Physical fitness, bone mineral density and associations with physical activity in females with longstanding eating disorders and non-clinical controls.

AIM: To examine (i) aerobic fitness, muscular strength, and bone mineral density (BMD) in female inpatients with longstanding eating disorders and non-clinical controls, and (ii) associated and explanatory factors for BMD among the inpatients. METHODS: Adult females with DSM-IV anorexia nervosa (AN), bulimia nervosa (BN) or eating disorders not otherwise specified (EDNOS) (n=59, mean(SD) age 30.1(8.5) yrs and ED duration 14.3 yrs) and non-clinical age-matched controls (n=53, mean(SD) age 31.3(8.3) yrs) accepted participation in this cross-sectional study. Measurements included accelerometer assessed and self reported amount of different types of physical activities, VO2max on treadmill, 1RM in leg and chest press, and BMD in lumbar spine (L2-L4), femur neck and total body analyzed by DXA. RESULTS: Muscular strength and BMD were lower in patients with AN, not in patients with BN or EDNOS, compared to controls. Aerobic fitness did not differ between patients and controls. BMD in the patients was positively associated with body weight, muscular strength and self reported high impact PA (min.w-1), not self reported general weight-bearing PA (min.w-1) or accelerometer assessed PA (counts.min). History of AN (28%) and muscular strength (9%) contributed significantly to explain the variance in total body BMD. CONCLUSION: Muscular strength and only high impact PA are associated with BMD in patients with longstanding ED. An implication of this is the need for more specific guidelines regarding types of PA recommended for this patient population. Special considerations should be made for severely malnourished patients, and for patients with osteoporosis.

The aerobic fitness of substance abusers voluntary participating in a rehabilitation project.

AIM: The aim of the study was to assess the physical fitness in a group of substance abusers using direct, maximal testing and testing of blood lactate threshold. METHODS: Forty-seven patients, 34 males and 13 females, with substance dependence, taking part in a rehabilitation project, served as subjects. Mean age and SD were 30.5+/-9.2 years for the males and 29.7+/-10.2 for the females. They performed a lactate threshold test and a maximal oxygen uptake test (V.O(2max)). The threshold test was performed on either a cycle ergometer or a treadmill, the V.O(2max) test was the Bruce protocol. RESULTS: The range in aerobic fitness was large, and the mean result of aerobic power (V.O(2max)) was somewhat higher than previously estimated in groups of similar age: 39+/-10 and 31+/-8 mL.kg(-1).min(-1) for males and females, respectively. The mean heart rate at blood lactate threshold did not differ between the sexes and was 74+/-7% of maximal heart rate (HRmax). There was no statistical difference between the users of different intoxicants on either V.O(2max) or lactate threshold. CONCLUSIONS: This group of substance abusers did show a large range in physical fitness. The maximal oxygen uptake was better than previously assessed in groups of substance dependent people using indirect methods. The primary intoxicant had no significant influence on the fitness.

Physical activity in treatment units for eating disorders: clinical practice and attitudes.

OBJECTIVE: Physical activity (PA) in eating disorders (ED) may be harmful, but in a therapeutic setting also beneficial. The purpose of this survey was to examine these contradictory aspects of PA in ED specialist treatment settings. We examined whether 1) PA is assessed by the unit, 2) the units have guidelines for managing excessive PA, 3) the units have staff with higher education and special competence in PA and exercise science, 4) how units regard PA in ED, 5) whether regular PA is integrated in the treatment programs, and 6) how the units rate the role of PA in the treatment of ED compared with other mental disorders. METHODS: Of the 49 units located in Scandinavia and the United Kingdom, 41 (84%) responded to a questionnaire. RESULTS: In 28 units (68%) PA was assessed regularly. Excessive PA was considered a harmful symptom in ED, and most units reported guidelines to manage excessive PA. Thirty-two units included PA in their treatment programmes. Clinicians found PA most relevant in the treatment of obesity and, except for binge eating, less for ED. CONCLUSION: PA was more commonly integrated in treatment compared to previous studies. Future research should address how to manage excessive PA, and the potential beneficial role of PA in the treatment of ED.

Cardiorespiratory fitness in relation to self-reported physical function in cancer patients after chemotherapy.

AIM: The aim of this study was to estimate the association between objective cardiorespiratory fitness (CRF) and subjective self-reported physical function, taking into account the influence of mental distress. We hypothesized an association between these parameters, since they might be thought to measure parts of the same phenomenon. METHODS: Approximately 1 month after discontinuation of all primary treatment, 90 cancer patients aged 18-50 years treated with chemotherapy were surveyed. CRF was determined by the Astrand-Ryhming indirect cycle ergometer test, which indicate peak VO2 in mL x kg(-1) x min(-1) (predicted VO2max). Self-reported physical function was assessed by The European Organisation for Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC QLQ-C30). The relation between VO2max and self-reported physical function was estimated by multiple linear regression. Mental distress (assessed by The Hospital Anxiety and Depression scale), age, gender, body mass index (BMI), time from treatment to physical test and diagnoses were included as potential confounders. RESULTS: There was no association between predicted VO2max and self-reported physical function. Mental distress was negatively associated with self-reported physical function (P<0.001), but is not associated with predicted VO2max. CONCLUSIONS: The results suggest that predicted VO2max does not reflect self-reported physical function and vice versa in cancer patients after chemotherapy. If information about cardiac and/or pulmonary status is required, direct or indirect measures of VO2max should be used.

Cognitive-behavioral group therapy for panic disorder in the general clinical setting: a naturalistic study with 1-year follow-up.

BACKGROUND: Cognitive-behavioral therapy (CBT) is well documented in the treatment of panic disorder. As most investigators have studied selected patients without comorbid disorders, it is less clear how well the treatment will perform in the usual clinical setting for patients with comorbid disorders and with physicians who do not have training in CBT. During the last 6 years, we have offered CBT in outpatient groups for patients with panic disorder and agoraphobia. The purpose of this prospective study was to assess the outcome of group treatment and compare the results with those of studies that used individual treatment. We wanted to identify variables that might predict outcome at follow-up and to assess the number and characteristics of dropouts. METHOD: Eighty-three consecutive patients with DSM-III-R panic disorder (56 women and 27 men; mean age = 34.5 years) were studied. Mean duration of panic disorder was 7.5 years. There was a high degree of comorbid major depression, social phobia, and psychoactive substance abuse/dependence. Treatment consisted of 4-hour group sessions conducted once a week for 11 weeks. More than half of the patients used antidepressant drugs. Degree of phobic avoidance, bodily sensations, anxiety cognitions, and depression were assessed at pretreatment, baseline, and end of treatment and at follow-up after 3 and 12 months. RESULTS: There was a large decrease in scores from start to end on all assessments. Sixty-three (89%) of 73 completers responded (> or = 50% reduction in Phobic Avoidance Rating Scale scores). Gains were maintained and even improved upon at follow-up. The results are comparable with studies that used individual therapy. A high depression score at the end of treatment predicted poor outcome at 1-year follow-up. Twelve (14%) of 83 did not complete the program. The presence of severe personality disorders and ongoing alcohol or substance abuse or dependence was associated with poor outcome and high dropout rate. CONCLUSION: CBT appears to be effective in the usual clinical setting, even in the hands of therapists without formal competence. Group therapy is a feasible arrangement, and the results from group treatment are comparable to those of individual approaches. Precise diagnosis and treatment of comorbid depression are of utmost importance. Patients with additional substance abuse or dependence, as well as severe personality disorders, may find this treatment modality less helpful.

Benefits of exercise for the treatment of depression.

In general, depressed patients are physically sedentary. They have reduced physical work capacity but normal pulmonary function compared with the general population. This indicates that the reduced fitness level is caused by physical inactivity and is a strong argument for integrating physical fitness training into comprehensive treatment programmes for depression. Exercise is associated with an antidepressive effect in patients with mild to moderate forms of nonbipolar depressive disorders. An increase in aerobic fitness does not seem to be essential for the antidepressive effect, because similar results are obtained with nonaerobic forms of exercise. More than half of the patients continue with regular exercise 1 year after termination of the training programmes. Patients who continue to exercise tend to have lower depression scores than the sedentary ones. Patients appreciate physical exercise, and rank exercise to be the most important element in comprehensive treatment programmes. Exercise seems to be a promising new approach in the treatment of nonbipolar depressive disorders of mild to moderate severity.

Quality of life, loneliness, and social contact among long-term psychiatric patients.

OBJECTIVE: Long-term patients who resided in county-operated psychiatric nursing homes in a county in Norway as of November 15, 1989, were visited by researchers in 1996 to assess how they perceived their living situations and how they had adjusted to a large reduction in county psychiatric beds during the six-year period. METHODS: Of 107 patients identified in 1989, a total of 75 were still alive in 1995. Seventy-four took part in the study and were visited at their place of residence. Thirty patients were living in general nursing homes, 23 patients remained in the psychiatric nursing homes, and 21 patients lived outside of institutions, in a personal residence. The quality of the patients' contact with others was rated by health care providers who were familiar with the patients. Forty-two patients, with a mean age of 56.9 years, responded to personal questions about their life situation, loneliness, and quality of life. RESULTS: Health care providers constituted the patients' most important network. Patients outside of institutions were the most socially active and had the most satisfying contact with their families. Patients reported a satisfactory quality of life, and those who lived outside institutions tended to be most satisfied. The variables of loneliness, satisfaction with neighborhood, and leisure time activities explained 63 percent of the variance in patients' subjective well-being. CONCLUSIONS: Most long-term patients who had moved out of psychiatric institutions were satisfied with their living situation and reported a relatively high quality of life.

Tolerance to intensive exercise and high levels of lactate in panic disorder.

We wanted to test the tolerance of intensive exercise and corresponding high levels of lactate in patients with panic disorder. Thirty-five consecutive patients with DSM-III-R panic disorder completed submaximal tests, and 24 completed additional supramaximal exercise tests. All experienced high values of lactate during the supramaximal test (M = 10.7 mmol/L, SD = 2.9), but only 1 patient experienced a panic attack. The blood lactate values in the present study were higher than the usually achieved values of 5 to 6 mmol/L during infusion. In general, 67% of patients panic during infusion, compared to 4% in the present study. This discrepancy in frequency of panic following exposure to endogenous and exogenous lactate is discussed on the basis of various hypotheses of panic disorder, with an emphasis on cognitive theory of panic. The study indicates that patients with panic disorder can safely undergo vigorous exercise of such intensity to result in significant lactate production, with the chances of panic being small.

Mental health locus of control in agoraphobia and depression: a longitudinal study of inpatients.

This study represents a longitudinal extension for 75 inpatients of a previous cross-sectional study, wherein agoraphobic inpatients, both depressed and nondepressed, attributed mental health locus of control more to chance than non-anxious depressed inpatients. This difference regarding chance locus of control persisted across posttest and one-year follow-up. At pre- and posttest, but not at follow-up, the group differences regarding externality to chance could be reduced to differences in reported fear of fear. Mental health locus of control scores exhibited moderate to high stability across assessments. Pretreatment level and during-treatment change of externality to chance did not predict proneness to relapse after treatment. Both a vulnerability model and a symptom model of the relation between externality to chance and agoraphobia received some support. On the other hand, reductions in internality during treatment predicted posttreatment relapse. Locus of control variables were also associated with effectiveness of treatment and posttreatment course, both with respect to fear of fear and to depression.

Physical fitness, anxiety and depression.

This article reviews the literature to determine whether patients with anxiety and depressive disorders are less physically fit than the general population, and critically examines the scientific basis for recommending exercise intervention in the management of these disorders.

[Physical training as a therapeutic method in depression]. / Fysisk trening i behandling av depresjoner.

For 15 years physical fitness training has been an integrated part of a comprehensive inpatient treatment programme for depression. At admission patients are less physically fit than the average population. Training three times a week for six to nine weeks is associated with significant increase in fitness and reduction in depression scores. More than half of the patients continue regular exercise one year after discharge. Retrospectively, patients rank physical fitness training as one of the most valuable elements in the treatment programme. The article describes practical experiences from exercise at the institution. There were no serious complications. A motivated staff is the most important factor in motivating the patients. Physical fitness training is a valuable element in a comprehensive treatment programme for depression.

[An ambulatory model for treatment of panic and agoraphobia]. / En poliklinisk modell for behandling av panikkangst og agorafobi.

The article describes an 11-session outpatient treatment programme in groups for patients with panic disorder and agoraphobia. The main components are cognitive-behavioural therapy and use of tricyclic antidepressives. Preliminary results after the first year of this programme indicate that most patients were much improved after completing the programme, and most of them had maintained their gains at follow-up.

Physical activity and depression: clinical experience.

Two quasi-experimental and 10 experimental exercise intervention studies have been performed in depressed subjects. Some of the studies have methodological shortcomings, but in all studies the results point in the same direction: aerobic exercise is more effective than no treatment, but not significantly different from other forms of therapy, including various forms of psychotherapy. Aerobic and anaerobic forms of exercise are equally effective. The results are restricted to patients with mild to moderate forms of unipolar depression. Patients appreciate exercise and consider it a useful form of therapy. Physical exercise may be an alternative or adjunct to traditional forms of treatment in mild to moderate forms of unipolar depression.

[Physical activity for mental health]. / Fysisk aktivitet for sinnets helse.

BACKGROUND: About 50% of the population will be affected by a mental disorder during their lifetime; the most common forms are mood and anxiety disorders and abuse of or dependence on drugs or alcohol. The standard forms of therapy are medication and various forms of psychotherapy. The cost of treating disease is escalating, and the health care system will never be able to meet the need for treatment in this large group of patients. Hence, development of effective self help strategies is important. MATERIAL AND METHODS: In this paper, the scientific basis for promoting exercise as treatment for mental disorders is evaluated on the basis of a review of the literature. RESULTS: Beneficial psychological effects of exercise are best documented for mild to moderate forms of unipolar depression and chronic fatigue syndrome; in these disorders, exercise is an alternative to traditional forms of treatment. A therapeutic effect may also be achieved in panic and generalised anxiety disorder, schizophrenia, conversion and somatoform pain disorder, and alcohol abuse and dependence. INTERPRETATION: Beneficial effects of exercise are well documented. A simple and inexpensive approach like exercise is helpful and might be important for public health.

Cognition and coping in agoraphobia and depression: a multivariate approach.

A multivariate strategy for the cognitive study of overlapping symptom disorders is presented and exemplified by an empirical investigation. Inpatients who met DSM-III-R criteria for anxiety and/or unipolar depressive disorders were assessed on 13 agoraphobic and depressive symptom subscales. Factor analyses of these scales were performed and yielded an agoraphobic and a depressive factor. The patients (N = 117) completed the Multidimensional Health Locus of Control scales, the Attributional Style Questionnaire, and the Ways of Coping Check List. Stepwise regression analyses were performed with the cognitive and coping variables as independent variables. The externalizing of mental health locus of control to chance was the only significant predictor of agoraphobia factor score. Attributional variables were the only consistent predictors of depression factor score.

Coping strategies in major depressed, agoraphobic and comorbid in-patients: a longitudinal study.

The first aim of this study was to explore the diagnostic specificity of coping styles by comparing ways of coping in non-anxious major depressed, non-depressed agoraphobic, and both major depressed and agoraphobic (comorbid) in-patients. The second aim was to investigate whether a vulnerability model, a state model, or a combined vulnerability-state model of coping accounted best for the data. On admission and when discharged, 95 patients completed the Way of Coping Checklist and were evaluated on several symptom scales. Self-report symptom scales were completed at one-year follow-up as well. The 'purely' agoraphobic and the comorbid patients showed less seeking of social support and more wishful thinking than the major depressed patients. For the wishful thinking scale, these differences were related to differences in level of global psychopathology. Overall, the results for the seeking social support scale were consistent with a combined vulnerability-state model. The problem-focused coping and wishful thinking scores behaved mostly as state phenomena. The avoidance scores provided ambiguous evidence. In a subsample of 30 agoraphobic patients who received a combination of exposure and psychodynamic treatment, higher pre-treatment levels of seeking social support and lower pre-treatment levels of avoidance as coping both predicted a more favourable course of symptoms pertaining to fear of fear in the one-year follow-up period.

[Psychiatric consultations at a somatic central hospital. Review of 383 referrals over 3 years]. / Psykiatrisk tilsyn ved et somatisk sentralsykehus. En gjennomgang av 383 henvisninger over tre år.

We present an analysis of all psychiatric consultations with inpatients in the somatic wards at the Central Hospital in Alesund over a period of three years. About 1% of the patients were referred for psychiatric consultation. Most of these patients had no previous experience of psychiatry. Mean age was 45 years (range 16-90), and 56% were females. The reasons for referral were assessment of suicidal behaviour (47%), depression (16%) and psychosis (11%). The most common psychiatric diagnoses were personality disorders (16%), affective disorders (14%) and alcohol and drug abuse and dependence (14%). About 10% were admitted to psychiatric wards, and 21% were referred to psychiatric outpatient clinics. The referring physicians were satisfied with the psychiatric consultation service.

[Intoxication with tricyclic antidepressive agents in therapeutic doses. Benefits of routine blood level measurements]. / Intoksikasjon med tricykliske antidepressiva i terapeutiske doser. Nytten av rutinemessig måling av serumnivå.

Measurement of the level of tricyclic antidepressants in the blood is useful in the treatment of affective disorders. We describe four patients, all of whom became intoxicated by the recommended therapeutic doses of tricyclic antidepressants. The only obvious sign of such gradual intoxication may be worsening of the depressive syndrome. Therefore, to enable administration of high enough doses without intoxication we recommend routine blood level measurements. We present therapeutic ranges and intoxication levels, based on the international literature.

Physical fitness level in patients with anxiety and depressive disorders.

Physical work capacity (PWC) and pulmonary function were measured shortly after admission in 90 inpatients with anxiety and depressive disorders. PWC was dramatically reduced while pulmonary function was slightly increased compared with predicted normal values. This indicates that the low fitness levels were caused by physical inactivity, and it is a strong argument for integrating physical fitness training into psychiatric treatment programs. Values obtained by direct measurement and indirect calculations of PWC were highly correlated (R = 0.67). The mean differences between the two tests were 21% on an individual level and 5% on a group level.