Physical exercise can be a powerful therapy for psychiatric inpatients, new research suggests.
Investigators at the University of Vermont, in Burlington, found that exercise reduces anxiety, depression, anger, psychomotor agitation, and muscle tension and allows these patients to develop a more balanced and integrated sense of self. It may ultimately reduce reliance on pharmaceutical management for these disorders.
"The primary finding of our research was the consistent high rates of reported well-being among psychiatric inpatients," principal investigator David L. Tomasi, PhD, PhD-EdD, told Medscape Medical News.
"Over 90% of patients reported positive benefit throughout our diagnostic framework, which means there was a consistent benefit for mood disorder, major depressive disorder, as well as patients suffering from more neurologically based disorders, such as schizophrenia and psychosis," added Tomasi, a lecturer at the University of Vermont.
One of the secondary benefits of the study was that it led patients to attend group therapeutic sessions they may otherwise have avoided.
"Our research not only presented physical activities, because we also implemented nutrition and psychoeducation as part of the study. In other words, the exercise served as a way to attract patients who would otherwise not be prone to attending psychotherapeutic interventions in a group setting," he said.
"If a patient is in a manic or psychotic state, they have a tendency to isolate themselves and not want to leave their rooms. In those cases, it doesn't matter how good your pharmacological interventions and psychotherapy are. On the other hand, this type of activity will promote the full spectrum of therapeutic offerings that we have in an inpatient psychiatry unit," Tomasi added.
The study was published online May 21 in Global Advances in Health and Medicine.
Empowering Patients
Psychotherapy and pharmacologic intervention are the most commonly used methods to address psychiatric disorders. Nevertheless, the complexity of today's diagnostic presentations among inpatient populations demands more integrative approaches to health and well-being, Tomasi noted.
Previous research has indicated that a multidisciplinary approach — one focused on mind-body connection — can play an important role in promoting well-being among the general population.
To test the applicability of such approaches to inpatients with psychiatric disorders, the researchers aimed to develop clinical strategies and healthier coping skills for anger, anxiety, and depression.
The goal of these strategies was to use exercise and nutrition education to promote self-esteem and healthier sleep and reduce anxiety while enhancing mood and emotional-behavioral regulation.
"The primary goal of the study was simply to empower patients to take better care of themselves by way of integrative therapies, and exercise is one of the most researched integrative therapies," said Tomasi.
"Our study was also set in an acute inpatient psychiatry unit, for which admission rates are high, and the expectation is that the patient won't spend too long on the unit. Therefore, if they learn to exercise, they might be able to reduce costs for the healthcare system as a whole over the long run," he added.
To achieve these goals, psychotherapists and group therapists offered four weekly exercise and nutrition-education sessions to 100 adult patients in the institution's inpatient psychiatry units. The study was conducted over a 12-month period.
Each of the 60-minute exercise sessions comprised a combination of cardiovascular training, resistance training, and flexibility development. These included free-body exercises; stretching and strengthening exercises; and exercises on muscle activation–specific fitness equipment.
Multiple Positive Outcomes
To ensure patient safety, international safety and effectiveness parameters for fitness training were followed, as well as general recommendations from the American College of Sports Medicine.
Each 60-minute nutrition education session included information on identifying food groups, making healthy food choices, budgeting, and meal preparation and planning. Sessions were performed in accordance with recent scientific recommendations regarding the connection between gastrointestinal health and psychological well-being.
As part of the education sessions, participants and facilitators engaged in discussions regarding the challenges of maintaining a healthy lifestyle in light of fluctuating psychiatric concerns attributed to cognitive functioning.
Interestingly, the researchers opted not to include specific measures of fitness in the trial so as to help present an individual-focused assessment to each participant. This, they said, is particularly relevant considering possible negative influences of standardized expectations on the participants' values of self-image and self-esteem, especially among patients with major depressive disorder.
Self-reported changes in mood and general well-being were monitored through surveys and questionnaires that the participants completed before and after the exercise and nutrition sessions.
These surveys addressed overall mood, willingness to engage in further education, physical condition, physical fitness/readiness, movement-based practices, nutrition-group attendance, and perceived body image using a combination of yes/no responses and Likert-type scales.
Results showed multiple positive outcomes that were the direct result of the exercise and nutrition education programs. Patients reported lower levels of anger, anxiety, and depression in addition to higher self-esteem and overall improved mood.
An average of 95% of patients reported that their moods improved after completing the structured exercises. Similarly, 63% of participants reported being either happy or very happy, as opposed to feeling neutral, sad, or very sad, after the exercises.
An average of 91.8% of patients reported that they were pleased with the way their bodies felt after performing the structured exercises.
The researchers were encouraged by the participants' attitudes toward exercise after the trial. Indeed, more than 97% of the participants expressed interest in continuing a fitness routine after attending the group sessions.
More than two thirds of participants said they found the nutrition education component of the study to be helpful.
Far-reaching Implications
The findings have far-reaching implications for psychiatric inpatients, for whom pharmaceutical therapy has often been the first line of defense. Instead, the mind-body connection forged by the exercise and nutrition program allowed patients to better understand, monitor, and control their psychophysical well-being, said Tomasi.
"Of course, the intrinsic therapeutic value of patient-provider relationship remains essential for positive outcomes in this setting," the investigators write.
This, they say, is particularly relevant in exercise programs, where facilitators lead by example and directly demonstrate techniques in person to the patients.
With this in mind, they emphasized the importance of offering positive reinforcement to individuals embarking on such programs, including empowering, self-nurturing, and self-awareness-raising strategies that are common to standard practices in positive psychology, motivational interviewing, and health/wellness coaching.
As compelling as the findings may be, the researchers point out that this structured program should be viewed as just one part of a multipronged approach to treating inpatient psychiatric disorders.
"Our proposal is not a substitution of exercise for pharmacological intervention. Nevertheless, we overmedicate in this country, and we'd like to reduce overreliance on pharmacological intervention," Tomasi added.
"Of course, with an antipsychotic or antidepressant, you have much more precise capacity to target specific response than exercise would do. But the good thing with exercise is that the patient, especially upon discharge, can take care of themselves by learning more about their own body's response," he said.
Neuronal Connection Boost
Commenting on the findings for Medscape Medical News, Stephen Sammut, PhD, from the Franciscan University of Steubenville, in Ohio, said the study could make a tangible impact on the well-being of psychiatric inpatients.
"From a neuroscientific perspective, we have evidence that exercise increases neuronal connections within the brain," said Sammut, who was not involved in the study.
"Psychiatric disorders involve an imbalance in brain communication, so giving these patients something that actually assists them in keeping those connections active is terrific," Sammut added.
Perhaps one of the underappreciated benefits of the study's exercise program is its ability to help psychiatric patients forge their own path toward healing.
"I think there's a certain aspect here of empowering the patient, which gives them a sense of dignity," he noted.
"So if mental health institutions spend the time and effort necessary to implement this type of program, I think we would see a significant improvement in mental health quality, and potentially even a reduction in the amount of medications that are used, at least in some cases," he said.
The study was funded through a University of Vermont Medical Center research grant. Tomasi and Sammut have disclosed no relevant financial relationships.
Glob Adv Health Med. Published online May 21, 2019. Full text
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Cite this: Exercise Significantly Benefits Psychiatric Inpatients - Medscape - May 30, 2019.
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