Research finds that people diagnosed with bipolar, schizophrenia, and major depressive disorders have lower physical activity rates and higher sedentary rates than the general population. A new study also explores how these differences may vary across geographic regions.
A group of researchers led by Davy Vancampfort published a systematic review and meta-analysis exploring the relationship between sedentary behavior, physical activity, and ‘severe mental illness (SMI)’. In this study, SMI included people diagnosed with bipolar, schizophrenia and major depressive disorders. The results of the meta-analysis demonstrated that people diagnosed and treated for SMI were significantly more sedentary than age- and gender-matched healthy controls.
“Understanding sedentary behavior, physical activity levels, and their correlates among people with severe mental illness may aid in tailoring efforts to improve their long-term physical health outcomes,” the authors write.
Previous studies have demonstrated that people diagnosed with (SMI) have higher levels of premature mortality than the general population. and that these higher rates may primarily be accounted for by cardiovascular disease. Further, a recent study demonstrated a widening of the mortality gap between people with a diagnosis of bipolar or schizophrenia and the general population. Given that prolonged periods of sedentary behavior can increase the risk of cardiovascular disease, the authors of this meta-analysis aimed to:
- Determine time spent being sedentary or physically active per day
- Compare rates across clinical subgroups (schizophrenia, bipolar disorder, and major depressive disorder)
- Explore predictors of physical activity and sedentary behavior
- Compare physical activity and sedentary behavior among people diagnosed with SMI and healthy comparisons
Sixty-nine studies, totaling 35,682 individuals diagnosed with SMI and 2,933 controls were included. Physical activity was defined as “any activity that involved bodily movement produced by skeletal muscles and that required energy expenditure” and sedentary behavior was defined as “energy expenditure less than or equal to 1.5 metabolic equivalents of task (METs), while in a sitting or reclining posture during waking hours”. Studies utilized objective measures (n=23), objective and subjective measures (n=3), and self-report questionnaires (n=57) or physical activity.
Time spent being sedentary or physically active per day:
People diagnosed with SMI were sedentary for 476 minutes per day during waking hours and were more sedentary than healthy controls. Interestingly, study results found that people in Europe were significantly less sedentary (413 min /day) than those in North America (586 min/day), South America (555 min/day), or Asia (579 min/day).
Mean amount of physical activity in the SMI group was 38.4 min per day. Individuals with a SMI diagnosis had significantly lower rates of moderate physical activity and vigorous physical activity than healthy controls. Those in Europe had higher levels of moderate or vigorous physical activity (47.6 min/day) than those in North America (26 min/day), and Oceania (13. 1 min/day). People diagnosed with SMI were more likely to not meet the physical activity guidelines than healthy controls.
Compare rates across clinical subgroups (schizophrenia, bipolar disorder, and major depressive disorder):
Those with a bipolar diagnosis were significantly more sedentary (615 min/day) than those with schizophrenia (493 min/day) or major depressive disorder (414 min/day).
People with a bipolar diagnosis engaged in significantly more moderate or vigorous physical activity (84.2 min/day) than those with a schizophrenia diagnosis (37.5 min/day), and major depressive disorder (28.8 min/day).
Explore predictors of physical activity and sedentary behavior:
Lower physical activity levels were associated with male gender, being single, unemployment, fewer years of education, higher BMI, longer illness duration, antidepressant and antipsychotic medication use, lower cardiorespiratory fitness and having a diagnosis of schizophrenia.
The authors of this study conclude that physical activity and sedentary behavior present important and modifiable risk factors for premature mortality. Moreover, not meeting physical activity guidelines is associated with longer ‘illness’ duration, fewer years of education and antipsychotic prescription.
There are numerous potential benefits for increasing physical activity rates and/or decreasing rates of sedentary behavior. The significant differences between geographic regions highlights that although there exists an interest in promoting physical activity in treatment for people diagnosed with SMI, it has yet to be fully embraced by most parts of the world.
Vancampfort, D., Firth, J., Schuch, F. B., Rosenbaum, S., Mugisha, J., Hallgren, M., … & Carvalho, A. F. (2017). Sedentary behavior and physical activity levels in people with schizophrenia, bipolar disorder and major depressive disorder: a global systematic review and meta‐analysis. World Psychiatry, 16(3), 308-315. (Link)