Prevention and treatment of psychiatric disorders through physical activity, exercise, and sport

Open AccessPrevention and treatment of psychiatric disorders through physical activity, exercise, and sportMarkus Gerber, Todd Stull, and Malte Christian ClaussenMarkus GerberProf. Dr. Markus Gerber, Department of Sport, Exercise, and Health (DSBG), University of Basel, Grosse Allee 6, 4052 Basel, Switzerlandmarkus.gerber@unibas.ch Department of Sport, Exercise, and Health, University of Basel, Switzerland Search for more papers by this author, Todd Stull Department of Psychiatry and Neuroscience, University of California, Riverside School of Medicine, CA, USA Search for more papers by this author, and Malte Christian Claussen Department of Psychiatry, Psychotherapy, and Psychosomatics, Psychiatric University Hospital Zurich, University of Zurich, Switzerland Private Clinic Wyss AG, Münchenbuchsee, Switzerland Adult Psychiatry, Psychiatric Services Grisons, Chur, Switzerland Search for more papers by this authorPublished Online:August 18, 2022https://doi.org/10.1024/2674-0052/a000023PDF ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinkedInReddit SectionsMoreHot topics in sports psychiatryIn some regions, such as North America, sports psychiatry strongly focuses on competitive sports and treating psychiatric disorders in elite athletes [1, 2]. In other regions, such as German-speaking countries, sports psychiatry has developed in two ways: competitive sports on the one hand, and physical activity, exercise and sport in the case of mental illnesses on the other. Both topics are also addressed by the Sport and Exercise Psychiatry Special Interest Group (SEPSIG) of the Royal College of Psychiatrists and in the World Psychiatric Association (WBA), Section Sport and Exercise. As shown in this issue by Claussen and colleagues [3], sports psychiatry professionals today identify several other fields of activities that they consider relevant for this young discipline.Over the past two decades, there has been a steady increase in awareness that physical activity, exercise and sport can play an essential role in preventing and treating mental illness. The number of methodically sound studies has increased significantly [4, 5]. In recent years, knowledge has also been pooled in the form of systematic reviews and meta-analyses [6, 7]. In the meantime, a solid basis of scientific evidence exists, from which conclusions for practice can be derived [8]. As a result, several international professional societies now recommend physical activity, exercise and sport in treating mental disorders as standard therapy [9]. It can also be seen that many psychiatric institutions have moved to follow these recommendations [10]. This is a positive development, as physical activity, exercise, and sport in psychiatric care not only positively affect symptom severity but can also counteract increased morbidity and mortality in psychiatric patients [11].Adding some pieces of puzzle to the bigger pictureGiven this background, the current issue of Sports Psychiatry focuses explicitly on the topic of physical activity, exercise, and sport in preventing and treating psychiatric disorders. Various contemporary topics are addressed: First, Sousa Martins [12] presents a physical activity program specifically designed for psychiatric patients of community mental health services. Such initiatives are welcome, as information is still lacking about the best way to integrate physical activity, exercise and sport programs into clinical practice. In the second article, Nahman and Holland [13] highlight that exercise is not always healthy. Particularly among patients with eating disorders, unhealthy exercise practices are frequently observed. This study shows that in this patient group, the risks of addressing exercise must be carefully balanced against the risks of not addressing it. In the third article, Reimer and colleagues [14] attempt to systematically review the current evidence regarding the effects of sport therapy on psychosocial outcomes in forensic patients. The study draws attention to the fact that research in this specific population is still in its infancy and we still know far too little about how physical activity, exercise and sport can be used profitably in forensic psychiatry. In the fourth contribution, Nigg and colleagues [15] highlight that the mechanisms by which physical activity, exercise and sport influence mental health are still poorly understood. For instance, it is still unclear which role the context plays in this relationship and whether being physically active (e.g., parks, forests, rocks, rivers, lakes) is more beneficial than engaging in activities in less “natural” environments such as laboratories or indoor facilities. A better understanding is required, as recent developments show that web-based exercise therapy is increasingly advertised in treating psychiatric disorders (see commentary of Haller [16] in this issue). Not surprisingly, these developments have received a significant boost during the COVID-19 pandemic. Due to measures taken in connection with the pandemic, people’s freedom of movement was restricted [17], which was reflected in increased stress levels and reduced well-being [18, 19]. A significant advantage of web-based exercise interventions is that they are not affected by such measures and can be implemented cost-efficiently. However, the effects have not yet been studied much, and further research is needed.A long way to go: Further unexplored avenuesAlthough the number of studies in this field of research has increased, there are still a lot of “white spots” and under-researched areas. Therefore, we encourage researchers to continue their efforts and submit their innovative work to Sports Psychiatry. For instance, there is still a lack of prospective, large-scale epidemiological studies in which the association between physical activity, exercise and sport and the prevalence/incidence of psychiatric disorders are tested [20]. Such studies are essential to gain insights into dose-response relationships and ensure that recommendations regarding moderate-to-vigorous physical activity are suitable for psychiatric populations. Furthermore, since current physical activity recommendations were established to prevent cardiovascular diseases [21], it is not sure whether they also apply to patients with psychiatric disorders [22]. We further observe that few studies have so far examined trajectories of physical activity/inactivity in patients with psychiatric disorders and how these trajectories are associated with changes in mental health outcomes [23]. A further underexplored area is physical activity assessment and fitness testing in psychiatric populations. While it can be assumed that device-based physical activity assessments work well in healthy and psychiatric populations, this is not necessarily the case for questionnaires that assess self-reported physical activity [24], as certain psychological traits can cause physical activity to be systematic under-/overreported by psychiatric patients [25]. Similarly, although psychiatric patients are at higher risk of having poor physical fitness [26], little is known about which fitness tests are most suitable for psychiatric populations. In addition, more information is required if cardiovascular fitness testing should become a routine in psychiatric care [27]. We also perceive a great need to explore factors that facilitate or hinder the adoption/maintenance of a physically active lifestyle. Previous studies have shown that there is a high likelihood that psychiatric patients fall back into sedentary lifestyle patterns once structured physical activity programs come to an end [28]. We, therefore, hold that a better understanding is needed about how behavioral skills can be improved to foster the sustainability of physical activity and exercise programs [29]. We also believe that current measurement and evaluation approaches should go beyond efficacy testing by more deeply investigating patients’ experiences while participating in physical activity and exercise programs. To do this, a combination of both qualitative and quantitative methods seems inevitable and desirable. Finally, we see a great need to compare different exercise modalities to figure out which types of physical activity, exercise and sport are most beneficial for preventing and treating psychiatric issues. While most previous studies have compared endurance and strength training [30], future studies should go more into detail by differentiating different endurance/strength training modalities [31] or by examining the effects of specific activities such as climbing [32], Zumba dancing [33], paddle boarding or paddle tennis. While these topics are just examples, they highlight that there is still a long way to go and that many new avenues are waiting to be explored in this field of research by motivated and inspired researchers.References1 Reardon CL, Factor RM. Sport psychiatry: A systematic review of diagnosis and medical treatment of mental illness in athletes. Sports Med. 2010;40:961–80. First citation in articleGoogle Scholar2 Stull T, Glick ID, Kamis D. The role of a sport psychiatrist on the sports medicine team, circa 2021. Psychiatr Clin North Am. 2021;44:333–45. First citation in articleGoogle Scholar3 Claussen MC, Imboden C, Hemmeter UM, Iff S. 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First citation in articleGoogle ScholarFiguresReferencesRelatedDetailsCited byHow to coach people with psychiatric disorders in sports Qualitative evaluation of the teaching aid for the training with individuals with psychiatric disordersRahel Lauber, Daniela Loosli, and Nikolai Kiselev23 December 2022 | Sports Psychiatry, Vol. 0, No. 0 Volume 1Issue 3August 2022ISSN: 2674-0052eISSN: 2674-0052 InformationSports Psychiatry (2022), 1, pp. 85-87 https://doi.org/10.1024/2674-0052/a000023.© 2022The Author(s)LicensesDistributed as a Hogrefe OpenMind article under the license CC BY 4.0 ( https://creativecommons.org/licenses/by/4.0)PDF download