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Il ruolo degli operatori sanitari nel motivare all'attività fisica utenti dei servizi psichiatrici
Full text linkPsychotic disorders are among the chronic diseases with a major impact on the life of those affected, because of related disabilities, stigma and the difficulties involving family members and care services. Statistics report that 1.7% of the Italian population requires every year at least one treatment to mental health services: at least one-fifth of these treatments, is due to psychotic disorders. The therapeutic intervention is typically structured with a multidisciplinary approach to meet the different needs of these people: it involves the use of psychopharmacological therapies associated with psychotherapeutic, educational and rehabilitative treatment. In the last years research has shown that physical activity (PA) can positively influence the treatment of psychotic disorders. Compared to the general population, in fact, people suffering for severe mental illness have higher levels of overweight and obesity and present higher possibilities of developing chronic diseases such as type 2 diabetes, cardiovascular disease and metabolic syndrome. Moreover, these disorders are associated with higher levels of physical inactivity and lower levels of quality of life than the general population. Regular PA, on the other hand, improves lipid profiles, helps to regulate body composition and glucose metabolism, reduces blood pressure, increases fitness levels and has also positive effects on mood and anxiety levels. The main obstacles that these people encounter in adhering to regular PA programs are primarily related to the pathology and and to theirs socio-economic conditions. The side effects of antipsychotic drugs, the lack of motivation, poor concentration and difficulty in accessing the proposed activity, contribute to limit the exercise capacity of these persons and hinder their participation in regular PA programs long-lasting. Literature highlighted the importance and usefulness of educational interventions to support treatment compliance, helping people who suffer from psychotic disorders to deal with their disease and the correlated risks. Moreover, educational intervention are necessary to promote the insight of illness and to involve patients in tailored care. In addition, increasing evidence underline the crucial role of health professionals in health promotion interventions, that affect very significantly the healthy behaviors and physical habits of people with psychotic disorders. These observations are theoretically supported especially by Deci and Ryan in the theory of self-determination and by Hagger and Chatzisarantis in Trans-Contextual Model. The authors have shown that contextual factors such as social support, self-efficacy, autonomy, competence, social skills and the role of significant others are of fundamental importance in determining the motivation of people of being physically active. Even the enjoyment, defined as an emotional response positive sports experience, which reflects the general feelings of pleasure, satisfaction and fun, is considered one of the main determinants of adherence AF, as it is able to influence the will to begin and to maintain a program of regular exercise. Based on these findings, the research took into consideration some virtuous experiences operating in our country, offering regular PA programs as an integral part of the therapeutic treatments for users of psychiatric services. The purpose was to bring out the opinions of health professionals involved in regular PA programs with the users of psychiatric services, to highlight the benefits, barriers and facilitators of PA proposals. For this purpose it was decided to adopt a blended approach: participants completed a package of questionnaires which investigated the amount of PA, motivation, enjoyment, self-efficacy and quality of life reported by the participants. Therefore, a comparison was made between the two groups of participants on the basis of the variables examined. Moreover, four focus groups have been carried out, with health professionals involved in the study. They were asked to tell their personal experiences in PA with users of psychiatric services, highlighting the faced difficulties, the greatest benefits for users and the most important elements that can facilitate the implementation of PA proposals and to increasing their effectiveness. The results of the research are in line with literature. The content-analysis of focus groups, moreover, highlighted important data in support of the central role of the health care workers, in supporting users of the psychiatric services, to take part in the activities concerning health promotion. Results showed the need of a specific preparation, for these people, especially in what concern motivational processes and the management of strategies to promote active lifestyles. Finally, the statements reported by the health care workers confirmed and enriched the evidences about the utility of PA programs within the rehabilitative paths for people with severe mental disorders. They highlighted, in particular, the need to promote these initiatives making them an integral part of the therapeutic treatments. Moreover, it was highlighted the need to work on the network of contacts between the realities that promote these initiatives; health care workers underlined also the growing need for collaboration with local institutions at different levels, to promote and support the debate on this topic; finally they stressed that it is important to increase more effective PA proposals with the aim to respond to the needs of the users of psychiatric services
The role of health care workers in motivating users of psychiatric services to physical activity
No full textAim: regular physical activity (PA) can positively influence the treatment of psychotic disorders.
The main obstacles in adhering to regular PA programs for people with severe mental illness are the side effects of antipsychotic drugs, the lack of motivation and poor concentration abilities. All these elements reduce the exercise capacity of these persons and hinder their long-lasting participation in regular PA. Health care workers have a crucial role in the promotion of healthy behaviors and physical habits of people with psychotic disorders but, even if they are aware of the importance of PA, they have to cope with lots of barriers to sustaining patients participation in PA programs (Mo et al., 2011; Verhaeghe, 2011).
Methods: four focus groups have been conducted with health care staff members where PA programs are part of the treatment proposed to the users of psychiatric services. They were asked to highlight the benefits, barriers and facilitators of outpatients’ PA in their personal experiences.
Results: the content-analysis of the focus groups confirmed and enriched the evidences about the utility of PA programs within the rehabilitative paths for people with psychotic disorders. Moreover results highlighted the need for a specific preparation, for health care workers, especially in what concern motivational processes and the management of strategies to promote active lifestyles. Participants also affirmed the key role of exercise specialists within the health care staff and the growing need for collaboration with local institutions to support the promotion of PA.
Conclusions: results provide evidence for the increasing need of regular PA in the rehabilitative interventions of psychiatric disorders. The engagement of exercise specialist within the health care staff is desirable to facilitate the managing of PA programs and support educational interventions also for health care workers.
Reference: Mo P et al. (2011) Getting healthcare staff more active: the mediating role of self-efficacy. Brit J of H Psy 16: 690-706
Verhaeghe N et al. (2011) Perception of mental health nurses and patients about health promotion in mental health care: a literature review. J of Psy and MHNurs 18:487-49
Development of a questionnaire to measure hyperactivity in eating disorders patients
No full textIntroduction
Compulsive exercise is often associated with eating disorders (ED), particularly with anorexia nervosa (Naylor et al., 2011). ED patients develop frequently compulsive physical activity behaviours, engaging in excessive exercise, that is extreme in frequency and duration and physiologically, psychologically and socially impairing. (Meyer et al., 2011).
The purpose of this study was to contribute to the reliability (internal consistency) and construct validity of a new instrument named ‘Physical Activity and Unrest Questionnaire’ (PAUQ), oriented to evaluate hyperactivity in ED patients. The study was conducted at the U. P. Centre-K.U.L. Kortenberg, Belgium.
Methods
PAUQ is composed by 15 items, investigating cognitive, emotional and behavioural features of hyperactivity in ED patients. The score of each items ranges from 0 to 3. PAUQ was administered together with two other questionnaires about body experience: the Body Attitude Test and two subscales of the Eating Disorders Inventory (Drive for Thinness and Body Dissatisfaction). Participants were a sample (N = 972) of women, 269 were ED inpatients (mean age 21.2 years, SD±6.2; mean BMI 17.4, SD±3.9), 703 were students and university employees (mean age 18.6 years SD±4.7, mean BMI 21.3, SD±2.7).
Results
Internal consistency were good (ED α=0.94; students α=0.81) . A factor analysis highlighted two main factors: ‘the duty of being physically active’ and ‘the attitude and frame of mind’. A MANOVA analysis between the two groups showed significant differences in values of each item (p<.01), with the exception of the items 7 and 8.
Discussions
Results contributed to test reliability and validity of the PAUQ. The questionnaire evaluates levels of hyperactivity in ED patients. Data confirm the hypothesis that hyperactivity is more frequent in ED patients than in control subjects. Moreover, the study supports the notion to deep knowledge on this topic, to better guide screening and therapeutic interventions
The role of health care workers in motivating users of psychiatric services to physical activity
No full textAim: regular physical activity (PA) can positively influence the treatment of psychotic disorders.
The main obstacles in adhering to regular PA programs for people with severe mental illness are the side effects of antipsychotic drugs, the lack of motivation and poor concentration abilities. All these elements reduce the exercise capacity of these persons and hinder their long-lasting participation in regular PA. Health care workers have a crucial role in the promotion of healthy behaviors and physical habits of people with psychotic disorders but, even if they are aware of the importance of PA, they have to cope with lots of barriers to sustaining patients participation in PA programs (Mo et al., 2011; Verhaeghe, 2011).
Methods: four focus groups have been conducted with health care staff members where PA programs are part of the treatment proposed to the users of psychiatric services. They were asked to highlight the benefits, barriers and facilitators of outpatients’ PA in their personal experiences.
Results: the content-analysis of the focus groups confirmed and enriched the evidences about the utility of PA programs within the rehabilitative paths for people with psychotic disorders. Moreover results highlighted the need for a specific preparation, for health care workers, especially in what concern motivational processes and the management of strategies to promote active lifestyles. Participants also affirmed the key role of exercise specialists within the health care staff and the growing need for collaboration with local institutions to support the promotion of PA.
Conclusions: results provide evidence for the increasing need of regular PA in the rehabilitative interventions of psychiatric disorders. The engagement of exercise specialist within the health care staff is desirable to facilitate the managing of PA programs and support educational interventions also for health care workers.
Reference: Mo P et al. (2011) Getting healthcare staff more active: the mediating role of self-efficacy. Brit J of H Psy 16: 690-706
Verhaeghe N et al. (2011) Perception of mental health nurses and patients about health promotion in mental health care: a literature review. J of Psy and MHNurs 18:487-49
Exercise intensity and major depression: results of a preliminary study
No full textBackground
Depression is a complex disorder characterized by depressed mood, loss of interest or pleasure in activities, low self-worth, low energy and poor concentration. Depression is one of the most common psychiatric disorders, affecting about 121 million people worldwide (WHO, 2010), is the leading cause of disability measured by YLDs and the 2nd cause of DALYs in the age 15-44 for both sexes and are expected to show a rising trend during the coming 10 years (Lopez et al., 2006). Exercise has been recognized as a potentially effective treatment for depression. Literature has been significantly growing in the last 20 years, with results of RCTs indicate that participation in physical activity programs reduces depression symptoms (Daley, 2008; Krogh et al. 2010; Perraton et al., 2009;). Exercise can be a good option which has few negative side effects and could be cost-effective in comparison to both drug and non-drug options.
Purpose
This preliminary study was designed to test the response of two different exercise intensity in depressive symptoms measured with Hamilton Rating Scale for Depression (HRSD).
Setting/participants
Exercise was performed in a supervised clinical setting by 20 inpatients of both genders (mean age 47.4, SD ±9.8), diagnosed with major depression according to DSM-IV-TR. Patients received antidepressant medications in accordance with international recommendations.
Intervention
Participants were randomized in two exercise groups (high intensity -5 METs- or low intensity -3 METs-), performing 1 hour of exercise/day, 5days/week in 4 consecutive weeks.
Results
HRSD mean scores at 4 weeks were significantly reduced from baseline (t -9.8, p < .001), with no significant differences between the two groups.
Conclusion
Differently from previous studies (Dunn et al., 2005), in the present trial exercise intensity did not appear a determinant factor to reduce depressive symptoms, with results of higher intensity group that were similar to those of lower
STANDING BALANCE IMPROVEMENTS IN ALCOHOLIC PATIENTS AFTER A SHORT-TERM TREATMENT
No full textIntroduction Alcohol ingestion negatively impacts physical performance, causing worsening of psychomotor skills and reduced balance
(Wober et al., 1999). Evidence indicates that exercise-related activities are associated with positive outcomes in the treatment of alcohol
misuse disorders (Carraro, 2013; Weinstock, Barry & Petry, 2008). The purpose of the present study was to analyse changes in standing
balance after a multidimensional short-term treatment of alcohol misuse, including exercise programs, in a group of chronic alcoholics.
Method Participants were 32 alcoholic patients (20 men, 12 women; mean age 45.4, SD 9.2 years) consecutively admitted to a residential
treatment. They participated to a mean of 15 (SD 3.5) group-based exercise sessions during a 4-week period of hospitalization. Pre- postmeasures
of standing balance were collected by using a low cost set up based on Nintendo Wii Balance Board (WBB) and administrating
a Romberg test with opened and closed eyes, with and without a pad-foam on the WBB. A 41 healthy subjects control group was also
considered. Results Compared with healthy subjects, alcoholic patients revealed at the pre-test reduced standing balance(-44.3%, Cohen’s d = -0.58). Patients reported significant improvements after the treatment in the opened-eyes WBB tests (mean sway area pre vs.
post without foam 7.0 vs. 4.1, p = .001; with foam 25.8 vs. 15.5, p = .048). Significant differences were recorded also in the closed-eyes
tests (mean sway area 10.43 vs. 8.10, p = .041; 84.6 vs. 59.2, p < .001 respectively). Discussion Findings support the notion that standing
balance control seems to be a serious problem for chronic alcoholics. A multidimensional treatment of alcohol misuse, including exercise-related
activities, appears as an effective strategy to ameliorate in the short time standing balance control in this population. Further
research is needed to evaluate the maintenance over the time of these positive outcomes. References Carraro A (2013). The role of exercise
in alcohol dependence recovery. Edi-Ermes, Milano. Weinstock J, Barry D, Petry N (2008). Addict Behav, 33, 1072–1075. Wober C,
Wober-Bingol C, Karwautz A, Nimmerrichter A, Deecke L, Lesch O (1999). Acta Neurol Scand, 99, 48-53
Enjoyment is not the same when exercise is performed with different cardio fitness equipments: results of a preliminary study
No full textEnjoyment has been implicated as a main determinant of physical activity adherence in people of all ages (Scanlan & Simons, 1992; Allender et al., 2006). The purpose of this study was to test enjoyment of exercise performed with three different cardio fitness trainers.
Method
Participants were 41 university students, 12men and 29 women, mean age 25.6 years (SD ± 4.4). They performed 8 minutes each of exercise at their preferred intensity with three cardio fitness machines: treadmill, elliptical and Vario (it is a new trainer developed by Technogym). We invited participants to use the first 3 minutes to check the characteristics of the apparatus on the basis of their feelings (only regulation buttons were accessible, monitors were covered), then to set the functions and to maintain them for 5 consecutive minutes. Access to the equipments was randomized, rest times between the different exercises were free. At the end of each performance, participants filled in a questionnaire included a 12 items adapted version of the PACES (Physical Activity Enjoyment Scale, Motl et al., 2001; Carraro et al., 2008) and two visual-analogue scales.
Results
Participants had different experiences with equipments, 26.8% never used a treadmill before, 46.3% never used an elliptical, 87.8% never used Vario. PACES-pros mean score after exercise with elliptical was significantly lower compare to treadmill and Vario (Cohen’s d 0.87 and 0.71 respectively), that had similar values. PACES-cons mean score with elliptical was higher compare to treadmill and Vario (Cohen’s d 0.64, 0.63), that had still similar values. Exercise with treadmill was perceived more natural (p <.001) than Vario and elliptical (p <.001), exercise with Vario was perceived more natural than that with elliptical (p =.018).
Conclusion
Despite the fact that aerobic exercise when performed with machines is mainly considered in term of energetic expenditure possibility, differences in movement structure appear to influence enjoyment
L'attività fisica nella terapia delle patologie psichiatriche:l'esperienza della Casa di Cura Parco dei Tigli
No full textObiettivo.
Lo scopo di questa comunicazione è di presentare il Servizio di Attività Fisica organizzato per i pazienti assistiti presso la Casa di Cura Parco dei Tigli a Villa di Teolo in provincia di Padova.
La struttura e il servizio.
La Casa di Cura Parco dei Tigli è una struttura sanitaria specializzata nel trattamento residenziale delle patologie neuropsichiatriche dell’adulto. Accanto alle altre forme di terapia, in particolare farmacoterapie, psicoterapie individuali e di gruppo e terapia ad espressione artistica, dal 1990 è stato organizzato al Parco dei Tigli un servizio di attività fisica riservato ai pazienti ricoverati. Sono attualmente attivati otto gruppi differenziati in funzione delle diverse problematiche psicopatologiche e delle caratteristiche degli utenti (ad esempio età, abitudini motorie e sportive e concomitanza di problemi organici). Nel 2009 sono stati seguiti 725 pazienti, per un totale di oltre 11.700 presenze. Vengono organizzati specifici programmi per il trattamento dei disturbi del comportamento alimentare, dei disturbi dell’umore, dei disturbi d’ansia, della schizofrenia e degli altri disturbi psicotici, dei disturbi correlati all’abuso di sostanze e dell’obesità. Secondo il tipo di programma i gruppi, condotti da un’équipe multidisciplinare, si incontrano da tre a sei volte la settimana.
Finalità e contenuti dell’attività.
L’attività viene proposta con lo scopo di mantenere e recuperare le capacità e le abilità psicomotorie, per stimolare la socializzazione, per potenziare l’autostima, per aiutare i partecipanti a prendere coscienza delle proprie possibilità e dei propri limiti e per educare/ri-educare all’adozione di uno stile di vita attivo. L’attività svolge inoltre un’ importante funzione di regolazione delle emozioni, favorendo lo scarico delle tensioni e facilitando il ristabilimento di una corretta funzione tonica.
Le proposte includono situazioni e giochi di gruppo, l’uso di tecniche di problem soving, sport adattati, attività di fitness a corpo libero e con attrezzi, sedute di rilassamento secondo la tecnica di Jacobson. Un ruolo importante è svolto dalle attività all’aria aperta.
Progetti di ricerca e collaborazioni.
L’équipe del servizio è impegnata in attività di ricerca che attualmente riguardano soprattutto il trattamento delle obesità psicogene e l’effetto dose-response dell’attività fisica nel trattamento dei disturbi depressivi.
Numerose sono le collaborazioni internazionali con centri europei ed extra-europei e vi è una stretta collaborazione con l’Università di Padova
Motivation to physical activity in obese psychiatric patients
No full textPURPOSE: Obesity is frequently comorbid with psychiatric disorders, representing a crucial
question in terms of the compliance to treatments and of several medical complications. The
aim of this study was to compare the modifications in motivation to physical activity (PA) of
seriously overweight and obese psychiatric patients, with normal weight psychiatric patients,
during a multidimensional residential treatment which included daily group-based exercise
programs.
METHOD: A pre-post comparative design was used. Participants were 32 seriously
overweight (BMI: 27.5-29.9) or obese (BMI ≥ 30), and 71 normal-weight or moderate
overweight (BMI ≤ 27.4) psychiatric patients, consecutively admitted to a middle term (45-60
days) residential treatment. The 6 Minutes Walking Test (6MWT), the Situational Motivation
Scale, the Physical Activity Enjoyment Scale and the Decisional Balance Questionnaire were
used. T-tests, ANOVAs and regression analyses were conducted on the different variables.
RESULT(S): Despite overweight and obese patients reported at the admission significantly
lower level in the 6MWT and in motivation scales compared to moderate overweight and
normal weight patients, at the end of the treatment they improved significantly exercise
tolerance, as measured by the 6MWT, intrinsic motivation and identified regulation,
enjoyment in PA and decisional balance. Improvements in the 6MWT seem to predict
positive changes in motivation. CONCLUSION(S): The organization of exercise programs appears a cost-effective strategy to
change, in the short time, the attitudes toward PA of obese psychiatric patients, increasing
their motivation and enjoyment. Exercise should be regularly included in psychiatric
treatment protocols and strategies to facilitate and stimulate participation should be
implemented also at community-based levels
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