Systematic review of physical activity interventions assessing physical and mental health outcomes on patients with severe mental illness (SMI) within secure forensic settings.
Systematic review of physical activity interventions assessing physical and mental health outcomes on patients with severe mental illness (SMI) within secure forensic settings.
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DOI：
10.1111/jpm.12832
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发表时间：
2022-10
影响因子：
2.7
通讯作者：
Breslin, Gavin
中科院分区：
文献类型：
--
作者：
Hassan, Jessica;Shannon, Stephen;Tully, Mark A.;McCartan, Claire;Davidson, Gavin;Bunn, Richard;Breslin, Gavin
患有严重精神疾病（SMI）的人与普通人群相比，身体活动较少，预期寿命较短，因为心脏代谢疾病（肥胖症，糖尿病和呼吸系统疾病）和其他健康风险的风险增加。体力活动已被用作SMI患者的辅助治疗，可改善认知功能，生活质量和减少精神症状。居住在安全的法医环境中的重度精神障碍患者减少了身体活动的机会，这可能是由于许多因素，包括动力不足和使用锻炼设施受限，以及缺乏知识和/或对工作人员协助身体活动计划的信心。这项审查表明，对于居住在安全法医环境中的SMI患者，身体活动的影响知之甚少，很少或没有长期影响的报道。体育活动干预已经显示出一些积极的结果，通过减少体重和腰围，以及减少负面症状评分的运动组相比，“无治疗”对照组干预后。服务使用者不愿意从事体育活动，可以通过提高工作人员的承诺，创造一个激励的气氛，促进服务使用者的决策。参与体育活动有很多好处，但那些生活在法医环境中的严重精神疾病（SMI）患者不太可能活跃，更有可能经历健康不良。本研究的目的是系统地审查身体活动方案对身心健康的有效性，特别是在法医环境中减少重度精神创伤症状。除了灰色文献检索外，还对6个数据库进行了系统检索。如果研究有SMI参与者，则纳入研究;基于法医环境;涉及身体活动计划并报告身心健康结果。共有112名参与者被纳入四项研究。一项研究显示，与常规治疗组相比，运动组的阴性症状评分有显著改善。两项研究报告了精神症状的改善，两组之间没有显著差异;然而，体重和腰围的统计学显著变化是明显的（p < .001）。未报告不良反应。只有少数研究被纳入，并且设计和质量有限，没有随访评估;因此，需要更多的研究来确定身体活动对改善法医环境中SMI症状的真正影响。这项综述强调了进一步研究的必要性，探讨安全法医环境中身体活动的障碍和促进因素。研究需要包括更全面的研究设计。此外，干预措施如果设计时考虑到患者和护理人员，可能会降低法医环境中所有人的精神症状并增加身体健康益处。
Individuals with a severe mental illness (SMI) are less physically active and have a lower life expectancy than the general population due to increased risks of cardiometabolic diseases (obesity, diabetes and respiratory diseases) and other health risks. Physical activity has been used as an adjunct therapy for individuals with SMI yielding improvements in cognitive functioning, quality of life and a reduction in psychiatric symptoms. Individuals with SMI residing within a secure forensic setting have reduced physical activity opportunities, possibly due to a number of factors including low motivation and restricted access to exercise facilities combined with a lack of knowledge and/or confidence in staff members to assist in physical activity programmes. This review demonstrates that little is known around the effects of physical activity for people with SMI who reside in secure forensic settings, with little to no long‐term effects reported. Physical activity interventions have shown some positive results through decreasing weight and waist circumference as well as a reduction in negative symptom scores in an exercise group compared with the “no treatment” control group post‐intervention. Service users’ reluctance to engage in physical activity may be overcome by improving staff commitment, creating a motivational atmosphere and promoting service user decision making. Participating in physical activity has many benefits, yet those with severe mental illness (SMI) living in forensic settings are less likely to be active, and more likely to experience ill‐health. The aim of this study was to systematically review the effectiveness of physical activity programmes on mental and physical health and specifically on reducing symptoms of SMI in forensic settings. A systematic search of six databases was conducted, in addition to a grey literature search. Studies were included if they had participants with SMI; were based in a forensic setting; involved a physical activity programme and reported physical and mental health outcomes. A total of 112 participants were included in four studies. One study showed a significant improvement in negative symptom scores in the exercise group compared with a treatment as usual group. Two studies reported improvements in psychiatric symptoms with no significant difference between groups; however, statistically significant changes in weight and waist circumference were evident (p < .001). No adverse effects were reported. Only a small number of studies were included and of limited design and quality, with no follow‐up assessments; therefore, more research is needed to determine the true effects of physical activity for improving SMI symptoms in a forensic setting. This review highlights the need for further studies exploring the barriers and facilitators of physical activity in secure forensic settings. Studies are required that include a more thorough research design. Furthermore, interventions if designed with patients and caring staff in mind may lead to lowered psychiatric symptoms and increased physical health benefits for all in forensic settings.
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