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 E R 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 “Lack of activity destroys the good condition of every human being, while movement and methodical physical exercise save it and preserve it.” H E - Plato (~400bc) A L T H Y B O D Y 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 Scandal of premature mortality 4 brc.slam.nhs.uk 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 Patients with SMI: • 53% higher risk of having CVD • 78% higher risk of developing CVD • 85% higher risk of death from CVD brc.slam.nhs.uk 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 People with SMI engage in • Less moderate-vigorous PA • More sedentary behaviour • 50% less likely meet international recommendations of weekly PA brc.slam.nhs.uk
Benefits of physical activity in people with 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 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%; 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 Dropout from physical activity interventions 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 Optimal exercise programme Individualised Aerobic exercise > 12 weeks moderate/high intensity Resistance training Supervised by recognised professional 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
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 Poor and excessive dietary intake in people with SMI Firth et al 2018 35 30 25 20 Grams per day more 15 than controls 10 5 0 MDD* BPD SZ* MDD* BPD* SZ* MDD* BPD* SZ* Protein Carbohydrates Sugars 10 9 8 7 6 Grams 5 per day more than controls 4 3 2 1 0 MDD BPD SZ MDD* BPD SZ* MDD* BPD* SZ* Fibre Fats (all) Saturated fats 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 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 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 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 brc.slam.nhs.uk
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