This review provides the reader with the up-to-date evidence-based basis for prescribing exercise as medicine in the treatment of 26 different diseases: psychiatric diseases (depression, anxiety, stress, schizophrenia); neurological diseases (dementia, Parkinson's disease, multiple sclerosis); metabolic diseases (obesity, hyperlipidemia, metabolic syndrome, polycystic ovarian syndrome, type 2 diabetes, type 1 diabetes); cardiovascular diseases (hypertension, coronary heart disease, heart failure, cerebral apoplexy, and claudication intermittent); pulmonary diseases (chronic obstructive pulmonary disease, asthma, cystic fibrosis); musculo-skeletal disorders (osteoarthritis, osteoporosis, back pain, rheumatoid arthritis); and cancer. The effect of exercise therapy on disease pathogenesis and symptoms are given and the possible mechanisms of action are discussed. We have interpreted the scientific literature and for each disease, we provide the reader with our best advice regarding the optimal type and dose for prescription of exercise.

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Exercise as medicine – evidence for prescribing exercise as therapy in 26 different chronic diseases

The Beck Depression Inventory (BDI) is perhaps the most commonly used screening instrument for depression in the general population. We examined the psychometric properties of a Persian-language version of the second edition of this instrument (BDI-II) [Beck et al., 1996] in an Iranian college-student sample. In a sample of 125 student volunteers from two Iranian universities, we compared mean item scores on the BDI-II-Persian with those on the English-language version administered to North American college students, and assessed internal consistency and test-retest reliability of the BDI-II-Persian and its concurrent validity against a measure of negative automatic thoughts in depression, the Automatic Thoughts Questionnaire [Hollon and Kendall, 1980]. We also examined the factor structure of the BDI-II-Persian through comparing the fit of various proposed models to the data using confirmatory factor analysis. The BDI-II-Persian had high internal consistency (Cronbach's alpha=0.87) and acceptable test-retest reliability (r=0.74). The instrument correlated strongly with the Automatic Thoughts Questionnaire. In factor analysis, models with strongly correlated affective-cognitive and somatic-vegetative factors provided a better fit than models with one global factor. These data support the reliability and concurrent validity of the BDI-II-Persian as a measure of depressive symptoms in nonclinical samples.

Psychometric properties of a Persian-language version of the Beck Depression Inventory--Second edition: BDI-II-PERSIAN.

Schizophrenia is often referred to as one of the most severe mental disorders, primarily because of the very high mortality rates of those with the disorder. This article reviews the literature on excess early mortality in persons with schizophrenia and suggests reasons for the high mortality as well as possible ways to reduce it. Persons with schizophrenia have an exceptionally short life expectancy. High mortality is found in all age groups, resulting in a life expectancy of approximately 20 years below that of the general population. Evidence suggests that persons with schizophrenia may not have seen the same improvement in life expectancy as the general population during the past decades. Thus, the mortality gap not only persists but may actually have increased. The most urgent research agenda concerns primary candidates for modifiable risk factors contributing to this excess mortality, i.e., side effects of treatment and lifestyle factors, as well as sufficient prevention and treatment of physical comorbidity.

Excess Early Mortality in Schizophrenia

Background: For the last decade, mHealth has constantly expanded as a part of eHealth. Mobile applications for health have the potential to target heterogeneous audiences and address specific needs in different situations, with diverse outcomes, and to complement highly developed health care technologies. The market is rapidly evolving, making countless new mobile technologies potentially available to the health care system; however, systematic research on the impact of these technologies on health outcomes remains scarce. Objective: To provide a comprehensive view of the field of mHealth research to date and to understand whether and how the new generation of smartphones has triggered research, since their introduction 5 years ago. Specifically, we focused on studies aiming to evaluate the impact of mobile phones on health, and we sought to identify the main areas of health care delivery where mobile technologies can have an impact. Methods: A systematic literature review was conducted on the impact of mobile phones and smartphones in health care. Abstracts and articles were categorized using typologies that were partly adapted from existing literature and partly created inductively from publications included in the review. Results: The final sample consisted of 117 articles published between 2002 and 2012. The majority of them were published in the second half of our observation period, with a clear upsurge between 2007 and 2008, when the number of articles almost doubled. The articles were published in 77 different journals, mostly from the field of medicine or technology and medicine. Although the range of health conditions addressed was very wide, a clear focus on chronic conditions was noted. The research methodology of these studies was mostly clinical trials and pilot studies, but new designs were introduced in the second half of our observation period. The size of the samples drawn to test mobile health applications also increased over time. The majority of the studies tested basic mobile phone features (eg, text messaging), while only a few assessed the impact of smartphone apps. Regarding the investigated outcomes, we observed a shift from assessment of the technology itself to assessment of its impact. The outcome measures used in the studies were mostly clinical, including both self-reported and objective measures. Conclusions: Research interest in mHealth is growing, together with an increasing complexity in research designs and aim specifications, as well as a diversification of the impact areas. However, new opportunities offered by new mobile technologies do not seem to have been explored thus far. Mapping the evolution of the field allows a better understanding of its strengths and weaknesses and can inform future developments. [J Med Internet Res 2013;15(5):e95]

Mapping mHealth Research: A Decade of Evolution

In this meta-analytic review, the authors summarized the effects of depression prevention programs for youth as well as investigated participant, intervention, provider, and research design features associated with larger effects. They identified 47 trials that evaluated 32 prevention programs, producing 60 intervention effect sizes. The average effect for depressive symptoms from pre-to-posttreatment (r = .15) and pretreatment to-follow-up (r = .11) were small, but 13 (41%) prevention programs produced significant reductions in depressive symptoms and 4 (13%) produced significant reductions in risk for future depressive disorder onset relative to control groups. Larger effects emerged for programs targeting high-risk individuals, samples with more females, samples with older adolescents, programs with a shorter duration and with homework assignments, and programs delivered by professional interventionists. Intervention content (e.g., a focus on problem-solving training or reducing negative cognitions) and design features (e.g., use of random assignment and structured interviews) were unrelated to effect sizes. Results suggest that depression prevention efforts produce a higher yield if they incorporate factors associated with larger intervention effects (e.g., selective programs with a shorter duration that include homework).

http://thebluesprogram.weebly.com/uploads/1/4/2/1/14217397/stice_shaw_bohon_marti_rohde_2009.pdf

A meta-analytic review of depression prevention programs for children and adolescents: factors that predict magnitude of intervention effects

Although the benefits of exercise are well documented, few published research studies have examined exercise in persons with schizophrenia. This pilot examined a 16-week walking program for outpatients diagnosed with schizophrenia (N = 10). Six-minute walking distance, body mass index, percent body fat and severity of psychiatric symptoms were measured. Experimental participants in the walking group experienced significant reductions in body fat (p = 0.03) compared to a control group not participating in the exercises during the same time period. Experimental participants also had greater aerobic fitness, lower body mass indexes, and fewer psychiatric symptoms than controls at the conclusion of the program. Research is needed to identify effective exercise interventions and feasible delivery modalities for persons with schizophrenia in community settings.

Effects of exercise on mental and physical health parameters of persons with schizophrenia

Currently a clinical professor of psychiatry at the UCLA School of Medicine with training in pediatrics and child, adolescent, and adult psychiatry, Dr. Siegel is a recognized expert in the interpl...

The Mindful Therapist: A Clinician's Guide to Mindsight and Neural Integration

Ninety seven outpatients with schizophrenia spectrum disorders (SSDs) were randomly assigned to the Walk, Address Sensations, Learn About Exercise, Cue Exercise Behavior for SSDs (WALC-S), a motivational intervention designed to increase exercise in SSDs (n = 48), or a time and attention control group (TAC, n = 49). WALC-S and TAC groups met weekly for 4 weeks before a 16 week walking program was offered to all subjects. We compared the exercise attendance, persistence and compliance of the groups during the walking program. WALC-S recipients attended more walking groups, for more weeks and walked more minutes than those receiving TAC. Percent of WALC-S or TAC groups attended was significantly correlated with overall attendance (r = 0.38, P = 0.001) and persistence (r = −.29, P = 0.01), as well as number of minutes walked. This study is among the first to examine interventions designed to enhance exercise motivation in SSDs.

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Effect of a Motivational Intervention on Exercise Behavior in Persons with Schizophrenia Spectrum Disorders

The authors tested the long-term effectiveness of a cognitive-behavioral group intervention in reducing depressive symptoms, decreasing negative thinking, and enhancing self-esteem in 92 college women aged 18 to 24 years who ere at risk for clinical depression. The women were randomly assigned to either an experimental or a no-treatment control group. The experimental group participated in a 6-week cognitive-behavioral intervention that targeted identification and reduction of negative thinking, using such techniques as thought stopping and affirmations. Data on depressive symptoms, self-esteem, and negative thinking were collected before the intervention and at intervals of 1, 6, and 18 months postintervention. The women in the intervention group experienced a greater decrease in depressive symptoms and negative thinking and a greater increase in self-esteem than those in the control group. The beneficial effects continued over an 18-month follow-up period. These findings support the importance of thought stopping and affirmations as prevention interventions with at-risk college women.

Preventing depression in high-risk college women: a report of an 18-month follow-up.

TOPIC. This paper discusses some of the potential lessons to be learned from pilot studies, using a recently completed pilot study of exercise in outpatients with schizophrenia as a case example.

CONCLUSIONS. Pilot studies are a source of important research and clinical information in the areas of recruitment barriers, attendance at study intervention sessions, monitoring procedures, physical sensations from study interventions, and additional outcomes.

PRACTICE IMPLICATIONS. The author challenges psychiatric nurse clinicians to conduct and report the findings of pilot studies to enhance our knowledge and advance nursing science.

Lora Humphrey Beebe

Papers

Effects of exercise on mental and physical health parameters of persons with schizophrenia

The Mindful Therapist: A Clinician's Guide to Mindsight and Neural Integration

Effect of a Motivational Intervention on Exercise Behavior in Persons with Schizophrenia Spectrum Disorders

Preventing depression in high-risk college women: a report of an 18-month follow-up.

What can we learn from pilot studies