Journal Articles

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Adherence to physical activity recommendations and physical and mental health risk in people with severe mental illness in Uganda
(Elsevier: Psychiatry Research, 2018-02) Vancampfort, Davy; Probst, Michel; Basangwa, David; De Hert, Marc; Myin-Germeys, Inez; Winkel, Ruudvan; Ward, Philip B.; Rosenbaum, Simon; Mugisha, James
This study investigated cardio-metabolic risk factors among patients with severe mental illness who do or do not meet the recommendations of 150 min per week of physical activity. A secondary aim was to assess whether those that do meet the recommendations report lower levels of mental health symptoms. 107 (60♀) Ugandan in- and outpatients (mean age=34.4 ± 9.7 years) with severe mental illness (depression=7, bipolar disorder=55, schizophrenia=45) completed the Physical Activity Vital Sign (PAVS) method and Brief Symptoms Inventory −18. Participants were also screened for abdominal obesity (waist circumference>90 cm), overweight (body mass index≥25) and hypertension (systolic pressure≥140 mmHg and/or diastolic pressure≥90 mmHg).48.6% (n = 52) of patients met the physical activity recommendations as assessed by the PAVS method. 41.1% (n = 44) were overweight, 40.2% (n = 43) had abdominal obesity and 23.4% (n = 25) had hypertension. Those who did not meet the physical activity recommendations were significantly older, had a higher BSI-18 somatisation score, and had a higher risk of overweight [relative risk (RR) = 2.88, 95% confidence interval (CI) = 1.59–4.99], abdominal obesity (RR = 1.82, 95%CI = 1.13–2.93), and hypertension (RR = 2.16, 95%CI = 0.99–4.73). The PAVS is a feasible method of assessing physical activity among patients with severe mental illness in a low resource setting. The PAVS may have clinical utility for physical and mental health risk stratification.
Associations of the built environment with physical activity and sedentary time in Ugandan outpatients with mental health problems
(Journal of Physical Activity and Health, 2018) Vancampfort, Davy; Stubbs, Brendon; Sallis, James F.; Nabanoba, Justine; Basangwa, David; Oyeyemi, Adewale L.; Kasoma, Sandra S.; De Hert, Marc; Myin-Germeys, Inez; Mugisha, James
This study investigated whether reported neighborhood variables explained variance in time spent walking, exercising, and being sedentary, in addition to mental health and demographic variables among Ugandan outpatients with mental illness. Methods: Ninety-nine outpatients (78 men; 31.1 [8.6] y) of the Butabika National Referral Hospital in Uganda completed the Neighborhood Environment Walkability Scale for Africa, the Simple Physical Activity Questionnaire, and the Brief Symptoms Inventory-18. Multiple regression analyses were performed. Results: Seven percent of the variance in walking time was explained by the variance in anxiety/depression and an additional 13% by the variance in perceived mixed land use and the availability of roads and walking paths. Eight percent of the variance in exercise time was explained by variance in age and an additional 6% by the variance anxiety/depression. The availability of recreational space added 8%. Six percent of variance in time spent sedentary was explained by family income, while availability of roads and walking paths added another 6%. Conclusions: This study shows the relevance of availability of roads and walking paths and recreational space for more physical activity and less sedentary behavior in people with mental illness. This is particularly relevant in low-income countries where a rapid urbanization is taking place.
Exercise self-efficacy correlates in people with psychosis
(Elsevier: Psychiatry Research, 2018-04) Vancampfort, Davy; Gorczynski, Paul; De Hert, Marc; Probst, Michel; Naisiga, Annetie; Basangwa, David; Mugisha, James
Despite the recognition of the importance of exercise self-efficacy in exercise adoption and maintenance, previous investigations on exercise self-efficacy in people with psychosis is scarce. The present study aimed to (1) explore if exercise self-efficacy differed between stages of behavior change in Ugandan outpatients with psychosis, and (2) assess sociodemographic, clinical and motivational correlates of exercise self-efficacy. In total, 48 patients (24 women) completed the Exercise Self-Efficacy Scale (ESES), the Patient-centered Assessment and Counseling for Exercise questionnaire, the Brief Symptoms Inventory-18 (BSI-18), and questions pertaining to intrinsic motivation in the Behavioral Regulation in Exercise Questionnaire-2. Additionally, participants were asked about their exercise behavior in the past 7 days and screened for cardio-metabolic risk factors. Higher ESES-scores were observed in those in the maintenance (n = 17) versus those in the pre-action stage (n = 17) of behavior change. Higher ESES-scores were also significantly associated with lower BSI-18 somatization and higher intrinsic motivation scores. Our data indicated that health care professionals should assist patients with psychosis in interpreting physiological states during exercise. Future research should explore whether bolstering such sources of information might directly or indirectly effect exercise self-efficacy.
Interest, competence, appearance, fitness and social relatedness as motives for physical activity in Ugandan outpatients with psychosis
(Elsevier: Mental Health and Physical Activity, 2017-10) Vancampfort, Davy; De Hert, Marc; Probst, Michel; Firth, Joseph; Myin-Germeys, Inez; Winkel, Ruudvan; Naisiga, Annetie; Basangwa, David; Mugisha, James
Motivating people with psychosis to meet recommended physical activity levels is a public health priority. It remains unclear whether physical activity motives differ between male and female patients, those with and without cardio-metabolic risks, those who exercise alone versus in group and in aerobic exercise versus resistance training. The aim of this study was to explore differences in PA motives related to several patient characteristics in Ugandan outpatients with psychosis. Methods 48 patients (24♀; 33.3 ± 9.6 years) completed the Motives for Physical Activity Measure – Revised (MPAM-R), Patient-centred Assessment and Counselling for Exercise questionnaire, the Brief Symptoms Inventory - 18 (BSI -18), were asked for their physical activity participation in the last 7 days and screened for abdominal obesity, overweight, hypertension, smoking, medication use and the presence of chronic conditions. Results A multivariate analysis of variance demonstrated main effects for stages of physical activity behavior change (Wilks λ = 0.40, F = 2.98, P = 0.043) and gender (Wilks λ = 0.45, F = 3.45, P = 0.031). There were no interaction effects between stage of change and gender (Wilks λ = 0.35, F = 1.89, P = 0.089). Men scored higher on appearance (P = 0.046) and interest/enjoyment (P = 0.042). Higher (P < 0.05) MPAM-R were observed in action and maintenance behaviour stages versus pre-action stages but there were no differences between the action and maintenance stage. There were no significant correlates between MPAM-R and BSI-18 scores. Conclusions Extrinsic (fitness, appearance, social benefits) and intrinsic (interest, competence) motives are equally important in adopting and maintaining physical activity in people with psychosis. Socio-cultural role patterns should be considered, also in Western settings (e.g., in refugees).
Motives for physical activity in the adoption and maintenance of physical activity in men with alcohol use disorders
(Elsevier: Psychiatry Research, 2018-03) Vancampfort, Davy; Van Damme, Tine; Probst, Michel; Vandael, Hannelore; Hallgren, Mats; Mutamba, Byamah Brian; Nabanoba, Justine; Basangwa, David; Mugisha, James
Within the self-determination theory and the trans-theoretical model (stages of change) frameworks, we investigated motives for physical activity adoption and maintenance in men with alcohol use disorder (AUD). Fifty Ugandan patients completed the Behavioral Regulation in Exercise Questionnaire-3 (BREQ-3) to assess exercise motives, the Patient-centred Assessment and Counselling for Exercise (PACE) to determine stage of change and the Alcohol Use Disorders Identification Test. The relationship between motives for physical activity and stage of change was investigated using ANOVA with post-hoc Scheffe tests. Multivariate analyses found significantly higher levels of introjected, identified and integrated motivation in the action and maintenance stage versus the pre-action stage. There were no differences in intrinsic motivation between the stages of change. Our results suggest that in order to adopt and maintain an active lifestyle the most important source of motivation comes from the benefits that may be obtained rather than from the inherent pleasure or challenge associated with it. The study provides a platform for future research to investigate the importance of autonomous motivation within physical activity interventions for people with AUD.
Motives for physical activity in the adoption and maintenance of physical activity in middle-aged and old age outpatients with a mental disorder: a cross-sectional study from a low-income country
(Elsevier: Psychiatry Research, 2019-12) Vancampfort, Davy; Basangwa, David; Nabanoba, Justine; Smith, Lee; Mugisha, James
Within the trans-theoretical model (stages of change) and self-determination theory frameworks, we investigated motives for physical activity adoption and maintenance in middle-aged and old age people with a mental disorder from a low-income setting. Ninety Ugandan outpatients completed the Behavioral Regulation in Exercise Questionnaire-3 (BREQ-3) to assess exercise motives and the Patient-centred Assessment and Counselling for Exercise (PACE) to determine stage of change. The relationship between motives for physical activity and stage of change was investigated using MANOVA with post-hoc Scheffe tests. Higher amotivation levels were observed in the pre-action compared with action and maintenance stages, while except for external regulation, all regulation scores were significantly lower in the pre-action compared with action and maintenance stages. There were no significant differences in levels of motivational types between the action and maintenance stage. The study provides a platform for future research to investigate relationships between motivational factors and physical and mental health outcomes within physical activity interventions for middle-aged and old age people with a mental disorder.
Physical activity is associated with the physical, psychological, social and environmental quality of life in people with mental health problems in a low resource setting
(Elsevier: Psychiatry Research, 2017-12) Vancampfort, Davy; Van Damme, Tine; Probst, Michel; Firth, Joseph; Stubbs, Brendon; Basangwa, David; Mugisha, James
There is a growing recognition of the importance of encouraging patients with mental health problems to become more active as an efficacious strategy to reduce the disability-associated burden. The aim of the current study was to investigate if there are differences in quality of life (QoL) outcomes between people with mental health problems that do and do not meet the recommendations of 150 min per week of physical activity. 109 (36♀) Ugandan in- and outpatients (mean age = 34.2 ± 10.2 years) (depression = 7, bipolar disorder = 31, schizophrenia = 21, alcohol use disorder = 50) completed the Physical Activity Vital Sign (PAVS) method and World Health Organization Quality of Life Assessment brief version. Those who did not achieve the minimum physical activity recommendations as assessed by the PAVS (n = 63) had a lower physical, psychological, social and environmental QoL. The current data offer further evidence that the PAVS method might be an important risk identification tool in people with mental health problems. The feasibility and acceptability of the PAVS may help promote the importance of physical activity assessment and prescription as a core part of the treatment of mental health problems in LMICs.
Physical health policies and metabolic screening in mental health care systems of sub-Saharan African countries: a systematic review
(Springer Nature: International Journal of Mental Health Systems., 2017-04-19) Mugisha, James; De Hert, Marc; Stubbs, Brendon; Basangwa, David; Vancampfort, Davy
There is a need for interventions to address the escalating mental health burden in sub-Saharan Africa (SSA). Addressing physical health needs should have a central role in reducing the burden and facilitating recovery in people with severe mental illness (SMI). We systematically investigated (1) physical health policies in the current mental health plans, and (2) the routine metabolic screening rates for people with SMI in SSA. Methods: The Mental Health Atlas and MiNDbank of the World Health Organization were screened for physical health policies in mental health plans. Next, we systematically searched PubMed from inception until February 1st, 2017 for relevant studies on metabolic screening rates in people with SMI in SSA. Results: The current systematic review shows that in 22 screened plans only 6 made reference to a physical health component or policy. Only the South-African mental health plan reported about routine screening and treatment of physical illness for people with SMI. In 2 South-African studies (n = 431) routine screening was unacceptably low with less than 1% adequately screened for all modifiable metabolic syndrome risk factors. Conclusions: Our review data clearly show that a physical health policy is yet to be embraced in mental health care systems of most SSA countries. There is a clear need for integrated mental and medical services in SSA. All psychiatric services, including poorly developed community-based primary health care settings should standardly assess the body mass index and waist circumference at initiation of psycho-pharmacotherapy, and afterwards at regular intervals. Optimal monitoring should include assessments of fasting glucose, lipids, cholesterol, and blood pressure. Mental health care providers in SSA countries need to be informed that their roles extend beyond taking care of the mental health of their patients and assume responsibility for the physical health of their patients as well. Policy makers should be made aware that investment in continued medial education and in screening for physical health risks could optimize mental and physical health improvements. The increased physical health needs of people with mental illness should be integrated into the existing Information, Education and Communication public health awareness programs of the World Health Organization
Test-retest reliability and correlates of the simple physical activity questionnaire in Ugandan out-patients with psychosis
(African Health Sciences, 2020) Vancampfort, Davy; Basangwa, David; Rosenbaum, Simon; Ward, Philip B; Mugisha, James
In order to facilitate people with psychosis to increase their physical activity (PA) levels, a reliable measure- ment of these levels is of relevance. Objectives: The primary aim of current study was to explore the test-retest of the Simple Physical Activity Questionnaire (SIMPAQ) in Ugandan outpatients with psychosis. A second aim was to explore correlates of the SIMPAQ, including de- mographic variables and antipsychotic medication dose. Methods: Thirty-four women (33.9±8.0 years) and 21 men completed the SIMPAQ twice in a day. The test-retest reliability was assessed using Spearman Rho correlations coefficients. Differences in subgroups were analysed with Mann Whitney U tests. Results: The SIMPAQ showed a good test-retest reliability with correlates ranging from 0.78 (P<0.001) for structured exer- cise to 0.96 (P<0.001) for walking. Women, non-smokers and those without HIV/AIDS showed higher incidental PA than men, smokers and those with HIV/AIDS. Conclusion: The SIMPAQ is a reliable tool to assess PA and sedentary levels in Ugandan outpatients with psychosis. Men, smokers and those with HIV/AIDS appear to be at risk for lower incidental PA.
Test-retest reliability, concurrent validity and correlates of the two-minute walk test in outpatients with alcohol use disorder
(Elsevier, 2021-02) Vancampfort, Davy; Kimbowa, Samuel; Basangwa, David; Hallgren, Mats; Damme, TineVan; Rosenbaum, Simon; Mugisha, James
We investigated the test-retest reliability of the 2-min walk test (2MWT) and its concurrent validity with the 6-min walk test (6MWT) in Ugandan outpatients with alcohol use disorder (AUD). We also explored practice effects, and assessed the minimal detectable change (MDC) and correlations with the 2MWT. Fifty outpatients [7 women; median age = 32.0 years] performed the 2MWT twice, the 6MWT once, and completed the Simple Physical Activity Questionnaire, Brief Symptoms Inventory-18 (BSI-18), and Alcohol Use Disorders Identification Test. The median (interquartile) 2MWT score on the first and second test were 162.0 (49.0) meters and 161.0 (58.0) meters, respectively, without significant difference between the two trials (p = 0.20). The intraclass correlation between the two 2MWTs was 0.96 (95% confidence interval = 0.94–0.98). The Spearman Rho correlation between the second 2MWT and the 6MWT was 0.91 (p < 0.001). The MDC for the 2MWT was 18 m. There was no evidence of a practice effect. Variance in BSI-18 depression and the presence of leg pain following the 2MWT explained 18.7% of 2MWT score variance. The 2MWT is a reliable and valid fitness test, which can be conducted without any special equipment or substantial time demands in outpatients with AUD.
Test-retest reliability, concurrent validity and correlates of the two-minute walk test in outpatients with psychosis
(Elsevier: Psychiatry Research., 2019-12) Vancampfort, Davy; Kimbowa, Samuel; Basangwa, David; Smith, Lee; Stubbs, Brendon; Damme, TineVan; De Hert, Marc; Mugish, James
The aim of this study was to investigate the test-retest reliability of the 2-minute walk test (2MWT) and the concurrent validity with the 6-minute walk test (6MWT) in outpatients with psychosis. We also explored whether there was a practice effect, determined minimal detectable changes (MDC) and assessed which factors are associated with the 2MWT performance. Fifty outpatients [22 women; 33.5 (14.3) years] performed the 2MWT twice and the 6MWT once and completed the Simple Physical Activity Questionnaire (SIMPAQ) and Brief Symptoms Inventory -18. The median (interquartile) 2MWT score on the first and second test were 128.0 (44.0) meters and 128.0 (31.5) meters, without significant difference between the two trials. The intraclass coefficient was 0.94 (95% confidence interval=0.91–0.97). The significant Spearman Rho correlation between the second 2MWT and the 6MWT was 0.69. The MDC was 22 m for men and 21 m for women. There was no evidence for a practice effect. Variability in SIMPAQ sedentary, exercise, incidental physical activity and leg pain following the test explained 54.6% of the variance in 2MWT score. The current study demonstrates that the 2MWT is a reliable, valid and clinically feasible tool for assessing and evaluating the functional exercise capacity in outpatients with psychosis.

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