The impact of exercise training complementary to early intervention in patients with first-episode psychosis: a qualitative sub-study from a randomized controlled feasibility trial

Lene Q Larsen, Helle Schnor, Britt P Tersbøl, Bjørn H Ebdrup, Nikolai B Nordsborg, Julie Midtgaard, Lene Q Larsen, Helle Schnor, Britt P Tersbøl, Bjørn H Ebdrup, Nikolai B Nordsborg, Julie Midtgaard

Abstract

Background: Burgeoning evidence suggests that exercise improves physical and mental health in people with schizophrenia. However, little is known about the feasibility and acceptability of high-intensity training in patients with first-episode psychosis. This qualitative study explored motivation, social interaction and experiences of participants and instructors in relation to an eight-week moderate to high intensity exercise training programme in a clinical trial including patients with first-episode psychosis.

Methods: The study used a combination of method, source and investigator triangulation. Data were collected by means of semi-structured individual interviews with participants at baseline (n = 16) and at follow-up (n = 9), as well as by means of participant observations during the programme (8 sessions × 1.5 h, 12 h in total) and focus group discussions with participants (n = 3) and instructors (n = 4), respectively, after the programme. Data were analysed using thematic analysis as described by Braun and Clarke.

Results: Three main themes and ten subthemes emerged during the analysis: 1) motivation and expectations for enrolment (subthemes: routines and structure, social obligation, goal setting and self-worth); 2) new demands and opportunities (subthemes: practicalities of the training, an understanding exercise setting, and alone and together); and 3) looking ahead - reflections on impact (subthemes: restored sleep and circadian rhythm, energy and sense of achievement, changed everyday life, and hope of finding a new path). Findings suggest that the programme was appealing to, and appreciated by, the participants because of its potential to create an equally challenging and caring non-clinical environment.

Conclusions: This study indicates that supervised, group-based, moderate to high intensity exercise training complementary to early intervention in psychosis is acceptable. Specifically, the intervention appeared to provide patients an opportunity to integrate the notion of being a young individual along with being a patient with a psychiatric diagnosis, thus supporting and promoting recovery.

Trial registration: ClinicalTrials.gov identifier: NCT03409393. Registered January 24, 2018.

Keywords: Early intervention; Exercise training; First-episode psychosis; Recovery; Schizophrenia; Thematic analysis; Young adults.

Conflict of interest statement

BHE has received lecture fees and is part of Advisory Boards of Bristol-Myers Squibb, Eli Lilly and Company, Janssen-Cilag, Otsuka Pharma Scandinavia AB, Takeda Pharmaceutical Company and Lundbeck Pharma A/S. Remaining authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart of participants during the study and points of qualitative data collection
Fig. 2
Fig. 2
Main themes with subthemes
Fig. 3
Fig. 3
Theoretical model of the potential meaningfulness of the COPUS programme

References

    1. van Os J, Kapur S. Schizophrenia. Lancet. 2009;374(9690):635–645. doi: 10.1016/S0140-6736(09)60995-8.
    1. Secher RG, Hjorthøj CR, Austin SF, Thorup A, Jeppesen P, Mors O, et al. Ten-year follow-up of the OPUS specialized early intervention trial for patients with a first episode of psychosis. Schizophr Bull. 2015;41(3):617–626. doi: 10.1093/schbul/sbu155.
    1. Institute for Health Metrics and Evaluation. GBD Compare [Internet]. 2016 [cited 2018 Sep 18]. Available from:
    1. Charlson FJ, Ferrari AJ, Santomauro DF, Diminic S, Stockings E, Scott JG, et al. Global epidemiology and burden of schizophrenia: findings from the global burden of disease study 2016. Schizophr Bull. 2018;44(6):1195–1203. doi: 10.1093/schbul/sby058.
    1. Rössler W, Joachim Salize H, Van Os J, Riecher-Rössler A. Size of burden of schizophrenia and psychotic disorders. Eur Neuropsychopharmacol. 2005;15(4):399–409. doi: 10.1016/j.euroneuro.2005.04.009.
    1. McGorry PD. Early intervention in psychosis: obvious, effective, overdue. J Nerv Ment Dis. 2015;203(5):310–318. doi: 10.1097/NMD.0000000000000284.
    1. Jeppesen Pia, Petersen Lone, Thorup Anne, Abel Maj-Britt, ⊘ehlenschlæger Johan, Christensen Torben Ø., Krarup Gertrud, Hemmingsen Ralf, J⊘rgensen Per, Nordentoft Merete. Integrated treatment of first-episode psychosis: effect of treatment on family burden. British Journal of Psychiatry. 2005;187(S48):s85–s90. doi: 10.1192/bjp.187.48.s85.
    1. Nordentoft M, Melau M, Iversen T, Petersen L, Jeppesen P, Thorup A, et al. From research to practice: how OPUS treatment was accepted and implemented throughout Denmark. Early Interv Psychiatry. 2015;9(2):156–162. doi: 10.1111/eip.12108.
    1. Albert N, Melau M, Jensen H, Emborg C, Jepsen JRM, Fagerlund B, et al. Five years of specialised early intervention versus two years of specialised early intervention followed by three years of standard treatment for patients with a first episode psychosis: randomised, superiority, parallel group trial in Denmark (OPUS II). BMJ. 2017;356:j1015.
    1. Melau M, Jeppesen P, Thorup A, Bertelsen M, Petersen L, Gluud C, et al. The effect of five years versus two years of specialised assertive intervention for first episode psychosis - OPUS II: study protocol for a randomized controlled trial. Trials. 2011;12:72. doi: 10.1186/1745-6215-12-72.
    1. Laursen TM, Wahlbeck K, Hällgren J, Westman J, Ösby U, Alinaghizadeh H, et al. Life expectancy and death by diseases of the circulatory system in patients with bipolar disorder or schizophrenia in the Nordic countries. PLoS One. 2013;8(6):e67133. doi: 10.1371/journal.pone.0067133.
    1. Oakley P, Kisely S, Baxter A, Harris M, Desoe J, Dziouba A, et al. Increased mortality among people with schizophrenia and other non-affective psychotic disorders in the community: a systematic review and meta-analysis. J Psychiatr Res. 2018;102:245–253. doi: 10.1016/j.jpsychires.2018.04.019.
    1. Lawrence D, Hancock KJ, Kisely S. The gap in life expectancy from preventable physical illness in psychiatric patients in Western Australia: retrospective analysis of population based registers. BMJ. 2013;346(7909):f2539. doi: 10.1136/bmj.f2539.
    1. Haennel RG, Lemire F. Physical activity to prevent cardiovascular disease. How much is enough? Can Fam Physician. 2002;48:65–71.
    1. Lin X, Zhang X, Guo J, Roberts CK, McKenzie S, Wu WC, et al. Effects of exercise training on cardiorespiratory fitness and biomarkers of cardiometabolic health: a systematic review and meta-analysis of randomized controlled trials. J Am Heart Assoc. 2015;4(7).
    1. Chekroud SR, Gueorguieva R, Zheutlin AB, Paulus M, Krumholz HM, Krystal JH, et al. Association between physical exercise and mental health in 1·2 million individuals in the USA between 2011 and 2015: a cross-sectional study. Lancet Psychiatry. 2018;5(9):739–746. doi: 10.1016/S2215-0366(18)30227-X.
    1. Firth J, Stubbs B, Rosenbaum S, Vancampfort D, Malchow B, Schuch F, et al. Aerobic exercise improves cognitive functioning in people with schizophrenia: a systematic review and meta-analysis. Schizophr Bull. 2017;43(3):546–556.
    1. Firth J, Carney R, Jerome L, Elliott R, French P, Yung AR. The effects and determinants of exercise participation in first-episode psychosis: a qualitative study. BMC Psychiatry. 2016;16:36. doi: 10.1186/s12888-016-0751-7.
    1. Curtis J, Watkins A, Rosenbaum S, Teasdale S, Kalucy M, Samaras K, et al. Evaluating an individualized lifestyle and life skills intervention to prevent antipsychotic-induced weight gain in first-episode psychosis. Early Interv Psychiatry. 2016;10(3):267–276. doi: 10.1111/eip.12230.
    1. Abdel-Baki A, Brazzini-Poisson V, Marois F, Letendre É, Karelis AD. Effects of aerobic interval training on metabolic complications and cardiorespiratory fitness in young adults with psychotic disorders: a pilot study. Schizophr Res. 2013;149(1–3):112–115. doi: 10.1016/j.schres.2013.06.040.
    1. Firth J, Carney R, Elliott R, French P, Parker S, McIntyre R, et al. Exercise as an intervention for first-episode psychosis: a feasibility study. Early Interv Psychiatry. 2018;12(3):307–315. doi: 10.1111/eip.12329.
    1. Tibana RA, Frade De Sousa NM. Are extreme conditioning programmes effective and safe? A narrative review of high-intensity functional training methods research paradigms and findings. BMJ Open Sport Exerc Med. 2018;4(1):e000435. doi: 10.1136/bmjsem-2018-000435.
    1. Claudino JG, Gabbett TJ, Bourgeois F, Souza H de S, Miranda RC, Mezêncio B, et al. CrossFit overview: systematic review and meta-analysis. Sport Med Open. 2018;4(1):11. doi: 10.1186/s40798-018-0124-5.
    1. World Health Organization. ICD-10 WHO version for 2016 [internet]. 2016 [cited 2018 Sep 10]. Available from:
    1. Lewin S, Glenton C, Oxman AD. Use of qualitative methods alongside randomised controlled trials of complex healthcare interventions: methodological study. BMJ. 2009;339:b3496. doi: 10.1136/bmj.b3496.
    1. Patton MQ. Qualitative research & evaluation methods. 3. Ed. thousand oaks, calif: Sage Publications; 2002.
    1. Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77–101. doi: 10.1191/1478088706qp063oa.
    1. Zarrett Nicole, Eccles Jacquelynne. The passage to adulthood: Challenges of late adolescence. New Directions for Youth Development. 2006;2006(111):13–28. doi: 10.1002/yd.179.
    1. Leamy M, Bird V, Le Boutillier C, Williams J, Slade M. Conceptual framework for personal recovery in mental health: systematic review and narrative synthesis. Br J Psychiatry. 2011;199(6):445–452. doi: 10.1192/bjp.bp.110.083733.
    1. Soundy A, Freeman P, Stubbs B, Probst M, Coffee P, Vancampfort D. The transcending benefits of physical activity for individuals with schizophrenia: a systematic review and meta-ethnography. Psychiatry Res. 2014;220(1–2):11–19. doi: 10.1016/j.psychres.2014.07.083.
    1. Ward MC, White DT, Druss BG. A meta-review of lifestyle interventions for cardiovascular risk factors in the general medical population. J Clin Psychiatry. 2015;76(04):e477–e486. doi: 10.4088/JCP.13r08657.
    1. Schuch FB, Vancampfort D, Richards J, Rosenbaum S, Ward PB, Stubbs B. Exercise as a treatment for depression: a meta-analysis adjusting for publication bias. J Psychiatr Res. 2016;77:42–51. doi: 10.1016/j.jpsychires.2016.02.023.
    1. Brooke Lauren E., Lin Ashleigh, Ntoumanis Nikos, Gucciardi Daniel F. Is sport an untapped resource for recovery from first episode psychosis? A narrative review and call to action. Early Intervention in Psychiatry. 2018;13(3):358–368. doi: 10.1111/eip.12720.
    1. Mason OJ, Holt R. Mental health and physical activity interventions: a review of the qualitative literature. J Ment Health. 2012;21(3):274–284. doi: 10.3109/09638237.2011.648344.
    1. Secker J, Membrey H, Grove B, Seebohm P. Recovering from illness or recovering your life? Implications of clinical versus social models of recovery from mental health problems for employment support services. Disabil Soc. 2002;17(4):403–418. doi: 10.1080/09687590220140340.
    1. Carless D, Douglas K. Narrative, identity and mental health: how men with serious mental illness re-story their lives through sport and exercise. Psychol Sport Exerc. 2008;9(5):576–594. doi: 10.1016/j.psychsport.2007.08.002.
    1. Ryan RM, Deci EL. Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. Am Psychol. 2000;55(1):68–78. doi: 10.1037/0003-066X.55.1.68.
    1. Shenton AK. Strategies for ensuring trustworthiness in qualitative research projects. Educ Inf. 2004;22:63–75.

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