Changes in mental health in compliers and non-compliers with physical activity recommendations in patients with stress-related exhaustion

Agneta Lindegård, Ingibjörg H Jonsdottir, Mats Börjesson, Magnus Lindwall, Markus Gerber, Agneta Lindegård, Ingibjörg H Jonsdottir, Mats Börjesson, Magnus Lindwall, Markus Gerber

Abstract

Background: There is a lack of research regarding the long-lasting effects of a more physically active lifestyle in patients with mental disorders. In the present study, clinical data were analysed to examine if initially physically inactive patients, clinically diagnosed with stress-related exhaustion, taking part in 12-month multimodal treatment (MMT), differ at the 18-month follow-up regarding mental health, depending on whether they did or did not comply with the physical activity (PA) recommendations resembling those of the American College of Sports Medicine.

Methods: The study population consisted of 69 patients (65% women) who were referred to a stress clinic due to stress-related exhaustion. All patients received MMT. A major goal was to increase patients' PA levels. The patients received general comprehensive instructions including personal advice regarding the positive effects of PA on mental health and could self-select for an 18-week coached exercise program. Changes in mental health symptoms over an 18-month period were compared between non-compliers (n = 26), mild compliers (n = 22) and strong compliers (n = 21) with the PA recommendations included in the MMT.

Results: Non-compliers, mild and strong compliers did not differ regarding burnout, depression and anxiety at baseline. Although substantial improvements occurred in all groups, mild and strong compliers reported significantly lower burnout and depression levels at the 18-month follow-up than the non-complying group (p < .05). The general pattern of findings was corroborated, if standard cut-off criteria for clinical burnout were used.

Conclusions: Compliance with PA recommendations is associated with decreased levels of burnout and depression in patients with stress-related exhaustion. Thus, the promotion of a more active lifestyle among patients with stress-related exhaustion should be implemented as a part of MMT, to achieve a more sustainable decrease of symptoms of burnout and depression.

Trial registration: This is not a clinical trial.

Figures

Fig. 1
Fig. 1
Differences between patients who were inactive versus active at baseline and differences between compliance groups regarding age, sex, burnout, depression and anxiety
Fig. 2
Fig. 2
Changes in symptoms of burnout from baseline to 18-month follow-up across groups

References

    1. Josefsson T, Lindwall M, Archer T. Physical exercise intervention in depressive disorders: meta-analysis and systematic review. Scand J Med Sci Sports. 2013;24:259–272. doi: 10.1111/sms.12050.
    1. Mammen G, Faulkner G. Physical activity and the prevention of depression: a systematic review of prospective studies. Am J Prev Med. 2013;45:649–657. doi: 10.1016/j.amepre.2013.08.001.
    1. Rosenbaum S, Tiedemann A, Sherrington C, Curtis J, Ward PB. Physical activity interventions for people with mental illness: a systematic review and meta-analysis. J Clin Psychiatry. 2014;75:964–974. doi: 10.4088/JCP.13r08765.
    1. Wegner M, Helmich I, Machado S, Nardi AE, Arias-Carrion O, Budde H. Effects of exercise on anxiety and depression disorders: review of meta-analyses and neurobiological mechanisms. CNS Neurol Disord Drug Targets. 2014;13:1002–1014. doi: 10.2174/1871527313666140612102841.
    1. Knöchel C, Oertel-Knöchel V, O’Dwyer L, Prvulovic D, Alves G, Kollmann B, Hampel H. Cognitive and behavioural effects of physical exercise in psychiatric patients. Prog Neurobiol. 2012;96:46–68. doi: 10.1016/j.pneurobio.2011.11.007.
    1. Mura G, Carta MG. Physical activity in depressed elderly. A systematic review. Clin Pract Epidemiol Ment Health. 2013;12:125–135. doi: 10.2174/1745017901309010125.
    1. Mura G, Sancassiani F, Machado S, Carta MG. Efficacy of exercise on depression: a systematic review. Int J Psychol Rehab. 2014;18:23–36.
    1. Lawlor DA, Hopker SW. The effectiveness of exercise as intervention in the management of depression: systematic review and meta-regression analysis of randomised controlled trials. BMJ. 2001;322:1–8. doi: 10.1136/bmj.322.7289.763.
    1. Stathopoulou G, Power M, Berry A, Smits JA, Otto MW. Exercise interventions for mental health: a quantitative and qualitative review. Clin Psychol Sci Pract. 2006;13:179–193. doi: 10.1111/j.1468-2850.2006.00021.x.
    1. Rethorst CD, Wipfli BM, Landers DM. The antidepressive effects of exercise: a meta-analysis of randomized trials. Sports Med. 2009;39:491–511. doi: 10.2165/00007256-200939060-00004.
    1. Mead GE, Morley W, Campbell P, Greig CA, McMurdo MET, Lawlor DA. Exercise for depression. Cochrane Database Syst Rev. 2009: Art. No:CD004366. doi:10.1002/14651858.CD004366.pub4.
    1. Krogh J, Nordentoft M, Sterne JA, Lawlor DA. The effect of exercise in clinically depressed adults: systematic review and meta-analysis of randomized controlled trials. J Clin Psychiatry. 2011;72:529–538. doi: 10.4088/JCP.08r04913blu.
    1. Wipfli BM, Rethorst CD, Landhorst DM. The anxiolytic effects of exercise: a meta-analysis of randomized trials and dose-response analysis. J Sport Exerc Psychol. 2008;30:392–410.
    1. Rebar AL, Stanton R, Geard D, Short C, Duncan MJ, Vandelanotte C. A meta-meta-analysis of the effect of physical activity on depression and anxiety in non-clinical adult populations. Health Psychol Rev 2015. doi:10.1080/17437199.17432015.
    1. Conn VS. Anxiety outcomes after physical activity interventions: meta-analysis findings. Nurs Res. 2010;59:224–231. doi: 10.1097/NNR.0b013e3181dbb2f8.
    1. Conn VS. Depressive symptom outcomes of physical activity interventions: meta-analysis findings. Ann Behav Med. 2010;39:128–138. doi: 10.1007/s12160-010-9172-x.
    1. Blumenthal JA, Babyak MA, Moore KA, Craighead WE, Herman S, Khatri P, Waugh R, Napolitano MA, Forman LA, Appelbaum M, et al. Effects of exercise training on older patients with major depression. Arch Intern Med. 1999;159:2349–2356. doi: 10.1001/archinte.159.19.2349.
    1. Blumenthal JA, Michael A, Babjak A. Exercise and pharmacotherapy in the treatment of major depressive disorder. Psychosom Med. 2007;69:587–596. doi: 10.1097/PSY.0b013e318148c19a.
    1. Dunn AL, Trivedi MH, Kampert JB, Clark CG, Chambliss HO. Exercise treatment for depression. Efficacy and dose response. Am J Prev Med. 2005;28:1–8. doi: 10.1016/j.amepre.2004.09.003.
    1. Schuch FB, Vasconcelos-Moreno MP, Borowsky C, Zimmerman AB, Rocha NS, Fleck MP. Exercise and severe major depression: effect on symptom severity and quality of life at discharge in an inpatient cohort. J Psychiatr Res. 2015;61:25–32. doi: 10.1016/j.jpsychires.2014.11.005.
    1. Driessen MT, Proper KI, Anema JR, Knol DL, Bongers PM, van der Beek AJ. Participatory ergonomics to reduce exposure to psychosocial and physical risk factors for low back pain and neck pain: results of a cluster randomised controlled trial. Occup Environ Med. 2011;68:674–681. doi: 10.1136/oem.2010.056739.
    1. Hoffman BM, Babyak M, Craighead E, Sherwood A, Doraiswamy PM, Coons MJ, Blumenthal JA. Exercise and pharmacotherapy in patients with major depression: One-year follow-up of the SMILE study. Psychosom Med. 2011;73:127–133. doi: 10.1097/PSY.0b013e31820433a5.
    1. Gerber M, Brand S, Elliot C, Holsboer-Trachsler E, Pühse U, Beck J. Aerobic exercise training and burnout: A pilot study with male participants suffering from burnout. BMC Res Notes 2013;6. doi:10.1186/1756-0500-1186-1178.
    1. Bretland RJ, Thorsteinsson EB. Reducing workplace burnout: The relative benefits of cardiovascular and resistance exercise. PeerJ 2015;3. doi:10.7717/peerj.7891.
    1. Beck J, Gerber M, Brand R, Pühse U, Holsboer-Trachsler E. Executive function performance is reduced during occupational burnout but can recover to the level of healthy controls. J Psychiatr Res. 2013;47:1824–1830. doi: 10.1016/j.jpsychires.2013.08.009.
    1. Grossmann J, Mackenzie FJ. The randomized controlled trial: Gold standard, or merely standard? Perspect Biol Med. 2005;48:516–534. doi: 10.1353/pbm.2005.0092.
    1. Toppinen-Tanner S, Ojajärvi A, Väänänen A, Kalimo R, Jäppinen P. Burnout as a predictor of medically certified sick-leave absences and their diagnosed causes. Behav Med. 2005;31:18–27. doi: 10.3200/BMED.31.1.18-32.
    1. Glise K, Hadzibajramovic E, Jonsdottir IH, Ahlborg G., Jr Self-reported exhaustion: a possible indicator of reduced work ability and increased risk of sickness absence among human service workers. Int Arch Occup Environ Health. 2010;83:511–520. doi: 10.1007/s00420-009-0490-x.
    1. Glise K, Ahlborg GJ, Jonsdottir IH. Course of mental symptoms in patients with stress-related exhaustion: Does sex or age make a difference. BMC Psychiatry 2012;12. doi:10.1186/1471-1244X-1112-1118.
    1. Glise K, Ahlborg G, Jonsdottir I. Prevalence and course of somatic symptoms in patients with stress-related exhaustion: Does sex or age matter. BMC Psychiatry 2014;14. doi:10.1186/1471-1244X-1114-1118.
    1. Jonsdottir I, Nordlund A, Ellbin S, Ljung T, Glise K, Währborg P, Wallin A. Cognitive impairment in patients with stress-related exhaustion. Stress. 2013;16:181–190. doi: 10.3109/10253890.2012.708950.
    1. Gerber M, Jonsdottir I, Arvidson E, Lindwall M, Lindegård A. Promoting graded exercise as part of multimodal treatment in patients diagnosed with stress-related exhaustion. J Clin Nurs 2015. doi:10.1111/jocn.12820.
    1. Daumit GL, Goldberg RW, Anthony C, Dickerson F, Brown CH, Kreyenbuhl JP, Wohlheiter K, Dixon L. Physical activity patterns in adults with severe mental illness. J Nerv Ment Dis. 2005;193:641–646. doi: 10.1097/01.nmd.0000180737.85895.60.
    1. Rütten A, Abu-Omar K. Prevalence of physical activity in the European Union. Soc Prev Med. 2004;49:281–289.
    1. Garber CE, Blissmer B, Deschenes MR, Franklin BA, Lamonte MJ, Lee IM, Nieman DC, Swain DP. Quantity and quality of exerrcise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. Med Sci Sports Exerc. 2011;7:1334–1359. doi: 10.1249/MSS.0b013e318213fefb.
    1. Haskell WL, Blair SN, Hill JO. Physical activity: health outcomes and importance for public health policy. Prev Med. 2009;49:280–282. doi: 10.1016/j.ypmed.2009.05.002.
    1. Saltin B, Grimby G. Physiological analysis of middle-aged and older former athletes. Comparison with still active athletes of the same ages. Circulation. 1968;38:1104–1115. doi: 10.1161/01.CIR.38.6.1104.
    1. Saltin B. Physiological effects of physical conditioning. In: Hansen AT, Schnohr P, Rose G, editors. Ischaemic heart disease: the strategy of postponement. Chicago: Medical Publishers; 1977. pp. 104–115.
    1. Aires N, Selmer R, Thelle D. The validity of self-reported leisure time physical activity, and its relationship to serum cholesterol, blood pressure and body mass index. A population based study of 332, 182 men and women aged 40–42 years. Eur J Epidemiol. 2003;18:479–485. doi: 10.1023/A:1024682523710.
    1. Rödjer L, Jonsdottir I, Rosengren A, Björck L, Grimby G, Thelle DS, et al. Self-reported leisure time physical activity: a useful assessment tool in everyday health care. BMC Public Health 2012;12. doi:10.1186/1471-2458-1112-1693.
    1. Apullan FJ, Bourassa MG, Tardif JC, Fortier A, Gayda M, Nigam A. Usefulness of self-reported leisure-time physical activity to predict long-term survival in patients with coronary heart disease. Am J Cardiol. 2008;102:375–379. doi: 10.1016/j.amjcard.2008.03.072.
    1. Byberg L, Melhus H, Gedeborg R, Sundström J, Ahlbom A, Zethelius B, Berglund LG, Wolk A, Michaëlsson K. Total mortality after changes in leisure time physical activity in 50 year old men: 35 year follow-up of population based cohort. BMJ. 2009;338:b688. doi: 10.1136/bmj.b688.
    1. Wilsgaard T, Jacobsen BK. Lifestyle factors and incident metabolic syndrome. The Tromso Study 1979–2001. Diabetes Res Clin Pract. 2007;78:217–224. doi: 10.1016/j.diabres.2007.03.006.
    1. Haskell WL, Lee IM, Pate RR, Powell WW, Blair SN, Franklin BA, Macera CA, Heath GW, Thompson A, Bauman A. Physical activity and public health. Updated recommendation for adults from the American College of Sports Medicine and the American Heart Association. Med Sci Sports Exerc. 2007;39:1423–1434. doi: 10.1249/mss.0b013e3180616b27.
    1. Melamed S, Kushnir T, Shirom A. Burnout and risk factors for cardiovascular disease. Behav Med. 1992;18:53–60. doi: 10.1080/08964289.1992.9935172.
    1. Grossi G, Perski A, Evengard B, Blomkvist V, Orth-Gomer K. Physiological correlates of burnout among women. J Psychosom Res. 2003;55:309–316. doi: 10.1016/S0022-3999(02)00633-5.
    1. Lundgren-Nilsson A, Jonsdottir IH, Pallant J, Ahlborg G. Internal construct validity of the Shirom-Melamed Burnout Questionnaire (SMBQ). BMC Public Health 2012;12. doi:10.1186/1471-2458-1112-1181.
    1. Shirom A, Melamed S. A comparison of the construct validity of two burnout measures in two groups of professionals. Int J Stress Manag. 2006;13:176–200. doi: 10.1037/1072-5245.13.2.176.
    1. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67:361–370. doi: 10.1111/j.1600-0447.1983.tb09716.x.
    1. Bjelland I, Dahl AA, Haug TT, Neckelmann D. The validity of the hospital anxiety and depression scale. An updated literature review. J Psychosom Res. 2002;52:69–77. doi: 10.1016/S0022-3999(01)00296-3.
    1. Herrmann C. International experiences with the hospital anxiety and depression scale: a review of validation data and clinical results. J Psychosom Res. 1997;42:17–41. doi: 10.1016/S0022-3999(96)00216-4.
    1. Löwe B, Spitzer RL, Gräfe K, Kroenke K, Quenter A, Zipfel S, Buchholz C, Witte S, Herzog W. Comparative validity of three screening questionnaires for DSM-IV depressive disorders and physicians’ diagnoses. J Affect Disord. 2004;78:131–140. doi: 10.1016/S0165-0327(02)00237-9.
    1. Wilkinson M, Barczak P. Psychiatric screening in general practice: comparison of the general health questionnaire and hospital anxiety depression scale. J R Coll Gen Pract. 1988;38:311–313.
    1. Cohen J. Statistical power analysis for the behavioral sciences. Mahwah: Erlbaum; 1988.
    1. Leiter MP, Durup J. The discriminant validity of burnout and depression: a confirmatory factor analytic study. Anxiety Stress Coping. 1994;7:357–373. doi: 10.1080/10615809408249357.
    1. Gerber M, Lang C, Feldmeth AK, Elliot C, Brand S, Holsboer-Trachsler E, Pühse U. Mental health in swiss vocational students: the moderating role of physical activity. J Res Adolesc. 2015;25:63–74. doi: 10.1111/jora.12097.
    1. Elliot C, Lang C, Brand S, Holsboer-Trachsler E, Pühse U, Gerber M. Burnout symptoms among adolescents above versus below current recommendations for vigorous physical activity: An exploratory study with vocational students. J Sport Exerc Psychol. In press.
    1. Jonsdottir IH, Rödjer L, Hadzibajramovic E, Börjesson M, Ahlborg GJ. A prospective study of leisure-time physical activity and mental health in Swedish health care workers and social insurance officers. Prev Med. 2010;51:373–377. doi: 10.1016/j.ypmed.2010.07.019.
    1. Lindwall M, Ljung T, Hadzibajramovic E, Jonsdottir I. Self-reported physical activity and aerobic fitness are differently related to mental health. Ment Health Phys Act. 2012;5:28–34. doi: 10.1016/j.mhpa.2011.12.003.
    1. Galper DI, Trivedi MH, Barlow CE, Dunn AL, Kampert JB. Inverse association between physical inactivity and mental health in men and women. Med Sci Sports Exerc. 2006;38:173–178. doi: 10.1249/01.mss.0000180883.32116.28.
    1. Gupta NK, Mueller WH, Chan W, Meininger JC. Is obesity associated with poor sleep quality in adolescents? Am J Hum Biol. 2002;14:762–768. doi: 10.1002/ajhb.10093.
    1. Mekary RA, Lucas M, Pan A, Okereke OI, Willett WC, Hu FB, Ding EL. Isotemporal substitution analysis for physical activity, television watching, and risk of depression. Am J Epidemiol. 2013;178:474–483. doi: 10.1093/aje/kws590.
    1. Shephard RJ. Limits to the measurement of habitual physical activity by questionnaires. Br J Sports Med. 2003;37:197–206. doi: 10.1136/bjsm.37.3.197.

Source: PubMed

3
Abonnere