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Thementalhealth-physicalhealthinterface:ACENTRALroleforphysicaltherapists
BrendonStubbsMCSP,PhDHeadofPhysiotherapy– SouthLondonandMaudsley NHS
FoundationTrustPostDoctoralResearchPhysiotherapist– IoPPN,KCL
@BrendonStubbs
Talkoutline
• PoorerphysicalhealthinpeoplewithSMI• HowWEcanmakeadifference
ConflictofinterestNoneAcknowledgments:SouthLondonCLAHRC
Scandalofprematuremortality
3Nielsen 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
CausesofprematuremortalityMales:Averagelifeexpectancy79.1yearsWAgeneralpopulation
Schizophrenia- 62.7years(61.1to64.3)years(difference16.4(14.7to18.0))AffectivePsychosis- 64.9years(62.9to67.0)years(difference14.1(12.1to16.2))OtherPsychosis56.3(54.2to58.5)years(difference22.7(20.5to24.9))
Females:Averagelifeexpectancy83.8years
Schizophrenia- 71.3years(69.3to73.3)(difference20.7(17.7to23.7))Affectivepsychosis- 73.9yeas(72.5to75.3)(difference12.5(10.5to14.5))Otherpsychosis61.2years(57.6to64.8)(difference22.6(19.0to26.2))
Maincausesdeath:over70%duetopreventablephysicalhealthcomorbiditiesCardiovasculardiseaseSchizophrenia(31.8%ofmalesand46.3%offemales),Otherpsychosis(32.5%ofmalesand40.6%offemales)
Lawrenceetal2013BMJ
De Hert M, et al. Physical illness in patients with severe mental disorders. II. Barriers to care, monitoring and treatment guidelines, and recommendations at the system and individual levels. World Psychiatry. 2011;10(2):138-151.
Currentfocusoftreatmentinschizophrenia
• Psychotropicmedication– antipsychoticmedication.Moderateeffectsizesonpsychoticsymptoms(Leucht etal2013).
• Psychologicaltherapy(e.g.CBT),smallES(e.gJauhar etal2013).
• Lifestyleinterventionse.g.physicalactivitygrowingimportancebutstillseenasluxury/secondary
StubbsetalSchiz Res2016;Stubbs,WilliamsetalSchiz Res2016
-3.4 mins/day -14.2 mins/day NS ? +2.8 hours/day
g = -0.39 g = -0.45 NS ? g = 1.13
0
2
4
6
8
10
12
14
Depression Bipolar Schizophrenia
Sedentarytime(hoursperday)
StubbsetalSchiz Res2016;Stubbs,WilliamsetalSchiz Res2016;Vancampfort etal2016JAD;Schuch etal(underreview)
Sedentarybehaviour inSMI
BenefitsofphysicalactivityinpeoplewithSchizophrenia
SymptomsofSchizophreniaSMD=1.0(95%CI,0.37–1.64)
QualityoflifeSMD=0.64;(95%CI,0.35to0.92;I2=0%).
AnthropometricmeasuresSMD=0.24;(95%CI,0.06–0.41;I2=0%)
DepressivesymptomsSMD=0.80(95%CI,0.47–1.13,I2=84%;
Fitnessversusfatness
Vancampfort etal2016SportsMed1;Vancampfort etal2015Acta PsychScan2;Vancampfort etal2015Schiz Res3;Stubbsetal2015JAD4
Among SMI population1:• Negative symptoms, BMI & female = ↓CRF• First episode and inpatient status = ↑CRF
3.052.8
0
0.5
1
1.5
2
2.5
3
3.5
Depression Schizophrenia
VolumeOxygenmL/kg/m
in(V
O2)
Improvementsinfitnessfollowingaverage12-weekexerciseinterventions2.3
ExerciseworksbuthowcanWEmaximiseeffectiveness
Exerciseismosteffectivewhendeliveredbyrecognisedexerciseprofessionalse.g.physiotherapistsfor:• Cognition(Firthetal2016)• Cardiorespiratoryfitness(Vancampfort etal2016)
• Reducingdropout(Stubbsetal2016)
Summary
• Peoplewithmentalillnesshavemanyphysicalhealthcomplaintsthatwecanhelp.
• PeoplewithSMIarelikelytodieearlierduetophysicalhealthconditions– CVD.
• WehaveakeyroleinmaintainingthehealthofpeoplewithSMI
Acknowledgments
• SimonRosenbaum&PhilipWard,UNSWPsychiatry
• DavyVancampfort,KULeuven,Belgium• FelipeSchuch,Universidade FederaldoRioGrandedoSul,Brazil
• JosephFirth,UniversityofManchester• FionaGaughran,KCL
Questions?