Illness , 2016, The Journal of nervous and mental disease.

[30]  L. Raudsepp Bidirectional association between sedentary behaviour and depressive symptoms in adolescent girls , 2016, European journal of sport science.

[31]  A. Watkins,et al.  A nutrition intervention is effective in improving dietary components linked to cardiometabolic risk in youth with first-episode psychosis , 2016, British Journal of Nutrition.

[32]  B. Stubbs,et al.  How sedentary are people with psychosis? A systematic review and meta-analysis , 2016, Schizophrenia Research.

[33]  A. Tiedemann,et al.  Implementing evidence-based physical activity interventions for people with mental illness: an Australian perspective , 2016, Australasian psychiatry : bulletin of Royal Australian and New Zealand College of Psychiatrists.

[34]  D. Vancampfort,et al.  Risk of metabolic syndrome and its components in people with schizophrenia and related psychotic disorders, bipolar disorder and major depressive disorder: a systematic review and meta‐analysis , 2015, World psychiatry : official journal of the World Psychiatric Association.

[35]  R. Murray,et al.  Cardiovascular risk factors and metabolic syndrome in people with established psychotic illnesses: baseline data from the IMPaCT randomized controlled trial , 2015, Psychological Medicine.

[36]  A. Watkins,et al.  Individual Dietetic Consultations in First Episode Psychosis: A Novel Intervention to Reduce Cardiometabolic Risk , 2015, Community Mental Health Journal.

[37]  B. Cohen,et al.  Using Smartphone Apps to Promote Psychiatric and Physical Well-Being , 2015, Psychiatric Quarterly.

[38]  K. Lovell,et al.  An exploratory randomized controlled study of a healthy living intervention in early intervention services for psychosis: the INTERvention to encourage ACTivity, improve diet, and reduce weight gain (INTERACT) study. , 2014, The Journal of clinical psychiatry.

[39]  K. Berger,et al.  Dietary patterns and the risk of depression in adults: a systematic review of observational studies , 2014, European Journal of Nutrition.

[40]  R. Murray,et al.  Improving physical health and reducing substance use in psychosis – randomised control trial (IMPACT RCT): study protocol for a cluster randomised controlled trial , 2013, BMC Psychiatry.

[41]  C. Mangurian,et al.  Food insecurity among adults with severe mental illness. , 2013, Psychiatric services.

[42]  R. Bressan,et al.  A 6-month randomized controlled trial to test the efficacy of a lifestyle intervention for weight gain management in schizophrenia , 2013, BMC Psychiatry.

[43]  P. McGuire,et al.  The dietary pattern of patients with schizophrenia: a systematic review. , 2013, Journal of psychiatric research.

[44]  M. Kivimäki,et al.  Bidirectional association between physical activity and symptoms of anxiety and depression: the Whitehall II study , 2012, European Journal of Epidemiology.

[45]  C. Lynch,et al.  A Double Blind, Placebo-Controlled, Randomized Crossover Study of the Acute Metabolic Effects of Olanzapine in Healthy Volunteers , 2011, PloS one.

[46]  B. Franklin,et al.  American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. , 2011, Medicine and science in sports and exercise.

[47]  H. Möller,et al.  Physical illness in patients with severe mental disorders. II. Barriers to care, monitoring and treatment guidelines, plus recommendations at the system and individual level , 2011, World psychiatry : official journal of the World Psychiatric Association.

[48]  R. Sallis,et al.  Developing healthcare systems to support exercise: exercise as the fifth vital sign , 2011, British Journal of Sports Medicine.

[49]  H. Möller,et al.  Physical illness in patients with severe mental disorders. I. Prevalence, impact of medications and disparities in health care , 2011, World psychiatry : official journal of the World Psychiatric Association.

[50]  Christos Pantelis,et al.  Cognitive functioning in schizophrenia, schizoaffective disorder and affective psychoses: meta-analytic study , 2009, British Journal of Psychiatry.

[51]  George Mendelson,et al.  Book Reviews , 1995 .

[52]  M. Merlo,et al.  Working memory impairments in first-episode psychosis and chronic schizophrenia , 2009, Psychiatry Research.

[53]  D. Borsook,et al.  Food Intake and Reward Mechanisms in Patients with Schizophrenia: Implications for Metabolic Disturbances and Treatment with Second-Generation Antipsychotic Agents , 2006, Neuropsychopharmacology.

[54]  G. Remington,et al.  Validation of a physical activity assessment tool for individuals with schizophrenia , 2006, Schizophrenia Research.

[55]  S. Brown,et al.  A randomized controlled trial of a brief health promotion intervention in a population with serious mental illness , 2006 .

[56]  Carl W. Cotman,et al.  The exercise-induced expression of BDNF within the hippocampus varies across life-span , 2005, Neurobiology of Aging.

[57]  B. Ainsworth,et al.  International physical activity questionnaire: 12-country reliability and validity. , 2003, Medicine and science in sports and exercise.

[58]  M. Müller,et al.  Effects of long-term voluntary exercise on the mouse hypothalamic-pituitary-adrenocortical axis. , 2003, Endocrinology.

[59]  D. Altman,et al.  Multiple significance tests: the Bonferroni method. , 1995, BMJ.

[60]  A. Neil,et al.  Dietary intervention in primary care: validity of the DINE method for diet assessment. , 1994, Family practice.

[61]  L. Opler,et al.  The Positive and Negative Syndrome Scale (PANSS): Rationale and Standardisation , 1989, British Journal of Psychiatry.

[62]  P. M. Podsakoff,et al.  Self-Reports in Organizational Research: Problems and Prospects , 1986 .

[63]  M. Åsberg,et al.  A New Depression Scale Designed to be Sensitive to Change , 1979, British Journal of Psychiatry.

[64]  K. Greenwood,et al.  A health promotion intervention to improve lifestyle choices and health outcomes in people with psychosis: a research programme including the IMPaCT RCT , 2020, Programme Grants for Applied Research.

[65]  D. J. van der Valk,et al.  How accurately can sitting and the intensity of walking and cycling be classified using an accelerometer on the waist for the purpose of the “Global recommendations on physical activity for health”? , 2015 .

[66]  E. Bora,et al.  Cognitive impairment in schizophrenia and affective psychoses: implications for DSM-V criteria and beyond. , 2010, Schizophrenia bulletin.

[67]  H. Strüder,et al.  Influence of exercise on serotonergic neuromodulation in the brain , 2001, Amino Acids.

[68]  E M Mathus-Vliegen,et al.  [Healthy diet]. , 1995, Nederlands tijdschrift voor tandheelkunde.