【医脉通】2018+EPA指南:体力活动作为严重精神疾病的一种治疗方法( 英文版).pdf
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1、Original articleEPA guidance on physical activity as a treatment for severe mentalillness:a meta-review of the evidence and Position Statement from theEuropean Psychiatric Association(EPA),supported by the InternationalOrganization of Physical Therapists in Mental Health(IOPTMH)Brendon Stubbsa,b,*,D
2、avy Vancampfortc,Mats Hallgrend,Joseph Firthe,f,Nicola Veroneseg,Marco Solmih,Serge Brandi,j,k,Joachim Cordesl,Berend Malchowm,Markus Gerberj,Andrea Schmittm,n,Christoph U.Corrello,p,q,Marc De Hertr,Fiona Gaughrana,b,Frank Schneiders,Florence Kinnafickt,Peter Falkaim,Hans-Jrgen Mllerm,Kai G.KahluaSo
3、uth London and Maudsley NHS Foundation Trust,Denmark Hill,London,SE5 8AZ,United KingdombInstitute of Psychiatry,Psychology and Neuroscience(IoPPN),Kings College London,London,United KingdomcUniversity Psychiatric Centre,Department of Neurosciences and Department of Rehabilitation Sciences,Katholieke
4、 Universiteit Leuven,Kortenberg,3070,BelgiumdDepartment of Public Health Sciences,Karolinska Institutet,Solna,171 77,SwedeneNICM Health Research Institute,Western Sydney University,Sydney,AustraliafCentre for Youth Mental Health,University of Melbourne,Melbourne,AustraliagNational Research Council,N
5、euroscience Institute,Aging Branch,Via Giustiniani 2,35128,Padova,ItalyhDepartment of Neurosciences,University of Padova,Padova,Italy and Padova Neuroscience Center,University of Padua,Padua,ItalyiUniversity of Basel,Psychiatric Clinics(UPK)Center for Affective,Stress and Sleep Disorders,CH-4002,Bas
6、el,SwitzerlandjUniversity of Basel,Department of Sport,Exercise,and Health,Division of Sport and Psychosocial Health,CH-4052,Basel,SwitzerlandkKermanshah University of Medical Sciences,Substance Abuse Prevention Research Center and Sleep Disorders Research Center,Kermanshah,IranlDepartment of Psychi
7、atry and Psychotherapy,Heinrich-Heine Universitt Dsseldorf,GermanymDepartment of Psychiatry and Psychotherapy,Ludwig Maximilian University Munich,Nussbaumstrasse 7,80336,Munich,GermanynLaboratory of Neuroscience(LIM27),Institute of Psychiatry,University of Sao Paulo,Rua Dr.Ovidio Pires de Campos 785
8、,05453-010,So Paulo,SP,BraziloHofstra Northwell School of Medicine Hempstead,New York,USApThe Zucker Hillside Hospital,Department of Psychiatry,New York,USAqCharit Universittsmedizin,Department of Child and Adolescent Psychiatry,Berlin,GermanyrUniversitair Psychiatrisch Centrum KU Leuven,3070,Korten
9、berg,BelgiumsDepartment of Psychiatry,Psychotherapy and Psychosomatic,University of Aachen(RWTH),GermanytSchool of Sport,Exercise and Health Sciences,National Centre for Sport and Exercise Medicine,Loughborough University,Loughborough,Leicestershire,LE11 3TU,UKuDepartment of Psychiatry,Social Psychi
10、atry and Psychotherapy,Hannover Medical School,GermanyA R T I C L E I N F OArticle history:Received 30 May 2018Received in revised form 17 July 2018Accepted 18 July 2018Keywords:Physical activitySedentary behaviourExercisePsychosisSchizophreniaSevere mental illnessBipolar disordersMajor depressive d
11、isordersA B S T R A C TPhysical activity(PA)may be therapeutic for people with severe mental illness(SMI)who generallyhave low PA and experience numerous life style-related medical complications.We conducted a meta-review of PA interventions and their impact on health outcomes for people with SMI,in
12、cludingschizophrenia-spectrum disorders,major depressive disorder(MDD)and bipolar disorder.Wesearched major electronic databases until January 2018 for systematic reviews with/without meta-analysis that investigated PA for any SMI.We rated the quality of studies with the AMSTAR tool,gradingthe quali
13、ty of evidence,and identifying gaps,future research needs and clinical practicerecommendations.For MDD,consistent evidence indicated that PA can improve depressive symptomsversus control conditions,with effects comparable to those of antidepressants and psychotherapy.PAcan also improve cardiorespira
14、tory fitness and quality of life in people with MDD,although the impacton physical health outcomes was limited.There were no differences in adverse events versus controlconditions.For MDD,larger effect sizes were seen when PA was delivered at moderate-vigorousintensity and supervised by an exercise
15、specialist.For schizophrenia-spectrum disorders,evidenceindicates that aerobic PA can reduce psychiatric symptoms,improves cognition and various*Corresponding author at:Physiotherapy Department,South London and Maudsley NHS Foundation Trust,Denmark Hill,London,United Kingdom.E-mail address:brendon.s
16、tubbskcl.ac.uk(B.Stubbs).http:/dx.doi.org/10.1016/j.eurpsy.2018.07.0040924-9338/2018 Elsevier Masson SAS.All rights reserved.European Psychiatry 54(2018)124144Contents lists available at ScienceDirectEuropean Psychiatryjournal homepage:htt p:/www.europsy-journa subdomains,cardiorespiratory fitness,w
17、hilst evidence for the impact on anthropometric measures wasinconsistent.There was a paucity of studies investigating PA in bipolar disorder,precluding anydefinitive recommendations.No cost effectiveness analyses in any SMI condition were identified.Wemake multiple recommendations to fill existing r
18、esearch gaps and increase the use of PA in routineclinical care aimed at improving psychiatric and medical outcomes.2018 Elsevier Masson SAS.All rights reserved.1.Introduction1.1.Serious mental illness,physical co-morbidity and prematuremortalitySevere mental illnesses(SMI),defined as schizophrenia-
19、spectrum disorders,bipolar disorder(BD)and major depressivedisorder(MDD),are leading causes of years lived with globaldisability and are of considerable public health importance 1.Inaddition to the impact of the mental health symptoms and reduceddaily life functioning,people with SMI are at increase
20、d risk ofpremature mortality by between 1020 years compared to age-and sex-matched controls 25.While suicide accounts for aconcerning portion of the early mortality 6,7,there is increasingrecognition that physical disorders account for approximately 70%of these premature deaths 3,8.Of notable concer
21、n,cardiovascularand metabolic diseases appear to greatly increase the risk of earlydeath in those with SMI 9,which is of particular importance,given the high prevalence of these diseases in SMI 911.Peoplewith SMI are also at increased risk of various other physicalcomorbidities,such as respiratory d
22、isease 12,13,poor bonehealth 14 and physical multimorbidity 15.Moreover,peoplewith SMI typically experience pronounced cognitive impairment,which often worsens over time 1618 and for which treatmentapproaches remain limited 19,20.Current treatment for mental health symptoms and func-tioning largely
23、revolves around psychotropic medication 21,22and/or psychotherapeutic interventions 2325.Whilst both ofthese dominant approaches,alone and in combination,havedemonstrated treatment efficacy on mental health symptoms26,their impact on the rising physical health burden in thispopulation is limited,and
24、 psychotropic medication may evenhave an adverse relationship with cardiometabolic/physicalhealth 8,9.In addition,antipsychotic medication has beenassociated with reduced grey matter volume in people withschizophrenia 27 while psychotherapeutic interventionsappear to have limited efficacy for cognit
25、ive impairment inthis population 28.1.2.Established benefits of physical activity in the general populationIn the general population,there is evidence that physicalactivity is equally effective as frontline pharmacological inter-ventions,such as statins and beta-blockers,in preventingcardiovascular
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