Association between physical activity and leisure-time sedentary behavior among 140,808 adolescents aged 12 to 15 from 47 low- and middle-income countries.

OBJECTIVES: Data from high-income countries (HICs) indicate that sedentary behavior is negatively associated with moderate-to-vigorous physical activity (MVPA) in young people. We examined associations between leisure-time sedentary behavior (LTSB) and MVPA in adolescents from 47 low- and middle-income countries (LMICs). STUDY DESIGN: Cross-sectional study. METHODS: Data from the Global school-based Student Health Survey were analyzed in 140,808 adolescents (13.8 ± 1.0 years; 49% girls). Time spent in LTSB was a composite variable assessing time spent sitting and playing computer games, watching TV, talking with friends during a typical day. The PACE + Adolescent Physical Activity Measure assessed MVPA levels. The association between ≥3 h/day of LTSB and adequate physical activity levels (every day last week 60 min MVPA) was explored with multivariable logistic regression analyses. RESULTS: The prevalence of ≥3 h/day of LTSB and 60 min of MVPA/day last week were 26.3% (girls 26.2%; boys 26.5%) and 15.3% (girls 12.1%; boys 18.4%), respectively. LTSB of ≥3 h/day versus <3 h/day was associated with a 35% increased odds for adequate levels of MVPA in boys [OR = 1.35 (95%CI = 1.23-1.48)] and 22% in girls [1.22 (95%CI = 1.10-1.36)]. CONCLUSIONS: Our data indicate that being physically active 60 min per day every day and at moderate-to-vigorous intensity and being sedentary ≥3 h/day during leisure-time might co-exist in adolescents in some LMICs.

Metabolic syndrome and its components in people with intellectual disability: a meta-analysis.

BACKGROUND: People with intellectual disability have an increased risk for cardiovascular diseases and associated premature mortality. Metabolic syndrome (MetS) and its components are highly predictive of cardiovascular diseases. The aim of this meta-analysis was to describe the pooled prevalence of MetS and its components in people with intellectual disability taking into account variations in demographic, clinical and treatment-related variables. METHODS: Pubmed, Embase and CINAHL were searched until 5 August 2020 for studies reporting cross-sectional data on prevalences of MetS and its components in people with intellectual disability. Two independent reviewers extracted data. Random effects meta-analyses with subgroup and meta-regression analyses were employed. RESULTS: The pooled MetS prevalence after adjusting for publication bias was 22.5% [95% confidence interval (CI) = 16.8%-29.6%; N studies = 10; n participants = 2443, median age at study level = 38.5 years; 52% male]. Abdominal obesity was observed in 52.0% (95% CI = 42.0%-61.9%; I2  = 86.5; N = 5; n = 844), hypertension in 36.7% (95% CI = 26.1%-48.7%; N = 6; n = 926), hypertriglyceridaemia in 23.5% (95% CI = 18.8%-28.9%; N = 5; n = 845), low high-density-lipoprotein-cholesterol in 23.4% (95% CI = 19.3%-28.0%; N = 6; n = 917), and hyperglycaemia in 10.2% (95% CI = 7.6%-13.3%; N = 5; n = 845). Meta-regression revealed that a higher MetS frequency was moderated by older age (coefficient = 0.03; standard error = 0.01, 95% CI = 0.008 to 0.055; N = 19; n = 2443) and a higher proportion of people on antidepressants in the study (coefficient = 7.24; standard error = 0.90, 95% CI = 5.48-9.00; N = 4; n = 546). There were insufficient data comparing MetS in people with intellectual disability with age-matched and gender-matched controls. CONCLUSIONS: Considering that more than one fifth of people with intellectual disability have MetS, routine screening and multidisciplinary management of metabolic abnormalities in people with intellectual disability is needed. Attention should be given to older people and those on antidepressants.

[The efficacy of physical activity on psychiatric symptoms and physical health in people with psychiatric disorders: a systematic review of recent meta-analyses]. / Effect van bewegen op psychiatrische symptomen en lichamelijke gezondheid bij mensen met psychiatrische aan-doeningen; systematische review van recente meta-analyses.

BACKGROUND: Physical activity (PA) has been introduced in the sixties as standard care in the mental health care systems of The Netherlands and Belgium.
AIM: To summarize the recent meta-analytic evidence of PA in the prevention and treatment of depressive disorders, anxiety disorders, psychotic disorders, bipolar disorders, substance use disorders, adhd, autism, and eating disorders.
METHOD: medline/PubMed, Psycarticles and Embase were searched from January 1st, 2015 until January 31st, 2020 for meta-analyses of randomized controlled trials and cohort studies.
RESULTS: There is strong evidence for the beneficial effects of PA in the treatment of mild and moderate depression in children / adolescents and adults, severe depression, anxiety disorders and psychotic disorders in adults and reductions in adhd-symptoms in children. PA reduces the risk for depression, anxiety and to a lesser extent also psychosis. PA also improves cardiorespiratory fitness and quality of sleep in people with a psychiatric disorder.
CONCLUSION: There is trans-diagnostic scientific evidence for the beneficial effects of PA on psychiatric symptoms and physical health in people with a psychiatric disorder.

Is there an association between cardiorespiratory fitness and stage of illness in psychotic disorders? A systematic review and meta-analysis.

BACKGROUND: Clinical staging models describe where an individual exists on a continuum from asymptomatic at-risk states (Stage 0) through to established late-stage disease (Stage 4). We applied this framework to systematically assess evidence for any associations between objectively assessed cardiorespiratory fitness (CRF) and stage of psychosis. METHOD: Nine electronic databases were searched for relevant publications from inception until October 31, 2019. Pooled effect sizes (Hedges' g and 95% confidence intervals (95% CI)) were estimated for differences in CRF for studies that reported mean oxygen uptake (max, peak, or predicted VO2 in ml/kg/min). RESULTS: Thirty-eight studies were eligible. Findings indicated that suboptimal CRF can be present at Stages 0 and 1. Meta-analyses of 22 studies demonstrated that CRF was significantly reduced in individuals classified between Stages 1 and 4 compared with matched or general population controls (g = -0.93; 95% CI -1.14, -0.71). Mean VO2 was decreased by 28% in Stage 4 compared with Stage 1 (34.1 vs. 24.66 ml/kg/min); the largest effect size for CRF reduction was reported between Stages 2 and 3 (g = -1.16; 95% CI -1.31, -1.03). CONCLUSIONS: Although not identifying direct causal links between clinical stage and CRF, using this framework may enhance understanding of co-associations between mental and physical health markers across the entire spectrum of psychosis. Limitations include lack of research on CRF in Stages 0 and 1 alongside problems determining stage in some studies. However, impaired CRF is reported in emerging psychosis, supporting calls that early intervention programmes should address both mental and physical wellbeing.

Psychotic experiences and subjective cognitive complaints among 224 842 people in 48 low- and middle-income countries.

AIMS: Cognitive deficits are an important factor in the pathogenesis of psychosis. Subjective cognitive complaints (SCCs) are often considered to be a precursor of objective cognitive deficits, but there are no studies specifically on SCC and psychotic experiences (PE). Thus, we assessed the association between SCC and PE using data from 48 low- and middle-income countries. METHODS: Community-based cross-sectional data of the World Health Survey were analysed. Two questions on subjective memory and learning complaints in the past 30 days were used to create a SCC scale ranging from 0 to 10 with higher scores representing more severe SCC. The Composite International Diagnostic Interview was used to identify past 12-month PE. Multivariable logistic regression and mediation analyses were performed. RESULTS: The final sample consisted of 224 842 adults aged ⩾18 years [mean (SD) age 38.3 (16.0) years; 49.3% males]. After adjustment for sociodemographic factors, a one-unit increase in the SCC scale was associated with a 1.17 (95% CI 1.16-1.18) times higher odds for PE in the overall sample, with this association being more pronounced in younger individuals: age 18-44 years OR = 1.19 (95% CI 1.17-1.20); 45-64 years OR = 1.15 (95% CI 1.12-1.17); ⩾65 years OR = 1.14 (95% CI 1.09-1.19). Collectively, other mental health conditions (perceived stress, depression, anxiety, sleep problems) explained 43.4% of this association, and chronic physical conditions partially explained the association but to a lesser extent (11.8%). CONCLUSIONS: SCC were associated with PE. Future longitudinal studies are needed to understand temporal associations and causal inferences, while the utility of SCC as a risk marker for psychosis especially for young adults should be scrutinised.

Physical activity correlates in people with mild cognitive impairment: findings from six low- and middle-income countries.

OBJECTIVES: Despite promising research showing that physical activity (PA) might improve cognitive functioning in people with mild cognitive impairment (MCI), people with MCI are less physically active compared with the general population. Therefore, the aim of this study was to assess PA correlates among community-dwelling older people with MCI in six low- and middle-income countries. DESIGN: Cross-sectional data from the World Health Organization's Study on Global Ageing and Adult Health were analysed. METHODS: PA level was assessed by the Global Physical Activity Questionnaire. 4854 participants with MCI (mean age 64.4 years; 55.1% females) were grouped into those who do and do not (low PA) meet the 150 min of moderate-to-vigorous PA per week recommendation. Associations between PA and the correlates were examined using multivariable logistic regressions. RESULTS: The prevalence of low PA was 27.4% (95% confidence interval = 25.0-30.0). In the multivariable analysis, older age and unemployment were the only sociodemographic correlates of low PA. The significant positive correlates of low PA in other domains included depression, being underweight, obesity, asthma, chronic lung disease, hearing problems, visual impairment, slow gait, weak grip strength, poor self-rated health, and lower levels of social cohesion. CONCLUSIONS: The current data illustrate that a number of sociodemographic and health factors are associated with PA levels among older people with MCI. The promotion of social cohesion may increase the efficacy of public health initiatives while from a health care perspective, somatic co-morbidities, muscle strength and slow gait need to be considered when activating those at risk for dementia.

Sedentary behavior and anxiety: Association and influential factors among 42,469 community-dwelling adults in six low- and middle-income countries.

OBJECTIVE: This study investigated the association between sedentary behavior (SB) and anxiety, and explored factors that influence this relationship in six low- and middle-income countries. METHOD: Cross-sectional data were analyzed from the World Health Organization's Study on Global Ageing and Adult Health. Multivariable linear and logistic regression analyses were conducted to assess the association between anxiety and self-reported SB. Potentially influential factors were examined with mediation analysis. RESULTS: The sample consisted of 42,469 adults aged≥18years (50.1% female; mean age 43.8years). After adjusting for sociodemographics and country, people with anxiety engaged in 24 (95%CI=7-41) more minutes per day of SB than non-anxious individuals; the corresponding figure for the elderly (≥65years) was much higher (55min; 95% CI=29-81). Anxiety was associated with a 2.0 (95%CI=1.5-2.7) times higher odds for high SB (i.e., ≥8h/day). Overall, the largest proportion of the high SB-anxiety relationship was explained by mobility limitations (46.8%), followed by impairments in sleep/energy (44.9%), pain/discomfort (31.7%), disability (27.0%), cognition (13.3%), and physical activity levels (6.3%). CONCLUSIONS: Anxiety was significantly associated with high SB, particularly among older adults. Future longitudinal studies are warranted to disentangle the potentially complex interplay of factors that may influence the anxiety-SB relationship.

Depression and pain: primary data and meta-analysis among 237 952 people across 47 low- and middle-income countries.

BACKGROUND: Depression and pain are leading causes of global disability. However, there is a paucity of multinational population data assessing the association between depression and pain, particularly among low- and middle-income countries (LMICs) where both are common. Therefore, we investigated this association across 47 LMICs. METHODS: Community-based data on 273 952 individuals from 47 LMICs were analysed. Multivariable logistic and linear regression analyses were performed to assess the association between the International Classification of Diseases, 10th Revision depression/depression subtypes (over the past 12 months) and pain in the previous 30 days based on self-reported data. Country-wide meta-analysis adjusting for age and sex was also conducted. RESULTS: The prevalence of severe pain was 8.0, 28.2, 20.2, and 34.0% for no depression, subsyndromal depression, brief depressive episode, and depressive episode, respectively. Logistic regression adjusted for socio-demographic variables, anxiety and chronic medical conditions (arthritis, diabetes, angina, asthma) demonstrated that compared with no depression, subsyndromal depression, brief depressive episode, and depressive episode were associated with a 2.16 [95% confidence interval (CI) 1.83-2.55], 1.45 (95% CI 1.22-1.73), and 2.11 (95% CI 1.87-2.39) increase in odds of severe pain, respectively. Similar results were obtained when a continuous pain scale was used as the outcome. Depression was significantly associated with severe pain in 44/47 countries with a pooled odds ratio of 3.93 (95% CI 3.54-4.37). CONCLUSION: Depression and severe pain are highly comorbid across LMICs, independent of anxiety and chronic medical conditions. Whether depression treatment or pain management in patients with comorbid pain and depression leads to better clinical outcome is an area for future research.

Depression and physical health multimorbidity: primary data and country-wide meta-analysis of population data from 190 593 people across 43 low- and middle-income countries.

BACKGROUND: Despite the known heightened risk and burden of various somatic diseases in people with depression, very little is known about physical health multimorbidity (i.e. two or more physical health co-morbidities) in individuals with depression. This study explored physical health multimorbidity in people with clinical depression, subsyndromal depression and brief depressive episode across 43 low- and middle-income countries (LMICs). METHOD: Cross-sectional, community-based data on 190 593 individuals from 43 LMICs recruited via the World Health Survey were analysed. Multivariable logistic regression analysis was done to assess the association between depression and physical multimorbidity. RESULTS: Overall, two, three and four or more physical health conditions were present in 7.4, 2.4 and 0.9% of non-depressive individuals compared with 17.7, 9.1 and 4.9% among people with any depressive episode, respectively. Compared with those with no depression, subsyndromal depression, brief depressive episode and depressive episode were significantly associated with 2.62, 2.14 and 3.44 times higher odds for multimorbidity, respectively. A significant positive association between multimorbidity and any depression was observed across 42 of the 43 countries, with particularly high odds ratios (ORs) in China (OR 8.84), Laos (OR 5.08), Ethiopia (OR 4.99), the Philippines (OR 4.81) and Malaysia (OR 4.58). The pooled OR for multimorbidity and depression estimated by meta-analysis across 43 countries was 3.26 (95% confident interval 2.98-3.57). CONCLUSIONS: Our large multinational study demonstrates that physical health multimorbidity is increased across the depression spectrum. Public health interventions are required to address this global health problem.

Dropout from physical activity interventions in people living with HIV: a systematic review and meta-analysis.

Physical activity (PA) interventions have been shown to improve the health of people living with HIV (PLWH), yet treatment dropout poses an important challenge. We conducted a meta-analysis to investigate the prevalence and predictors of treatment dropout in PA interventions in PLWH. Electronic databases were searched for records up to September 2016. Randomized control trials of PA interventions in PLWH reporting dropout rates were included. Random effects meta-analysis and meta-regression analyses were employed. In 36 studies involving 49 PA intervention arms, 1128 PLWH were included (mean age = 41.6 years; 79.3% male; 39% White). The trim and fill adjusted treatment dropout rate was 29.3% (95% CI = 24.5-34.7%). There was a significant lower dropout rate in resistance training interventions compared with aerobic (p = 0.003) PA interventions, in studies utilizing supervised interventions throughout the study period (p < 0.001), and in studies using adequately qualified professionals (p < 0.001). Exerciser/participant variables that moderated higher dropout rates were a lower percentage of male participants (ß = 1.15, standard error (SE) = 0.49, z = 2.0, p = 0.048), a lower body mass index(BMI) (ß = 0.14, SE = 0.06, z = 2.16, p = 0.03), and a lower cardiorespiratory fitness (ß = 0.10, SE = 0.04, z = 2.7, p = 0.006). The dropout from PA interventions is much higher in PLWH than in many other populations with chronic morbidities. Qualified professionals (i.e., exercise physiologists, physical educators, or physical therapists) should be incorporated as key care providers in the multidisciplinary care of HIV/AIDS and should prescribe supervised PA for PLWH in order to enhance adherence and reduce the burden of HIV/AIDS. Special attention should be given men, those with a higher BMI, and those with a lower cardiorespiratory fitness.

Physical activity and depression: a large cross-sectional, population-based study across 36 low- and middle-income countries.

OBJECTIVE: Physical activity (PA) is good for health, yet several small-scale studies have suggested that depression is associated with low PA. A paucity of nationally representative studies investigating this relationship exists, particularly in low- and middle-income countries (LMICs). This study explored the global association of PA with depression and its mediating factors. METHOD: Participants from 36 LMICs from the World Health Survey were included. Multivariable logistic regression analyses were undertaken exploring the relationship between PA and depression. RESULTS: Across 178 867 people (mean ± SD age = 36.2 ± 13.5 years; 49.9% male), the prevalence of depression and the prevalence of low PA were 6.6% and 16.8% respectively. The prevalence of low PA was significantly higher among those with depression vs. no depression (26.0% vs. 15.8%, P < 0.0001). In the adjusted model, depression was associated with higher odds for low PA (OR = 1.42; 95% CI = 1.24-1.63). Mediation analyses demonstrated that low PA among people with depression was explained by mobility limitations (40.3%), pain and discomfort (35.8%), disruptions in sleep and energy (25.2%), cognition (19.4%) and vision (10.9%). CONCLUSION: Individuals with depression engage in lower levels of PA in LMICs. Future longitudinal research is warranted to better understand the relationships observed.

Motivating factors and barriers towards exercise in severe mental illness: a systematic review and meta-analysis.

Exercise can improve clinical outcomes in people with severe mental illness (SMI). However, this population typically engages in low levels of physical activity with poor adherence to exercise interventions. Understanding the motivating factors and barriers towards exercise for people with SMI would help to maximize exercise participation. A search of major electronic databases was conducted from inception until May 2016. Quantitative studies providing proportional data on the motivating factors and/or barriers towards exercise among patients with SMI were eligible. Random-effects meta-analyses were undertaken to calculate proportional data and 95% confidence intervals (CI) for motivating factors and barriers toward exercise. From 1468 studies, 12 independent studies of 6431 psychiatric patients were eligible for inclusion. Meta-analyses showed that 91% of people with SMI endorsed 'improving health' as a reason for exercise (N = 6, n = 790, 95% CI 80-94). Among specific aspects of health and well-being, the most common motivations were 'losing weight' (83% of patients), 'improving mood' (81%) and 'reducing stress' (78%). However, low mood and stress were also identified as the most prevalent barriers towards exercise (61% of patients), followed by 'lack of support' (50%). Many of the desirable outcomes of exercise for people with SMI, such as mood improvement, stress reduction and increased energy, are inversely related to the barriers of depression, stress and fatigue which frequently restrict their participation in exercise. Providing patients with professional support to identify and achieve their exercise goals may enable them to overcome psychological barriers, and maintain motivation towards regular physical activity.

Bone mineral density, osteoporosis, and fractures among people with eating disorders: a systematic review and meta-analysis.

OBJECTIVE: To provide meta-analytical evidence of bone mineral density (BMD), fractures, and osteoporosis rates in eating disorders (ED) vs. healthy controls (HCs). METHOD: Three independent authors searched major electronic databases from inception till August 2015 for cross-sectional studies reporting BMD in people with ED (anorexia nervosa, (AN); bulimia nervosa, (BN); eating disorders not otherwise specified, (EDNOS)) vs. HCs. Standardized mean differences (SMDs) ±95% and confidence intervals (CIs) were calculated for BMD, and odds ratios (ORs) for osteopenia, osteoporosis, and fractures. RESULTS: Overall, 57 studies were eligible, including 21 607 participants (ED = 6485, HCs = 15 122). Compared to HC, AN subjects had significantly lower BMD values at lumbar spine (SMD = -1.51, 95% CI = -1.75, -1.27, studies = 42), total hip (SMD = -1.56, 95%CI = -1.84, -1.28, studies = 23), intertrochanteric region (SMD = -1.80, 95%CI = -2.46, -1.14, studies = 7), trochanteric region (SMD = -1.05, 95%CI = -1.44, -0.66, studies = 7), and femoral neck (SMD = -0.98, 95%CI = -1.12, -0.77, studies = 20). Reduced BMD was moderated by ED illness duration and amenorrhea (P < 0.05). AN was associated with an increased likelihood of osteoporosis (OR = 12.59, 95%CI = 3.30-47.9, P < 0.001, studies = 4) and fractures (OR = 1.84, 95% CI = 1.17-2.89, I(2) = 56, studies = 6). No difference in BMD was found between BN and EDNOS vs. HC. CONCLUSION: People with AN have reduced BMD, increased odds of osteoporosis and risk of fractures. Proactive monitoring and interventions are required to ameliorate bone loss in AN.

The prevalence and predictors of type two diabetes mellitus in people with schizophrenia: a systematic review and comparative meta-analysis.

OBJECTIVE: To conduct a meta-analysis investigating the prevalence of type two diabetes mellitus (T2DM) in people with schizophrenia compared to controls. METHOD: Systematic review of electronic databases from inception till November 2014. Articles reporting the prevalence of T2DM in people with schizophrenia and healthy controls (without mental illness) were included. Two independent authors conducted searches and extracted data. A random effects relative risks (RR) meta-analysis was conducted. RESULTS: Twenty-five studies including 145,718 individuals with schizophrenia (22.5-54.4 years) and 4,343,407 controls were included. The prevalence of T2DM in people with schizophrenia was 9.5% (95% CI = 7.0-12.8, n = 145,718) and 10.75% (95% CI 7.44-14.5%, n = 2698) in studies capturing T2DM according to recognized criteria. The pooled RR across all studies was 1.82 (95% CI = 1.56-2.13; = 4,489,125). Subgroup analyses found a RR of 2.53 (95% CI = 1.68-3.799, n = 17,727) in studies ascertaining T2DM according to recognized criteria and RR 1.65 (95% CI = 1.34-2.03, n = 4,243,389) in studies relying on T2DM determined through medical records. CONCLUSION: People with schizophrenia are at least double the risk of developing T2DM according to recognized T2DM criteria. Proactive lifestyle and screening programmes should be given clinical priority.

Weight gain and obesity in schizophrenia: epidemiology, pathobiology, and management.

OBJECTIVE: To review recent advances in the epidemiology, pathobiology, and management of weight gain and obesity in patients with schizophrenia and to evaluate the extent to which they should influence guidelines for clinical practice. METHOD: A Medline literature search was performed to identify clinical and experimental studies published in 2005-2014 decade. RESULTS: Weight gain and obesity increase the risk of adult-onset diabetes mellitus and cardiovascular disorders, non-adherence with pharmacological interventions, quality of life, and psychiatric readmissions. The etiology includes adverse effects of antipsychotics, pretreatment/premorbid genetic vulnerabilities, psychosocial and socioeconomic risk factors, and unhealthy lifestyle. Patients with schizophrenia have higher intake of calories in the form of high-density food and lower energy expenditure. The inverse relationship between baseline body mass index and antipsychotic-induced weight gain is probably due to previous antipsychotic exposure. In experimental models, the second-generation antipsychotic olanzapine increased the orexigenic stimulation of hypothalamic structures responsible for energy homeostasis. CONCLUSION: The management of weight gain and obesity in patients with schizophrenia centers on behavioural interventions using caloric intake reduction, dietary restructuring, and moderate-intensity physical activity. The decision to switch antipsychotics to lower-liability medications should be individualized, and metformin may be considered for adjunctive therapy, given its favorable risk-benefit profile.

Promotion of cardiorespiratory fitness in schizophrenia: a clinical overview and meta-analysis.

OBJECTIVE: Cardiorespiratory fitness (CRF) is a major modifiable risk factor for cardiovascular disease (CVD). We conducted a clinical overview to highlight the reduced CRF expressed as maximal oxygen uptake (VO2max) (or predicted) or peak oxygen uptake (VO2 peak) in people with schizophrenia compared to the general population. We also aimed to identify correlates of and clinical strategies to improve CRF. METHOD: We systematically searched major electronic databases from inception until November 2014. A meta-analysis calculating the standardised mean difference (SMD) was employed. RESULTS: CRF was significantly reduced in people with schizophrenia (n = 154) with a SMD of -0.96 (95% CI -1.29 to -0.64) (N = 5) compared to controls (n = 182). Negative symptoms, increased body mass index and female gender were negatively associated with CRF. Promoting physical activity may improve CRF in people with schizophrenia by up to 4-4.5 ml/kg/min following a 6-8 weeks programme (N = 4, n = 98). CONCLUSION: People with schizophrenia have a large and significantly reduced CRF. Given the overwhelming evidence for physical activity as the cornerstone of preventing and managing CVD in the general population, incorporating such interventions in the treatment of people with schizophrenia is justified and urgently required. We present clear practical strategies of how this can be achieved within clinical settings.

How can we promote smoking cessation in people with schizophrenia in practice? A clinical overview.

OBJECTIVE: High rates of smoking and nicotine dependence are associated with increased physical comorbidity and premature death in people with schizophrenia. We conducted a clinical overview to establish how smoking cessation should be promoted in practice. METHOD: Systematic clinical review of major electronic databases from inception till November 2014. RESULTS: A growing body of evidence supports pharmacological interventions to assist smoking cessation. The most promising evidence is for bupropion with several meta-analyses demonstrating its effectiveness. Currently, there is limited evidence demonstrating the effectiveness of nicotine replacement therapy (NRT) and varenicline, although this is likely to be due to the paucity of research. There are no consistent data to suggest that pharmacological interventions increase adverse events. Behavioural and psychosocial interventions also demonstrate promise, particularly when combined with pharmacotherapy. Careful monitoring of antipsychotic levels (in particular clozapine) is essential, and the promotion of physical activity may be useful to negate potential weight gain and diabetes risk following smoking cessation. CONCLUSION: Evidence from systematic reviews and meta-analyses suggests that smoking cessation interventions are effective in people with schizophrenia, although more long-term research is required. Promoting smoking cessation should be given utmost priority in clinical practice, and we offer practical strategies to facilitate this.

Six minutes walk test for individuals with schizophrenia.

PURPOSE: The six-minute walk test (6MWT) is a sub-maximal exercise test measuring the distance that a patient can walk quickly in a period of 6 minutes (6MWD). The objectives of this systematic review are to evaluate the 6MWT's suitability for measuring the impact of an intervention, to compare the 6MWD walked by patients with schizophrenia with data for the general population or matched controls, to identify the determinants of 6MWD and to examine the measurement properties and quality procedures of the 6MWT. METHODS: Using five databases, we performed a systematic review of full-text articles published through August 2013. RESULTS: Sixteen studies met our selection criteria. The assessment of the 6MWT's suitability for measuring the impact of interventions was not made because none of the interventional studies reported a significant increase in 6MWD. The distance walked by adults with schizophrenia seemed generally shorter than that walked by healthy adults. Mean 6MWDs ranged from 421 m to 648 m in the included studies. The 6MWD is usually negatively associated with a higher Body Mass Index, increased cigarette consumption, higher doses of antipsychotic medication and lower physical self-worth in individuals with schizophrenia. The 6MWT demonstrates high reliability. To date, however, its criterion validity has not been investigated. In spite of existing guidelines, the test procedures used in the studies reviewed varied significantly. CONCLUSIONS: Future physical health monitoring recommendations for patients with schizophrenia should include the 6MWT. Future studies should investigate its predictive role and continue to assess its measurement properties. IMPLICATIONS FOR REHABILITATION: The Six-Minute Walk Test reliably assesses the functional exercise capacity in patients with schizophrenia. The impact of therapeutic interventions on patients, as measured by the 6MWT, cannot be confirmed. Clinicians should take into account overweight, antipsychotic medication use and the physical self-perception when considering the functional exercise capacity in schizophrenia. Clinicians should follow International standards such as these of the American Thoracic Society when using the Six-Minute Walk Test in patients with severe mental illnesses.