Physical activity and sedentary behavior levels among individuals with mental illness: A cross-sectional study from 23 countries.

People with mental illness tend to present low levels of physical activity and high levels of sedentary behavior. The study aims to compare these levels in mental illness patients, exploring the role of socioeconomic development and treatment setting. This cross-sectional study used accelerometers and the Simple Physical Activity Questionnaire (SIMPAQ) to assess physical activity and sedentary behavior in mental illness individuals living in 23 countries. Two-way ANOVAs were used to evaluate the interaction between socioeconomic development and the treatment settings on physical activity and sedentary behavior. A total of 884 (men = 55.3%) participants, mean age of 39.3 (SD = 12.8), were evaluated. A significant interaction between socioeconomic development and treatment settings was found in sedentary behavior (F = 5.525; p = 0.019; η2p = 0.009; small effect size). Main effects were observed on socioeconomic development (F = 43.004; p < 0.001; η2p = 0.066; medium effect size) and treatment setting (F = 23.001; p < 0.001; η2p = 0.036; small effect size) for sedentary behavior and physical activity: socioeconomic development (F = 20.888; p < 0.001; η2p = 0.033; small effect size) and treatment setting (F = 30.358; p < 0.001; η2p = 0.047; small effect size), showing that HIC patients were more active, while MIC patients were more sedentary. Moreover, despite of inpatients had presented higher levels of physical activity than outpatients, they also spent more time sitting. Socioeconomic development plays an important role in sedentary behavior in patients with mental disorders, warning the need to develop new strategies to reduce these levels in this population.

Evaluation of a smoking cessation program for adults with severe mental illness in a public mental health service.

WHAT IS KNOWN ON THE SUBJECT: Smoking rates have decreased in the general population but remain high among people with severe mental illness (SMI). WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE: An individualized smoking cessation program was tested with 99 adults with SMI. The program showed it is possible to help people with SMI smoke fewer cigarettes and reduce nicotine addiction. Customized smoking cessation programs are essential for those with high nicotine dependence and mental health challenges. IMPLICATIONS FOR PRACTICE: Mental health services should offer tailored tobacco cessation programs because these programs can improve the health of people with mental illness who smoke. It is important for mental health services to follow government guidelines and provide evidence-based support. ABSTRACT: INTRODUCTION: Despite significant reductions in smoking rates in the general population over recent decades, smoking rates remain relatively unchanged among people with SMI. AIM: To evaluate the feasibility and preliminary effectiveness of the Keep Quitting in Mind pilot program, an individualized smoking cessation program for people experiencing SMI. METHODS: In total, 99 adult participants with SMI and engaged with a community mental health service, participated in the intervention. The intervention included motivational interviewing and goal setting, in addition to provision of pharmaceutical aids (including nicotine replacement therapy). RESULTS: Analysis determined that the Keep Quitting in Mind pilot program was feasible in a public adult mental health service and participation in the program was associated with reductions in the number of cigarettes smoked daily and level of nicotine addiction. DISCUSSION: This real-world pilot program demonstrated feasibility and potential effectiveness in reducing smoking among adults with mental illness. Aligning with government guidelines, tailored smoking cessation programs are crucial due to high nicotine dependence and mental health complexities. IMPLICATIONS FOR PRACTICE: Given the high rates of cigarette smoking by people with mental illness and the cardiometabolic health risks associated with this, mental health services should consider adding evidence-based and bespoke tobacco cessation programs as part of core business.

Implementation of a lifestyle and life-skills intervention to prevent weight-gain and cardiometabolic abnormalities in young people with first-episode psychosis as part of routine care: The Keeping the Body in Mind program.

OBJECTIVES: In 2013, a cluster-controlled pilot study found the 12-week Keeping the Body in Mind (KBIM) lifestyle and life skills intervention was able to prevent weight gain in a small sample of youth experiencing first-episode psychosis (FEP) with fewer than 4 weeks of antipsychotic exposure. This study aims to evaluate the effectiveness of KBIM as routine care on anthropometry and metabolic biochemistry in a larger sample of youth with FEP across three community mental health services. METHOD: This retrospective chart audit was conducted on youth with FEP, prescribed a therapeutic dose of antipsychotic medication, and who engaged with KBIM between 2015 and 2019. Primary outcomes were weight and waist circumference. Secondary outcomes were blood pressure, blood glucose, and blood lipids. Outcomes were collected in at baseline and at 12 weeks. Data on program engagement were obtained from the participant's medical file. RESULTS: One-hundred and eighty-two people met inclusion criteria, and up to 134 people had baseline and 12-week data on one or more outcome. Mean number of sessions attended was 11.1 (SD = 7.3). Increases in weight and waist circumference were limited to 1.5 kg (SD = 5.3, t(133) = 3.2, p = .002) and 0.7 cm (SD = 5.8, t(109) = 1.2, p = .23) respectively. Eighty-one percent of participants did not experience clinically significant weight gain (>7% of baseline weight). There were no significant changes in blood pressure or metabolic biochemistry. CONCLUSION: The prevention of substantial gains in weight and waist circumference observed in the initial pilot study was maintained with implementation of KBIM as part of routine clinical care for youth with FEP.

The resting metabolic rate of people with severe mental illness: a systematic review and meta-analysis.

People with severe mental illness (SMI), including schizophrenia and related psychoses and bipolar disorder, are at greater risk for obesity compared with people without mental illness. An altered resting metabolic rate (RMR) may be a key driving factor; however, published studies have not been systematically reviewed. This systematic review and meta-analysis aimed to determine whether the RMR of people with SMI assessed by indirect calorimetry differs from (i) controls, (ii) predictive equations and (iii) after administration of antipsychotic medications. Five databases were searched from database inception to March 2022. Thirteen studies providing nineteen relevant datasets were included. Study quality was mixed (62 % considered low quality). In the primary analysis, RMR in people with SMI did not differ from matched controls (n 2, standardised mean difference (SMD) = 0·58, 95 % CI -1·01, 2·16, P = 0·48, I2 = 92 %). Most predictive equations overestimated RMR. The Mifflin-St. Jeor equation appeared to be most accurate (n 5, SMD = -0·29, 95 % CI -0·73, 0·14, P = 0·19, I2 = 85 %). There were no significant changes in RMR after antipsychotic administration (n 4, SMD = 0·17, 95 % CI -0·21, 0·55, P = 0·38, I2 = 0 %). There is little evidence to suggest there is a difference in RMR between people with SMI and people without when matched for age, sex, BMI and body mass, or that commencement of antipsychotic medication alters RMR.

A grounded theory exploration of programme theory within Waves of Wellness surf therapy intervention.

OBJECTIVE: Poor mental health represents a large proportion of disease burden faced by young Australians, which has been further exacerbated by the Covid-19 pandemic and the reluctance of this population to seek support. Surf therapy is a novel form of intervention targeting mental health. The objective of this study was to interrogate programme theory within surf therapy, as delivered by the Waves of Wellness Foundation (WOW) in Australia. METHODS AND MEASURES: The study utilised grounded theory to understand or develop theoretical mediators for WOW surf therapy based on interviews exploring the experiences of previous intervention participants (n = 16; mean age = 18.4 years, SD = 2.8, range 14-24). Data were analysed through constant comparative analysis. RESULTS: Five categories emerged from participant data as foundational to WOW programme theory: (a) Safe Space, (b) Social Support, (c) Sensory Grounding, (d) Mastery and (e) Respite. These categories have novel theoretical and practical implications for both surf therapy and wider clinical practice, especially around concepts such as delivering 'mental health by stealth' and fostering longer term 'mental health maintenance' for participants. CONCLUSION: The study developed an initial WOW programme theory, highlighting the importance of foundational therapeutic structures beyond simply going surfing.

Exercise as medicine for depressive symptoms? A systematic review and meta-analysis with meta-regression.

OBJECTIVE: To estimate the efficacy of exercise on depressive symptoms compared with non-active control groups and to determine the moderating effects of exercise on depression and the presence of publication bias. DESIGN: Systematic review and meta-analysis with meta-regression. DATA SOURCES: The Cochrane Central Register of Controlled Trials, PubMed, MEDLINE, Embase, SPORTDiscus, PsycINFO, Scopus and Web of Science were searched without language restrictions from inception to 13 September2022 (PROSPERO registration no CRD42020210651). ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Randomised controlled trials including participants aged 18 years or older with a diagnosis of major depressive disorder or those with depressive symptoms determined by validated screening measures scoring above the threshold value, investigating the effects of an exercise intervention (aerobic and/or resistance exercise) compared with a non-exercising control group. RESULTS: Forty-one studies, comprising 2264 participants post intervention were included in the meta-analysis demonstrating large effects (standardised mean difference (SMD)=-0.946, 95% CI -1.18 to -0.71) favouring exercise interventions which corresponds to the number needed to treat (NNT)=2 (95% CI 1.68 to 2.59). Large effects were found in studies with individuals with major depressive disorder (SMD=-0.998, 95% CI -1.39 to -0.61, k=20), supervised exercise interventions (SMD=-1.026, 95% CI -1.28 to -0.77, k=40) and moderate effects when analyses were restricted to low risk of bias studies (SMD=-0.666, 95% CI -0.99 to -0.34, k=12, NNT=2.8 (95% CI 1.94 to 5.22)). CONCLUSION: Exercise is efficacious in treating depression and depressive symptoms and should be offered as an evidence-based treatment option focusing on supervised and group exercise with moderate intensity and aerobic exercise regimes. The small sample sizes of many trials and high heterogeneity in methods should be considered when interpreting the results.

Hospital service utilisation of people previously hospitalised with different subtypes of psychotic disorder: A record linkage study.

OBJECTIVE: Little research has examined the physical and mental comorbidities, and health service use patterns, of people diagnosed with psychotic disorder subtypes other than schizophrenia spectrum disorders. This study aims to examine the physical and mental comorbidities, and subsequent hospital service use patterns, of individuals previously hospitalised with various psychotic disorder subtypes using linked health service data. METHODS: We included individuals hospitalised with a psychotic disorder in New South Wales, Australia, between 1 July 2002 and 31 December 2014 (N = 63,110). We examined the demographic profile of the cohort and rates of subsequent acute hospital care and ambulatory mental health service use. We compared the rates of subsequent hospital admissions, emergency department presentations and ambulatory mental health treatment days of people hospitalised with different psychotic disorder subtypes to people hospitalised with schizophrenia spectrum disorders using Poisson regression. RESULTS: People most recently hospitalised with mood/affective disorders and psychotic symptoms had a higher rate of subsequent hospital admissions than those most recently hospitalised with schizophrenia spectrum and delusional disorders (adjusted incident rate ratio = 1.06; 95% confidence interval = [1.02, 1.10]), while people most recently hospitalised with drug-induced and other organic (adjusted incident rate ratio = 1.19; 95% confidence interval = [1.12, 1.27]) and acute psychotic disorders (adjusted incident rate ratio = 1.10; 95% confidence interval = [1.03, 1.18]) had more subsequent emergency department presentations than those most recently hospitalised with schizophrenia spectrum and delusional disorders. All three groups had fewer subsequent mental health ambulatory days than those most recently hospitalised with schizophrenia spectrum and delusional disorders (adjusted incident rate ratios = 0.85-0.91). CONCLUSION: The health profiles and subsequent hospital service use patterns of people previously hospitalised with different psychotic disorder subtypes are heterogeneous, and research is needed to develop targeted health policies to meet their specific health needs.

A 10-hours workshop improves physical activity prescription for mental illness knowledge and confidence in health care professionals: a nation-wide multicentre study from Uganda.

PURPOSE: Lack of knowledge about and confidence in physical activity (PA) prescription for people with mental illness are important barriers for clinical practice in low-income countries. The aim of this study was to evaluate whether a 10-hour workshop improved the knowledge and confidence in PA prescription among health care professionals in 13 regional referral hospitals across Uganda. MATERIAL AND METHODS: 260 health care professionals (age = 40.4 ± 10.8 years; 48% women; 63.8% nurses, 10% social workers, 8.1% psychologists, 7.3% medical doctors, 5.8% psychiatrists, 5% physical or occupational therapists) completed the Exercise in Mental Illness Questionnaire - Health Professionals Version (EMIQ-HP) pre- and post-workshop. RESULTS: The EMIQ-HP PA knowledge score (3.1 ± 0.7 versus 1.3 ± 1.3, p < 0.001, Cohen's d = 1.28, 95% confidence interval, CI = 1.04-1.52, i.e., large effect) and EMIQ-HP confidence in PA prescription score (3.0 ± 0.8 versus 1.2 ± 1.2, p < 0.001, Cohen's d = 1.14, 95% CI = 0.91-1.36, i.e., large effect) improved significantly following training. Significantly more benefits and fewer barriers to prescribing PA in busy low-resourced settings were reported. CONCLUSIONS: Training in PA counselling improved the knowledge and confidence in PA prescription in Ugandan health care professionals. Future research should investigate whether PA uptake in people with mental illness can be improved via additional training of health care professionals.IMPLICATIONS FOR REHABILITATIONThe majority of mental health professionals never recommend physical activity to their patients in low-resourced settings and increased awareness is needed to improve rehabilitation programs.Training in prescribing physical activity using the 5A framework improves knowledge about physical activity prescription in mental health professionals at all levels of care.Training in prescribing physical activity using motivational interviewing improves confidence in physical activity prescription in rehabilitation programs.Training in prescribing physical activity reduces perceived barriers for prescribing in rehabilitation programs in low-resourced settings.

Tackling change in mental health service delivery: A qualitative evaluation of a lifestyle program targeting mental health staff - Keeping our Staff in Mind (KoSiM).

ISSUES ADDRESSED: People with severe mental illness have adverse health outcomes compared to the general population. Lifestyle interventions are effective in improving health outcomes in this population. Current cultural processes in mental health services do not generally incorporate physical health care practices. Innovative education is required to improve knowledge and confidence of staff in the delivery of preventative health measures. METHODS: The Keeping our Staff in Mind (KoSiM) program delivered a brief lifestyle intervention to mental health staff. A qualitative analysis following the Standards for Reporting Qualitative Research was undertaken. Semi-structured interviews designed to elicit information about the acceptability of the program and the impact of the intervention on participants' personal and professional lives. The interviews were analysed using thematic analysis, with coding independently developed and reviewed by three authors. RESULTS: Of the 103 eligible participants, 75 were interviewed. Responses revealed four main themes: (i) positive changes in clinician's approach to physical health care, (ii) improvements in attitudes to self-care and family wellbeing, (iii) positive changes in workplace culture associated with physical health care delivery and (iv) high levels of acceptability of the program. CONCLUSION: The KoSiM model may be useful in other settings as a means of changing the culture of mental health services to better integrate physical health care as a core part of mental health service provision. SO WHAT?: A novel approach using staff focussed lifestyle interventions model may cut through the resistance that is encountered when implementing proven methods of clinical intervention where cultural barriers exist.

Sedentary behavior and physical activity: barriers and facilitators for active behavior during the COVID-19 pandemic / Comportamento sedentário e atividade física: barreiras e facilitadores para o comportamento ativo durante a pandemia de COVID-19

ABSTRACT Objectives: The objectives of the present study were to assess sedentary behavior and physical activity levels before and during the COVID-19 pandemic in healthy individuals and in those with self-reported diagnosis of anxiety and/or depression, and also identify facilitators and barriers to physical activity in these populations. Methods: This is a cross-sectional survey based on a self-report questionnaire applied during the COVID-19 pandemic period. Results: In the total sample (N = 1,285) the prevalence of sedentary behavior (>8 hours/day) increased by 25% during social isolation. Social isolation increased sedentary time and decreased physical activity levels in healthy individuals and in those with self-reported diagnosis of anxiety and/or depression. In both groups, the most prevalent facilitators were supervised physical activity (before the pandemic) and activities and equipment to practice at home (during the pandemic). The most prevalent barriers were the lack of time to perform physical activities (before the pandemic) and inaccessible or distance places to practice (during the pandemic). Conclusion: The COVID-19 pandemic is related to an increased sedentary behavior and reduced physical activity levels. Significant changes in perceived barriers and facilitators to exercise were observed during the social isolation period.

RESUMO Objetivos: Os objetivos do presente estudo foram avaliar o comportamento sedentário e os níveis de atividade física antes e durante da pandemia de COVID-19 em indivíduos saudáveis e com diagnóstico autorreportado de ansiedade e/ou depressão e identificar os facilitadores e barreiras para a prática de atividade física nessas populações. Métodos: Trata-se de uma pesquisa de corte transversal baseada em um questionário de autorrelato aplicado durante o período de pandemia da COVID-19. Resultados: Na amostra total (N = 1.285), a prevalência de comportamento sedentário (>8 horas/dia) aumentou em 25% durante o isolamento social. O isolamento social aumentou o tempo sedentário e diminuiu os níveis de atividade física em indivíduos saudáveis, com ansiedade e/ou depressão autorreportada. Nos dois grupos, os facilitadores mais prevalentes foram a atividade física supervisionada (antes da pandemia) e as atividades e equipamentos para a prática em casa (durante a pandemia). As barreiras mais prevalentes foram a falta de tempo para realizar atividades físicas (antes da pandemia) e os locais inacessíveis ou distantes para a prática (durante a pandemia). Conclusão: A pandemia de COVID-19 está relacionada a aumento do comportamento sedentário e redução dos níveis de atividade física. Mudanças significativas nas barreiras percebidas e facilitadores ao exercício foram observadas durante o período de isolamento social.

Web-based exercise interventions for patients with depressive and anxiety disorders: a systematic review of randomized controlled trials

Objective: The number of people suffering from depression and/or anxiety has increased steadily due to the coronavirus disease 2019 (COVID-19) pandemic. In this context, web-based exercise interventions have emerged as a potential treatment strategy. The objective of this study was to synthetize evidence from randomized controlled trials regarding the effects of web-based exercise interventions on patients with depressive and/or anxiety disorders. Methods: Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Six databases were searched (Cochrane Library, EBSCO, PubMed, SciELO, Scopus, and Web of Science), and eligible articles were identified according to a PICOS inclusion-exclusion approach (participants with depressive or anxiety disorders; web-based exercise interventions; active or passive control group; assessment of changes in depressive or anxiety disorders; randomized design). Primary outcomes were depressive and/or anxiety symptoms. The quality of evidence was assessed with Grading of Recommendations Assessment, Development, and Evaluation. Results: Of 7,846 search results, three studies met the inclusion criteria (172 participants between 18 and 65 years of age, 95.9% women). The web-based exercise interventions lasted 8-12 weeks and involved endurance training, yoga, or combined endurance and strength training. The comparators involved non-exercise controls or active controls. Compliance rates were low. Web-based exercise interventions were not superior to controls regarding anxiety symptoms, and only one study found benefits for depressive symptoms (p ≤ 0.05). The quality of the cumulative evidence was low. Conclusion: The available data regarding the effects of web-based exercise interventions on depression and/or anxiety symptoms is scarce, the risk of bias is high, and the quality of the cumulative results is low. Currently, no clear recommendations can be provided. Registration number: PROSPERO CRD42021225938.

Moderate to vigorous physical activity and sedentary behavior changes in self-isolating adults during the COVID-19 pandemic in Brazil: a cross-sectional survey exploring correlates.

Background: The COVID-19 pandemic imposed major changes on daily-life routine worldwide. To the best of our knowledge, no study quantified the changes on moderate to vigorous physical activity (MVPA) and sedentary behaviors (SB) and its correlates in Brazilians. This study aimed to (i) evaluate the changes (pre versus during pandemic) in time spent in MVPA and SB in self-isolating Brazilians during the COVID-19 pandemic, and (ii) to explore correlates. Methods: A cross-sectional, retrospective, self-report online web survey, evaluating the time spent in MVPA and SB pre and during the COVID-19 pandemic in self-isolating people in Brazil. Sociodemographic, behavioral, and clinical measures, and time in self-isolation were also obtained. Changes in MVPA and SB and their correlates were explored using generalized estimating equations (GEE). Models were adjusted for covariates. Results: A total of 877 participants (72.7% women, 53.7% young adults [18-34 years]) were included. Overall, participants reported a 59.7% reduction (95% CI 35.6-82.2) in time spent on MVPA during the pandemic, equivalent to 64.28 (95% CI 36.06-83.33) minutes per day. Time spent in SB increased 42.0% (95% CI 31.7-52.5), corresponding to an increase of 152.3 (95% CI 111.9-192.7) minutes per day. Greater reductions in MVPA and increases in SB were seen in younger adults, those not married, those employed, and those with a self-reported previous diagnosis of a mental disorder. Conclusions: People in self-isolation significantly reduced MVPA levels and increased SB. Public health strategies are needed to mitigate the impact of self-isolation on MVPA and SB. Supplementary Information: The online version contains supplementary material available at 10.1007/s11332-021-00788-x.

An open trial of the RECONNECT exercise program for NSW Police Officers with posttraumatic stress disorder or psychological injury.

OBJECTIVE: Posttraumatic stress disorder (PTSD) and psychological injuries are debilitating health problems facing police officers. There is increasing interest in the role of exercise as an intervention. We aimed to determine the preliminary effectiveness of the RECONNECT exercise program for NSW Police Officers experiencing PTSD or psychological injury. METHODS: An open trial was conducted between 2016 and 2017 across three NSW sites. RECONNECT consisted of twice weekly, supervised exercise sessions for three months. Outcomes were assessed at baseline, week 6 and week 12 (intervention completion) and included PTSD symptoms, depression, anxiety and stress, insomnia severity and alcohol use. Data were analysed using linear mixed models. RESULTS: In total, n = 60 Officers were consecutively referred to the program (35% female, mean age 42.0 ± 8.9 years). The majority had a clinical diagnosis of PTSD (n = 48, 80%). A clinically significant reduction in PTSD (Cohen's d = 0.96), depression (d = 0.71), anxiety (d = 0.55) and stress (d = 0.69) symptoms was found from baseline to week 12. Drop-out and lost to follow-up was high. Higher baseline PTSD severity was associated with an increased likelihood to complete postintervention assessment. CONCLUSIONS: RECONNECT appears to be effective in reducing symptoms of PTSD. Exercise may be an effective component of PTSD treatment.

Mental contrasting and implementation of physical activity intentions in Ugandan primary care patients with mental health problems: A real-world intervention involving support partners.

This study explored the efficacy of lay health worker (LHW)-led physical activity (PA) counselling for primary care patients with mental health problems (PCMH) and their support partners. Forty-nine (41♀, median age=47, interquartile range=22) PCMH and 49 support partners [9♀, 31(9)years] participated in once weekly counselling based on the mental contrasting and implementation of intentions framework for 8 weeks. All participants completed the Simple Physical Activity Questionnaire (SIMPAQ) and World Health Organization Disability Assessment Schedule 2 (WHODAS 2), while PCMH completed the Multidimensional Scale for Perceived Social Support (MSPSS), Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and Alcohol Use Disorders Identification Test (AUDIT) pre- and immediately post-intervention. In PCMH significant (P<0.001) increases in walking, exercising and incidental PA (SIMPAQ) levels, reductions in depressive (PHQ-9) and anxiety (GAD-7) symptoms and improvements in mobility and participation (WHODAS 2) were observed. Perceived support from significant others (MSPSS) significantly increased. In support partners, a significant reduction in time spent sedentary, increase in incidental PA (SIMPAQ) and improvement in the perception of getting alone with others (WHODAS 2) was seen. Our study demonstrates that LHW-led PA counselling is beneficial for PCMH and their support partners. Randomized controlled trials are warranted to confirm these positive findings.

Web-based exercise interventions for patients with depressive and anxiety disorders: a systematic review of randomized controlled trials.

OBJECTIVE: The number of people suffering from depression and/or anxiety has increased steadily due to the coronavirus disease 2019 (COVID-19) pandemic. In this context, web-based exercise interventions have emerged as a potential treatment strategy. The objective of this study was to synthetize evidence from randomized controlled trials regarding the effects of web-based exercise interventions on patients with depressive and/or anxiety disorders. METHODS: Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Six databases were searched (Cochrane Library, EBSCO, PubMed, SciELO, Scopus, and Web of Science), and eligible articles were identified according to a PICOS inclusion-exclusion approach (participants with depressive or anxiety disorders; web-based exercise interventions; active or passive control group; assessment of changes in depressive or anxiety disorders; randomized design). Primary outcomes were depressive and/or anxiety symptoms. The quality of evidence was assessed with Grading of Recommendations Assessment, Development, and Evaluation. RESULTS: Of 7,846 search results, three studies met the inclusion criteria (172 participants between 18 and 65 years of age, 95.9% women). The web-based exercise interventions lasted 8-12 weeks and involved endurance training, yoga, or combined endurance and strength training. The comparators involved non-exercise controls or active controls. Compliance rates were low. Web-based exercise interventions were not superior to controls regarding anxiety symptoms, and only one study found benefits for depressive symptoms (p ≤ 0.05). The quality of the cumulative evidence was low. CONCLUSION: The available data regarding the effects of web-based exercise interventions on depression and/or anxiety symptoms is scarce, the risk of bias is high, and the quality of the cumulative results is low. Currently, no clear recommendations can be provided. REGISTRATION NUMBER: PROSPERO CRD42021225938.

Correlates of physical activity stages of change in people living with HIV in a Ugandan community.

PURPOSE: The transtheoretical model (TTM) of behavioral change posits that individuals move through five stages of change when adopting new behaviors: pre-contemplation, contemplation, preparation, action, and maintenance. The aim of this study was to determine the proportion of patients with HIV/AIDS within a Ugandan fishing community in the different physical activity (PA) stages. We also explored differences in variables, motives, and barriers for PA across the stages. METHODS: In total, 256 individuals (77 men, 40.5 ± 10.3 years) completed the Patient-centered Assessment and Counseling for Exercise Questionnaire, the Patient Health Questionnaire-9 (PHQ-9) to assess depressive symptoms, and the Alcohol Use Disorders Identification Test. They were also asked about their most important PA motive and barrier. RESULTS: Seventy-five individuals (29%) were in the (pre-)preparatory stages, 140 (55%) in the action and 41 (16%) in the maintenance stage. Those in the (pre-)preparatory stages had higher PHQ-9 total scores (p < 0.001) and were more likely to report barriers than those in the later stages (p < 0.001). Compared with those in the (pre-)preparatory stage, patients in the action stage experienced less body weakness (p = 0.015). CONCLUSIONS: Depression and barriers to PA should be considered in people with HIV/AIDS in low-resource settings when implementing interventions to assist them to become more active.Implications for rehabilitationPeople with HIV/AIDS are among the most physically inactive clinical populations.Clinicians should consider depression when motivating patients with HIV in low resourced settings to become active.Clinicians should consider body weakness when motivating patients with HIV in low resourced settings to become active.

"Feels Good to Get Wet": The Unique Affordances of Surf Therapy Among Australian Youth.

Increasing prevalence rates of mental health problems among adolescents is an issue of growing concern. Surf therapy is a novel intervention that may provide tangible benefits to address this problem. Congruent with the ecological dynamics perspective (EDP), the existing research postulates that surf therapy yields psychological benefits in part due to the unique affordances of immersion in a blue space such as the ocean. Evidence worldwide has validated the use of surfing as a therapeutic mediator to achieve positive change, however, no such research has been conducted on Australian adolescents. The current study aimed to evaluate the impact of the Waves of Wellness (WOW) Foundation's 8 week surf therapy program on mental health outcomes in Australian at-risk youth. The study employed a mixed-methods design to examine the experiences of participants. Nine adolescents (M age = 14.9; SD = 1.2; 8 female) participated in the quantitative stage, with four completing the qualitative interview. Results indicated positive changes in resilience, self-esteem, social connectedness, and depressive symptoms post-intervention, however, improvements were not maintained at follow-up. Participants unanimously agreed that the program normalised their experiences with mental health through the unique leaning environment and fostered personal growth through mastery experiences and the development of healthy relationships. The EDP provided the most compelling explanation of the results denoting that benefits arise from the reciprocal relationship between individual, task, and environment. Despite the small and heterogenous sample, the findings provided preliminary evidence of the efficacy of surf therapy among Australian youth and offer a potential starting point for further research utilising larger more diverse samples.

Trauma and Mental Health Awareness in Emergency Service Workers: A Qualitative Evaluation of the Behind the Seen Education Workshops.

Emergency service workers (ESWs) are at high risk of experiencing poor mental health, including posttraumatic stress disorder (PTSD). Programs led by ex-service organizations may play an unrecognized but critical role in mental health prevention and promotion. Behind the Seen (BTS) is an Australian ex-service organization that runs workshops to raise awareness and facilitate conversations around the mental health of ESWs. The purpose of the study is to conduct a qualitative evaluation of workshop participants' experiences, to understand the acceptability and perceived usefulness over the immediate- (within 1 month), intermediate- (6 months) and longer-terms (12 months). Participants (n = 59 ESWs) were recruited using purposive sampling across five fire and rescue services in metropolitan, regional, and rural locations. Focus groups methodology was used for data collection and data were analyzed using iterative categorization techniques. Participants reported (i) a high perceived need for education about PTSD, (ii) highly salient aspects of the presentation that made for a positive learning experience, including the importance of the lived experiences of the facilitators in the learning process, (iii) key features of changes to intentions, attitudes, and behavior, and (iv) major aspects of the organizational context that affected the understanding and uptake of the program's key messages. BTS was perceived as an acceptable means of delivering mental health, PTSD, and help-seeking information to ESWs. The program is a promising candidate for scaling-up and further translation.

Correlates of missed HIV appointments in low-resource settings: a study from Uganda.

Aims: Alarming reports of antiretroviral treatment failure have recently emerged in sub-Saharan Africa. The onset of virologic failure has multiple causes but suboptimal treatment adherence is one of the leading causes. This study aimed to explore correlates of adherence to HIV appointments in community care patients living with HIV/AIDS in Uganda.Methods: Two hundred and ninety-five people living with HIV (median age 37.0 years; interquartile range 16.0; female 67.8% [n = 200]) reported whether they had missed any of their four-weekly appointments during the past 24 weeks. They also completed the Internalized AIDS-Related Stigma Scale, Generalized Anxiety Disorder-7, the Patient Health Questionnaire-9, the Alcohol-Use Disorders Identification Test, and the Physical Activity Vital Sign.Results: Thirty-three (11.2%) patients missed at least one of their six scheduled appointments in the 24-week period. The adjusted odds ratio for missing at least one of six appointments was 3.03 (95% CI: 1.21-8.43, p = 0.01) for those who were physically inactive, and 2.29 (95% CI: 0.93-5.63, p = 0.046) for those with depression.Conclusions: Targeting future rehabilitation studies for PLHIV around feelings of depression and around physical inactivity could be important in achieving optimal HIV treatment adherence.