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Cardiorespiratory Fitness in Severe Mental Illness: A Systematic Review and Meta-analysis
Abstract
Background Cardiorespiratory fitness (CRF) among people with severe mental illness (SMI) (i.e., schizophrenia, bipolar disorder, and major depressive disorder) is a critical clinical risk factor given its relationship to cardiovascular disease and premature mortality.Objectives This study aimed to: (1) investigate the mean CRF in people with SMI versus healthy controls; (2) explore moderators of CRF; and (3) investigate whether CRF improved with exercise interventions and establish if fitness improves more than body mass index following exercise interventions.Methods Major electronic databases were searched systematically. A meta-analysis calculating Hedges' g statistic was undertaken.Results Across 23 eligible studies, pooled mean CRF was 28.7 mL/kg/min [95 % confidence interval (CI) 27.3 to 30.0 mL/kg/min, p < 0.001, n = 980]. People with SMI had significantly lower CRF compared with controls (n = 310) (Hedges' g = -1.01, 95 % CI -1.18 to -0.85, p < 0.001). There were no differences between diagnostic subgroups. In a multivariate regression, first-episode (β = 6.6, 95 % CI 0.6-12.6) and inpatient (β = 5.3, 95 % CI 1.6-9.0) status were significant predictors of higher CRF. Exercise improved CRF (Hedges' g = 0.33, 95 % CI = 0.21-0.45, p = 0.001), but did not reduce body mass index. Higher CRF improvements were observed following interventions at high intensity, with higher frequency (at least three times per week) and supervised by qualified personnel (i.e., physiotherapists and exercise physiologists).Conclusion The multidisciplinary treatment of people with SMI should include a focus on improving fitness to reduce all-cause mortality. Qualified healthcare professionals supporting people with SMI in maintaining an active lifestyle should be included as part of multidisciplinary teams in mental health treatment.
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“The latter being especially relevant since it lowers [100] the elevated cardiovascular risk of patients with depression [101,102].”
From The effects of exercise on sleep in unipolar depression: a systematic review and network meta-analysis (2021) · cites this paper as [102]
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Self-citation
Metadata
- Authors
- Vancampfort, D., Rosenbaum, S., Schuch, F., Ward, P. B., Richards, J., Mugisha, J., Probst, M., & Stubbs, B.
- Affiliations
- KU Leuven (BE)
- UNSW Sydney (AU)
- Universidade Federal do Rio Grande do Sul (BR)
- The University of Sydney (AU)
- Butabika Hospital (UG)
- King's College London (GB)
- Corresponding author
- Vancampfort, Davy
- ORCID
- Venue
- Sports Medicine
- Published
- 2016-06-14
- Volume
- 47
- Issue
- 2
- Pages
- 343-352
- ISSN
- 0112-1642 (ISSN-L)
- 1179-2035
- OpenAlex
- W2421186665
- Cited by
- 224
- References
- 73
- Citations by year
- 2026: 11 · 2025: 16 · 2024: 13 · 2023: 21 · 2022: 24 · 2021: 26 · 2020: 24 · 2019: 25 · 2018: 33 · 2017: 24 · 2016: 7
- FWCI
- 3.48
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Sports Medicine (publishedVersion)
- PubMed (publishedVersion)
- Research Portal (King's College London) (submittedVersion)
- Lirias (submittedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Physical Activity and Health
- Health Sciences › Medicine › Physiology (medical) › Cardiovascular and exercise physiology
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Keywords
- cardiorespiratory fitness, severe mental illness, schizophrenia, bipolar disorder, major depressive disorder, exercise intervention, body mass index, cardiovascular risk, all-cause mortality, first-episode psychosis, inpatient status, supervised exercise, high-intensity exercise
- MeSH terms
- Cardiorespiratory Fitness, Depressive Disorder, Major, Major Depressive Disorder, Humans, Physical Fitness, Schizophrenia, Schizophrenic Psychology, Severity of Illness Index, Exercise, Body Mass Index
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